. Introductory case . A young 70-kg man was transferred to the Genius GeneralICU for management of stupor. He had been diagnosed with aortic valve endocarditis due to heroin abuse two weeks earlier, but left the hospital against medical advice. Shortly after admission to Genius General, the lab called with a critical sodium value of […]
The tale of six blind physicians and the elephant
. An elderly man was admitted to the ICU and evaluated by six blind physicians. . The blind cardiologist noted that the patient had a malignant pericardial effusion with tamponade. She recommended an immediate pericardial drain followed by intra-pericardial chemotherapy. . The blind oncologist noted that the patient had stage IV lung cancer. He recommended […]
EMCrit 156 – Central Lines – Part I: Avoiding Complications and Confirmation
Stop Effing Up Your Central Lines
Wee – Avoiding Disaster – Endotracheal Tube Cuff Leaks and Tube Exchanges
It seems simple, but not treating this situation with respect can lead to disaster.
You Don’t Understand the Osm Gap – Guest Post by Rory Spiegel
Think you understand the Osm Gap–you don’t
Proposal: Early ventilator weaning to HFNC in hypoxemic respiratory failure
. Case example . A previously healthy 45-year-old man was transferred to the Genius General Hospital ICU for management of pneumonia. He was intubated prior to transfer due to hypoxemia (details unavailable). His chest radiograph showed dense right lower lobe consolidation, which was confirmed with ultrasonography. He was treated with a regimen of dexamethasone, […]
The New Definition of Shock
definition of shock
The Abbreviated ED Thoracotomy Tray
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Evidence-based treatment for severe community-acquired pneumonia
Introduction . Community-acquired pneumonia (CAP) remains the leading cause of infectious disease death in developed countries. Described by Sir William Osler as “captain of the men of death,” it dates back to antiquity. However, we are only beginning to understand the best ways to treat it. . Part 1: The Pneumococcal meningitis story . Ceftriaxone […]
EMCrit 155 – Status Epilepticus with Tom Bleck
Tom Bleck on Status Epilepticus
Proposal: Most community acquired pneumonias with extensive ultrasonographic consolidation are pneumococcus
Introduction with a case . A 45-year-old man was transferred to the Genius General Hospital ICU for management of pneumonia. His chest radiograph is shown above. Chest ultrasonography showed extensive consolidation of the entire right lower lobe with dynamic air bronchograms (video below). He was treated with ceftriaxone and azithromycin. . Extensive lobar consolidation with […]
Does central line position matter? Can we use ultrasonography to confirm line position?
. Introduction . Suppose you just placed the central line shown above. Does it need to be repositioned? . I was trained that the tip of the central line must lie in the lower portion of the superior vena cava. If the line was in the right atrium, it would cause cardiac perforation. If the […]
The 2015 EEM/EMCrit Fellowship Winner is…
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EMCrit 154 – Preemptive Sepsis Panel SmaccBack
A preemptive smaccback on the SMACC Chicago Sepsis Panel
Myth-busting: Azithromycin does not cause torsade de pointes or increase mortality
. Introduction . In 2012 a NEJM article by Ray et al. reported a correlation between azithromycin and cardiovascular death. This received extensive press and ultimately led the FDA to issue a drug safety communication warning about the risk of QT prolongation and torsade de pointes. Subsequent studies have failed to replicate this result. Nonetheless, […]
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