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 […]
Search Results for: airway
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
PulmCrit Wee: Lung pathology of COVID-19: is AFOP in play?
We’re beginning to start to see some information about lung pathology due to COVID-19. But before jumping into that, a little background… background: lung pathology, DAD, and AFOP Lung pathology & treatment: the bigger picture In an ideal world, different insults to the lung would cause specific histologic patterns. These patterns would be related to […]
EMCrit Guest Post – The good, the bad, and the ugly of the Joint Statement on REBOA by Zaffer Qasim
@emeddoc on the current state of REBOA and that bad, bad joint agreement:
PulmCrit – Validation of my model for converting VBGs to ABGs
background and general concept My research project in fellowship was the construction of a mathematical model to convert VBG values into ABG values. The fundamental concept for the model was pretty simple: we can approximate the respiratory quotient (RQ) of tissue in the hand as being constant. This indicates that changes in oxygen content and […]
Posterior Reversible Encephalopathy Syndrome (PRES)
CONTENTS Basics Pathogenesis Causes Clinical presentation PRES-RCVS (Reversible Cerebral Vasoconstriction Syndrome) overlap Imaging Lumbar puncture EEG & seizure semiology Diagnosis Differential diagnosis Treatment Prognosis Podcast Questions & discussion Pitfalls PRES refers to reversible, vasogenic edema which occurs predominantly in the posterior brain. PRES is less commonly known as “reversible posterior leukoencephalopathy syndrome” (RPLS). However, both […]
PulmCrit- A better approach to Torsade de Pointes
A common approach to TdP is shown above. The initial episode is controlled with magnesium and perhaps defibrillation. The patient is sent to ICU for close observation. Usually the patient will be fine, but sometimes TdP does recur. Recurrence triggers second-tier therapies, often including overdrive pacing.
All in the Game: The Psychology of FOAM Part 2 by Mike Lauria
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Troponin elevation in non-cardiac critical illness
CONTENTS Rapid Reference 🚀 Introduction How to screw this up Approach to ischemia evaluation Step #1: should we check troponin? Step #2: does this troponin-positive patient have an MI? Step #3: type-1 versus type-2 MI? Treatment Type-1 MI Type-2 MI Unclear type-1 vs. type-2 MI Podcast Questions & discussion Pitfalls approach to ischemic evaluation for […]
PulmCrit- Does the HIGH trial debunk high-flow nasal cannula?
High-flow nasal cannula (HFNC) has become popular for the hypoxemic respiratory failure, driven partially by the FLORALI trial.1 Recently, the HIGH trial evaluated the ability of HFNC to reduce mortality among immunocompromised patients with acute hypoxemic respiratory failure.2 HFNC failed to improve mortality or significantly reduce intubation rates. Popular narrative about this trial A common […]
PulmCrit: Validation of test-dose strategy for beta-lactam allergies
Background Kimberly Blumenthal and colleagues at the Massachusetts General Hospital have been performing groundbreaking work on beta-lactam allergies. Their work forms the foundation for much of the IBCC chapter on beta-lactam allergies (you might want to read it before this post, but if you don’t have time, a one-minute synopsis is below). One fundamental technique […]
PulmCrit- Triple therapy for influenza with naproxen, clarithromycin, and oseltamavir?
Flu seasons is upon us again. A recent paper in CHEST provides some tantalizing evidence about possible treatment. Will this pan out, or is it just another fairy tale?
Toxic Shock Syndrome (TSS)
CONTENTS Rapid Reference 🚀 Pathophysiology Epidemiology Clinical presentation Lab tests Diagnosis Differential diagnosis Overall approach to diagnosis CDC diagnostic criteria Treatment Basic sepsis resuscitation Antibiotics Source control Intravenous immunoglobulin (IVIG) Purpura fulminans Preventing nosocomial transmission Podcast Questions & discussion Pitfalls pathophysiology Some Streptococcus and Staphylococcus species secrete superantigens that causes widespread activation of T-lymphocytes (figure […]
PulmCrit- Tranexamic acid for traumatic brain injury (CRASH3)
preamble CRASH-3 is the latest massive, pragmatic multi-center RCT brought to us by the London School of Hygiene and Tropical Medicine Trials Unit. These investigators have created an extensive network of hospitals throughout the world with the capability of performing truly impressive trials. Especially in the critical care arena, these trials have uniquely high power […]
PulmCrit- Epinephrine challenge in sepsis: An empiric approach to catecholamines
A 55-year-old woman was admitted with toxic shock syndrome. Her norepinephrine requirement was labile, fluctuating between 15 mcg/min and 30 mcg/min. Bedside echocardiogram showed a dilated inferior vena cava without respiratory variability, and a normal ejection fraction. On examination her extremities were cool and her urine output was marginal.
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