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 […]
Nocardia
CONTENTS Epidemiology Clinical presentation CNS involvement Diagnosis Laboratory diagnosis Chest imaging Nocardia vs. actinomyces ➡️ Treatment Questions & discussion abbreviations used in the pulmonary section: 3 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 […]
NeuroEMCrit – 31 #NeuroPostItPearls
A multiplicity of neuro tips
PulmCrit- Triple therapy for influenza with naproxen, clarithromycin, and oseltamavir?
Flu seasons is upon us again. A recent paper in CHEST provides some tantalizing evidence about possible treatment. Will this pan out, or is it just another fairy tale?
Non-anion-gap metabolic acidosis (NAGMA)
CONTENTS Diagnosis Causes Investigation Treatment Podcast Questions & discussion Pitfalls The diagnosis of NAGMA may be made in one of two ways (red arrows above) Patient has normal anion gap with metabolic acidosis (bicarbonate < 22 mM). Patient has an anion gap metabolic acidosis, but the decrease in bicarbonate is much greater than the elevation […]
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 […]
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 […]
Diabetic Ketoacidosis (DKA)
CONTENTS Rapid Reference 🚀 Getting started Evaluating anion gap & ketoacidosis Definition & severity of DKA Evaluating the cause of DKA Core components of DKA resuscitation Fluid administration Electrolyte management Insulin infusion Long-acting, basal insulin Management of severe or refractory ketoacidosis NAGMA management Monitoring & management of DKA recurrence Special situations DKA in a hemodialysis […]
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 […]
PulmCrit Wee – Urine toxicology screens should be removed from brain death guidelines
Prior to declaring a patient brain dead, confounding factors which could falsely cause the patient to appear dead must be eliminated. One important confounder is intoxication. Failure to recognize that a patient is intoxicated could lead to an incorrect diagnosis of brain death that in turn can lead to withdrawal of life support – thereby […]
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 & […]
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 […]
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