The CDC guidelines recommend placing subclavian lines to reduce the risk of catheter-related bloodstream infections. Meanwhile, mounting evidence suggests that we should probably be placing lines with ultrasound guidance. Unfortunately, the ultrasound-guided subclavian can be tricky. This post describes a slight modification that could make the technique easier and safer.
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Guide to APRV for COVID
CONTENTS Preamble Parameters Initial settings Monitoring Troubleshooting hypoxemia & acidemia Weaning Weaning initiation Spontaneous Breathing Trial & Extubation pathways Questions & discussion Pitfalls APRV can be a bit scary for folks who aren’t used to it. Everyone has slightly different ways of setting the parameters. However, over time I’ve come to believe that APRV is […]
Approach to new fever or rigors in the ICU patient
CONTENTS Definition & classification of fever Common causes of fever Evaluation Management Specific fever types Drug fever Neurogenic fever Podcast Questions & discussion Pitfalls definition of a fever Fever is a bedrock concept in medicine, yet its precise definition remains a bit elusive. The Infectious Disease Society of America defined fever in the ICU as […]
PulmCrit: Fighting refractory ARDS with physiologic jujitsu
Jui-jitsu is a Japanese martial art based on flexibility and technique, rather than a directly confronting an opponent with force. In the spirit of jui-jitsu, this post explores how to support ARDS patients without directly confronting lung dysfunction. This is useful in refractory ARDS, when frontal assault has failed.
CV-EMCrit 327 – Acute Valve Disasters Part 2 – Management of Critical Aortic Stenosis
Part 2 of crashing valves: aortic stenosis
Takotsubo syndrome
CONTENTS Epidemiology Symptoms Diagnostic studies ECG Phase I: STE Phase II: TWI Reverse Takotsubo Prominent T-waves Echocardiography Cardiac MRI Labs Diagnostic approach Treatment [1] Treat underlying problem [2] Anticoagulation [3] Arrhythmia management [4] Hemodynamic management [4a] Hemodynamically stable patient [4b] Hemodynamically unstable with LVOTO [4c] Hemodynamically unstable without LVOTO Prognosis Pathophysiology Podcast Questions & discussion […]
Neuro-ultrasound
CONTENTS Intracranial pressure 2D imaging of the brain: Initial 2D image – midbrain Hydrocephalus Midline shift Intracranial hematoma Transcranial Doppler Basic views & technique Pulsatility index Vasospasm Brain death Acute ischemic stroke Podcast Questions & discussion Pitfalls optic nerve sheath diameter The optic nerve sheath is part of the dura surrounding the brain.(35001377) When intracranial […]
EMCrit 296 – The French Connection, Part 1 – Resuscitation Geography, Logistics, & Ergonomics
A new series on the philosophy and psychology of resuscitation…
Acute decompensated heart failure (including cardiogenic shock)
CONTENTS Rapid Reference 🚀 Intro: what this chapter is about Hemodynamic evaluation & risk stratification Causes of heart failure decompensation Investigations Pulmonary artery catheter Radiologic findings in heart failure Findings may include: Usual CT scan findings in heart failure SCAPE (sympathetic crashing acute pulmonary edema) Asymmetric pulmonary edema Radiological differential diagnosis Treatment Fix the lungs […]
Acute exacerbation of interstitial lung disease (AE-ILD)
CONTENTS Definition and background Clinical presentation Differential diagnosis Investigation History Physical examination Laboratory studies CT scan Bronchoscopy Treatment Medical therapy D/c potential pneumotoxins Antibiotics Immunosuppressive therapy Diuresis & volume management Antifibrotic therapy Respiratory support Noninvasive respiratory support Invasive mechanical ventilation Lung transplantation Prognosis Questions & discussion abbreviations used in the pulmonary section: AE-ILD: Acute exacerbation […]
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 […]
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 […]
Neurological complications of COVID
CONTENTS Limitations of this chapter Brief word on pathogenesis General clinical principles Encephalopathy Diffuse leukoencephalopathy with diffusion restriction Acute necrotizing encephalopathy (ANE) Mild encephalopathy with reversible splenial lesion (MERS) Acute disseminated encephalomyelitis (ADEM) & Acute hemorrhagic leukoencephalitis (AHLE) Myelitis Autoimmune encephalitis Posterior reversible encephalopathy syndrome (PRES) Stroke Acute ischemic stroke Intracranial hemorrhage & microbleeds Cerebral […]
Spinal Cord
CONTENTS Spinal cord basics Anatomy Recognizing spinal cord injury Lesion localization Bowel and bladder symptoms Spinal cord radiology Patterns of axial involvement Patterns of longitudinal involvement Acute & subacute myelopathy Potential causes Investigation Blood tests CSF evaluation Imaging Specific myelopathies Spinal cord infarction Spinal dural arteriovenous fistula (dAVF) Spinal epidural hematoma Cauda equina syndrome Nitrous […]
Intracerebral hemorrhage (ICH)
CONTENTS Rapid Reference 🚀 Pathophysiology Causes of ICH Imaging Getting started – Which scans to order initially Noncontrast CT scan CT angiography +/- venography MRI Invasive angiography Treatment Airway management Anticoagulation reversal Blood pressure management Neurosurgical interventions Supratentorial hematoma evacuation Cerebellar hematoma Intraventricular hemorrhage & EVD Seizure monitoring & management Other supportive measures Prognostication Related […]
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