Crit Care during COVID19
Search Results for: septic shock
Mythbusting: (Empty IVC + hyperkinetic heart) does not equal volume depletion
0 Introduction with an example 0 A 60-year-old woman is admitted with septic shock due to pyelonephritis. Currently she has received two liters of crystalloid. Her mean arterial pressure is now 55 mm, her pulse is 120 b/m, and she is producing very little urine. Bedside ultrasound shows that her IVC is completely empty (sometimes […]
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 […]
IBCC chapter & cast: Acute pancreatitis
Management of severe pancreatitis has remained in a state of controlled chaos and persistent debate for years (mirroring evolution in our treatment of septic shock). This confusion shows no signs of abating in the near future. This chapter explores a reasonable approach to pancreatitis, with the caveat that there is very little evidence available to guide our combat against this challenging foe.
Toxic Shock Syndrome Management: A tale of two patients
0 Introduction 0 Toxic shock syndrome (TSS) is a true resuscitationist’s disease. It is potentially quite lethal, with many series of streptococcal toxic shock syndrome reporting mortality in the range of 30-50%. However, recent observational studies suggest that treatment with modern critical care, toxin-suppressive antibiotics, and IVIG may reduce the mortality to 10% (Linner […]
PulmCrit- High dose vasopressors: Never surrender
Every hospital and pharmacopeia have their own “maximum dose” of vasopressors. Which one is correct?
150 Lives in 150 Days
Sepsis Collaboratives work in Canada too
IBCC chapter & cast: Ascending cholangitis & calculus cholecystitis (community-acquired biliary sepsis)
Biliary infection is a fairly common cause of septic shock (especially ascending cholangitis). Evidence isn’t terrific regarding exactly when and how interventions should be done to obtain source control (particularly among cholecystitis). This chapter attempts to reach some clarity on the topic but honestly, it remains a bit murky.
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 […]
PulmCrit- Killer resuscitation: Abdominal hypertension as an occult driver of multiorgan failure
Introduction with a clinical conundrum A 66-year-old man is transferred from an outside hospital due to inability to be liberated from the ventilator. He presented a week earlier with pneumonia and sepsis. He received six liters of fluid initially, and has been running net positive 1-2 liters daily since then (for a total of about […]
IBCC chapter & cast: Tick-borne infections
It’s spring in Vermont… when a young intensivist’s thoughts go from fancy to tick-borne diseases. Climate shifts are causing an increase in tick-borne illnesses, such that these are now considered emerging infections in many areas (including the northeast United States and Canada). These diseases can be extremely difficult to diagnose, as they will often present with a nonspecific flu-like illness and may subsequently progress to multi-organ failure. Misdiagnosis of a tick-borne illness as bacterial septic shock would lead to inadequate treatment, as these diseases require specific antibiotic therapy (usually doxycycline). This chapter focuses on diagnosis and empiric therapy for these very challenging infections.
acid base overview (9/11/19 talk)
talk slides respiratory acid-base The diagnostic worthlessness of (most) ABGs Converting a VBG into an ABG Extracorporeal CO2 removal vs. extreme permissive hypercapnia metabolic acid-base IBCC core information Diagnosis HAGMA (high anion-gap metabolic acidosis) NAGMA (non-anion-gap metabolic acidosis) Metabolic alkalosis Fluid selection & pH guided resus (with section on how to use bicarbonate) Other stuff […]
IBCC chapter: Antibiotics for the critically ill patient
We spend a lot of time obsessing over the finer details of critical care: which fluid is best? which vasopressor is best? will another liter of fluid help? These details are important, but for a septic patient something more important than any of these details is choosing the right antibiotic(s). In septic shock, source control and […]
Catheter-associated urinary tract infection (CAUTI)
CONTENTS Rapid Reference 🚀 Is CAUTI real? Diagnostic criteria for CAUTI Diagnosis of CAUTI Treatment of CAUTI Prevention Podcast Questions & discussion Pitfalls some general principles Urinary tract infections may be divided into infections limited to the bladder and urethra (cystitis) and infections which ascend to involve the kidneys (pyelonephritis). Cystitis may cause local symptoms […]
IBCC chapter & cast – Hemophagocytic LymphoHistiocytosis (HLH)
Intensivists have long been struggling with the enigma of hemophagocytic lymphohistiocytosis (HLH). For example, this post from 2016 explores the challenge of dissecting HLH away from septic shock. The COVID pandemic has drawn some attention to the topic, although it’s not clear to what extent COVID might truly reflect HLH. This chapter attempts to lay […]
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