CONTENTS Rapid Reference 🚀 Overview Pathophysiology Diagnosis Epidemiology Presentation: Signs & symptoms Bottom line: key diagnostic clues Labs Neuroimaging Treatment Podcast Questions & discussion Pitfalls approach to critical illness possibly due to tick borne disease ✅ #1) when to suspect tick borne illness (more) (#1) Sepsis without a definite source of infection. (#2) Tick exposure […]
Search Results for: airway
PulmCrit: Neutrophil-Lymphocyte Ratio (NLR): Free upgrade to your WBC
introduction The neutrophil/lymphocyte ratio (NLR) has been gaining increasing attention across many fields of medicine within the past five years. Currently, there are 2,230 publications about this in PubMed, mostly within the past few years. This post will attempt to create a framework for understanding this ratio. overview definition & physiology The NLR is simply […]
PulmCrit – Oscar awards for the best COVID prognostic models
We are continually tasked with triaging COVID patients, a situation which will become more complex as the numbers continue to rise. This involves making educated guesses about which patients are most likely to deteriorate, and which patients may benefit most from critical care. That’s enormously difficult. At this point, we’re quite familiar with individual risk […]
Buprenorphine & opioid use disorder
CONTENTS Rapid Reference 🚀 All hands on deck Buprenorphine basics Buprenorphine induction Acute pain in a patient on chronic buprenorphine Podcast Questions & discussion Pitfalls Between 1999-2017, ~400,000 people died from opioid overdose. That’s over half the number of Americans who have ever died from HIV. It is increasingly clear that opioid use disorder (OUD) […]
Thrombotic microangiopathies (including TTP, ST-HUS, and C-HUS)
CONTENTS Thrombotic Microangiopathy(TMA) Definition of TMA Causes of TMA Investigating the cause of TMA Initial empiric therapy for TMA Thrombotic thrombocytopenic purpura (TTP) Epidemiology of acquired TTP Clinical presentation of TTP Initial treatment of acquired TTP Shiga-Toxin mediated Hemolytic Uremic Syndrome (ST-HUS) Epidemiology & presentation of ST-HUS Diagnosis of ST-HUS Treatment of ST-HUS Complement-mediated Hemolytic […]
Spontaneous Bacterial Peritonitis (SBP)
CONTENTS Presenting clinical features Paracentesis Differentiating spontaneous versus secondary bacterial peritonitis Diagnosis of SBP Treatment Spontaneous bacterial empyema (SBE) Podcast Questions & discussion Pitfalls presenting signs & symptoms SBP is often subtle (for example, 13% of patients are asymptomatic).(19266595) Fever or hypothermia. Nausea/vomiting, ileus, and/or diarrhea. Abdominal pain occurs in about half of patients. However, […]
Neuro-ultrasound
CONTENTS Intracranial pressure 2D imaging of the brain: Initial 2D image – midbrain Hydrocephalus Midline shift Intracranial hematoma Transcranial Doppler Basic views & technique Pulsatility index Vasospasm Brain death Acute ischemic stroke Podcast Questions & discussion Pitfalls optic nerve sheath diameter The optic nerve sheath is part of the dura surrounding the brain.(35001377) When intracranial […]
Community acquired biliary sepsis (ascending cholangitis & calculus cholecystitis)
CONTENTS Rapid Reference 🚀 Introduction Clinical presentation & differential diagnosis Diagnostic tests Labs Ultrasonography CT scan HIDA scan Diagnostic criteria Treatment Antibiotics Interventional tx for ascending cholangitis Interventional tx for cholecystitis Interventional tx for combined cholecystitis & cholangitis Podcast Questions & discussion Pitfalls community-acquired biliary sepsis checklist ✅ investigations Electrolytes, CBC with differential, coags. Liver […]
Wernicke encephalopathy
CONTENTS Rapid Reference 🚀 Pathophysiology Signs & Symptoms Risk factors Epidemiology Laboratory studies Imaging Differential diagnosis & securing the diagnosis Prevention Treatment Prognosis Related topics Metronidazole induced encephalopathy (MIE) Podcast Questions & discussion Pitfalls biochemistry Thiamine is a co-factor in numerous enzymatic reactions involved in energy metabolism, as shown below. Thiamine deficiency has consequences including […]
EMCrit 318 – SSC Guidelines 2021 – The Good, The Bad, & The Ugly and What You Need to Know in Sepsis Resuscitation
It has been a while since we did a sepsis and septic shock update, so the time has come! No better framework for the discussion than the most recent iteration of the Surviving Sepsis Campaign Guidelines. Foreshadowing: they don’t suck as hard as in prior years.
PulmCrit- TEG for cirrhotic coagulopathy: Time for clinical implementation?
Introduction Traditional coagulation studies (especially the INR) fail miserably in cirrhosis. Thromboelastography (TEG) is a superior approach for understanding the global balance of pro-coagulants versus anti-coagulants in these patients. This isn’t anything particularly new – for example, it was explored in this post from 2015 (if you’re not familiar with this concept already, it’s explained […]
Severe community-acquired pneumonia
CONTENTS Rapid Reference 🚀 Definition of severe CAP Diagnosis: Pneumonia diagnosis Differential diagnosis Post-diagnosis evaluation: Laboratory studies Imaging Lobar pneumonia Bronchopneumonia Interstitial pneumonia Necrotizing pneumonia (cavitation) Nodular pneumonia Pleural effusion Pneumothorax Chest wall invasion Septic pulmonary emboli ➡️ Bronchoscopy Triage: who needs ICU? Treatment Antibiotic selection Resuscitation Respiratory support Steroid Effusion management Treatment failure Duration […]
PulmCrit: A-lines in septic shock: the wrist versus the groin
Historically, emphasis has rested on the distinction between noninvasive versus invasive BP (e.g., cuff pressure vs. radial arterial pressure). Attention focused on whether noninvasive oscillometric BP monitoring is adequate. Meanwhile, it has been assumed that all invasive BP measurement sites are created equal.
Neuroimaging
CONTENTS OF THIS CHAPTER Introduction Radiologic anatomy Cisterns CT anatomy overview Vascular distributions CT radiology CT basics Approach to reading a CT scan MRI Understanding the sequences T1 T1 with contrast T2 & FLAIR DWI & ADC T2* (GRE & SWI) Hematoma evolution on MRI Approach to reading an MRI Selected neuroimaging differentials Leptomeningeal enhancement […]
Hyperkalemia
CONTENTS Rapid Reference: treatment for severe hyperkalemia 🚀 Diagnosis of hyperkalemia Severity & risk stratification Causes of hyperkalemia Treatment: Moderate hyperkalemia Treatment of severe hyperkalemia Temporizing measures Volume expansion with isotonic bicarbonate Potassium elimination Sodium zirconium cyclosilicate Podcast Questions & discussion Pitfalls volume resuscitation if hypovolemic Bicarb <22 mM ➡️ use isotonic bicarbonate. 💉 Bicarb […]