CONTENTS Cryptococcal meningitis Dimorphic fungi (endemic mycoses) Histoplasmosis Coccidioidomycosis Blastomycosis Molds Aspergillosis Rhinocerebral mucormycosis Candidiasis Podcast Questions & discussion Pitfalls basics Cryptococcus neoformans is a widespread opportunistic fungus found in soil and bird droppings. Cryptococcus gattii causes infection in immunocompetent patients, but it is restricted to specific geographic locales (British Columbia and the Pacific Northwest; […]
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Hypokalemia
CONTENTS Rapid Reference 🚀 Physiology: Potassium pharmacokinetics Diagnosis Clinical significance Causes Workup Risk stratification Treatment Target potassium level? Enteral route generally preferred Intravenous potassium Magnesium repletion Other measures Podcast Questions & discussion Pitfalls consider risk factors for arrhythmia 📖 EKG changes (especially QT prolongation). Digoxin. Myocardial ischemia. Medications that prolong QT interval and promote torsade […]
Letter to the Editor – High-Sensitivity Troponin is not a Myth, and “Myth-busting” is often another Myth to be Busted
Shots fired…
Contrast Nephropathy, myth thereof
CONTENTS Venous injection of contrast (e.g. for CT scan) The birth of the contrast nephropathy myth Current lack of evidence regarding contrast nephropathy Weighing the risks vs. benefits of using contrast (Renalism) The attention given to contrast nephropathy is insane Intra-arterial contrast (e.g. cardiac catheterization) Algorithm Podcast Questions & discussion Pitfalls The concept of contrast […]
Sympathomimetic intoxication
CONTENTS Overview Clinical presentation Evaluation Management Serotonergic medications to avoid Agitation Seizures Hyperthermia Hypertension Chest pain & acute coronary syndrome Arrhythmia Atrial fibrillation Monomorphic ventricular tachycardia QT prolongation & torsade de pointes Hepatic failure Respiratory complications Rhabdomyolysis Hyponatremia Podcast Questions & discussion Pitfalls common sympathomimetic intoxications: Cocaine. Methamphetamine: Illicit “crystal meth.” Medicinally prescribed methamphetamine, used […]
GI Bleeding
CONTENTS Rapid Reference: Overview & Checklist 🚀 Investigations Diagnosis & bedside evaluation Risk stratification Resuscitation basics Causes Specific bleeding location/types Approach to upper GI bleed Variceal bleed Hematochezia and (presumed) lower GI bleed Podcast Questions & discussion Pitfalls history & physical History: NSAID use? Abdominal pain? Alcoholism? Liver disease? Surgical history: Gastric bypass surgery? AAA […]
Sodium Channel Blocker Toxicity (including tricyclic antidepressants)
CONTENTS Overview – sodium channel blockers & tricyclic antidepressants Pathophysiology and terminology Agents that inhibit cardiac sodium channels Diagnosis EKG findings of sodium channel blockade Clinical manifestations Management – three antidotes #1) Bicarbonate #2) Lidocaine #3) Lipid emulsion Management – clinical approach Intubation if necessary Hypotension Ventricular tachycardia Seizure Podcast Questions & discussion Pitfalls Tricyclic […]
Mycobacterial & unusual bacterial infections of CNS
CONTENTS Listeria Nocardia Legionella Mycoplasma Tuberculosis Tuberculous meningitis Tuberculomas Lyme Neurosyphilis Podcast Questions & discussion Pitfalls basics Listeria is a bacterial pathogen which can cause meningitis, encephalitis, or meningoencephalitis. Among bacterial pathogens, Listeria is notable because it may sometimes be associated with a relatively unimpressive CSF profile. Research on Listeria is confusing to interpret, since […]
