EMCrit Project

Logistics of Whole Bowel Irrigation (WBI) for Toxicologic Overdose

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IBCC – Critical care nutrition

Critical care nutrition is a perpetually challenging topic, due to the difficulty in performing high-quality research on it. This chapter aims to describe reasonable practices, based largely on the 2019 ESPEN guidelines. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

IBCC – Cardiac glycoside poisoning (including digoxin)

Cardiac glycoside poisoning continues to be a relevent topic, due to both digoxin and plants containing cardiac glycosides. As with all things toxicologic, ongoing debate surrounds the precise dosing and indications for anti-digoxin antibody fragments. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

EMCrit 298 – Calcium in Exsanguinating Patients with Ricky Ditzel and Jeffrey Siegler

Something I have been preaching for a decade has finally gotten the attention and research it deserves. On this episode, I get two of the authors from the Lethal Diamond Paper to discuss hypocalcemia in the bleeding patient.

IBCC – Approach to the poisoned patient

Poisoning is one of the most common causes of ICU admission. The vast majority of these patients do fine, with minimal supportive therapy and observation. However, occasional patients will progress to organ failures and potentially death. This chapter explores how to approach these patients, with an eye towards identification and prompt treatment of the critically […]

IBCC – Thrombotic microangiopathies (TTP, HUS, et al.)

Thrombotic microangiopathy is a rapidly moving target, which has evolved considerably in just the past few years. Complementopathies (e.g., atypical hemolytic uremic syndrome) probably represent a largely unappreciated, yet critical, dimension of many diseases. Thrombotic thrombocytopenic purpura (TTP) remains an important hematologic emergency that must be promptly recognized. This chapter attempts to disentangle these entities, […]

EMCrit 297 – EVARs, TEVARs, and Endoleaks – Oh My! with Ani Aydin

EVAR complications can be deadly. Learn how they present and how to work them up.

IBCC – Opioid intoxication

The opioid epidemic has caused us all to become far more familiar with opioid intoxication than we ever wanted to be. However, some nuances still remain (e.g., management of methadone and loperamide intoxications). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

IBCC – Sodium channel blocker toxicity (including tricyclic antidepressants)

Blockade of the fast cardiac sodium channels is an important component of cardiotoxicity due to many intoxicants. Historically the most common cause of sodium channel blockade has been tricyclic antidepressant poisoning, but a wide variety of xenobiotics can affect the sodium channels. Fortunately, close attention to the EKG may be sufficient to reach an accurate […]

IBCC – Anticholinergic intoxication

Anticholinergic intoxication has been a moving target recently, with a resurgence in the popularity of physostigmine. The thoughtful administration of physostigmine has much to offer these patients, but it must be provided within the context of a systematic approach. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on […]

IBCC – Neuroleptic Malignant Syndrome (NMS)

Neuroleptic malignant syndrome is rare, but this will be encountered in the ICU. Particularly with the rising utilization of antipsychotics for a variety of indications (e.g., emesis, agitation), we should be cognizant of this entity. Another relevent cause of NMS is abrupt withdrawal of Parkinson’s medications (e.g., due to NPO status). The IBCC chapter is […]

EMCrit 296 – The French Connection, Part 1 – Resuscitation Geography, Logistics, & Ergonomics

A new series on the philosophy and psychology of resuscitation…

PulmCrit – ACEP task force on septic shock should replace the Surviving Sepsis Campaign

The critical care community has long been plagued by a series of antiquated, overbearing guidelines created by the Surviving Sepsis Campaign (SSC). The campaign was originally sponsored by Eli Lilly and Edwards Life Sciences, as a commercial marketing campaign. The backbone of the original guidelines was a single center trial by Rivers, which has failed […]

IBCC – Local Anesthetic Systemic Toxicity (LAST)

Local Anesthetic Systemic Toxicity (LAST) is fortunately extremely rare. However, with the ongoing expansion of nerve blocks and lidocaine infusions in a variety of different contexts, this is likely to be seen more often over time. Prompt recognition and antidotal therapy are essential. The IBCC chapter is located 👉 here. The podcast & comments are […]

IBCC – Calcium channel blocker & beta blocker poisoning

Calcium channel blocker poisoning is one of the most formidable intoxications encountered critical care. As for most topics in toxicology, there is no level-I evidence regarding this. This chapter explores treatment options for beta blocker and calcium channel blocker poisoning, with the admitted limitation that it’s impossible to know which treatments are optimal and in […]

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