Pulmonary Hypertension and Acute on Chronic RV Failure
Search Results for: mental toughness
Pulmonary embolism diagnosis & treatment of low-risk PE
CONTENTS Rapid reference 🚀 Risk factors and epidemiology Clinical presentation of PE Massive/submassive PE Large central PE Pulmonary infarction DVT Individual tests: D-dimer Arterial blood gas (ABG) DVT ultrasound to evaluate for PE Chest radiograph Radiology CT angiography in pulmonary embolism Causes of a filling defect on CT angiography CT angiography Causes of filling defect: […]
Management of COVID-19 patients admitted to stepdown or ICU
CONTENTS Rapid Reference 🚀 Initial tests to guide management Chest CT findings Organ support Cardiovascular Respiratory Noninvasive respiratory support Invasive mechanical ventilation Infectious disease – antibiotics Renal Hematology Neurology Immunomodulation Steroid Tocilizumab Baricitinib Tofacitinib Things that don’t work Remdesivir Convalescent plasma Questions & Discussion References checklist for COVID admission to ICU/stepdown ✅ Review medication list […]
PulmCrit- SUP-ICU: Is pantoprazole the elixir of life? Should it be?
SUP-ICU is a massive, modern RCT of stress ulcer prophylaxis (SUP) in the ICU. With 3298 patients, it is larger than many meta-analyses of SUP. Its primary mortality endpoint is deeply flawed. However, the study still provides a wealth of information about SUP in the ICU.
EMCrit 129 – LAMW: The Neurocritical Care Intubation
This is the another of the Laryngoscope as a Murder Weapon lectures; though in this case it is really more of an aggravated assault.
“The Adventure in the Valley of Fear”
In the biomedical industry’s relentless war against clinical reasoning, a multitude of biomarkers have been developed that promise assistance in the diagnosis and management of sepsis. In this ocean of mediocrity, procalcitonin has risen to the top. Since its predictive value is only slightly better than chance alone, it behooves those promoting its value to […]
PulmCrit- Rigorous vs. lenient spontaneous breathing trials: The answer at last?
background There has long been debate about exactly how to design a spontaneous breathing trial. If the trial is made too easy, then patients would be extubated before being ready (leading to re-intubation). Alternatively, if the trial is too hard, that would prolong mechanical ventilation beyond the point of being beneficial. The figure above shows […]
Pulmcrit – Renoresuscitation, vasopressin, vepinephrine, and VANISH
My goals during sepsis resuscitation focus largely on preservation of renal function and maintence of a reasonable fluid balance (renoresuscitation). The kidney is one of the most fragile organs, which may be rapidly injured by hypoperfusion. Renal failure correlates closely with mortality, participating in a vicious spiral of multi-organ failure. Alternatively, if you can save the kidneys, you’re likely to save the patient too. In this context, any beneficial effect of vasopressin on renal function could be helpful.
Viral pneumonia (non-COVID/influenza)
CONTENTS General properties of viral pneumonias Herpesviruses ⍺-herpesviruses HSV VZV β-herpesviruses CMV Paramyxoviruses RSV (respiratory syncytial virus) Parainfluenza Metapneumovirus Adenovirus Rhinovirus Hantavirus 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 […]
PulmCrit – An alternative view of the PEPTIC trial
The PEPTIC multi-center RCT compared histamine-2 receptor blockers (H2RBs) versus proton pump inhibitors (PPIs) for stress ulcer prophylaxis among ventilated ICU patients.1 It’s a landmark trial of unprecedented size and statistical power. PEPTIC was presented at the Critical Care Reviews meeting in Ireland and live-cast around the world (available here). This presentation and the editorials […]
Septic Shock
CONTENTS Rapid Reference 🚀 Definitions of septic shock Diagnosis & evaluation Clinical Presentations Biomarkers: NLR Procalcitonin & CRP ➡️ Evaluation for the source Sepsis mimics Treatment Vasopressors Source control Fluid Steroid DVT prophylaxis with heparin REFRACTORY SHOCK Methylene blue Resuscitative endpoints MAP Heart rate Urine output Fluid balance Lactate Skin perfusion Interventions of no real […]
EMCrit 77 – Left Ventricular Assist Devices (LVADS)
LVADs are complicated especially when the patient starts going downhill. Zack Shinar is going to attempt to make it a bit easier.
CC Nerd-The Case of the Unknown Quantity
Lung-protective ventilation is often considered a simple truth when managing critical care patients on mechanical ventilation. Despite this sense of certainty, the knowledge of exactly how and when to perform such ventilatory strategies is incomplete. The recently published PReVENT adds yet more uncertainty to the true efficacy of low tidal volume ventilation in patients without […]
PulmCrit- Metabolic sepsis resuscitation: Strike hard, strike fast, no remorse
Escalation-deescalation There are roughly two strategies for adjusting the intensity of treatment: Titrated strategy: Treatment intensity is adjusted to match the severity of the disease. Escalation-deescalation strategy: Treatment intensity is increased rapidly to exceed disease severity and gain control of the disease. After the patient improves, treatment intensity is reduced. The best strategy depends on […]
Lung Transplantation
CONTENTS candidacy for lung transplantation General concept of the transplant window Contraindications to lung transplantation Transplant window for various conditions COPD Interstitial lung disease Cystic fibrosis Pulmonary arterial hypertension post-transplantation complications Chronic immunosuppressive regimens PGD (primary graft dysfunction) Acute rejection ACR (acute cellular rejection) AMR (antibody-mediated rejection) CLAD (chronic lung allograft dysfunction) BOS (bronchiolitis obliterans […]
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