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: […]
Search Results for: lauria
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 […]
Invasive candidiasis
CONTENTS Introduction Candidemia Clinical manifestations Diagnosis Further investigation after diagnosis Treatment Intra-abdominal candidiasis Candida pneumonia? Candiduria Podcast Questions & discussion Pitfalls candida in the ICU Most cultures of Candida represent colonization (e.g., in the urine or especially in the sputum). Thus, there is a major risk of overtreating candidiasis. However, candida does occasionally cause severe […]
Buprenorphine & opioid use disorder
CONTENTS Rapid Reference 🚀 All hands on deck Buprenorphine basics Buprenorphine induction Acute pain in a patient on chronic buprenorphine Podcast Questions & discussion Pitfalls Between 1999-2017, ~400,000 people died from opioid overdose. That’s over half the number of Americans who have ever died from HIV. It is increasingly clear that opioid use disorder (OUD) […]
PulmCrit- Alpha-2 agonists: clonidine, guanfacine, lofexidine, and KetaDex
Dexmedetomidine is an intravenous alpha-2 agonist used as a sedative infusion. It has some uniquely useful properties, particularly that it doesn’t suppress respiration (allowing it to be safely used in non-intubated patients). The main drawbacks of dexmedetomidine are logistic: it is expensive and can be administered only as an IV infusion within an ED or ICU. Oral clonidine offers some similar benefits compared to dexmedetomidine, without these logistic constraints.
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 […]
EMCrit 321 – CV-EMCrit – Acute Valve Disasters – Critical Aortic & Mitral Regurgitation and Bonus: VSDs with Trina Augustin
Valve Disasters Part 1 – Regurg…
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 […]
Sarcoidosis
CONTENTS Basics Epidemiology Pulmonary sarcoidosis Clinical presentation Radiographic staging (Scadding stage) Chest CT scan Lymphadenopathy ➡️ Nonfibrotic parenchymal abnormalities Fibrotic parenchymal abnormalities Necrotizing sarcoid granulomatosis Pulmonary function tests Reduced DLCO Restriction Obstruction Pleural involvement Pulmonary hypertension Large airway involvement Treatment of pulmonary sarcoid Approach to sarcoidosis patient with cardiopulmonary deterioration Extrapulmonary sarcoidosis Skin Erythema nodosum […]
Ventricular arrhythmias
CONTENTS approach to wide-complex monomorphic tachycardia Diagnostic approach to wide complex tachycardia [1] Consider pretest probability for VT [2] Compare to old ECG if available [3] Initiation of wide complex tachycardia [4] Signs of potential VT mimic [5] Evidence of AV dissociation? [6] Morphology in Leads II & aVR Morphology rules [7a] RBBB-type [7b] LBBB-type […]
Hepatic encephalopathy in chronic liver disease
CONTENTS Rapid Reference 🚀 Introduction Clinical features 1) Manifestations of hepatic encephalopathy 2) Triggers of hepatic encephalopathy Diagnostic approach Differential diagnosis Laboratory testing Ammonia EEG Neuroimaging Treatment – overall strategy Cathartic Polyethylene glycol Lactulose Rifaximin Manage triggers & coexisting problems Avoid sedatives like the plague Nutritional support & gut access Treatments of desperation Podcast Questions […]
Septic Shock
CONTENTS Rapid Reference 🚀 Definitions of septic shock Diagnosis & evaluation Clinical Presentations Biomarkers: NLR Procalcitonin & CRP ➡️ Evaluation for the source Sepsis mimics Treatment Vasopressors Source control Fluid Steroid DVT prophylaxis with heparin REFRACTORY SHOCK Methylene blue Resuscitative endpoints MAP Heart rate Urine output Fluid balance Lactate Skin perfusion Interventions of no real […]
Posterior Reversible Encephalopathy Syndrome (PRES)
CONTENTS Basics Pathogenesis Causes Clinical presentation PRES-RCVS (Reversible Cerebral Vasoconstriction Syndrome) overlap Imaging Lumbar puncture EEG & seizure semiology Diagnosis Differential diagnosis Treatment Prognosis Podcast Questions & discussion Pitfalls PRES refers to reversible, vasogenic edema which occurs predominantly in the posterior brain. PRES is less commonly known as “reversible posterior leukoencephalopathy syndrome” (RPLS). However, both […]
Nonconvulsive Status Epilepticus (NCSE)
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 […]
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. […]
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