. Introduction with a clinical question . A 50-year-old woman with no prior medical problems was admitted to Genius General Hospital with severe influenza pneumonia and acute kidney injury. She was transferred to the ICU and treated with high-flow nasal cannula oxygen support. Over time she gradually improved with decreasing oxygen requirements and improving renal […]
Search Results for: mike lauria
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.
Petition to retire the surviving sepsis campaign guidelines
We are disseminating an international petition that will allow clinicians to express their displeasure and concern over these guidelines. If you believe that our septic patients deserve more evidence-based guidelines, please stand with us.
NeuroEMCrit – 31 #NeuroPostItPearls
A multiplicity of neuro tips
Modification of Scalpel Finger Bougie Technique
No more bougie hold-up for scalpel-finger-bougie cric
EMCrit 69 – The Future of CPR with Keith Lurie and Demetris Yannopoulos
Drs. Keith Lurie and Demetris Yannopoulos elaborate on the future of CPR
EMCrit 279 – The Decision to use Ketamine – Disruptive and Dangerous with Reub Strayer
I frequently see both residents and attendings inappropriately using ketamine for agitated patients. Inappropriately both by giving it when it is unecessary and giving it in poor fashion when it is indicated.
EMCrit RACC Lit Review – January 2024
All the lit goodness for Jan 2024
A Study in Scarlet
A recent article published in the NEJM by Steg et al demonstrates that it is not the efficacy of an intervention that determines the success or failure of a trial, but rather the definition of its endpoints (1). In contrast to the majority of trials examining novel anticoagulants for ACS, Steg et al chose […]
EMCrit – RACC Lit Review Oct/Nov 2022
Oct/Nov 2022
PulmCrit- Epinephrine vs. atropine for bradycardic periarrest
Introduction with a case An elderly woman is admitted with atrial fibrillation and fast ventricular rate. She is asymptomatic, with a heart rate of 160 b/m. She is treated with a 20 mg diltiazem bolus followed by an infusion at 15 mg/hour for several hours. Her heart rate slows to 110 b/m. She is then […]
The Case of Dubious Squire Continues
In the era before the ubiquitous use of bedside ultrasound, BNP and its derivative natriuretic peptides were, at best, a mediocre test that added little to clinical judgment. In today’s world of sonographic abundance, they simply add noise to our already deafening workflow. Despite a wealth of evidence demonstrating natriuretic peptides’ lack of clinical utility, […]
Atrial Fibrillation (AF) & Flutter complicating critical illness
CONTENTS Introduction Diagnosis of AF Investigation of the cause of AF Management – Overall approach Emergent cardioversion Is immediate cardioversion indicated? How to perform DC cardioversion (1) Universal AF stabilization package (2) Rate vs. rhythm control decision Rhythm control in critical illness Rate control (3) Anticoagulation Atrial flutter Pharmacopeia for AF in the ICU: Amiodarone […]
Bupropion intoxication
CONTENTS Overview Pharmacodynamics Pharmacokinetics Diagnostics & doses Clinical evolution Treatment Activated Charcoal Whole bowel irrigation Neurotoxicity management Cardiotoxicity management Podcast Questions & discussion Pitfalls Bupropion is increasingly used for several indications (depression, tobacco cessation, and ADHD). Unfortunately, it is also a uniquely dangerous and increasingly common source of intoxication (especially the extended-release formulations). For example, […]
PulmCrit- Ranking antibiotics in order of allergenicity
Our current approach to allergy is primarily patient-based. This focuses on the patient’s prior history of reaction: how severe was it, when was it, how certain are we that it was truly allergic? This strategy has been proven to be inaccurate. For example, ~90% of patients who report a penicillin allergy are not allergic when skin-tested.
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