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 […]
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NeuroEMCrit – The Perils of the ICH Score
Don’t use the ICH score in isolation to not give aggressive critical care…
EMCrit 146 – Who Needs an Acute PCI with Steve Smith (Part I)
Finally in one place, all of the STEMI equivalents with Steve Smith
Hemophagocytic LymphoHistiocytosis (HLH)
CONTENTS Basics – what is HLH? Clinical features of HLH Laboratory findings Ferritin Lumbar puncture Pathology – Hemophagocytosis Causes of HLH Differential diagnosis – Closest mimics of HLH Approach to the diagnosis of HLH Treatment Treatment of the underlying cause (if possible) Steroid IL1 antagonism JAK inhibition Etoposide Podcast Questions & discussion Pitfalls what is […]
PulmCrit – Myth-busting the conditional nephrotoxicity of piperacillin-tazobactam
Most medical myths arose decades ago, prior to the era of modern evidence-based medicine. When investigating the origin story of those myths, we wind up reading grainy old papers from the 1950s. Surely, we think, such myths wouldn’t arise today – not in our shiny, interconnected, science-based, hyper-argumentative medical world. Unfortunately, new myths do continue […]
Avoiding over-diagnosis and over-treatment of MI in critically ill patients
Introduction 0 It’s common for critically ill patients to be screened for MI using troponin. Troponin levels are often positive. One thing leads to another, and before you know it the frail 99-year-old lady you admitted for a COPD exacerbation has an intracranial hemorrhage from the heparin drip she was put on because her troponin […]
The Adventure of the Crooked Man
A recent study entitled, “Outcomes at 12 Months After Early Magnetic Resonance Imaging in Acute Trauma Patients With Persistent Midline Cervical Tenderness and Negative Computed Tomography” published in the June 2013 issue of Spine has attempted to shine a small amount of light on a topic that has cast a large shadow of doubt on […]
Catastrophic Antiphospholipid Syndrome (CAPS)
CONTENTS Rapid Reference – When to consider CAPS? 🚀 Pathophysiology Epidemiology & precipitating factors Clinical presentation Lab tests Testing for antiphospholipid antibody syndrome Laboratory abnormalities seen in CAPS Laboratory panel to investigate for possible CAPS Tissue diagnosis Differential diagnosis Diagnostic criteria Treatment Podcast Questions & discussion Pitfalls Diagnosing CAPS is challenging. A thumbnail of clues […]
Approach to beta-lactam allergy in critical care
CONTENTS Rapid Reference 🚀 Getting started Types of drug reaction Allergy history How allergies cause harm Basic science of beta-lactam allergy Techniques for allergy management Skin testing Graded challenge Desensitization General approach to beta-lactam allergy in critical care Groups of antibiotics with cross-allergy: Aminopenicillins & select G1-G2 cephalosporins Cefazolin Nafcillin Piperacillin-tazobactam Cefepime & most G3 […]
PulmCrit – Sodium Zirconium Cyclosilicate for urgent treatment of hyperkalemia?
Sodium Zirconium Cyclosilicate (SZC) is a potassium-exchange resin similar in concept to sodium polystyrene sulfonate (Kayexalate). It’s not particularly new, as the original studies were performed around 2015. Accumulating evidence over the last five years supports the drug’s safety. The real question is how effective it may be. Efficacy data for short-term improvement in potassium […]
Anemia & transfusion targets
CONTENTS Rapid Reference – Approach to falling hemoglobin 🚀 Acute anemia: Physiology Causes Evaluation Gradual anemia: the ICU drift Transfusion targets for stable patients Managing Jehovah’s Witness patients Podcast Questions & discussion Pitfalls evaluation 📖 FAST exam if hemothorax or hemoperitoneum are suspected (e.g., s/p trauma – including CPR). Labs: Repeat complete blood count to […]
Anticoagulant reversal
CONTENTS General considerations Approach to warfarin reversal Urgent reversal Non-urgent supratherapeutic INR Approach to DOAC reversal Dabigatran Factor Xa inhibitors (riveroXABAN, apiXABAN, edoXABAN, fondaparinux) Reversal of other agents Thrombolytics (e.g. tPA) Heparin reversal Antiplatelet agent reversal Pharmacology of broad-spectrum reversal agents Fresh Frozen Plasma (FFP) Prothrombin Complex Concentrate (PCC) Factor IX Complex DDAVP Tranexamic acid […]
PulmCrit- The Rothman Index: Artificial intelligence or merely a symptom of a broken healthcare system?
We are constantly hunting for newer and better sources of information. This leads to a perpetual generation of newer lab tests, different hemodynamic gizmos, and fresh decision tools. Some of these pan out. Most don’t. Why are these new sources of information generally disappointing? The answer is simple: we’re already doing pretty well. In order […]
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 […]
Dual External Defibrillation: Close, but Not Touching by Mark Ramzy
The scoop on dual defibrillation