A satisfactory clinical definition of sepsis has been eluding us since the ancient Greeks first coined the term. Current definitions of sepsis attempt to achieve two goals: to provide a rapid screening test to detect sepsis and to render a definitive diagnosis of sepsis. However, it remains unclear whether any definition can achieve this.
Search Results for: mental toughness
Superior vena cava syndrome (SVCS)
CONTENTS Causes Signs & symptoms Diagnosis: CT scan findings Grading system to define severity Management: Range of treatment options Management of critical SVC syndrome Pathophysiology & anatomy Questions & discussion abbreviations used in the pulmonary section: 5 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AFB: Acid […]
Respiratory manifestations of systemic disorders
CONTENTS Gastroenterology Inflammatory bowel disease Cirrhosis Hepatopulmonary syndrome Hepatic hydrothorax ➡️ Spontaneous bacterial pleuritis ➡️ Portopulmonary hypertension ➡️ Pancreas-related pleural effusions ➡️ Hematology TRALI (transfusion-related acute lung injury) Complications after hematopoietic stem cell transplantation Sickle cell disease Acute chest crisis ➡️ Pulmonary hypertension ➡️ Leukostasis due to leukemia ➡️ Questions & discussion abbreviations used in […]
Viral infections of CNS
CONTENTS Herpesviruses ⍺-herpesviruses HSV encephalitis HSV-2 radiculomyelitis Varicella zoster virus (VZV) β-herpesviruses Cytomegalovirus (CMV) Human herpesvirus 6 (HHV-6) Gamma-herpesviruses Epstein-Barr virus (EBV) Enteroviruses Arboviruses West Nile virus (WNV) Eastern equine encephalitis (EEE) JC virus and PML (progressive multifocal leukoencephalopathy) Podcast Questions & discussion Pitfalls basics Herpes simplex virus encephalitis is caused mostly by HSV-1 (95% […]
The Case of an Ugly Truth
The great tragedy of Science — the slaying of a beautiful hypothesis by an ugly fact. […]
Steroids in septic shock: Four misconceptions and one truth
Introduction 0 The utility of steroids in sepsis has been debated passionately for decades. There is hope that steroids might improve mortality, but also fear that they could increase infectious complications. Practice varies widely. What does the data truly indicate? 0 Four misconceptions and one truth 0 Misconception #1: Stress-dose steroids decrease mortality 0 This […]
Hyperthermia & heat stroke
CONTENTS Rapid Reference 🚀 Definition & diagnosis of hyperthermia Differential diagnosis Evaluation Treatment Sedation & Shivering tx Intubation if necessary Temperature control overview (1) Internal cooling: IV fluid (2) Surface cooling (3) Respiratory cooling Management of complications Podcast Questions & discussion Pitfalls what is hyperthermia? Fever is temperature elevation due to activity of the hypothalamus, […]
Sleep-disordered breathing
CONTENTS Sleep-disordered breathing basics Obstructive sleep apnea (OSA) Epidemiology (including causes & consequences) Clinical features & assessment Diagnosis Treatment Obesity hypoventilation syndrome (OHS) Chronic OHS Epidemiology Signs & symptoms Evaluation & diagnosis Treatment Acute exacerbation of OHS (AEOHS) Definition Causes & patient evaluation Treatment Central sleep apnea (CSA) overview Hypercapnic CSA Nonhypercapnic CSA CSA due […]
PulmCrit – Optimizing the respiratory drive to avoid failure
Scott Weingart just posted a podcast about management of the hypercapneic, obtunded COPD patient who is failing BiPAP. Do we need to intubate these patients, or could we somehow clear their CO2 noninvasively? This post will start off by exploring respiratory drive as a mediator of disease. With that groundwork, we’ll explore the obtunded COPD patient.
The Problem of Thor Bridge
Disclosure: This post is unusually full of hearsay and conjecture. Like a secondary endpoint that flirts with statistical significance it should be viewed purely as hypothesis generating. For a more reasoned and experienced view of the following data please read Josh Farkas’s wonderful post on pulmcrit.org. Damage control ventilation is not a novel concept. It functions […]
PulmCrit Wee – Therapeutic anticoagulation for COVID ICU patients: Is the heparin vial half empty, or half full?
A fresh preprint reveals the results of combining three trials to evaluate therapeutic anticoagulation among severe COVID patients (defined as patients requiring high flow nasal cannula, noninvasive ventilation, intubation, vasopressors, or inotropes). Patients were randomized to therapeutic anticoagulation versus thromboprophylaxis per usual care guidelines. REMAP-CAP also simultaneously randomized some patients to receive aspirin as well. […]
Original RUSH Article
This concept was first conceived by the authors above in 2006 and discussed in national lectures in 2007 and on. It has been available on emcrit.org since March 2008 and was the first hit on a google search of ‘RUSH Exam’ from this date on. It was published on Emedhome in May 2009. Rapid […]
PulmCrit- Dogmalysis of PCI for NSTEMI patients with a history of CABG
Many patients with prior CABG probably benefit from catheterization and repeat revascularization (PCI or a repeat CABG). However, this cannot be assumed to be universally true. In particular, patients with smaller infarcts and advanced renal failure could be harmed.
PulmCrit – Baricitinib for COVID-19: The rise of the jakinibs
Background: JAK-inhibitors (jakinibs) in the greater context Much of the harm from infections is mediated by hyperactive inflammatory reactions. To date, most research has focused on two classes of medications to treat this: Corticosteroids have the advantage of being cheap, widely available, and often effective. The disadvantage is that corticosteroids modulate innumerable molecular pathways, thereby […]
Hypocaloric Nutrition: Theory, Evidence, Nuts, and Bolts
0 Introduction 0 Until recently there has been little evidence regarding the caloric target for feeding critically ill patients. In the absence of evidence, it has been assumed that we should aim to meet 100% of predicted energy needs. New multicenter RCTs challenge this dogma, particularly the PERMIT trial by Arabi et al. 0 Theory […]
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