EMCrit Project

IBCC – Stupor & Coma

Stupor and coma can be a challenging presentation, because it has a broad differential filled with very severe diseases. An organized approach is essential. One core feature of that approach is the coma neurologic examination, which remains central to the evaluation even in the era of abundant CT and MRI scanning. The IBCC chapter is […]

PulmCrit Rant – Intermediate DVT prophylaxis in COVID: We need for better pants

COVID will eventually lead to many improvements in our approach to critical illness. I’ve been hoping that one of these would be an improved understanding of venous thromboembolism (VTE) prophylaxis, but perhaps that was overly optimistic. We provide VTE prophylaxis to nearly every patient in the ICU. Consequently, even tiny changes in our VTE prophylaxis […]

IBCC – Acute Eosinophilic Pneumonia (AEP)

Acute Eosinophilic Pneumonia is rare, but it definitely happens. It typically causes relatively rapid-onset ARDS, frequently leading to mechanical ventilation. Prompt recognition is critical, because AEP responds beautifully tosteroid therapy. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

EMCrit 294 – Acute Crit Care Grand Rounds with Josh Farkas

The man, the myth, the legend–Farkas unleashed

IBCC – Acute on Chronic Liver Failure (ACLF)

Acute on Chronic Liver Failure (ACLF) refers to decompensated cirrhosis causing failure of at least two organs (e.g. hepatic encephalopathy, hepatorenal syndrome, shock, or respiratory failure). It may be useful to conceptualize these patients as having ACLF (rather than, for example, hepatic encephalopathy plus hepatorenal syndrome), because this provides a more accurate global understanding of […]

PulmCrit Wee – Therapeutic anticoagulation for COVID ICU patients: Is the heparin vial half empty, or half full?

A fresh preprint reveals the results of combining three trials to evaluate therapeutic anticoagulation among severe COVID patients (defined as patients requiring high flow nasal cannula, noninvasive ventilation, intubation, vasopressors, or inotropes). Patients were randomized to therapeutic anticoagulation versus thromboprophylaxis per usual care guidelines. REMAP-CAP also simultaneously randomized some patients to receive aspirin as well. […]

PulmCrit Wee: High-titer convalescent plasma fails again for hospitalized COVID patients

Convalescent plasma use against epidemic respiratory viruses dates back to the influenza pandemic of 1918. This intervention has persisted for over a century based on high face-validity, rather than any high-quality evidence. The COVID epidemic reignited enthusiasm for this therapy, leading to its use in tens of thousands of patients (e.g., an expanded-use program organized […]

IBCC – Acute Liver Failure

Acute liver failure is rare, but when it does occur it requires an organized diagnostic and therapeutic approach. Success often relies upon aggressive support of other organs (e.g. renal failure and management of intracranial hypertension). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

IBCC – Spontaneous Bacterial Peritonitis

Spontaneous bacterial peritonitis is an important consideration for any hospitalized patient with substantial ascites. Patients can have minimal symptoms. To complicate matters further, in some cases spontaneous bacterial peritonitis may present with failure of other organs (e.g. hepatic encephalopathy, or disseminated intravascular coagulation leading to gastrointestinal hemorrhage). The IBCC chapter is located 👉 here. The […]

EMCrit 293 – The Jerk & Check, Functional Heuristics in Resuscitation Project (MotR)

Mind of the Resuscitationist Episode on Functional Heuristics

IBCC – Invasive candidiasis

Invasive candidiasis is growing more common in the ICU, as our patients are becoming increasingly complex, with longer stays. However, most isolation of Candida in the ICU represents colonization rather than infection – so there is a major risk of overdiagnosis resulting in unnecessary medication toxicity and antimicrobial resistance. The IBCC chapter is located 👉 here. […]

EMCrit 292 – IV T3 for Myxedema Coma, A Different Take with Eve Bloomgarden

A different take on IV T3 for Myxedema

IBCC – Hepatorenal Syndrome

We’ve been seeing a lot of decompensated liver disease recently, likely related to increases in alcohol intake due to the COVID pandemic. Over the next month, several chapters on critical care hepatology be released, exploring how to manage these patients. We start with hepatorenal syndrome and hepatorenal physiology, because this is often the crux of […]

IBCC – Coagulation management in cirrhosis

Cirrhosis causes a derangement of all components of coagulopathy. Fortunately, these derangements tend to balance one another out (so the best approach is often to merely observe). However, sometimes imbalances may spin out of control and require aggressive management (e.g. causing hyperfibrinolysis with refractory bleeding). The IBCC chapter is located 👉 here. The podcast & […]

PulmCrit – RECOVERY confirms benefit of toci combined with dexamethasone

The RECOVERY trial just released a preprint demonstrating benefit from tocilizumab in COVID-19. As with the prior RECOVERY studies, this is a multicenter, open-label, pragmatic trial. A robust mortality benefit was detected (the fragility index calculates to 17, which isn’t too shabby). Several important secondary endpoints were positive as well (e.g., reduced intubation rate, reduced […]

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