Introduction 0 Traditionally it has been thought that during septic shock, renal blood flow decreases leading to pre-renal kidney injury. This implied that if we could improve the cardiac output and renal blood flow, the kidneys would recover. Recent research challenges these concepts, with interesting therapeutic implications. 0 New paradigm of microvascular physiology in renal acute kidney […]
EMCrit 138 – Vasopressor Basics
There is a ton to speak about regarding vasopressors, but before we get to the edge cases, we need to set-up a foundation.
Is correcting hyperchloremic acidosis beneficial?
0 Clinical Question 0 An elderly woman presents with renal failure due to severe dehydration from diarrhea. She has a hyperchloremic acidosis from diarrhea with a chloride of 115 mEq/L, bicarbonate of 15 mEq/L, and a normal anion gap. During her volume resuscitation, should isotonic bicarbonate be used to correct her hyperchloremic acidosis? Does […]
A Case of Identity Part Two
Our standards for acceptable benefit of antiplatelet agents in the management of ACS have become deplorably low. When ISIS-2 was first published we defined success only by aspirin’s ability to affect mortality. The number commonly cited, 2.4%, only describes aspirin’s absolute benefit to decrease death (1). In the one trial that examined its properties to […]
EMCrit 137 – Delayed Sequence Intubation ( DSI ) Update
The DSI study is finally published! Listen to this podcast for a discussion of the paper and the things we have learned since the original DSI podcast.
Facial hair, airway management, and Movember
Preamble: Movember 0 Movember is an annual event involving growing a mustache during November to raise awareness and funds to support men’s health issues including prostate cancer. To support Movember, this post is about mustaches… and critical care, of course. 0 Introduction with a Case 0 Once upon a time at Genius General Hospital, there was […]
Hydro-Point: Ultrasound sign of air-fluid level in the pleura
Introduction with a case 0 Hydro-point on thoracic ultrasound is diagnostic of an intrapleural air-fluid level, which may be caused by hydropneumothorax, hemopneumothorax, or pyopneumothorax. This has been described in the literature but is not widely appreciated (Volpicelli 2013). For example, a prominent ultrasound website may have misdiagnosed this. Before going further, watch the video […]
A Secondary Examination of The Adventure of the Cardboard Box
In November of 1995 stroke care as we know it drastically and permanently changed. With the publication of NINDS-2 the NEJM ushered in the interventional era of acute ischemic stroke (1). No longer were we powerless in our management of these patients. Finally we could offer them more than an aspirin to chew on, a […]
ICU Physiology
from Jon-Emile Kenny
Antifragile in EM by George Kovacs
George Kovacs writes on a book he just finished.
EMCrit 136 – Getting Shit Done
Not quite ED Critical Care, but I hope this discussion of EM/Resus Productivity may be helpful to some of you out there.
Mythbusting: Correcting the anion gap for albumin is not helpful
0 Introduction 0 In 1998 Figge reported a strong linear relationship between anion gap and albumin concentration, which has led to the widespread recommendation to correct anion gap for albumin. It was proposed that since albumin is an anion, failing to correct for a low albumin level could allow an anion-gap acidosis to go undetected. […]
The Science (Fiction) of FOAM
If you want to know how we practiced medicine 5 years ago, read a textbook. If you want to know how we practiced medicine 2 years ago, read a journal. If you want to know how we practiced medicine last year, go to a (good) conference. If you want to know how we practice medicine now and in […]
Mythbusting: Heparin isn’t beneficial for noninvasive management of NSTEMI
Introduction 0 The use of heparin for noninvasive management of non-ST elevation MI (NSTEMI) is one of the most deeply entrenched myths of modern medicine. Although heparin reduces reinfarction, when it is discontinued there is a rebound in infarction rates. Ultimately, short-term treatment with heparin delays reinfarction without having any sustained benefit. Clinical trials which fail […]
EMCrit 135 – Trauma Thoughts with John Hinds
John Hinds on Blunt Traumatic Arrest
- « Previous Page
- 1
- …
- 67
- 68
- 69
- 70
- 71
- …
- 92
- Next Page »