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 […]
Search Results for: lauria
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 […]
Liberation from the ventilator
CONTENTS Rapid Reference: Optimization & items to consider prior to extubation 🚀 Spontaneous Breathing Trial (SBT) If the patient fails the SBT Causes of failed SBT Investigation If the patient passes the SBT A trial of extubation Post-extubation support Timing of tracheostomy Some additional concepts Unplanned extubation Nocturnal extubation Understanding & navigating the obesity quagmire […]
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 […]
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 […]
Pneumothorax and bronchopleural fistula (BPF)
CONTENTS Definitions & classifications Symptoms Signs Radiology: POCUS for diagnosis and monitoring Chest radiograph Signs of pneumothorax Size determination CT scan Causes of pneumothorax Management of various situations: Primary spontaneous pneumothorax Secondary spontaneous pneumothorax Indications for pleurodesis Management of persistent air leak Traumatic pneumothorax (including iatrogenic) Tension pneumothorax Oxygen to encourage nitrogen reabsorption? Pigtail versus […]
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 […]
Antifungal Agents
CONTENTS Rapid Reference 🚀 Overview Azoles (#1) Choosing your azole: Spectrum & use of each azole Choice of azole for various infections Contraindications & drug-drug interactions (#2) Pharmacology, dosing, and drug levels: Voriconazole Isavuconazole Fluconazole Itraconazole (#3) Toxicity & monitoring Echinocandins (caspofungin, micafungin, anidulafungin) Liposomal amphotericin Podcast Questions & discussion Pitfalls antifungal agents: azole interactions: […]
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 […]
Type-1 Myocardial Infarction (OMI & NOMI)
CONTENTS diagnosis Nomenclature & types of MI Diagnosis DDx of MI EKG findings in MI Anterior OMI Inferior OMI RV OMI (RVMI, including management) Posterior OMI High lateral OMI OMI in LBBB or RV-pacing OMI vs aneurysm Hyperacute T-waves & de Winter pattern Wellens patterns Subendocardial ischemia patterns Risk stratification management General supportive care PCI […]
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 […]
Submassive & Massive PE
CONTENTS Most useful material: Crashing patient: Massive PE resuscitation guide 🚀 General approach to (sub)massive PE: (#1) Investigation package (#2) Risk stratification (#3) Thrombolytic contraindications (#4) Treatment approach Resuscitation of massive PE Avoid procedures if possible Fluid management Inotropes & vasopressors Inhaled pulmonary vasodilator(s) Hematologic management: Anticoagulation (heparin) Thrombolysis Regimens: Full dose Half dose Quarter […]
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 […]
Pleural effusion
CONTENTS approach to pleural effusion of unclear etiology Initial trifecta: History CXR, POCUS, & review of prior radiology Blood tests More advanced testing: CT scan Thoracentesis differential diagnosis All causes of pleural effusion Transudates Exudates pleural radiology POCUS Chest radiograph Subpulmonic effusion Pseudotumor Specific radiologic findings: Chronic pleural effusion Rapidly growing effusion Pleural plus pericardial […]
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