All the lit goodness for Jan 2024
Search Results for: lauria
EMCrit – RACC Lit Review Oct/Nov 2022
Oct/Nov 2022
Community acquired urosepsis
CONTENTS Rapid Reference 🚀 Diagnosis Urinalysis Imaging Management: Resuscitation Decompression & source control Antibiotics General principles Preferred antibiotics for initial broad-spectrum coverage If gram stain is known Podcast Questions & discussion Pitfalls diagnostic tests Urinalysis & urine culture. Blood culture x2. Procalcitonin. Imaging, either: CT scan (especially if >35 YO). Renal ultrasonography (especially if <35 […]
PulmCrit- Ranking antibiotics in order of allergenicity
Our current approach to allergy is primarily patient-based. This focuses on the patient’s prior history of reaction: how severe was it, when was it, how certain are we that it was truly allergic? This strategy has been proven to be inaccurate. For example, ~90% of patients who report a penicillin allergy are not allergic when skin-tested.
EMCrit RACC-Lit Update – June 2023
So much lit goodness!!!
The Case of Dubious Squire Continues
In the era before the ubiquitous use of bedside ultrasound, BNP and its derivative natriuretic peptides were, at best, a mediocre test that added little to clinical judgment. In today’s world of sonographic abundance, they simply add noise to our already deafening workflow. Despite a wealth of evidence demonstrating natriuretic peptides’ lack of clinical utility, […]
Dear NEJM: We both know that conflicts of interest matter.
0 Introduction 0 Recently the New England Journal of Medicine launched a media campaign challenging the negative perception of industry conflicts of interests (COI). This was surprising, because it is the opposite of what editors of the NEJM have previously reported (see above books by former NEJM editors, published in 2004 and 2005). Big pharma […]
Pulmcrit – Renoresuscitation, vasopressin, vepinephrine, and VANISH
My goals during sepsis resuscitation focus largely on preservation of renal function and maintence of a reasonable fluid balance (renoresuscitation). The kidney is one of the most fragile organs, which may be rapidly injured by hypoperfusion. Renal failure correlates closely with mortality, participating in a vicious spiral of multi-organ failure. Alternatively, if you can save the kidneys, you’re likely to save the patient too. In this context, any beneficial effect of vasopressin on renal function could be helpful.
PulmCrit – Is COVID-19 ARDS, pseudoARDS, L, or H? Physiology data from Boston
There has been considerable speculation in the literature regarding the physiology of intubated patients with COVID, but little actual data. A fresh study describing the physiology of intubated patients at Massachusetts General Hospital and Beth Israel offers to finally answer some questions. This is a retrospective case series involving 66 patients intubated during March 11-30. […]
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 […]
Eosinophilic lung diseases
CONTENTS Eosinophilic lung disease Approach to eosinophilic lung disease Understanding blood eosinophil count Acute critical illness Chronic systemic steroid Asthma or COPD Causes of eosinophilia Atopic Medications Infection Neoplastic & paraneoplastic Bronchoalveolar lavage eosinophilia IgE level Specific diseases DRESS syndrome AEP (acute eosinophilic pneumonia) CEP (chronic eosinophilic pneumonia) ABPA (allergic bronchopulmonary aspergillosis) EGPA (eosinophilic granulomatosis […]
PulmCrit- Epinephrine vs. atropine for bradycardic periarrest
Introduction with a case An elderly woman is admitted with atrial fibrillation and fast ventricular rate. She is asymptomatic, with a heart rate of 160 b/m. She is treated with a 20 mg diltiazem bolus followed by an infusion at 15 mg/hour for several hours. Her heart rate slows to 110 b/m. She is then […]
Anion-gap metabolic acidosis
CONTENTS Diagnosis Causes of elevated anion gap Evaluation Evaluation of elevated anion gap Evaluation & treatment of elevated lactate Treatment Podcast Questions & discussion Pitfalls Anion gap should be evaluated on every electrolyte panel. Ideally the computer will do this automatically; otherwise, it should be calculated. Anion gap is calculated as (Na – Cl – […]
Atrial Fibrillation (AF) & Flutter complicating critical illness
CONTENTS Introduction Diagnosis of AF Investigation of the cause of AF Management – Overall approach Emergent cardioversion Is immediate cardioversion indicated? How to perform DC cardioversion (1) Universal AF stabilization package (2) Rate vs. rhythm control decision Rhythm control in critical illness Rate control (3) Anticoagulation Atrial flutter Pharmacopeia for AF in the ICU: Amiodarone […]
The Case of The Dying Detective…
…and his missing lactate I am, as I am sure many of you are, a big fan of using lactate to guide my resuscitative efforts in my critically ill septic patients. You would pour fluids into your large bore catheters, infuse pressors through your ultrasound guided central lines and revel in how quickly you […]
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