CLOVERS Trial Primer and Fluids in Septic Shock
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PulmCrit- Why most diagnostic procedures aren’t beneficial
We often assume that diagnostic procedures will help patients. A lot of training goes into learning how to do these procedures. Procedures are dramatic. We like performing them. Patients are impressed, perceiving that we are “doing” something for them. Everything is awesome.However, when strict evidence-based medicine is applied to procedures, they are often less impressive.
What Would Google Do?
What would Google do?
PulmCrit – Thrombosis update in COVID-19: Data from the Mount Sinai system in NYC
One of the most controversial issues regarding management of COVID-19 is the appropriate dosing of anticoagulation. It’s universally agreed upon that patients with COVID-19 should receive some dose of anticoagulation (at least prophylaxis), barring contraindications. However, the optimal dose is unclear. Numerous reports indicate that patients with COVID-19 have high rates of venous thromboembolic disease, […]
EMCrit – Overdiagnosis of uncomplicated pericarditis often leads to more harm than good
On waste basket diagnoses – Pericarditis
Understanding lactate in sepsis & Using it to our advantage
Introduction with a case 0 Once upon a time a 60-year-old man was transferred from the oncology ward to the ICU for treatment of neutropenic septic shock. Over the course of the morning he started rigoring and dropped his blood pressure from 140/70 to 70/40 within a few hours, refractory to four liters of crystalloid. […]
PulmCrit – Is piperacillin-tazobactam safe in patients with penicillin allergy?
Historically it was believed that allergic reactions could be mediated by the core structures. This would imply that a patient could be allergic to all penicillins, all cephalosporins, or even all beta-lactams. That would be hugely problematic, because a patient could simultaneously be allergic to dozens of antibiotics – greatly complicating their management.
Sickle Cell Acute Chest Syndrome
CONTENTS Rapid Reference 🚀 Background Pathophysiology Epidemiology Presentation & diagnosis Trigger of acute chest syndrome Symptoms Examination & POCUS Radiology Rapid progression & multi-organ failure Definition & differential diagnosis Management Non-transfusion related Aggressive oxygenation & monitoring Volume resuscitation Antibiotics Pain management Transfusion General considerations about transfusion Simple transfusion (top-up transfusion) Exchange transfusion Manual exchange transfusion […]
Anion-gap metabolic acidosis
CONTENTS Diagnosis Causes of elevated anion gap Evaluation Evaluation of elevated anion gap Evaluation & treatment of elevated lactate Treatment Podcast Questions & discussion Pitfalls Anion gap should be evaluated on every electrolyte panel. Ideally the computer will do this automatically; otherwise, it should be calculated. Anion gap is calculated as (Na – Cl – […]
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 […]
EM Nerd-The Case of the Bridge to Nowhere Continues
So often we apply qualitative dichotomies to quantitative differences even when questionable clinical distinction exists. Such is the case with the general interpretation of a recent article published in Resuscitation. Huis in ’t Veld et al examined video recordings of real life Emergency Department resuscitations of patients in cardiac arrest (1). Over a one year […]
PulmCrit: What is the fragility index of the NINDS trial?
Medicine continues to be plagued by poorly reproducible studies. The storyline is familiar. First, a very positive study is released in a major medical journal, with great fanfare. This leads to widespread changes in practice. Decades later, it becomes clear that the study was incorrect. Recently a new tool was developed to help understand the reproducibility of clinical studies: the fragility index. This post will analyze the NINDS trial from the perspective of its fragility index.
PulmCrit – Preliminary report on NIAID trial of remdesivir (ACTT-1)
The preliminary report of the Adaptive COVID-19 Treatment Trial (ACTT-1), a multi-center, placebo-controlled RCT on remdesivir is here!1 The one we’ve all been waiting for! Patients Patients were recruited from 60 sites in several countries. Inclusion criteria were patients who were hospitalized due to COVID-19 with evidence of lower respiratory tract infection, defined in terms […]
EMCrit 309 – Critically Ill Diabetic Ketoacidosis (DKA)
Critically Ill diabetic ketoacidosis is usually a bit of a misnomer
EMCrit 115 – A New Paradigm for Post-Intubation Pain, Agitation, and Delirium (PAD)
What you do in the ED for post-intubation sedation will determine whether your patient lives or dies
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