introduction The neutrophil/lymphocyte ratio (NLR) has been gaining increasing attention across many fields of medicine within the past five years. Currently, there are 2,230 publications about this in PubMed, mostly within the past few years. This post will attempt to create a framework for understanding this ratio. overview definition & physiology The NLR is simply […]
Search Results for: septic shock
EMCrit 54 – Dr. Rivers on Severe Sepsis – Part I
Part I of an amazing talk by Dr. Emanuel Rivers on Severe Sepsis.
PulmCrit- Oral vasopressor to accelerate liberation from the ICU
Midodrine is an oral agent which functions as an alpha-1 agonist. It has been used in a variety of situations including autonomic dysfunction, hepatorenal syndrome, and dialysis-induced hypotension. Over the past few years there has been increasing interest in using midodrine to facilitate weaning off vasopressors.
Rapid Sequence Intubation and Procedurization
0 Introduction with a case 0 A otherwise healthy 70 year-old woman presented to Genius General Hospital with multifocal pneumonia. In the ED she was treated with appropriate antibiotics and two liters of crystalloid. During her ED course she was found to have increasing tachypnea to 30-35 breaths/min, and was subsequently transferred to the ICU. […]
EMCrit 120 – The ProCESS Trial with Derek Angus
I speak to the lead author of the ProCESS trial, Dr. Derek Angus
The SPLIT trial: Internal vs. external validity
. Introduction . Resuscitation with large volumes of normal saline (NS) causes hyperchloremic metabolic acidosis. Some evidence suggests that hyperchloremic metabolic acidosis may impair renal function, but the clinical relevance of this remains unclear. If hyperchloremic metabolic acidosis is truly detrimental, this would be one argument to use balanced crystalloids rather than NS. . . […]
Line infection
CONTENTS Rapid Reference 🚀 Physiology Prevention Clinical features Diagnosis Management Overall strategy Empiric antibiotic selection Treatment duration Persistent bacteremia Specific situations Septic thrombophlebitis Arterial line infection Chest port infection Podcast Questions & discussion Pitfalls various mechanisms of infection: Early infections often arise from the skin: (a) These may occur during line insertion. (b) There may […]
Shock
Set #1: Shock diagnosis Question 1: You are called to evaluate a patient in the emergency department with a terrifyingly huge pulmonary embolism on CT scan. The patient is a previously well 49 year old woman who developed severe gastroenteritis three days ago. She was having difficulty maintaining oral intake so she presented to the […]
PulmCrit Instagram Links
Welcome to the PulmCrit Instagram page. This has recent posts with links for further information. –Cheers, josh HYPERION trial on therapeutic hypothermia for patients with non-shockable cardiac arrest: Link to PulmCrit blog. CITRIS-ALI: Fresh multi-center RCT of vitamin C in sepsis-induced ARDS: Link to PulmCrit blog The crashing asthmatic with Leo Stemp: Link to fresh […]
IBCC chapter & cast – Endocarditis
Endocarditis is a classic disease of emergency medicine, inpatient medicine, and critical care. The opioid epidemic has caused a surge of endocarditis diagnoses, reminding us of the myriad ways that this disease can present itself.
2015 ACLS Guidelines: What happened to VSE?
. Introduction . In 2008 and 2013, two prospective RCTs from Greece reported benefits from the combination of vasopressin, steroids, and epinephrine (VSE) for in-hospital cardiac arrest. However, other studies investigating the addition of vasopressin alone to epinephrine have been negative. Consequently, vasopressin has been removed from the AHA/ACC algorithms, with a specific recommendation […]
EMCrit Wee – Breaking News on Fluid Choice and Rate – The BaSICS Trial
BaSICs Trial Results on Fluid Choice and Rate of Administration
EMCrit 169 – Sepsis 3.0 with Merv Singer
Hear from the lead author of the new Sepsis 3.0 definitions
Vasodilators for Severe Sepsis
A listener, Dave Glaser, points out that one portion of the EGDT protocol doesn’t get spoken about very often: the use of vasodilators for MAP optimization.
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 […]
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