CONTENTS Rapid reference 🚀 Risk factors and epidemiology Clinical presentation of PE Massive/submassive PE Large central PE Pulmonary infarction DVT Individual tests: D-dimer Arterial blood gas (ABG) DVT ultrasound to evaluate for PE Chest radiograph Radiology CT angiography in pulmonary embolism Causes of a filling defect on CT angiography CT angiography Causes of filling defect: […]
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EMCrit – RACC Lit Update 2021-12-22
All the Resus and Acute Crit Care Goodness in 10 minutes
Evidence for the Protocols
Evidence for Non-Invasive Protocol The paper that allowed us to start non-invasive protocols=gamechanger. [1. Jones AE, Shapiro NI, et al.; Emergency Medicine Shock Research Network (EMShockNet) Investigators. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010 Feb;303(8):739?46.] Is septic shock without lactate elevation as sick […]
ED Intensivist Roles
Appendix Resource Intensivist Model Detroit Receiving Hospital/Wayne State University Detroit Receiving Hospital (DRH) has addressed the challenges of caring for critically ill ED patients with an ED-centric model. A novel emergency department-based critical care (ED-CC) rotation was established in 2006 for all PGY-2 emergency medicine residents. The ED-CC resident functions as a floating resident 7:00 […]
EMCrit 267 – They are not All Right!! An interview on Hemodynamic Assessment with Mike Patterson
Patients can become neurologically injured or code with no overt signs
Flipping the Podcast: Approach to shocky patient in AF w/ RVR
Flipping the podcast? I’m going on Tyler Christifulli’s FOAMFrat podcast soon to talk about the approach to the shocky patient in atrial fibrillation with rapid ventricular rate (AF with RVR). Tough topic. I’ve been trying to iron out some general algorithms for this, but they aren’t perfect. So I thought it might be fun to […]
The Case of the Indiscriminate Waveform
From the very start of our Residency training, Emergency Medicine Physicians are tasked with committing to memory the correctable causes of PEA arrest. It is expected any intern worth their salt should be able to recite the H’s & T’s proselytized by the AHA as far back as 1995 (1). And yet, it quickly becomes […]
PulmCrit- TEG for cirrhotic coagulopathy: Time for clinical implementation?
Introduction Traditional coagulation studies (especially the INR) fail miserably in cirrhosis. Thromboelastography (TEG) is a superior approach for understanding the global balance of pro-coagulants versus anti-coagulants in these patients. This isn’t anything particularly new – for example, it was explored in this post from 2015 (if you’re not familiar with this concept already, it’s explained […]
EMCrit 314 – ShadowBoxing Case 1 – In the end, it’s always…
Our first shadowboxing episode…
EMCrit 322 – Shadowboxing Case 2 – Frack the EJ
The 2nd of the shadowboxing cases…
10 Pearls from the Levitan Airway Course
0 Introduction 0 Last week I attended Dr. Levitan’s airway course in Baltimore. It was a teriffic course, which I would recommend to anyone looking to improve their airway management skills. For those of you unable to attend the course, here are some points which were particularly interesting to me. 0 Pearl #10. Respect the […]
Mythbusting: (Empty IVC + hyperkinetic heart) does not equal volume depletion
0 Introduction with an example 0 A 60-year-old woman is admitted with septic shock due to pyelonephritis. Currently she has received two liters of crystalloid. Her mean arterial pressure is now 55 mm, her pulse is 120 b/m, and she is producing very little urine. Bedside ultrasound shows that her IVC is completely empty (sometimes […]
Bradycardia
CONTENTS Clinical aspects Rapid Reference 🚀 Bradycardia is dangerous: physiology review Causes of bradycardia Sinus node dysfunction AV block General evaluation for the etiology ECG evaluation & subtypes of bradycardia Heart blocks 1st degree AV block Mobitz I (Wenkebach Block) Mobitz II 2:1 Block 3rd degree AV block Escape rhythms Junctional escape Ventricular escape Sinus […]
Meningitis & Encephalitis
CONTENTS Rapid Reference: Obtundation with suspected CNS infection 🚀 Clinical manifestations When to suspect CNS infection Infectious disease history Neurological sequelae of bacterial meningitis Labs Blood tests to consider Lumbar puncture Imaging Imaging findings in meningitis Imaging to evaluate for HSV encephalitis Management Antibiotic selection Empiric regimen for undifferentiated CNS infection Empiric regimen for bacterial […]
Vasopressors
CONTENTS Rapid Reference 🚀 Core agents Inodilators (milrinone, dobutamine, isoproterenol) Pure vasopressors Inopressors (norepinephrine, epinephrine, dopamine) Peripheral vasopressors Midodrine Methylene Blue Podcast Questions & discussion Pitfalls classic inodilators (milrinone, dobutamine) Mechanism Dobutamine stimulates mostly beta-receptors, with very little stimulation of alpha-receptors. Milrinone inhibits intracellular adenylyl cyclase, thereby increasing intracellular cyclic AMP levels. Physiologic effect Primary […]
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