CONTENTS Spinal cord basics Anatomy Recognizing spinal cord injury Lesion localization Bowel and bladder symptoms Spinal cord radiology Patterns of axial involvement Patterns of longitudinal involvement Acute & subacute myelopathy Potential causes Investigation Blood tests CSF evaluation Imaging Specific myelopathies Spinal cord infarction Spinal dural arteriovenous fistula (dAVF) Spinal epidural hematoma Cauda equina syndrome Nitrous […]
Search Results for: acid base
GI Bleeding
CONTENTS Rapid Reference: Overview & Checklist 🚀 Investigations Diagnosis & bedside evaluation Risk stratification Resuscitation basics Causes Specific bleeding location/types Approach to upper GI bleed Variceal bleed Hematochezia and (presumed) lower GI bleed Podcast Questions & discussion Pitfalls history & physical History: NSAID use? Abdominal pain? Alcoholism? Liver disease? Surgical history: Gastric bypass surgery? AAA […]
Thoracic actinomycosis
CONTENTS Basics Epidemiology Clinical manifestations Radiology Laboratory evaluation Invasive diagnostic testing Differential diagnosis Nocardia vs. Actinomyces Treatment Questions & discussion abbreviations used in the pulmonary section: 3 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AFB: Acid Fast Bacilli AIP: Acute interstitial pneumonia (Hamman-Rich syndrome) 📖 ANA: […]
Rapid Sequence Termination (RST) of status epilepticus
[PLEASE NOTE: This post has been updated with a new post. If you have time, consider reading them in sequence, starting with this post first] 0 Introduction 0 Status Epilepticus is our favorite neurologic emergency. If managed correctly, patients will often have excellent neurologic outcomes and short ICU stays. Incorrect management increases risk of […]
Approach to the critically ill poisoned patient
CONTENTS History Exam Labs Urine toxicology panel EKG Other diagnostic interventions Management Airway management Activated charcoal Agitation management Obtundation management Hyperthermia management Seizure management Bradycardia management Monomorphic VT management Poison control consultation Podcast Questions & discussion Pitfalls Toxicology histories are notoriously unreliable. Key bits of information: Any available medical records, especially medication lists. Timing & […]
Sleep-disordered breathing
CONTENTS Sleep-disordered breathing basics Obstructive sleep apnea (OSA) Epidemiology (including causes & consequences) Clinical features & assessment Diagnosis Treatment Obesity hypoventilation syndrome (OHS) Chronic OHS Epidemiology Signs & symptoms Evaluation & diagnosis Treatment Acute exacerbation of OHS (AEOHS) Definition Causes & patient evaluation Treatment Central sleep apnea (CSA) overview Hypercapnic CSA Nonhypercapnic CSA CSA due […]
Acute Kidney Injury
CONTENTS Rapid Reference: Approach to AKI 🚀 Definition & significance of AKI Causes of AKI Nephrotoxins Evaluation of the cause of AKI Tests not to order Tests to evaluate the cause of AKI Approach to oliguria Management of AKI Dose-adjust renally cleared medications Hemodynamic optimization Treatment of acidosis Dialysis Phosphate binder Related Uremic encephalopathy Dialysis […]
EMDOCS.net hosted me on Ask Me Anything
EMDOCS.net brought me on for an AMA session
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 […]
Pleuroparenchymal fibroelastosis (PPFE)
CONTENTS Basics Epidemiology Clinical presentation Radiology Differential diagnosis Diagnostic approach Management Prognosis Questions & discussion abbreviations used in the pulmonary section: 1 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AFB: Acid Fast Bacillus AIP: Acute interstitial pneumonia (Hamman-Rich syndrome) 📖 ANA: Antinuclear antibody 📖 ANCA: Antineutrophil […]
Neuromuscular Disorders
CONTENTS Initial approach to acute, diffuse weakness History & physical examination Causes of acute, diffuse weakness Brain Spinal cord Anterior horn cells Neuropathy NMJ (neuromuscular junction) Myopathy Laboratory evaluation Evaluation of respiratory muscle strength: Bedside pulmonary function tests Single breath count test Blood gas measurement Specific neuromuscular disorders Myasthenia gravis ➡️ Guillain-Barre syndrome ➡️ Botulism […]
Typical bacterial pneumonias
CONTENTS Streptococcus pneumoniae (pneumococcus) Streptococcus pyogenes (Group A strep) Staphylococcus aureus (MSSA & MRSA) Haemophilus influenzae Moraxella catarrhalis Pseudomonas aeruginosa Klebsiella pneumoniae Other related topics: Rhodococcus equi Questions & discussion abbreviations used in the pulmonary section: 3 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AFB: Acid […]
PulmCrit Blogitorial – Use of ECGs for management of (sub)massive PE
(A blogitorial is like a tweetorial in blog form, so folks on different platforms can see it). Our approach to risk stratification and management of (sub)massive PE tends to be dominated by CT scan and echocardiography (eye-candy modalities). And these are great. But I think there are situations where ECG can be really helpful – […]
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 […]
Unfractionated heparin (UFH), LMWH, fondaparinux, argatroban, and bivalirudin
CONTENTS Overview of indirect-acting anticoagulants (heparin & fondaparinux) Risk assessment Basic science – how these agents work Choice of agent Protamine for reversal of unfractionated or low molecular-weight heparin Unfractionated heparin (UFH) Dosing and monitoring of unfractionated heparin Heparin resistance Management Pseudo-heparin resistance Low molecular-weight heparin (LMWH) Various LMWH agents & dosing Enoxaparin dosing & […]
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