. Introduction: Perpetual controversy . The use of magnesium for AF has been a controversial topic for decades. Magnesium is a normal electrolyte, so it is cheap and has an excellent safety profile. Ironically, this is also magnesium’s Achilles heel, because this has caused the pharmaceutical industry to have no interest in it. This leaves […]
EMCrit 159 – Rounding in the RACC
Rounding on critically ill patients in the ED
SMACC-Dub Registration Opens Tomorrow
You are unauthorized to view this page. Username Password Remember Me Forgot Password
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 […]
TXA – Brohi and a Very Odd Article
Such a great lecture by Brohi
Phenobarbital monotherapy for alcohol withdrawal: Simplicity and power
[PLEASE NOTE: For the most complete & updated material on alcohol withdrawal, please see the Internet Book of Critical Care Chapter on this topic here] Case example . A middle-aged man was admitted to the ICU for refractory alcohol withdrawal. Prior to arriving in the ICU he had been treated aggressively with an escalating […]
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. . . […]
EMCrit 158 – The FELLOW Trial on Apneic Oxygenation in ICU Patients
Matt Semler, MD and colleagues performed an RCT on Apneic Oxygenation in Medical ICU patients
The Case of the Blind Allocator
In the modern world of evidence based medicine we exist in a perpetual state of doubt, continually attempting to perceive truths through the veil of science. Far too often our sample cohort deviates from the population it intends to represent. Hypothesis testing and frequentist statistics are tools intended to quantify the extent to which the […]
Recognizing and managing paradoxical reactions from benzodiazepines & propofol
. A perplexing case . A young man with a history of seizures and alcoholism presented with a generalized seizure. His seizure responded to lorazepam, but he was intubated for airway protection and was transferred to the Genius General ICU. He was also loaded with levtiracetam to prevent further seizures. . Overnight he developed agitation. Despite […]
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, […]
Unconventional therapies for hyponatremia: Thinking outside the collecting duct
. Case: An unusual ICU referral . Some years ago at Genius General Hospital, the ICU was asked to accept a patient from the medicine ward with cirrhosis, confusion, and hyponatremia (Na 125 mM) for hypertonic saline therapy. There was concern that the patient’s confusion was due to his hyponatremia. . Chart review showed […]
Taking control of severe hyponatremia with DDAVP
. Introduction with a case . Imagine an elderly patient presenting with hypovolemic hyponatremia (sodium of 115 mM) and moderate confusion. How would you treat this patient? . The typical approach might be a slow infusion of 3% sodium chloride. The presence of neurologic symptoms supports the use of hypertonic saline. However, patients with hypovolemic […]
EMCrit 157 – Central Lines II – Placement Tips
Part II of the Central Line Series discusses placement tips
EMCrit Wee – Central Line MicroSkills (Deliberate Practice)
A break down of the skills needed for Seldinger technique
- « Previous Page
- 1
- …
- 60
- 61
- 62
- 63
- 64
- …
- 93
- Next Page »