Anyone who has spent some time in a cardiac intensive care unit understands the physiologic appeal of the intra-aortic balloon pump (IABP). Anecdotally its use improves multiple clinical endpoints that for years have been considered surrogates for patient important outcomes. And yet, despite these physiologic advantages when examined in a rigorous fashion, IABPs have failed […]
Search Results for: acid base
Spinal Cord
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 […]
Local Anesthetic Systemic Toxicity (LAST)
CONTENTS Epidemiology Presentation Differential diagnosis Treatment Podcast Questions & discussion Pitfalls patient-dependent risk factors Hepatic dysfunction: Most anesthetics are hepatically cleared. Clearance rate is most relevant if the agent is slowly absorbed, administered in multiple doses, or provided as a continuous infusion. Cardiac dysfunction: Reduced cardiac reserve function may render LAST more dangerous (e.g., patients […]
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: […]
ECMO manual
CONTENTS basic management issues Circuit parameters Pump speed (RPMs) Flow (v) Pven (venous drainage pressure) Pint (internal pressure) Part (arterial, post-membrane pressure) ▵P (transmembrane) Sweep gas flow rate FdO2 SarO2 & ParO2 (arterial return sat & pO2) SvdO2 (venous drainage O2%) Low circuit flow & circuit flow arrest Pump failure Membrane lung dysfunction Air embolism […]
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 […]
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 […]
EMDOCS.net hosted me on Ask Me Anything
EMDOCS.net brought me on for an AMA session
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 […]
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 […]
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 […]
Methemoglobinemia
CONTENTS Physiology Epidemiology Clinical presentation Diagnosis Treatment Treatment for most patients Rx in the G6PD deficient patient Podcast Questions & discussion Pitfalls normal oxyhemoglobin equilibrium Oxygen binds to HbFe2+ (ferrous) state. During oxygen transport, this transiently forms the HbFe3+ (ferric) state. The ferrous (HbFe2+) form of iron is needed to bind oxygen. formation of methemoglobin […]
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