Hemophagocytic LymphoHistiocytosis (HLH)
CONTENTS Basics – what is HLH? Clinical features of HLH Laboratory findings Ferritin Lumbar puncture Pathology – Hemophagocytosis Causes of HLH Differential diagnosis – Closest mimics of HLH Approach to the diagnosis of HLH Treatment Treatment of the underlying cause (if possible) Steroid IL1 antagonism JAK inhibition Etoposide Podcast Questions & discussion Pitfalls what is […]
Pericardial tamponade
CONTENTS Rapid Reference 🚀 Causes of tamponade Symptoms Physical exam Pulsus paradoxus Kussmaul’s sign EKG Radiology Echocardiography Diagnosis: Overall approach Low pressure tamponade Management Initial stabilization measures Ultrasound-guided pericardial drainage Interventional radiology or surgical drainage Tamponade patient in cardiac arrest Finer points: Limitations of this chapter Physiology Podcast Questions & discussion Pitfalls Key tests to […]
Antibiotics
CONTENTS commonly used antibiotics Aminoglycosides Ampicillin & Ampicillin-Sulbactam Aztreonam Carbapenems (meropenem & ertapenem) Cephalosporins Cephalosporin G1: cefazolin Cephalosporin G3: ceftriaxone Cephalosporin G3: ceftazidime Cephalosporin G4: cefepime Cephalosporin G5: ceftaroline Clindamycin Daptomycin Doxycycline Fluoroquinolones Linezolid Macrolides (Azithromycin, Clarithromycin) Metronidazole Nafcillin Nitrofurantoin Penicillin G Piperacillin-Tazobactam Rifampin Tigecycline Trimethoprim-Sulfamethoxazole Vancomycin specific pathogens Antibiogram & 1st line agents by […]
Septic Shock
CONTENTS Rapid Reference 🚀 Definitions of septic shock Diagnosis & evaluation Clinical Presentations Biomarkers: NLR Procalcitonin & CRP ➡️ Evaluation for the source Sepsis mimics Treatment Vasopressors Source control Fluid Steroid DVT prophylaxis with heparin REFRACTORY SHOCK Methylene blue Resuscitative endpoints MAP Heart rate Urine output Fluid balance Lactate Skin perfusion Interventions of no real […]
Neurological complications of COVID
CONTENTS Limitations of this chapter Brief word on pathogenesis General clinical principles Encephalopathy Diffuse leukoencephalopathy with diffusion restriction Acute necrotizing encephalopathy (ANE) Mild encephalopathy with reversible splenial lesion (MERS) Acute disseminated encephalomyelitis (ADEM) & Acute hemorrhagic leukoencephalitis (AHLE) Myelitis Autoimmune encephalitis Posterior reversible encephalopathy syndrome (PRES) Stroke Acute ischemic stroke Intracranial hemorrhage & microbleeds Cerebral […]
Antifungal Agents
CONTENTS Rapid Reference 🚀 Overview Azoles (#1) Choosing your azole: Spectrum & use of each azole Choice of azole for various infections Contraindications & drug-drug interactions (#2) Pharmacology, dosing, and drug levels: Voriconazole Isavuconazole Fluconazole Itraconazole (#3) Toxicity & monitoring Echinocandins (caspofungin, micafungin, anidulafungin) Liposomal amphotericin Podcast Questions & discussion Pitfalls antifungal agents: azole interactions: […]
Acute Pancreatitis (including hypertriglyceridemic pancreatitis)
CONTENTS Rapid Reference 🚀 Diagnosis Clinical findings Laboratory studies (lipase) Radiology Diagnostic criteria Evaluating the cause of pancreatitis Risk stratification – who needs ICU? Treatment General principle: pancreatoseptic equivalence Treatment of causative factors ERCP? Resuscitation Analgesia Nutrition Non-hypertriglyceridemic pancreatitis Hypertriglyceridemic pancreatitis Prophylactic & early antibiotics Fluid collections & infected necrosis Abdominal compartment syndrome Hemorrhage Hypertriglyceridemic […]
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