Introduction 0 The utility of steroids in sepsis has been debated passionately for decades. There is hope that steroids might improve mortality, but also fear that they could increase infectious complications. Practice varies widely. What does the data truly indicate? 0 Four misconceptions and one truth 0 Misconception #1: Stress-dose steroids decrease mortality 0 This […]
Video: Stab Wounds Led to Pericardial Window and then Sternotomy
Procedural Video
The Case of the Non-inferior Inferiority
The practice of Frequentist statistics is often a study in extremes. Based on an arbitrary threshold of significance, we are asked to interpret data as either positive or negative when in reality it merely shifts our probability of certainty. Even more important, because of the singular nature of Frequentist statistics, our interpretation of data is […]
Understanding lactate in sepsis & Using it to our advantage
Introduction with a case 0 Once upon a time a 60-year-old man was transferred from the oncology ward to the ICU for treatment of neutropenic septic shock. Over the course of the morning he started rigoring and dropped his blood pressure from 140/70 to 70/40 within a few hours, refractory to four liters of crystalloid. […]
EMCrit 153 – In Memory – John Hinds, On How He Ran His Unit
In Memory of Our Friend, John Hinds
John Hinds on Crack the Chest–Get Crucified
John’s SMACC keynote
EMCrit 152 – High Flow Nasal Cannulae – Just Blowin’ Hot Air?
HFNC–the new hot thing or just blowin’ hot air?
CT angiography for lower GI bleed: the University of Pennsylvania Experience
Introduction 0 A post two months ago explored the use of CT angiography instead of tagged RBC scans for the evaluation of lower GI bleeding (here). The algorithm below was developed based on evidence regarding the speed and performance of various tests. However, there was no direct evidence validating this algorithm. A new study from […]
The Case of the Irregular Irregularity
We have proven ourselves highly capable of managing atrial fibrillation in the Emergency Department. In recent years, a number of prospective cohorts have demonstrated that with the use of IV anti-arrhythmic medication and electrical cardioversion, patients presenting to the Emergency Department with new onset atrial fibrillation can be successfully discharged in sinus rhythm consistently and […]
Hypocaloric Nutrition: Theory, Evidence, Nuts, and Bolts
0 Introduction 0 Until recently there has been little evidence regarding the caloric target for feeding critically ill patients. In the absence of evidence, it has been assumed that we should aim to meet 100% of predicted energy needs. New multicenter RCTs challenge this dogma, particularly the PERMIT trial by Arabi et al. 0 Theory […]
EMCrit 151 – Procedural Sedation Part 3 with Jim Miner
Jim Miner discusses the fine points of ED/ICU procedural sedation
What Would Google Do?
What would Google do?
The Problem of Thor Bridge
Disclosure: This post is unusually full of hearsay and conjecture. Like a secondary endpoint that flirts with statistical significance it should be viewed purely as hypothesis generating. For a more reasoned and experienced view of the following data please read Josh Farkas’s wonderful post on pulmcrit.org. Damage control ventilation is not a novel concept. It functions […]
We are Complicit – A glimpse into the current state of Severe Sepsis/Septic Shock Quality Measures
Don’t read this unless you want to be annoyed
Flash cigarette burns: To intubate or not to intubate?
0 Getting warmed up with a multiple-choice question 0 A 70-year-old man with oxygen-dependent COPD is admitted following a flash burn. He started smoking with his oxygen running, and the cigarette “exploded” in his face. Currently he is in the emergency department on four liters nasal cannula (twice his chronic oxygen prescription). He is mentating […]
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