CONTENTS Overview – sodium channel blockers & tricyclic antidepressants Pathophysiology and terminology Agents that inhibit cardiac sodium channels Diagnosis EKG findings of sodium channel blockade Clinical manifestations Management – three antidotes #1) Bicarbonate #2) Lidocaine #3) Lipid emulsion Management – clinical approach Intubation if necessary Hypotension Ventricular tachycardia Seizure Podcast Questions & discussion Pitfalls Tricyclic […]
Search Results for: procedural sedation
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 […]
Brain Death
CONTENTS Brain death basics Clinical presentation of brain death Clinical context Clinical findings in brain death Spinal reflexes Diagnosis of brain death (1) Initial suspicion (2) Evaluate for confounders Excluding drug intoxication (3) Dedicated neurologic examination (4) Apnea test (5) Confirmatory test PRN If brain death is confirmed: Immediate next steps Supportive care prior to […]
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 […]
Acute-on-chronic liver failure (ACLF)
CONTENTS Definitions Pathophysiology Causes of ACLF Evaluation of ACLF Treatment Management of inciting cause Nonspecific management – Cirrhosis support package Podcast Questions & discussion Pitfalls decompensated cirrhosis This is defined roughly as the new onset of ascites, hepatic encephalopathy, gastrointestinal hemorrhage, or hepatorenal syndrome in a patient with cirrhosis. Organ failure may or may not […]
Angioedema
CONTENTS Rapid reference 🚀 Overview Diagnosis of angioedema Histamine-mediated vs bradykinin-mediated angioedema Airway management Histamine-mediated angioedema Bradykinin-mediated angioedema Pathophysiology Differential diagnosis Evaluation Treatment Extubating the angioedema patient Podcast Questions & discussion Pitfalls allergic vs. bradykinin-mediated angioedema: approach to angioedema: Angioedema is a common indication for critical care admission. An allergist usually won’t be immediately available, […]
Movement disorder emergencies
CONTENTS Hypokinetic Parkinson’s disease Managing Parkinson’s medications in the ICU Parkinsonism-hyperpyrexia syndrome Acute parkinsonism Psychosis in Parkinson’s disease Neuroleptic malignant syndrome (NMS) Catatonia Baclofen withdrawal Hyperkinetic Acute ballismus or chorea Akathisia Myoclonus Dystonia Acute dystonia Dystonic storm Post-hypoxic myoclonus Tetanus Propofol frenzy Podcast Questions & discussion Pitfalls general challenges (1) Parkinson’s medications must generally be […]
Bradycardia
CONTENTS Clinical aspects Rapid Reference 🚀 Bradycardia is dangerous: physiology review Causes of bradycardia Sinus node dysfunction AV block General evaluation for the etiology ECG evaluation & subtypes of bradycardia Heart blocks 1st degree AV block Mobitz I (Wenkebach Block) Mobitz II 2:1 Block 3rd degree AV block Escape rhythms Junctional escape Ventricular escape Sinus […]
Lung abscess
CONTENTS Basics Common causes: Epidemiology & clinical presentation Laboratory investigations Radiology Differential diagnosis Bronchoscopy Treatment Antibiotics Antibiotics for anaerobic abscess due to aspiration Antibiotics for other types of lung abscess Drainage Treatment failure Related: Echinococcosis Questions & discussion abbreviations used in the pulmonary section: 3 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD […]
Malignant Hyperthermia (MH)
CONTENTS Clinical presentation Differential diagnosis Management Podcast Questions & discussion Pitfalls causes & epidemiology Malignant hyperthermia (MH) can be caused by any inhalational anesthetic, other than nitrous oxide.(29600483) MH usually occurs intraoperatively or in the very early postoperative period (up to an hour after finishing anesthesia).(29600483; 32305961) Succinylcholine rarely can cause MH. Patients with central […]
Pericardial tamponade
CONTENTS Rapid Reference 🚀 Causes of tamponade Symptoms Physical exam Pulsus paradoxus Kussmaul’s sign EKG Radiology Echocardiography Diagnosis: Overall approach Low pressure tamponade Management Initial stabilization measures Ultrasound-guided pericardial drainage Interventional radiology or surgical drainage Tamponade patient in cardiac arrest Finer points: Limitations of this chapter Physiology Podcast Questions & discussion Pitfalls Key tests to […]
ARDS
CONTENTS Rapid Reference 🚀 Diagnosis of ARDS Definition of ARDS Cardiogenic pulmonary edema vs. ARDS Why is the patient in ARDS? Common causes of ARDS Evaluating the cause of ARDS ARDS pathophysiology: Intrapulmonary shunting Treatment: Basics Treating the cause of ARDS Steroid Conservative fluid strategy Treatment: Non-intubated patient High-flow nasal cannula & CPAP/BiPAP Awake proning […]
COVID 19 ICU/stepdown management
CONTENTS: Management of COVID-19 patients admitted to stepdown or ICU Link to full chapter here (more complete – but longer). Preamble & caveats Initial tests to guide management Organ support Cardiovascular Respiratory Noninvasive respiratory support Invasive mechanical ventilation Infectious disease – antibiotics Renal Hematology Neurology Immunomodulation Steroid Tocilizumab Baricitinib Things that don’t work Remdesivir Convalescent […]
PulmCrit- Extracorporeal CO2 removal: Putting the cart ahead of the horse?
Recently the concept of extracorporeal CO2 removal has become somewhat popular, with a goal of facilitating ultra low-tidal volume ventilation. Might there be other means to achieve the same goal? Let’s start with some basic concepts of mechanical ventilation… Fundamental unanswered questions Permissive hypercapnia refers to the concept of allowing the pCO2 level to increase […]
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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