Blood pressure is one of the least understood and yet most intervened on metrics in modern medicine. Though we have found meager success in controlling blood pressure over the long-term (1,2) our attempts to translate these benefits to the acute setting of the emergency room have not been met with improved short-term outcomes. Traditionally acutely […]
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PulmCrit- Six myths promoted by the new surviving sepsis guidelines
Early Goal-Directed Therapy: A house collapsing in slow motion The original foundation of the Surviving Sepsis Campaign was the Rivers trial on early goal-directed therapy. This is basically the NINDS trial of the critical care world: a study with ~300 patients showing implausibly positive results, published in NEJM, and rapidly brainwashing an entire discipline. The […]
EMCrit 296 – The French Connection, Part 1 – Resuscitation Geography, Logistics, & Ergonomics
A new series on the philosophy and psychology of resuscitation…
PulmCrit- Sedation update: IV olanzapine & combo vs. monotherapy
The potential role for IV olanzapine was examined in a post last year. The following conclusions were reached: IV olanzapine appears to be safe. IV olanzapine has equal potency compared to IV droperidol and about twice the potency of IV haloperidol. Olanzapine doesn’t affect QT interval or cause torsade de pointes. Two articles were just […]
EMCrit 248 – How to Teach Surgical Airways–you knows, Crics: The One-Hour Cricothyrotomy Course
Lessons learned from teaching hundreds of people to cric
PulmCrit – Heparin resistance in COVID & implications for DVT prophylaxis
background: what is heparin resistance? Heparin works by binding to antithrombin III and thereby activating antithrombin III, an endogenous anticoagulant which inhibits clotting factors (especially Xa). Heparin + Anti-thrombin III → [Heparin-Antithrombin-III complex] → Inhibition of Xa activity Heparin resistance refers to situations where unusually large doses of heparin are required to achieve anticoagulation. This […]
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 […]
Serotonin syndrome
CONTENTS Rapid Reference 🚀 Overview Causes of serotonin syndrome Clinical presentation Differential diagnosis Lab evaluation Diagnostic criteria Treatment Cyproheptadine? Dexmedetomidine Overall treatment strategy Podcast Questions & discussion Pitfalls diagnosis Hunter diagnostic criteria are shown below. ⚠️ Criteria are not 100% specific, so you also need to pay attention to the differential diagnosis.📖 management of serotonin […]
The Ties that Bind: Social Capital and the Psychology of FOAM by Mike Lauria
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EMCrit – I Have Issues with Andexanet by K. Kipp, PharmD
I have a problem with Andexanet
Situation Awareness in Resuscitation by Mike Lauria
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Purpura Fulminans
CONTENTS Rapid Reference 🚀 Basics of Purpura Fulminans Pathophysiology Common causes Clinical findings Diagnostic tests Diagnosis Treatment Antibiotics & source control Heparin & heparin resistance Protein C concentrates Blood product replacement Vasodilators Surgical debridement Vitamin K supplementation Podcast Questions & discussion Pitfalls basics Purpura fulminans is an extreme thrombotic subtype of disseminated intravascular coagulation, marked […]
CT Angiogram for evaluation of severe hematochezia
Introduction 0 Gastrointestinal hemorrhage is a common reason for ICU admission. The approach to severe upper GI bleeding is relatively straightforward (figure below). A predictable approach facilitates planning ahead, and anticipating who needs to be contacted for help when. 0 0 Unfortunately, the approach to severe hematochezia is often less clear. Below is a description […]
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 […]
Immunosuppressive therapies in pulmonology & transplantation
CONTENTS Disclaimer – Still consult transplant medicine Mycophenolate Azathioprine Calcineurin inhibitors (tacrolimus, cyclosporine) Sirolimus Questions & discussion abbreviations used in the pulmonary section: 2 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AFB: Acid Fast Bacilli AIP: Acute interstitial pneumonia (Hamman-Rich syndrome) 📖 ANA: Antinuclear antibody 📖 […]
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