CONTENTS Pathogenesis Epidemiology & risk factors Clinical findings Laboratory studies Imaging studies Antibiotic selection & timing Interventional management Podcast Questions & discussion Pitfalls route of spread Improved imaging techniques have demonstrated that the majority of epidural abscesses occur secondary to tracking from a nearby infected musculoskeletal structure (e.g., septic facet joint, discitis, vertebral osteomyelitis).(31021957) Infection […]
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Autoimmune Encephalitis
CONTENTS Definitions & classifications General clinical features Diagnostic evaluation CSF evaluation MRI EEG Evaluation for underlying malignancy Anatomic classification Limbic encephalitis Cortical-subcortical encephalitis Basal ganglia involvement, including striatal encephalitis Diencephalic encephalitis Brainstem encephalitis Cerebellitis Meningoencephalitis Encephalomyelitis Classification by antibody Antibodies against intracellular proteins Antibodies against cell surface proteins Management of autoimmune encephalitis Specific disorders Anti-NMDA […]
PulmCrit- Ten dubious beliefs in neurocritical care
Recently Geert Meyfroidt published an article in Intensive Care Medicine describing ten false beliefs in neurocritical care shown here: It’s a great article, but I think they could have been more aggressive about challenging neurocritical care dogmas (1). In response, here is a list of ten dubious beliefs that goes farther to challenge the status quo. […]
Hypothermia and Post-Arrest Studies
The Biggies TTM Trial TTM Trial Hemodynamics Polderman Editorial on TTM HACA Trial (NEJM 2002;346(8):549) Bernard RCT (NEJM 2002;346(8):557) Meta-Analysis ILCOR Hypothermia Statement ILCOR Post-Arrest Care Statement Lancet Review by Kees Polderman Nuts & Bolts Review by Kees Polderman (Crit Care Med 2009;37(3):1101-1120) Mechanisms of Hypothermia by Kees Polderman Study by Oddi ( )-Included Asystole […]
COMM CHECK: Sterile Cockpit
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PulmCrit- Fentanyl infusions for sedation: The opioid pendulum swings astray?
I’ve been using fentanyl infusions as the backbone of my sedative strategy, in keeping with the 2013 SCCM guidelines. This generally works well for patients who can be extubated quickly. However, for patients who remain on the ventilator for longer periods of time, it often leads to problems involving tolerance and withdrawal.
Lithium intoxication
CONTENTS Pharmacokinetics Presentations Evaluation Lithium level & ingested dose Treatment Decontamination Avoid medications which impair excretion Fluid resuscitation & diuresis Nephrogenic diabetes insipidus Dialysis Resumption of lithium Prognosis & SILENT syndrome Podcast Questions & discussion Pitfalls absorption Typically absorbed within ~1-2 hours (immediate release formulations) or ~4-6 hours (sustained release formulations). In acute overdose, absorption […]
Old Chapter from Crashingpatient.com
2010 ACLS Guidelines web site with tons of resources Do not place sheets between patients and cooling blankets history of hypothermia and review (Chest 2008;133;1267-1274) Hypothermia review article Bernard SA, Buist M, Induced hypothermia in critical care medicine: a review. Crit Care Med 2003;31:2041-51. Major clinical trials have been […]
Myasthenia gravis & myasthenic crisis
CONTENTS Rapid Reference 🚀 Myasthenia Gravis: Background information Pathophysiology Presentation Diagnosis Serologic testing & types Drugs to avoid in myasthenia gravis Myasthenic crisis: diagnosis Diagnosis of myasthenic crisis: basics Differentiation from cholinergic crisis Triggers of myasthenic crisis Myasthenic crisis: treatment Blood gas monitoring Bedside pulmonary function tests Respiratory support Nutrition & GI access Pyridostigmine Steroid […]
Approach to Stupor & Coma
CONTENTS Front matter: Most clinically relevant: Rapid Reference – Clinical approach 🚀 Causes of stupor & coma Definitions Distinctive states that mimic coma: Locked-in syndrome Abulia and akinetic mutism Hypokinetic catatonia Functional unresponsiveness Malingering Management – some additional comments Airway management Related Coma syndromes (section of Exam chapter) Podcast Questions & discussion Pitfalls diagnostic approach […]
COMM CHECK: On Checklists
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Community acquired urosepsis
CONTENTS Rapid Reference 🚀 Diagnosis Urinalysis Imaging Management: Resuscitation Decompression & source control Antibiotics General principles Preferred antibiotics for initial broad-spectrum coverage If gram stain is known Podcast Questions & discussion Pitfalls diagnostic tests Urinalysis & urine culture. Blood culture x2. Procalcitonin. Imaging, either: CT scan (especially if >35 YO). Renal ultrasonography (especially if <35 […]
Hepatic encephalopathy in chronic liver disease
CONTENTS Rapid Reference 🚀 Introduction Clinical features 1) Manifestations of hepatic encephalopathy 2) Triggers of hepatic encephalopathy Diagnostic approach Differential diagnosis Laboratory testing Ammonia EEG Neuroimaging Treatment – overall strategy Cathartic Polyethylene glycol Lactulose Rifaximin Manage triggers & coexisting problems Avoid sedatives like the plague Nutritional support & gut access Treatments of desperation Podcast Questions […]
EMCrit 296 – The French Connection, Part 1 – Resuscitation Geography, Logistics, & Ergonomics
A new series on the philosophy and psychology of resuscitation…
EMCrit 330 – Rural Resus Explosion
more on rural resus
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