CONTENTS Overview Clinical presentation Evaluation Management Serotonergic medications to avoid Agitation Seizures Hyperthermia Hypertension Chest pain & acute coronary syndrome Arrhythmia Atrial fibrillation Monomorphic ventricular tachycardia QT prolongation & torsade de pointes Hepatic failure Respiratory complications Rhabdomyolysis Hyponatremia Podcast Questions & discussion Pitfalls common sympathomimetic intoxications: Cocaine. Methamphetamine: Illicit “crystal meth.” Medicinally prescribed methamphetamine, used […]
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Acute Kidney Injury
CONTENTS Rapid Reference: Approach to AKI 🚀 Definition & significance of AKI Causes of AKI Nephrotoxins Evaluation of the cause of AKI Tests not to order Tests to evaluate the cause of AKI Approach to oliguria Management of AKI Dose-adjust renally cleared medications Hemodynamic optimization Treatment of acidosis Dialysis Phosphate binder Related Uremic encephalopathy Dialysis […]
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 […]
Septic Shock
CONTENTS Rapid Reference 🚀 Definitions of septic shock Diagnosis & evaluation Clinical Presentations Biomarkers: NLR Procalcitonin & CRP ➡️ Evaluation for the source Sepsis mimics Treatment Vasopressors Source control Fluid Steroid DVT prophylaxis with heparin REFRACTORY SHOCK Methylene blue Resuscitative endpoints MAP Heart rate Urine output Fluid balance Lactate Skin perfusion Interventions of no real […]
Autoimmune Encephalitis
CONTENTS Definitions & classifications General clinical features Diagnostic evaluation CSF evaluation MRI EEG Evaluation for underlying malignancy Anatomic classification Limbic encephalitis Cortical-subcortical encephalitis Basal ganglia involvement, including striatal encephalitis Diencephalic encephalitis Brainstem encephalitis Cerebellitis Meningoencephalitis Encephalomyelitis Classification by antibody Antibodies against intracellular proteins Antibodies against cell surface proteins Management of autoimmune encephalitis Specific disorders Anti-NMDA […]
PulmCrit: pH-guided fluid resuscitation & BICAR-ICU
The use of bicarbonate is a source of eternal disagreement. Bicarbonate has a shameful history of being abused in situations where it’s unhelpful (e.g. cardiac arrest). This has impugned its reputation, giving it an aura of ignorance and failure. Consequently, bicarbonate is underutilized in some situations where it might actually help.
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 […]
Toxic Shock Syndrome (TSS)
CONTENTS Rapid Reference 🚀 Pathophysiology Epidemiology Clinical presentation Lab tests Diagnosis Differential diagnosis Overall approach to diagnosis CDC diagnostic criteria Treatment Basic sepsis resuscitation Antibiotics Source control Intravenous immunoglobulin (IVIG) Purpura fulminans Preventing nosocomial transmission Podcast Questions & discussion Pitfalls pathophysiology Some Streptococcus and Staphylococcus species secrete superantigens that causes widespread activation of T-lymphocytes (figure […]
Liberation from the ventilator
CONTENTS Rapid Reference: Optimization & items to consider prior to extubation 🚀 Spontaneous Breathing Trial (SBT) If the patient fails the SBT Causes of failed SBT Investigation If the patient passes the SBT A trial of extubation Post-extubation support Timing of tracheostomy Some additional concepts Unplanned extubation Nocturnal extubation Understanding & navigating the obesity quagmire […]
Anticholinergic intoxication
CONTENTS Anticholinergic agents Epidemiology Clinical presentation Differential diagnosis Evaluation Management Physostigmine Treatment of agitation Other management issues Management of combined anticholinergic & sodium channel blocker toxicity Podcast Questions & discussion Pitfalls There are hundreds of substances with anticholinergic activity. Below are some of the most common and notable. agents which function predominantly as anticholinergics Atropine. […]
Pneumothorax and bronchopleural fistula (BPF)
CONTENTS Definitions & classifications Symptoms Signs Radiology: POCUS for diagnosis and monitoring Chest radiograph Signs of pneumothorax Size determination CT scan Causes of pneumothorax Management of various situations: Primary spontaneous pneumothorax Secondary spontaneous pneumothorax Indications for pleurodesis Management of persistent air leak Traumatic pneumothorax (including iatrogenic) Tension pneumothorax Oxygen to encourage nitrogen reabsorption? Pigtail versus […]
Hepatic encephalopathy in chronic liver disease
CONTENTS Rapid Reference 🚀 Introduction Clinical features 1) Manifestations of hepatic encephalopathy 2) Triggers of hepatic encephalopathy Diagnostic approach Differential diagnosis Laboratory testing Ammonia EEG Neuroimaging Treatment – overall strategy Cathartic Polyethylene glycol Lactulose Rifaximin Manage triggers & coexisting problems Avoid sedatives like the plague Nutritional support & gut access Treatments of desperation Podcast Questions […]
Submassive & Massive PE
CONTENTS Most useful material: Crashing patient: Massive PE resuscitation guide 🚀 General approach to (sub)massive PE: (#1) Investigation package (#2) Risk stratification (#3) Thrombolytic contraindications (#4) Treatment approach Resuscitation of massive PE Avoid procedures if possible Fluid management Inotropes & vasopressors Inhaled pulmonary vasodilator(s) Hematologic management: Anticoagulation (heparin) Thrombolysis Regimens: Full dose Half dose Quarter […]
Posterior Reversible Encephalopathy Syndrome (PRES)
CONTENTS Basics Pathogenesis Causes Clinical presentation PRES-RCVS (Reversible Cerebral Vasoconstriction Syndrome) overlap Imaging Lumbar puncture EEG & seizure semiology Diagnosis Differential diagnosis Treatment Prognosis Podcast Questions & discussion Pitfalls PRES refers to reversible, vasogenic edema which occurs predominantly in the posterior brain. PRES is less commonly known as “reversible posterior leukoencephalopathy syndrome” (RPLS). However, both […]
Invasive candidiasis
CONTENTS Introduction Candidemia Clinical manifestations Diagnosis Further investigation after diagnosis Treatment Intra-abdominal candidiasis Candida pneumonia? Candiduria Podcast Questions & discussion Pitfalls candida in the ICU Most cultures of Candida represent colonization (e.g., in the urine or especially in the sputum). Thus, there is a major risk of overtreating candidiasis. However, candida does occasionally cause severe […]
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