CONTENTS Rapid Reference 🚀 Diagnosis Presentation Differential diagnosis Evaluation Naloxone basics Treatment overview Opioid naive pathway Doing OK pathway Too Sleepy pathway Dying pathway Intubated pathway Additional treatment may be needed for certain agents: Methadone Loperamide Podcast Questions & discussion Pitfalls opioid toxidrome – key features Somnolence Reduced respiratory rate This is the most important […]
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Hyperthermia & heat stroke
CONTENTS Rapid Reference 🚀 Definition & diagnosis of hyperthermia Differential diagnosis Evaluation Treatment Sedation & Shivering tx Intubation if necessary Temperature control overview (1) Internal cooling: IV fluid (2) Surface cooling (3) Respiratory cooling Management of complications Podcast Questions & discussion Pitfalls what is hyperthermia? Fever is temperature elevation due to activity of the hypothalamus, […]
IBCC chapter & cast: Hepatic Encephalopathy
Hepatic encephalopathy is a common cause of ICU admission, as well as a common complication of ICU admission for other indications (e.g. gastrointestinal hemorrhage). At first the intubated patient with hepatic encephalopathy may seem a bit bewildering (will they ever wake up??). However, an organized and aggressive strategy combined with some patience is generally sufficient […]
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 […]
Asthma
CONTENTS Rapid Reference 🚀 Non-intubated asthmatic 🚀 Intubated asthmatic 🚀 Initial evaluation Asthma exacerbation diagnosis Risk stratification Non-intubated patients Inhaled bronchodilators Systemic bronchodilators Noninvasive ventilation (BiPAP) Sedation strategies Dexmedetomidine IV haloperidol/droperidol Benzodiazepines Opioids Ketamine Unable to tolerate BiPAP: Heliox vs. HFNC Steroid Other medications Evaluation & goals Beware of asthma treatment pseudofailure Intubation Indications for […]
PulmCrit- Neurocritical care of the comatose meningitis patient
Early in my training I had a few comatose meningitis patients. They were admitted, given antibiotics, and supported on a ventilator. They died. For a while, I believed that this condition was fairly hopeless. Then I encountered a comatose young man with meningitis due to adjacent mastoiditis. His lumbar puncture opening pressure was ~50cm. Following mastoidectomy and temporary placement of a lumbar drain, he recovered. Since then, I have been increasingly aggressive about managing this. Some patients have responded surprisingly well.
EMCrit 351 – Severe Acetaminophen (Tylenol) Toxicity
Massive Acetaminophen Overdose
Top 10 reasons to stop cooling to 33C
Introduction 0 Following the Nielsen study, many hospitals developed two protocols for temperature management after cardiac arrest (33C or 36C). For example, the 36C protocol could be used for patients with contraindications to hypothermia (33C). With ongoing evidence emerging about hypothermia, many hospitals are abandoning their 33C protocols and using 36C for all post-arrest patients. […]
Neuroleptic Malignant Syndrome (NMS)
CONTENTS Pathophysiology Epidemiology Clinical features Laboratory abnormalities Differential diagnosis & evaluation Diagnostic criteria Management Supportive care Bromocriptine Dantrolene Electroconvulsive therapy Podcast Questions & discussion Pitfalls As its name implies, NMS is often related to neuroleptic agents (i.e., antipsychotic medications) and is manifest by mental status changes, hyperthermia, rigidity, and autonomic dysfunction. It can present as […]
IBCC chapter & cast – Severe hemoptysis
Severe hemoptysis is a true challenge. Due to the rarity of this condition, there is little high-quality data on it. So you can’t become a hemoptysis whisperer by reading books. Unfortunately, due to the rarity of the condition it’s also difficult to accumulate clinical experience.
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.
EMCrit 88 – Oxygen Physiology with Daniel Davis
One of the last few airway topics for a little while: Pulse Ox Lag and an Understanding of the Oxyhemoglobin Dissociation Curve
Approach to the critically ill poisoned patient
CONTENTS History Exam Labs Urine toxicology panel EKG Other diagnostic interventions Management Airway management Activated charcoal Agitation management Obtundation management Hyperthermia management Seizure management Bradycardia management Monomorphic VT management Poison control consultation Podcast Questions & discussion Pitfalls Toxicology histories are notoriously unreliable. Key bits of information: Any available medical records, especially medication lists. Timing & […]
IBNCC – Baclofen intoxication & withdrawal
Baclofen is one of the most effective treatments for spasticity, but also perhaps the most toxic. Baclofen intoxication may lead to severe mental status suppression requiring intubation and occasionally hemodialysis. However, intrathecal baclofen withdrawal is more difficult to treat if it’s not possible to immediately re-institute intrathecal therapy. The IBCC chapter is located 👉 here. […]
EMCrit 181 – Pulmonary Hypertension and Right Ventricular Failure with Susan Wilcox
Pulmonary Hypertension and Acute on Chronic RV Failure
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