CONTENTS Overview of indirect-acting anticoagulants (heparin & fondaparinux) Risk assessment Basic science – how these agents work Choice of agent Protamine for reversal of unfractionated or low molecular-weight heparin Unfractionated heparin (UFH) Dosing and monitoring of unfractionated heparin Heparin resistance Management Pseudo-heparin resistance Low molecular-weight heparin (LMWH) Various LMWH agents & dosing Enoxaparin dosing & […]
Search Results for: airway
PulmCrit- How to use IV epinephrine for anaphylaxis
When treating anaphylaxis, epinephrine is generally given via an intramuscular (IM) route. This is well established to be effective and life-saving. One advantage of IM administration is immediate use (without requiring intravenous access), including by patient auto-injection. IM epinephrine is doubtless the best approach for patient self-treatment, for first responders, and for immediate treatment in […]
The Adventure of the Red Circle
When it comes to non-traumatic intracranial hemorrhage (ICH) the onus of the emergency physician is diagnosis, while location and severity are of far less importance. Once the diagnosis is made and the initial stabilization complete, there is very little for us to do other then notify the ICU team and contact the neurosurgeon, who, in […]
Necrotizing fasciitis
CONTENTS Basics Diagnosis Clinical presentation Laboratory abnormalities Ultrasonography Imaging Bedside surgical exploration Management Sepsis resuscitation Antibiotics Surgical debridement Therapy for simultaneous toxic shock syndrome Extra oxygen Podcast Questions & discussion Pitfalls general concept The fascia is a thin layer of connective tissue beneath the skin. Infection can spread rapidly along this fascial layer. Severe infection […]
PulmCrit- The Rothman Index: Artificial intelligence or merely a symptom of a broken healthcare system?
We are constantly hunting for newer and better sources of information. This leads to a perpetual generation of newer lab tests, different hemodynamic gizmos, and fresh decision tools. Some of these pan out. Most don’t. Why are these new sources of information generally disappointing? The answer is simple: we’re already doing pretty well. In order […]
Massive Transfusion Protocol (MTP)
CONTENTS Rapid Reference 🚀 Introduction to massive transfusion protocol (MTP) Procedural concerns Running the MTP 1) Blood products in 1:1:1 ratio 2) Fibrinogen supplementation? 3) Tranexamic acid? 4) Reversal of other coagulopathies 5) Calcium 6) Avoid acidosis 7) Avoid hypothermia 8) Hemodynamic management 9) Source control Post-MTP assessment & management Podcast Questions & discussion Pitfalls […]
Rhabdomyolysis
CONTENTS Rapid Reference 🚀 Preamble: Trust No One Causes of rhabdomyolysis Signs & symptoms Diagnosis Lab clues to rhabdomyolysis Creatine kinase (CK) McMahon Score Problems in defining rhabdomyolysis Treatment Basics Volume & pH management Dialysis Podcast Questions & discussion Pitfalls diagnosis: McMahon Score (≧6 indicates risk of renal failure): Age <50 = zero points. 51-70 […]
Reversible Cerebral Vasoconstriction Syndrome (RCVS)
CONTENTS Introduction Epidemiology Triggers & associated conditions Clinical features Diagnosis Management Prognosis Related topics: Primary angiitis of the CNS (PACNS) Podcast Questions & discussion Pitfalls basics of Reversible Cerebral Vasoconstriction Syndrome (RCVS) RCVS typically presents with thunderclap headache due to diffuse cerebral vasospasm. RCVS is usually benign, but can cause severe sequelae (most notably, ischemic […]
CAR-T cell therapy recipient in the ICU
CONTENTS Initial approach to CAR-T recipient in ICU CRS (cytokine release syndrome) Epidemiology Clinical manifestations Laboratory findings Differential diagnosis Staging Management Combined CRS & ICANS HLH (hemophagocytic lymphohistiocytosis) DIC (disseminated intravascular coagulation) ICANS (immune effector cell-associated neurotoxicity syndrome) Epidemiology Clinical manifestations Radiology Laboratory findings CSF EEG Diagnosis & differential diagnosis Staging Management Podcast Questions & […]
“The Adventure of the Golden Standard”
We have all been told ghost stories and fairy tales. Campfire fables intended to frighten the gullible populace into behaving in a manner deemed appropriate. Even in Emergency Medicine we have our fair share of ghost stories. Most notably we are taught from an early age to fear and respect the clinically occult pulmonary embolism. […]
Approach to new fever or rigors in the ICU patient
CONTENTS Definition & classification of fever Common causes of fever Evaluation Management Specific fever types Drug fever Neurogenic fever Podcast Questions & discussion Pitfalls definition of a fever Fever is a bedrock concept in medicine, yet its precise definition remains a bit elusive. The Infectious Disease Society of America defined fever in the ICU as […]
PulmCrit- How to convert a VBG into an ABG
This post is about a research project I did as a pulmonary critical care fellow in 2011. To understand it, you need to know a bit of the story behind it.
Hypernatremia & dehydration in the ICU
CONTENTS Rapid Reference 🚀 Why hypernatremia is important in the ICU Causes of hypernatremia Evaluation of cause Treatment Addressing specific causes Optimal rate of sodium reduction Free water replacement Is ICU admission required for elderly patients with severe hypernatremia? Podcast Questions & discussion Pitfalls routine management of hypernatremia in the ICU: (#0) If the patient […]
Viral infections of CNS
CONTENTS Herpesviruses ⍺-herpesviruses HSV encephalitis HSV-2 radiculomyelitis Varicella zoster virus (VZV) β-herpesviruses Cytomegalovirus (CMV) Human herpesvirus 6 (HHV-6) Gamma-herpesviruses Epstein-Barr virus (EBV) Enteroviruses Arboviruses West Nile virus (WNV) Eastern equine encephalitis (EEE) JC virus and PML (progressive multifocal leukoencephalopathy) Podcast Questions & discussion Pitfalls basics Herpes simplex virus encephalitis is caused mostly by HSV-1 (95% […]
PulmCrit: Myth-busting the fluid bolus
For centuries, medical experts practiced bloodletting for a variety of ailments. This was widely believed to rid the body of evil humors. When patients didn’t respond well, this was believed to reflect an inadequate or delayed bloodletting. Practitioners competed to see who could partake in the most rapid and aggressive bloodletting.
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