Introduction Traditional coagulation studies (especially the INR) fail miserably in cirrhosis. Thromboelastography (TEG) is a superior approach for understanding the global balance of pro-coagulants versus anti-coagulants in these patients. This isn’t anything particularly new – for example, it was explored in this post from 2015 (if you’re not familiar with this concept already, it’s explained […]
Search Results for: TXA
EMCrit Wee – RACC-Lit for August 2022
So much literature goodness for the scorching summer heat…
EMCrit 77 – Left Ventricular Assist Devices (LVADS)
LVADs are complicated especially when the patient starts going downhill. Zack Shinar is going to attempt to make it a bit easier.
PulmCrit – Lupus Anticoagulant in COVID-19: Culprit or correlate?
An emerging body of evidence relates lupus anticoagulant to COVID-19. Both of these topics are enormously confusing on their own, so let’s try to ease into this… background on lupus anticoagulant what is lupus anticoagulant? Lupus anticoagulant isn’t any single thing, but instead it refers to a variety of different antibodies which may behave […]
EMCrit 334 – CV-EMCrit – Concise HeartMate 3 LVAD Overview
A review on dealing with HeartMate 3 (most common LVAD you will see) Emergencies
Dear NEJM: We both know that conflicts of interest matter.
0 Introduction 0 Recently the New England Journal of Medicine launched a media campaign challenging the negative perception of industry conflicts of interests (COI). This was surprising, because it is the opposite of what editors of the NEJM have previously reported (see above books by former NEJM editors, published in 2004 and 2005). Big pharma […]
“The Adventure of the Veiled Lodger”
The HINTS exam is a 3-part test designed by Dr. Newman-Toker to clinically exclude a central cause of acute vertigo in patients who present with vertiginous symptoms. HINTS involves most famously, the head impulse test(see diagram below), a maneuver which involves torquing your patients head from midline to 20 degrees of rotation(or Vice Versa) and […]
EMCrit 121 – REBOA
This episode, we discuss REBOA (resuscitative endovascular balloon occlusion of the aorta).
EMCrit 170 – the ER REBOA Catheter with Joe DuBose
Resuscitative REBOA is interesting, but was probably too complex for Resus Doctors–well not anymore!
PulmCrit Wee: Reconceptualizing bradykinin-mediated angioedema as a universal vicious spiral
In 2015 I wrote this post on ACEi-induced angioedema. I still think it was a pretty good post (particularly for 2015), but it’s become increasingly clear recently that the post was fundamentally flawed. Let’s try to straighten this out. old model of bradykinin-mediated angioedema This is a conceptual model of how bradykinin-mediated angioedema occurs. Several […]
Double-coverage of gram negatives with a fluoroquinolone?
0 Introduction 0 The benefit of empirically using two antibiotics to cover gram negative bacilli is a perpetual controversy. For patients in septic shock, failure to provide effective initial antimicrobial therapy correlates with increased mortality. Using two drugs may increase the likelihood of an including at least one antibiotic which covers the pathogen. This […]
Medication Reconciliation at ICU admission
CONTENTS Introduction Basic principles of medication reconciliation Specific medications: Cardiology Pulmonology Gastroenterology Hematology Endocrinology Neurology Transplantation Questions & discussion When a patient is admitted to the ICU, which of their outpatient medications should be continued? This is a rather mundane task, one which is often delegated to junior team members. However, these decisions can be […]
PulmCrit Wee – Patient with nonfocal exam and thrombocytopenia
The case: A ~65 year-old human presents to the ICU with a working diagnosis of vasopressor-dependent septic shock. The patient was previously healthy with no significant medical problems or medications. History is notable for mild nonspecific symptoms (chills, nausea, and a headache), with nothing in particular standing out. Physical examination is unrevealing, with the patient […]
Community acquired biliary sepsis (ascending cholangitis & calculus cholecystitis)
CONTENTS Rapid Reference 🚀 Introduction Clinical presentation & differential diagnosis Diagnostic tests Labs Ultrasonography CT scan HIDA scan Diagnostic criteria Treatment Antibiotics Interventional tx for ascending cholangitis Interventional tx for cholecystitis Interventional tx for combined cholecystitis & cholangitis Podcast Questions & discussion Pitfalls community-acquired biliary sepsis checklist ✅ investigations Electrolytes, CBC with differential, coags. Liver […]
PulmCrit Wee – Therapeutic anticoagulation for COVID ICU patients: Is the heparin vial half empty, or half full?
A fresh preprint reveals the results of combining three trials to evaluate therapeutic anticoagulation among severe COVID patients (defined as patients requiring high flow nasal cannula, noninvasive ventilation, intubation, vasopressors, or inotropes). Patients were randomized to therapeutic anticoagulation versus thromboprophylaxis per usual care guidelines. REMAP-CAP also simultaneously randomized some patients to receive aspirin as well. […]
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