. Introductory case . A young 70-kg man was transferred to the Genius GeneralICU for management of stupor. He had been diagnosed with aortic valve endocarditis due to heroin abuse two weeks earlier, but left the hospital against medical advice. Shortly after admission to Genius General, the lab called with a critical sodium value of […]
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Guest Post – Down with STEMI – The OMI Manifesto by Pendell Meyers
Down with STEMI
Deresuscitation: Dominating the Diuresis
CONTENTS Rapid Reference 🚀 Intro Are diuretics nephrotoxic? Specific agents Acetazolamide Loop diuretics Thiazide diuretics Spironolactone Amiloride Triamterene (& why not to use it) Osmotic diuretics General strategies & problem-shooting Volume removal from pleura or peritoneum Large-volume diuresis Diuretic resistance Addressing common problems which arise Hypernatremia Metabolic alkalosis Hypokalemia & hypomagnesemia Hypotension Rising creatinine Podcast […]
Endocarditis
CONTENTS Rapid Reference 🚀 Diagnosis When to suspect endocarditis Lab workup Septic pulmonary emboli Echocardiography (TTE vs TEE) Diagnostic strategies & criteria European Society of Cardiology criteria Manifestations include: Metastatic infection Neurologic complications Septic embolic encephalitis Antibiotics Empiric therapy Definitive therapy Methicillin-sensitive Staph. 📖 Methicillin-resistant Staph. 📖 Enterococcus. 📖 Streptococcus pneumoniae. 📖 Beta-hemolytic Streptococci. 📖 […]
PulmCrit: No more antipsychotics for delirium? Not so fast!
Recently the MINDS-USA trial evaluated the use of haloperidol or ziprasidone for delirium in critical illness. Before jumping into the results of this study, it will help to establish a couple of foundational principles.
Hyponatremia
CONTENTS Rapid Reference 🚀 Diagnosis & symptoms Causes Evaluation Lab panel Isotonic fluid challenge Risk stratification Initial treatment (e.g., in ED) Initial hyponatremia package Target rate of increase Subsequent therapeutic strategy Rapidly reversible cause: DDAVP clamp DDAVP clamp-bolus strategy SIADH with persistent cause Heart failure Cirrhosis Hypokalemic hyponatremia Oops, the patient’s sodium over-corrected Why not […]
Metformin toxicity
CONTENTS Rapid Reference 🚀 Physiology of metformin-induced lactic acidosis Epidemiology & definitions Clinical presentation Differential diagnosis Prognosis Treatment Decontamination after acute ingestion Evaluate for other causes & consider empiric treatment for sepsis Glucose management & insulin (?) Volume resuscitation Respiratory support Dialysis indications Methylene blue?? Podcast Questions & discussion Pitfalls approach to metformin-associated lactic acidosis […]
The Case of the Balanced Solution
Saline-based resuscitation strategies were first proposed as far back as 1831 during the Cholera Epidemic. In an article published in the Lancet in 1831, Dr. O’Shaughnessy suggests the use of injected salts into the venous system as a means of combating the dramatic dehydration seen in patients afflicted with this bacterial infection(1). Saline’s potential harms […]
NeuroEMCrit – 31 #NeuroPostItPearls
A multiplicity of neuro tips
Lithium intoxication
CONTENTS Pharmacokinetics Presentations Evaluation Lithium level & ingested dose Treatment Decontamination Avoid medications which impair excretion Fluid resuscitation & diuresis Nephrogenic diabetes insipidus Dialysis Resumption of lithium Prognosis & SILENT syndrome Podcast Questions & discussion Pitfalls absorption Typically absorbed within ~1-2 hours (immediate release formulations) or ~4-6 hours (sustained release formulations). In acute overdose, absorption […]
EMCrit Shadowboxing Case 6 – A Respiratory Case along with Extra Commentary from Mae West
A pulm-crit shadowboxing case
Disclaimer
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PulmCrit- The hidden fragility of meta-analyses: case study of the IOTA trial
Meta-analyses are widely assumed to be robust, without any attempt to test their fragility. This post describes two techniques to evaluate the fragility of a meta-analysis
Original RUSH Article
This concept was first conceived by the authors above in 2006 and discussed in national lectures in 2007 and on. It has been available on emcrit.org since March 2008 and was the first hit on a google search of ‘RUSH Exam’ from this date on. It was published on Emedhome in May 2009. Rapid […]
PulmCrit- Do phenylephrine and epinephrine require central access?
Until recently I believed that prolonged vasopressor administration requires a central line, to avoid extravasation. I lumped together all vasopressors, treating them all as equal. I used the occurrence of an extravasation reaction from one vasopressor as evidence that all vasopressors could cause extravasation reactions (the fallacy of inappropriate generalization). Upon closer examination, these beliefs aren’t supported by evidence.
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