CONTENTS Definition of NCSE Epidemiology and causes of NCSE Various clinical presentations General clues to the diagnosis of NCSE Common differential diagnostic considerations EEG: Indications to obtain an EEG Duration of continuous EEG monitoring Antiepileptic trial for ictal/interictal continuum abnormalities Management of NCSE Subtypes of NCSE NCSE with coma Absence NCSE with onset in adulthood […]
Search Results for: mike lauria
Acute Ischemic Stroke (AIS)
CONTENTS Rapid Reference 🚀 Core topics in ICU stroke management Blood pressure control Anticoagulation & antiplatelet therapy Respiratory support Seizure management Dysphagia evaluation & nutritional support Additional supportive measures Specific management situations Neuroworsening in AIS Thrombolytic-induced angioedema Hemorrhagic transformation (including post-thrombolysis) Malignant MCA syndrome Cerebellar stroke & posterior fossa syndrome Basilar artery thrombosis Moyamoya disease […]
Waveform capnography in the intubated patient
CONTENTS Rapid Reference 🚀 Introduction: An emerging standard of care Physiology etCO2, PaCO2, and dead space etCO2 and cardiac output Clinical background Evidence: accuracy of etCO2 in predicting PaCO2 What is the PaCO2 target for an intubated patient? Interpretation of etCO2 waveform morphology Clinical utility Confirming endotracheal tube placement Guidance of cardiac arrest management Guidance […]
Myasthenia gravis & myasthenic crisis
CONTENTS Rapid Reference 🚀 Myasthenia Gravis: Background information Pathophysiology Presentation Diagnosis Serologic testing & types Drugs to avoid in myasthenia gravis Myasthenic crisis: diagnosis Diagnosis of myasthenic crisis: basics Differentiation from cholinergic crisis Triggers of myasthenic crisis Myasthenic crisis: treatment Blood gas monitoring Bedside pulmonary function tests Respiratory support Nutrition & GI access Pyridostigmine Steroid […]
Contrast Nephropathy, myth thereof
CONTENTS Venous injection of contrast (e.g. for CT scan) The birth of the contrast nephropathy myth Current lack of evidence regarding contrast nephropathy Weighing the risks vs. benefits of using contrast (Renalism) The attention given to contrast nephropathy is insane Intra-arterial contrast (e.g. cardiac catheterization) Algorithm Podcast Questions & discussion Pitfalls The concept of contrast […]
Coagulopathy in cirrhosis
CONTENTS Coagulation physiology in cirrhosis Primary hemostasis – von Willebrand factor and platelet function Secondary hemostasis – enzymatic coagulation Clinical pearls Fibrinolytic system & accelerated intravascular coagulation and fibrinolysis (AICF) Vitamin K challenge Relationship of infection with hemorrhage Approach to common problems Coagulation management during active hemorrhage Coagulation management prior to a planned procedure DVT […]
Tuberculosis
CONTENTS Epidemiology & risk factors Clinicoradiologic forms Natural history of tuberculosis Primary pulmonary TB Tuberculous pleural effusion ➡️ Chronic tuberculous empyema ➡️ Healed tuberculosis (Ghon complex) Postprimary TB Miliary TB Acute miliary TB Subacute/chronic miliary TB Tracheobronchial involvement Laryngeal TB Diagnosis of active pulmonary TB: overview Red flags to consider the diagnosis of TB Initial […]
Delirium
CONTENTS Definition & diagnosis Delirium mimics Causes Diagnostic approach Treatment Antipsychotics Butyrophenones (haloperidol & droperidol) Olanzapine Quetiapine Chlorpromazine Risperidone Lurasidone Podcast Questions & discussion Pitfalls definition Delirium is acute, generalized brain dysfunction (“cerebral insufficiency”). Key features: Acute (e.g. not dementia). Causes inattention (e.g. disorientation, inability to perform complex tasks). Tends to wax and wane: may […]
ABG, VBG, and pulse oximetry
CONTENTS Assessment of oxygenation: Advantages of pulse oximetry over ABG Situations where ABG is needed to assess oxygenation: Poor arterial waveform Dyshemoglobinemia P/F ratio A-a gradient Patients with dark skin Other causes of inaccurate pulse oximetry Assessment of ventilation: VBG to assess pH and ventilation end tidal CO2 (etCO2) Additional topics related to pulse oximetry: […]
Analgesia and sedation for the critically ill patient
CONTENTS Spectrum of medications available: Pure analgesics Acetaminophen Ketamine, pain-dose ➡️ (Lidocaine) (NSAIDs) Analgosedatives (analgesia > sedation) Opioids Opioid PCA Avoiding opioid infusions Tizanidine Gabapentinoids Sedalgesics (sedation > analgesia) Dexmedetomidine, Clonidine Ketamine, high-dose infusion ➡️ Pure sedatives Propofol ➡️ Guanfacine Phenobarbital ➡️ Melatonin (Benzodiazepines) (Hydroxyzine) Antipsychotics / anti-agitation Butyrophenones (haloperidol & droperidol) ➡️ Olanzapine ➡️ Quetiapine […]
Thrombotic microangiopathies (including TTP, ST-HUS, and C-HUS)
CONTENTS Thrombotic Microangiopathy(TMA) Definition of TMA Causes of TMA Investigating the cause of TMA Initial empiric therapy for TMA Thrombotic thrombocytopenic purpura (TTP) Epidemiology of acquired TTP Clinical presentation of TTP Initial treatment of acquired TTP Shiga-Toxin mediated Hemolytic Uremic Syndrome (ST-HUS) Epidemiology & presentation of ST-HUS Diagnosis of ST-HUS Treatment of ST-HUS Complement-mediated Hemolytic […]
Atypical pneumonias
CONTENTS Nonzoonotic atypical pneumonias: Legionella Mycoplasma Chlamydia pneumoniae Zoonotic atypical pneumonias: Chlamydia psittaci (psittacosis) Francisella tularensis (tularemia)* Coxiella burnetii (Q fever)* *May fail to respond to azithromycin; doxycycline will cover. Leptospirosis Questions & discussion diagnostic clues 🔍 Lack of upper respiratory features. 🔍 Extrapulmonary involvement (e.g., gastrointestinal, neurological). 🔍 Labs: Procalcitonin is usually moderately elevated. […]
Pulmonary hypertension (PH)
CONTENTS Symptoms of PH Functional assessment Diagnosis Chest radiograph CT scan Echocardiography Pulmonary artery catheterization (PAC) Vasoreactivity testing Causes of PH Evaluation for PH of unknown etiology Treatment – array of available therapies Basic supportive care for PH Calcium channel blockers Endothelin-receptor antagonists Phosphodiesterase-5 inhibitors & guanylate cyclase stimulators Prostacyclins & prostacyclin receptor agonists Systemic […]
Status Epilepticus
CONTENTS Getting started: (1) Initial approach to status 🚀 (2) After the dust has settled 🚀 Causes Diagnosis & definition Definition of status epilepticus Seizure mimics Differentiation from pseudoseizure Treatment overview Initial treatment Benzodiazepine Hypoglycemia, hyponatremia, and thiamine deficiency Conventional antiseizure medication Neurolytic intubation Subsequent management NORSE Neuromonitoring Waking & weaning Supportive medical management Approach […]
Preeclampsia & HELLP
Guide to emoji hyperlinks = Link to online calculator. = Link to Medscape monograph about a drug. = Link to IBCC section about a drug. = Link to IBCC section covering that topic. = Link to FOAMed site with related information. = Link to supplemental media. Going further References a dosing contraindications side effects indications […]
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