The illustrious Cardinal Commendoni suffered sixty epileptic paroxysms in the space of 24 hours, under which nature being debilitated and oppress’d he at leangth sank, and died. His skull being immediately taken off, I found his brain affected with a disorder of the hydrocephalous kind. -Gavassetti, 1586 The […]
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Neuroprognostication after cardiac arrest
CONTENTS Introduction Early brain death is (still) death Prognostic value of historical information Confounding factors & hypothermia Timing & serial evaluation Prognostic tests Neurological examination EEG EEG background Findings superimposed on the background Myoclonus SSEPs (Somatosensory evoked potentials) CT scan Qualitative CT scan Quantitative CT scan MRI Neuron-specific enolase Multimodal prognostication Related topics Delayed post-hypoxic […]
NeuroEMCrit – The Perils of the ICH Score
Don’t use the ICH score in isolation to not give aggressive critical care…
EM Nerd-The Case of Corporeal Clock
How exactly do trialists proceed when deciding upon the appropriate acronyms for their soon-to-be blockbuster trial? Is the proper etiquette to follow a traditional prospective process, utilizing the first letter of each word in a trial’s longer title? Or is the selection of an acronym based on its ability to inspire and only then, retrospectively […]
What Would Google Do?
What would Google do?
Smoking cessation
CONTENTS Overview Varenicline Nicotine replacement therapy Bupropion Clonidine Questions & discussion basics Nicotine and other substances in tobacco are extremely addictive. As such, tobacco addiction is a chronic relapsing disorder which requires aggressive and ongoing therapy. Patients frequently require several attempts before successfully quitting. Cravings can persist long after smoking cessation, making this a major […]
Pulmcrit- Evidence Update: Phenobarbital in Alcohol Withdrawal
Over the past year, the five papers below were published regarding the use of phenobarbital in alcohol withdrawal. These studies aren’t massive, glittering multicenter RCTs (and, realistically, it’s dubious whether such a study will happen). However, these papers bring some unique and interesting perspectives to the table. This post will summarize them briefly – a bit like a sampler flight of beers (figure above).
PulmCrit- Brain death, mimics, and flow scans
As with many uncommon situations that are unique to critical illness, we cannot always rely on specialist consultation. Critical care practitioners must develop a firm grasp of this diagnosis. This post will explore some diagnostic conundrums in brain death diagnosis. The radionuclide flow scan is emphasized because it is the most commonly used tool to sort out difficult cases.
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 […]
PulmCrit- Dogmalysis of PCI for NSTEMI patients with a history of CABG
Many patients with prior CABG probably benefit from catheterization and repeat revascularization (PCI or a repeat CABG). However, this cannot be assumed to be universally true. In particular, patients with smaller infarcts and advanced renal failure could be harmed.
NeuroEMCrit – Demystifying the EEG Report
EEGs are tougher than EKGs–but you can master the basics
Cerebral venous thrombosis (CVT)
CONTENTS Pathophysiology Clinical features Epidemiology Signs & symptoms Relationship between thrombus location & clinical features Investigations Laboratory studies Imaging Treatment Neurologic deterioration despite treatment Prognosis Podcast Questions & discussion Pitfalls anatomy The superior sagittal and transverse sinuses are most frequently involved (in 60% of patients). The internal jugular and cortical veins are involved less often. […]
Paroxysmal sympathetic hyperactivity (PSH)
CONTENTS Introduction Epidemiology Clinical findings Differential diagnosis Approach to the diagnosis Treatment Supportive care Medical therapy overview Abortive therapy Preventative therapy Podcast Questions & discussion Pitfalls basics Paroxysmal sympathetic hyperactivity (PSH) is a pattern of recurrent bursts of dysregulated sympathetic activity, resulting from severe brain injury. These episodes of sympathetic activation are short, dramatic, and […]
Cervical Artery Dissection
CONTENTS Pathophysiology Epidemiology Clinical presentations Manifestations of internal carotid dissection Manifestations of vertebral dissection Overt trauma complicated by cervical artery dissection Imaging Management Podcast Questions & discussion Pitfalls arterial dissection may begin in two ways: (#1) The true lumen may dissect into the arterial wall. This creates a true lumen and a false lumen (e.g., […]
The Complexity of Simple – Bringing Order to Complex Systems by Chris Hicks
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