CONTENTS approach to pleural effusion of unclear etiology Initial trifecta: History CXR, POCUS, & review of prior radiology Blood tests More advanced testing: CT scan Thoracentesis differential diagnosis All causes of pleural effusion Transudates Exudates pleural radiology POCUS Chest radiograph Subpulmonic effusion Pseudotumor Specific radiologic findings: Chronic pleural effusion Rapidly growing effusion Pleural plus pericardial […]
Search Results for: acid base
Catatonia
CONTENTS Basics Pathophysiology Epidemiology Clinical presentation Differential diagnosis Diagnostic criteria Diagnostic challenge with lorazepam or ketamine Causes of catatonia Investigation for underlying cause Management Podcast Questions & discussion Pitfalls core concepts of catatonia Catatonia is a motor dysregulation syndrome involving difficulty initiating or terminating actions.(19884605) Most commonly this causes periods of physical rigidity, negativism, or […]
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 […]
Analgesia and sedation for the critically ill patient
CONTENTS spectrum of medications available Pure analgesics Acetaminophen Ketamine, pain-dose ➡️ (Lidocaine) (NSAIDs) Analgosedatives (analgesia > sedation) Opioids Opioid PCA Tizanidine (Gabapentinoids) Sedalgesics (sedation > analgesia) Dexmedetomidine Clonidine Ketamine, high-dose infusion ➡️ Pure sedatives Propofol ➡️ Guanfacine Phenobarbital ➡️ (Melatonin) (Benzodiazepines) (Hydroxyzine) Antipsychotics / anti-agitation Butyrophenones (haloperidol & droperidol) ➡️ Olanzapine ➡️ Quetiapine ➡️ Chlorpromazine […]
NeuroEMCrit – 31 #NeuroPostItPearls
A multiplicity of neuro tips
Is correcting hyperchloremic acidosis beneficial?
0 Clinical Question 0 An elderly woman presents with renal failure due to severe dehydration from diarrhea. She has a hyperchloremic acidosis from diarrhea with a chloride of 115 mEq/L, bicarbonate of 15 mEq/L, and a normal anion gap. During her volume resuscitation, should isotonic bicarbonate be used to correct her hyperchloremic acidosis? Does […]
PulmCrit- New guidelines simplify ICU nutrition
Introduction to nutritional dogma Everyone has strong opinions about food. We all feel that we have some special, intuitive understanding of nutrition. Nonsense. Such intuitions have historically created a wide array of dogma regarding nutrition, complicating matters immensely. Fortunately, the 2016 SCCM/ASPEN guidelines have stripped away much of the nonsense involved in nutritional support. This […]
Alcohol withdrawal
CONTENTS Rapid Reference 🚀 Preamble & disclaimer Diagnosis Alcohol withdrawal vs. hepatic encephalopathy Therapeutic target (CIWA vs RASS) Treatment: Phenobarbital monotherapy Phenobarbital pharmacology Advantages of phenobarbital over benzodiazepines Contraindications to phenobarbital ➡️ Phenobarbital guideline Checking phenobarbital levels? ➡️ Pitfalls of phenobarbital Alternative agents Benzodiazepines Valproic acid Antipsychotics & alpha-2 agonists (dexmedetomidine, clonidine, guanfacine) Ketamine Other […]
Severe influenza
CONTENTS Rapid Reference 🚀 Clinical presentation Radiology Bacterial coinfection Diagnostic panel Treatment Resuscitation Antibiotics Anti-viral therapy Respiratory support Adjunctive therapy Virus-associated hemophagocytic syndrome (VAHS) Approach to treatment failure Extrapulmonary complications Virology of influenza Podcast Questions & Discussions Pitfalls severe influenza checklist ✅ diagnostic tests (more) Nares PCR for MRSA. Blood cultures. Sputum gram stain & […]
The Case of the Non-inferior Inferiority
The practice of Frequentist statistics is often a study in extremes. Based on an arbitrary threshold of significance, we are asked to interpret data as either positive or negative when in reality it merely shifts our probability of certainty. Even more important, because of the singular nature of Frequentist statistics, our interpretation of data is […]
Coagulation tests (conventional & viscoelastic)
CONTENTS Rapid Reference 🚀 Cell-based coagulation model Traditional tests of enzymatic coagulation INR prolongation with normal PTT PTT prolongation with normal INR Prolongation of both INR & PTT Thrombin Time & fibrinogen “level” (Clauss assay) Thromboelastography (TEG) Strengths and weaknesses of TEG TEG interpretation Using TEG to guide blood product transfusion Platelet dysfunction in critical […]
PulmCrit- TEG for cirrhotic coagulopathy: Time for clinical implementation?
Introduction Traditional coagulation studies (especially the INR) fail miserably in cirrhosis. Thromboelastography (TEG) is a superior approach for understanding the global balance of pro-coagulants versus anti-coagulants in these patients. This isn’t anything particularly new – for example, it was explored in this post from 2015 (if you’re not familiar with this concept already, it’s explained […]
Rhabdomyolysis
CONTENTS Rapid Reference 🚀 Preamble: Trust No One Causes of rhabdomyolysis Signs & symptoms Diagnosis Lab clues to rhabdomyolysis Creatine kinase (CK) McMahon Score Problems in defining rhabdomyolysis Treatment Basics Volume & pH management Dialysis Podcast Questions & discussion Pitfalls diagnosis: McMahon Score (≧6 indicates risk of renal failure): Age <50 = zero points. 51-70 […]
Antifungal Agents
CONTENTS Rapid Reference 🚀 Overview Azoles (#1) Choosing your azole: Spectrum & use of each azole Choice of azole for various infections Contraindications & drug-drug interactions (#2) Pharmacology, dosing, and drug levels: Voriconazole Isavuconazole Fluconazole Itraconazole (#3) Toxicity & monitoring Echinocandins (caspofungin, micafungin, anidulafungin) Liposomal amphotericin Podcast Questions & discussion Pitfalls antifungal agents: azole interactions: […]
Hypocalcemia
CONTENTS Signs & symptoms EKG findings Labs Etiology Investigation of cause Treatment Intravenous calcium for refractory shock Podcast Questions & discussion Pitfalls Clinical manifestations relate to both the magnitude and acuity of hypocalcemia. symptoms Neuromuscular excitation: Anxiety, delirium, depression, coma. Paresthesias (perioral & extremities). Muscle cramping (tetany, laryngospasm), weakness, myalgias. Seizure (generalized tonic-clonic, generalized absence, […]
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