0 Time and tide wait for no intervention – Geoffrey Chaucer 0 We are barraged by time-to-intervention studies (door-to-balloon time, time-to-antibiotics, door-to-needle, etc.). However, it must be kept in mind that these studies are purely correlational in design. Such studies cannot […]
Search Results for: mental toughness
PulmCrit- Oral vasopressor to accelerate liberation from the ICU
Midodrine is an oral agent which functions as an alpha-1 agonist. It has been used in a variety of situations including autonomic dysfunction, hepatorenal syndrome, and dialysis-induced hypotension. Over the past few years there has been increasing interest in using midodrine to facilitate weaning off vasopressors.
Renoresuscitation: Sepsis resuscitation designed to avoid long-term complications
0 Introduction 0 Over the last few years, I’ve gone through an almost 180-degree change in my conceptualization of septic shock. In a perfect world, this would be irrelevant. Ideally there would be sufficient randomized controlled trials (RCTs) to answer all important questions directly, and my opinions would be irrelevant. Unfortunately not. Reconceptualizing the disease […]
Pulmonary vasculitis & diffuse alveolar hemorrhage
CONTENTS Diffuse Alveolar Hemorrhage (DAH) Clinical presentation Radiology Bronchoscopy Causes Evaluation Management ANCA-associated vasculitides Overview of ANCA-associated vasculitides in the ICU Laboratory findings in GPA and MPA Clinical features of granulomatosis with polyangiitis (GPA) Radiology Tracheobronchial involvement Treatment pathway for GPA or MPA Podcast Questions & discussion Pitfalls clinical presentation (1) May present with hemoptysis […]
PulmCrit- Chasing mortality endpoints is a fool’s errand
“There is no mortality benefit for that.” How many times have you heard that? The implication is usually the same: that intervention is a waste of time. A smart, evidence-based clinician wouldn’t bother with it. But, what does it actually mean if there is no proven mortality benefit?
PulmCrit- The siren’s call: Double-coverage for ventilator associated PNA
Some theories are so attractive that they are nearly irresistible. No matter how many times they are disproven, these theories still seem compelling. One example is double-coverage for pseudomonas. Recently, the IDSA recommended this for ventilator-associated PNA (VAP), despite openly admitting that RCTs found it to be ineffective.
PulmCrit Rant – Intermediate DVT prophylaxis in COVID: We need for better pants
COVID will eventually lead to many improvements in our approach to critical illness. I’ve been hoping that one of these would be an improved understanding of venous thromboembolism (VTE) prophylaxis, but perhaps that was overly optimistic. We provide VTE prophylaxis to nearly every patient in the ICU. Consequently, even tiny changes in our VTE prophylaxis […]
PulmCrit – RECOVERY confirms benefit of toci combined with dexamethasone
The RECOVERY trial just released a preprint demonstrating benefit from tocilizumab in COVID-19. As with the prior RECOVERY studies, this is a multicenter, open-label, pragmatic trial. A robust mortality benefit was detected (the fragility index calculates to 17, which isn’t too shabby). Several important secondary endpoints were positive as well (e.g., reduced intubation rate, reduced […]
Inhaled Pulmonary Vasodilators
CONTENTS Rapid Reference 🚀 Physiologic effects Specific agents Nitric Oxide (NO) Nitroglycerine Epoprostenol Milrinone Oxygen Contraindications & adverse effects Indications Overall concept – temporary bridge ARDS Pulmonary embolism Decompensated chronic pulmonary hypertension Right ventricular myocardial infarction Podcast Questions & discussion Pitfalls Inhaled pulmonary vasodilators yield three physiological advantages: #1) reduced pulmonary vascular resistance Pulmonary vasodilation […]
Neuro-Oncology Emergencies
NEURO-ONCOLOGY Approach to nonspecific presentations Direct effect of tumor mass Focal mass effect with edema Primary CNS lymphoma (PCNSL) Pituitary apoplexy Spinal cord compression Leptomeningeal carcinomatosis Vascular Acute Ischemic Stroke Intracerebral Hemorrhage Cerebral Venous Thrombosis Intravascular large B-cell lymphoma Seizure Paraneoplastic syndromes Iatrogenic Radiation therapy Chemotherapy PRES due to chemotherapy Checkpoint inhibitors: Immune-Related Adverse Events […]
EMCrit RACC Lit Review for December 2022
All the resus/acute critical care literature goodness for December 2022
Large volume thoracentesis: How much can safely be removed?
0 Introduction 0 Completely draining a pleural effusion has many benefits including symptomatic improvement, avoiding multiple procedures, faster disposition home, and imaging the chest with the lung inflated. However, complete drainage is usually avoided to due to fear of re-expansion pulmonary edema. What is the evidence behind this? 0 Traditional model of reexpansion pulmonary edema (RPE) 0 […]
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 […]
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 📖 […]
Asbestosis, pneumoconiosis, and related disorders
CONTENTS Asbestos Asbestos interstitial lung disease (asbestosis) Benign asbestos pleural effusion (BAPE) ➡️ Pleural plaques Diffuse pleural thickening Mesothelioma Silicosis Coal workers pneumoconiosis Berylliosis Talcosis Intravenous talcosis Inhalational talcosis Silicone embolism syndrome Questions & discussion abbreviations used in the pulmonary section: 8 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute […]
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