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 […]
Search Results for: acid base
Subarachnoid Hemorrhage (SAH)
CONTENTS Rapid Reference: Initial management 🚀 Epidemiology, causes, & location Epidemiology Causes of SAH based on blood distribution Diffuse or basal SAH Convexity SAH Perimesencephalic SAH Presentation Thunderclap headache – causes & approach Grading scales Diagnostic approach Diagnosis of SAH Noncontrast CT CT angiography Lumbar puncture MRI & MRA Invasive angiography Overall diagnostic algorithm Diagnosis […]
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.
PulmCrit- Resuscitationist’s guide to status epilepticus
In 2014 I wrote a post suggesting an aggressive, streamlined approach to status epilepticus involving early intubation. The fundamentals of that post remain valid. However, much has changed over the last few years. This post aims to refresh and extend the prior post. It will also serve as a reference to explain my algorithm for […]
Ethylene glycol & methanol poisoning
CONTENTS Rapid Reference 🚀 Background Biochemistry Clinical features Epidemiology Symptoms Diagnostic tests Osmolal gap Anion gap Lactate gap Other lab clues of ethylene glcyol toxicity Specific tests for methanol or ethylene glycol Neuroimaging Treatment Decontamination Alcohol dehydrodgenase blockade (e.g., fomepizole) Hemodialysis Fluids & electrolytes Vitamins Methanol-induced brain death Podcast Questions & discussion Pitfalls labs to […]
Fluid selection & pH-guided fluid resuscitation
CONTENTS Rapid Reference 🚀 Forward Crystalloids vs. colloids Step I: Balanced Crystalloid Choice of balanced crystalloid Step II: pH-guided resuscitation Hypertonic & isotonic bicarbonate Therapeutic alkalinization to augment permissive hypercapnia Podcast Questions & discussion Pitfalls The illustration above may appear a bit amusing, but this actually mirrors various practices that I’ve encountered during my training […]
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 […]
COVID 19 Complete Chapter
CONTENTS Basic biology Infection control Transmission Personal protective equipment (PPE) Diagnosis Signs & symptoms Labs Imaging CXR & CT scan Lung ultrasonography General approach to imaging Bronchoscopy Diagnostic approach for admitted patients Treatment: General protocols ED patients getting admitted to the hospital Inpatient management of hypoxemic, non-intubated patients Intubated patients Treatment: Specific anti-viral & immunosuppressive […]
Hypercalcemia
CONTENTS Rapid Reference 🚀 Signs & symptoms Calcium and iCa levels Causes Evaluation Treatment overview Volume resuscitation Calcitonin IV bisphosphonate Refractory hypercalcemia Miscellaneous topics Milk-alkali syndrome Podcast Questions & discussion Pitfalls evaluation of hypercalcemia Ionized calcium level. Electrolytes including Mg/Phos. Parathyroid hormone (PTH). PTH-related peptide (PTHrp). 25-OH vitamin D and 1,25-OH vitamin D. Thyroid stimulating […]
Severe hemoptysis
CONTENTS Rapid Reference 🚀 Basics General principles of hemoptysis management Ddx vs pseudohemoptysis Triage: Who needs ICU? Common causes of severe hemoptysis Roadmap for management of severe hemoptysis 0) Initial evaluation Nebulized tranexamic acid 1) Reverse coagulopathy 2) Indications for intubation 3) CT scan 4) IR embolization 5) Intubation 6) Bronchoscopy 7) Interventional pulmonology 8) […]
PulmCrit- Angiotensin II: five cautions & three comparisons
Upon first reading the ATHOS-3 trial, I was pleasantly optimistic. Who wouldn’t be interested in a shiny new vasopressor? The trial didn’t prove much, but it was intriguing. However, it was alarming to hear that the FDA has approved angiotensin II for use based on it. Precious little evidence is available about this drug. With angiotensin II arriving at hospitals soon, some cautions are in order.
Alcohol withdrawal
CONTENTS Rapid Reference 🚀 Preamble & disclaimer Diagnosis Alcohol withdrawal vs. hepatic encephalopathy Therapeutic target (CIWA vs RASS) Treatment: Phenobarbital monotherapy Phenobarbital pharmacology Advantages of phenobarbital over benzodiazepines Contraindications to phenobarbital ➡️ Phenobarbital guideline Checking phenobarbital levels? ➡️ Pitfalls of phenobarbital Alternative agents Benzodiazepines Valproic acid Antipsychotics & alpha-2 agonists (dexmedetomidine, clonidine, guanfacine) Ketamine Other […]
PulmCrit- Coagulopathy management in the bleeding cirrhotic: Seven pearls and one crazy idea
Traditionally, coagulation management in patients with cirrhosis has focused largely on using large volumes of FFP to decrease the INR. However, recent evidence indicates that INR prolongation in these patients is nonspecific and that FFP usually isn’t helpful.
Aspiration syndromes
CONTENTS Management of aspiration itself: Risk factors for aspiration Investigation Prevention Aspiration syndromes: Aspiration pneumonitis Aspiration pneumonia Lung abscess ➡️ Lipoid pneumonia Foreign body aspiration Aspiration-induced interstitial lung disease Aspiration bronchiolitis ➡️ Questions & discussion abbreviations used in the pulmonary section: 8 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute […]
Waveform capnography in the intubated patient
CONTENTS Rapid Reference 🚀 Introduction: An emerging standard of care Physiology etCO2, PaCO2, and dead space etCO2 and cardiac output Clinical background Evidence: accuracy of etCO2 in predicting PaCO2 What is the PaCO2 target for an intubated patient? Interpretation of etCO2 waveform morphology Clinical utility Confirming endotracheal tube placement Guidance of cardiac arrest management Guidance […]
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