CONTENTS Rapid Reference 🚀 Background Pathophysiology Epidemiology Presentation & diagnosis Trigger of acute chest syndrome Symptoms Examination & POCUS Radiology Rapid progression & multi-organ failure Definition & differential diagnosis Management Non-transfusion related Aggressive oxygenation & monitoring Volume resuscitation Antibiotics Pain management Transfusion General considerations about transfusion Simple transfusion (top-up transfusion) Exchange transfusion Manual exchange transfusion […]
Search Results for: acid base
The Case of the Balanced Solution
Saline-based resuscitation strategies were first proposed as far back as 1831 during the Cholera Epidemic. In an article published in the Lancet in 1831, Dr. O’Shaughnessy suggests the use of injected salts into the venous system as a means of combating the dramatic dehydration seen in patients afflicted with this bacterial infection(1). Saline’s potential harms […]
Neurologic emergencies in pregnancy
CONTENTS General Differential diagnosis Initial approach Specific information about disease states in pregnancy Acute ischemic stroke Intracranial hemorrhage Seizures Cerebral edema Myasthenia Gravis (MG) Metastatic choriocarcinoma Ventriculoperitoneal shunt malfunction Podcast Questions & discussion Pitfalls neurological emergencies encountered in pregnancy 💡 Pregnant women presenting with neurologic emergencies can have several simultaneous neuropathologies (especially preeclampsia, PRES, and […]
Status Epilepticus
CONTENTS Getting started: (1) Initial approach to status 🚀 (2) After the dust has settled 🚀 Causes Diagnosis & definition Definition of status epilepticus Seizure mimics Differentiation from pseudoseizure Treatment overview Initial treatment Benzodiazepine Hypoglycemia, hyponatremia, and thiamine deficiency Conventional antiseizure medication Neurolytic intubation Subsequent management NORSE Neuromonitoring Waking & weaning Supportive medical management Approach […]
PulmCrit- Nucleic acid microarrays streamline bacteremia management
Verigene is a nucleic acid micro-array which can be used to provide rapid information about positive blood cultures. The array detects genetic information which may reveal the genus/species of bacteria and the presence of various resistance genes.
Liberation from the ventilator
CONTENTS Rapid Reference: Optimization & items to consider prior to extubation 🚀 Spontaneous Breathing Trial (SBT) If the patient fails the SBT Causes of failed SBT Investigation If the patient passes the SBT A trial of extubation Post-extubation support Timing of tracheostomy Some additional concepts Unplanned extubation Nocturnal extubation Understanding & navigating the obesity quagmire […]
Acute Pancreatitis (including hypertriglyceridemic pancreatitis)
CONTENTS Rapid Reference 🚀 Diagnosis Clinical findings Laboratory studies (lipase) Radiology Diagnostic criteria Evaluating the cause of pancreatitis Risk stratification – who needs ICU? Treatment General principle: pancreatoseptic equivalence Treatment of causative factors ERCP? Resuscitation Analgesia Nutrition Non-hypertriglyceridemic pancreatitis Hypertriglyceridemic pancreatitis Prophylactic & early antibiotics Fluid collections & infected necrosis Abdominal compartment syndrome Hemorrhage Hypertriglyceridemic […]
Critical care nutrition
CONTENTS Rapid Reference: Creating a tube feeding prescription 🚀 General Nutritional physiology in critical illness Nutritional assessment Macronutrient needs Caloric requirement Protein requirement Carbohydrate administration Macronutrient requirements in obesity Enteral nutrition: getting started When to initiate enteral nutrition Enteric tube type & location Selecting a tube feed formulation Intermittent vs. continuous feeding Troubleshooting enteral nutrition […]
Anticoagulant reversal
CONTENTS General considerations Approach to warfarin reversal Urgent reversal Non-urgent supratherapeutic INR Approach to DOAC reversal Dabigatran Factor Xa inhibitors (riveroXABAN, apiXABAN, edoXABAN, fondaparinux) Reversal of other agents Thrombolytics (e.g. tPA) Heparin reversal Antiplatelet agent reversal Pharmacology of broad-spectrum reversal agents Fresh Frozen Plasma (FFP) Prothrombin Complex Concentrate (PCC) Factor IX Complex DDAVP Tranexamic acid […]
Guide to APRV for COVID
CONTENTS Preamble Parameters Initial settings Monitoring Troubleshooting hypoxemia & acidemia Weaning Weaning initiation Spontaneous Breathing Trial & Extubation pathways Questions & discussion Pitfalls APRV can be a bit scary for folks who aren’t used to it. Everyone has slightly different ways of setting the parameters. However, over time I’ve come to believe that APRV is […]
PulmCrit – Is piperacillin-tazobactam safe in patients with penicillin allergy?
Historically it was believed that allergic reactions could be mediated by the core structures. This would imply that a patient could be allergic to all penicillins, all cephalosporins, or even all beta-lactams. That would be hugely problematic, because a patient could simultaneously be allergic to dozens of antibiotics – greatly complicating their management.
Brain Death
CONTENTS Brain death basics Clinical presentation of brain death Clinical context Clinical findings in brain death Spinal reflexes Diagnosis of brain death (1) Initial suspicion (2) Evaluate for confounders Excluding drug intoxication (3) Dedicated neurologic examination (4) Apnea test (5) Confirmatory test PRN If brain death is confirmed: Immediate next steps Supportive care prior to […]
Immunosuppressive therapies in pulmonology & transplantation
CONTENTS Disclaimer – Still consult transplant medicine Mycophenolate Azathioprine Calcineurin inhibitors (tacrolimus, cyclosporine) Sirolimus Questions & discussion abbreviations used in the pulmonary section: 2 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AFB: Acid Fast Bacilli AIP: Acute interstitial pneumonia (Hamman-Rich syndrome) 📖 ANA: Antinuclear antibody 📖 […]
BRASH syndrome
CONTENTS Rapid Reference 🚀 Pathophysiology Epidemiology Clinical presentation Diagnosis & differential diagnosis Evaluation of the underlying cause Treatment overview Procedures & vascular access Volume management Bradycardia management Hyperkalemia management Advanced reversal agents for CCB/BBl Podcast Questions & discussion Pitfalls if hypovolemic, provide volume resuscitation: Bicarb <22 mM use isotonic bicarbonate. Bicarb >22 mM use lactated Ringers or […]
Traumatic Brain Injury (TBI)
CONTENTS Rapid Reference 🚀 Epidemiology Primary vs. secondary injury Glasgow Coma Scale (GCS) Initial evaluation Specific types of injury Diffuse axonal injury (DAI) Contusions & intraparenchymal hematomas Epidural hematoma Subdural hematoma Subarachnoid hemorrhage Intraventricular hemorrhage Cerebral venous sinus thrombosis Fat embolism Management Coagulation management Hemodynamic management ICP management Ventilator management Seizure prophylaxis & management DVT […]
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