CONTENTS Rapid Reference 🚀 Definition of HHS Evaluation for an underlying process Treatment Treatment principles Volume resuscitation Insulin Hypertonicity management Background: Pathophysiology Osmolality versus tonicity Podcast Questions & discussion Pitfalls [1] diagnostic evaluation ⚡️ Electrolytes (including Ca/Mg/Phos), complete blood count. If diagnosis of HHS is unclear: beta-hydroxybutyrate & lactate. If infection suspected: blood cultures, urinalysis […]
Search Results for: acid base
PulmCrit- Metabolic Resuscitation: Was the answer inside us all along?
Now that VITAMINS is published, it’s worth trying to look at the big picture of sepsis treatment with hydrocortisone, ascorbate, and thiamine (HAT). Marik et al. 2017: The beginning HAT therapy began with a single-center, before/after study.1 There was a stark mortality reduction following the routine adoption of HAT therapy in septic shock (figure below, […]
Angioedema
CONTENTS Rapid reference 🚀 Overview Diagnosis of angioedema Histamine-mediated vs bradykinin-mediated angioedema Airway management Histamine-mediated angioedema Bradykinin-mediated angioedema Pathophysiology Differential diagnosis Evaluation Treatment Extubating the angioedema patient Podcast Questions & discussion Pitfalls allergic vs. bradykinin-mediated angioedema: approach to angioedema: Angioedema is a common indication for critical care admission. An allergist usually won’t be immediately available, […]
Sickle Cell Acute Chest Syndrome
CONTENTS Rapid Reference 🚀 Background Pathophysiology Epidemiology Presentation & diagnosis Trigger of acute chest syndrome Symptoms Examination & POCUS Radiology Definition & differential diagnosis Risk stratification 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 Prevention of acute […]
Tumor Lysis Syndrome
CONTENTS Rapid Reference 🚀 Clinically relevant physiology Epidemiology & risk factors Signs & symptoms Diagnosis Prevention Treatment Podcast Questions & discussion Pitfalls simplified Cairo definition of tumor lysis syndrome: (more) Malignancy plus at least two of the following: K >6 mEq/L. Phosphate >4.5 mg/dL (>1.45 mM). Uric acid >8 mg/dL (>476 uM). Calcium <7 mg/dL […]
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 […]
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 […]
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 […]
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- 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.
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 […]
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 […]
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.
Ethylene glycol & methanol poisoning
CONTENTS Rapid Reference 🚀 Clinical features Epidemiology Symptoms Diagnostic tests Anion gap Lactate Other lab clues of ethylene glcyol toxicity Specific tests for methanol or ethylene glycol Treatment Decontamination Alcohol dehydrodgenase blockade (e.g., fomepizole) Hemodialysis Fluids & electrolytes Vitamins Other miscellaneous topics Biochemistry of toxic alcohols Osmolal gap & why it’s unhelpful Neurologic injury: Neuroimaging […]
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 […]
- « Previous Page
- 1
- 2
- 3
- 4
- 5
- 6
- …
- 24
- Next Page »