…and his missing lactate I am, as I am sure many of you are, a big fan of using lactate to guide my resuscitative efforts in my critically ill septic patients. You would pour fluids into your large bore catheters, infuse pressors through your ultrasound guided central lines and revel in how quickly you […]
Search Results for: septic shock
Pulmcrit – An alternative viewpoint on phenylephrine infusions
Make no mistake, I’m not very fond of phenlephrine. I rarely use it (mostly for hypotensive atrial fibrillation). However, understanding phenylephrine is a prerequisite to understanding related vasopressors, particularly midodrine and norepinephrine.
PulmCrit- Why we fail at hemodynamics: The flaw of averages & the swan’s curse
With a resurgence of the Swan, a resident recently asked me: why don’t we use the Swan to guide sepsis resuscitation? Answering this question forced me to recognize that many problems with the Swan continue to haunt us today when using our new darling, bedside echocardiography.
Vasopressors
CONTENTS Rapid Reference 🚀 Core agents Inodilators (milrinone, dobutamine, isoproterenol) Pure vasopressors Inopressors (norepinephrine, epinephrine, dopamine) Peripheral vasopressors Midodrine Methylene Blue Podcast Questions & discussion Pitfalls classic inodilators (milrinone, dobutamine) Mechanism Dobutamine stimulates mostly beta-receptors, with very little stimulation of alpha-receptors. Milrinone inhibits intracellular adenylyl cyclase, thereby increasing intracellular cyclic AMP levels. Physiologic effect Primary […]
“The Case of the Dying Detective Continues…”
Survivors of the Armageddon in any of its many forms, zombie, alien, or otherwise, are often left in a state of emotional turmoil. They face an uncertain future, the loss of loved ones, and the constant stress of imminent danger. Underneath the obvious anguish lies a deeper more subtle but equally distressing sentiment, uncertainty. Now […]
IBCC – Purpura Fulminans
Purpura fulminans is a rare form of disseminated intravascular coagulation which requires specific management. Most commonly it is seen as a complication of septic shock with multi-organ failure. Unfortunately, purpura fulminans is often treated simply with a generic approach for septic shock. The IBCC chapter is located 👉 here. The podcast & comments are below. […]
EM Nerd-An Addendum to the Case of the Tarnished Standard
In a previous post we discussed the use of IVC variation and the concept of fluid responsiveness. Despite a strong physiological basis, no studies examining the use of fluid responsiveness to guide resuscitative efforts in patients with septic shock have been shown to improve patient important outcomes. Shortly after this post was released, Critical Care […]
PulmCrit- Angiotensin II: five cautions & three comparisons
Upon first reading the ATHOS-3 trial, I was pleasantly optimistic. Who wouldn’t be interested in a shiny new vasopressor? The trial didn’t prove much, but it was intriguing. However, it was alarming to hear that the FDA has approved angiotensin II for use based on it. Precious little evidence is available about this drug. With angiotensin II arriving at hospitals soon, some cautions are in order.
Cardiogenic shock following cardioversion of atrial flutter
0 Introduction with a case 0 Once upon a time at Genius General Hospital a 63-year-old woman was admitted with lower extremity edema and orthopnea. Her past medical history was unremarkable. She was noted to be in atrial flutter with a heart rate in the 120s and a blood pressure ranging from 100-120 mm systolic. She […]
Frequently Asked Questions (FAQ) regarding Sepsis
Severe Sepsis FAQ The FAQ below was designed to provide teams with a concise framework to describe the clinical rationale for undertaking the non-invasive and invasive severe sepsis protocols, and to link evidence and clinical resources to the protocols. The following sections outline key features of the components of the severe sepsis invasive and non-invasive […]
PulmCrit- Sepsis 4.0: Understanding sepsis-HLH overlap syndrome
Since the 1980s it has been recognized that some patients with sepsis also develop hemophagocytic lymphocytosis. For decades this was believed to be extremely rare. However, currently there is increasing recognition that this combination might represent a significant fraction of sepsis patients.
Preeclampsia & HELLP
Guide to emoji hyperlinks = Link to online calculator. = Link to Medscape monograph about a drug. = Link to IBCC section about a drug. = Link to IBCC section covering that topic. = Link to FOAMed site with related information. = Link to supplemental media. Going further References a dosing contraindications side effects indications […]
EM Nerd-The Case of the Cryptic Truth
On the morning of January 1st, 2017 a number of proud South Carolinians woke up to find themselves no longer living in their former state of residence. Without moving from the beds in which they slept, they were all magically transported into the neighboring the state of North Carolina. Due to a border dispute which […]
PulmCrit Wee – Patient with nonfocal exam and thrombocytopenia
The case: A ~65 year-old human presents to the ICU with a working diagnosis of vasopressor-dependent septic shock. The patient was previously healthy with no significant medical problems or medications. History is notable for mild nonspecific symptoms (chills, nausea, and a headache), with nothing in particular standing out. Physical examination is unrevealing, with the patient […]
EM Nerd-The Case of the Hurried Objective
In 2015, Centers for Medicare & Medicaid (CMS) published their sepsis core measure (SEP-1). This represented a nationally mandated sepsis management strategy presented in the form of a 3 and 6-hour bundle. Since its publication, the Surviving Sepsis Campaign (SSC) released their own 1-hour bundle (1), adding even more urgency to an already frenetic effort […]
- « Previous Page
- 1
- 2
- 3
- 4
- 5
- 6
- …
- 22
- Next Page »