TOPICS
- airway & procedures
- cardiology
- endocrinology
- gastroenterology
- hematology/oncology
- infectious diseases
- nephrology
- neurology
- pulmonology
- rheumatology
- toxicology
- methodology & miscellaneous
airway & procedures
Airway pharmacology
Arterial lines: wrist versus the groin?
Cricothyrotomy in asphyxial cardiac arrest
Difficult airway communication via allergy list
Drowned airway
ETT depth calculator
Laryngoscopy
Preoxygenation, apneic oxygenation, apneic ventilation
- High-flow nasal cannula
- Apneic ventilation using pressure-limited ventilation
- The primacy of pressure: is RSI a failed paradigm?
Vascular access
- Dirty Double: Immediate femoral arterial & venous access
- Central line positioning & ultrasound line confirmation
- Rapid sequence intubation & procedurization
- Shrug technique for US-guided subclavian lines
cardiology
Atrial fibrillation
- Magnesium infusions for AF & TdP
- Approaching new-onset AF in critical illness
- Cardiogenic shock after cardioversion of atrial flutter
- Approach to shocky AF patient
Bradycardic periarrest: atropine vs. epinephrine
Hemodynamics
- 2016 series
- Phenylephrine & epinephrine can be infused peripherally
- Empty IVC & LV doesn't prove volume depletion
- Central venous oxygen saturation = noise
- Killer resuscitation: abdominal compartment syndrome
- Myth-busting the fluid bolus
- more below: Infectious diseases / Sepsis / Vasopressors
MI
- Over-diagnosis & over-treatment of MI
- Heparin is nonbeneficial for noninvasive tx
- PCI unhelpful status post CABG
- EKG patterns of PE that mimic MI
- Acute infection & MI: How scared should we be?
Post-cardiac arrest care
Shock, undifferentiated
- Approaching cardiopulmonary failure: which tests are useful?
- Cognitive approach to shock diagnosis with POCUS
Torsade de Pointes: a better approach
⇒ more cardiology at iBookCC
endocrinology
DKA
Insulin poisoning refractory to glucose
⇒ more endocrinology at iBookCC
gastroenterology
Abdominal compartment syndrome & fluid overload
Cirrhosis
- Coagulopathy management in cirrhosis
- Secondary bacterial peritonitis
- Ultrasound-guided blakemore tube placement
Hematochezia
Nutrition
Pancreatitis
Stress ulcer prophylaxis (SUP-ICU)
⇒ more gastroenterology at iBookCC
heme/onc
Cirrhotic coagulopathy & TEG
NLR: Free upgrade to your WBC
Sepsis-associated DIC
⇒ more heme/onc at iBookCC
infectious diseases
Antibiotic allergy
- PCN allergy: strategy
- Ranking antibiotics in order of allergenicity
- Validation of test-dose strategy for beta-lactam allergy
Antibiotics – specific drugs
- Azithromycin
- Double-coverage?
- Fluoroquinolones unhelpful in ICU
- Piperacillin-tazobactam isn't nephrotoxic
- Vancomycin pharmacokinetics: Making vanco great again
- Antibiotics & delirium (brief rant)
Bacteremia
Pneumonia
- Community-onset PNA
- Influenza PNA: triple therapy?
- Metabolic resuscitation for severe pneumonia?
- Ventilator-associated PNA
Sepsis
- Definitions & guidelines
- Overview
- Concept: Renoresuscitation & avoidance of chronic sepsis
- Strategy: Accelerated goal directed therapy
- Fluids
- Steroids & metabolic sepsis resus
- Stress-dose steroids: overview 7/15
- VANISH trial: no effect from steroid?
- Metabolic sepsis resuscitation: evidence for ascorbate
- ADRENAL trial & implications for metabolic resus
- APROCCHSS vs. ADRENAL: really discordant?
- Metabolic resuscitation for severe pneumonia?
- Checkpoint inhibitors… for septic shock?
- Vasopressors
Toxic shock syndrome
⇒ more infectious diseases at iBookCC
nephrology
Acid-base status & fluid selection
- pH-guided resuscitation & re-boot after BICAR-ICU
- Is correcting hyperchloremic acidosis beneficial?
- Plasmalyte/normosol vs. LR
- SPLIT trial: internal vs external validity
- We should engineer a new crystalloid
- Get SMART: 9 reasons to quit using normal saline
- Don't correct the anion gap for albumin
- Some acid base discussion questions
Contrast nephropathy: does it still exist?
Diuretic resistance & natriuresis
Furosemide stress test to clarify resuscitative goals
Hyperkalemia
Hyponatremia
⇒ more nephrology at iBookCC
neurology
10 dubious beliefs in neurocritical care
Alcohol withdrawal & GABA receptor physiology
- Phenobarbital for EtOH w/d #1 (12/14)
- Phenobarbital for EtOH #2 (monotherapy, 10/15)
- Phenobarbital for EtOH #3 (monotherapy reloaded, 12/17)
- Phenobarbital for EtOH #4 (one order to sedate them all, 10/18)
- Phenobarbital for EtOH #5 (evidence update 2018-2019)
- Ketamine for alcohol withdrawal?
- Paradoxical reactions due to BZDs & propofol
Analgesia
- Fentanyl infusions vs. ketamine?
- Reengineered analgesic ladder for critical care
- Alpha-2 agnoists: clonidine, guanfacine, and KetaDex
- DEXACET trial: evidence behind scheduled acetaminophen
Anoxic brain injury
Antipsychotics
Brain death & flow scans
CNS infections
Delirium
Gag reflex dogmalysis
ICP elevation
Status epilepticus
Stroke
⇒ more neurology at iBookCC
pulmonology
ABG/VBG
- ABG unhelpful in diagnosis of cardiopulmonary failure
- ABG/VBG unhelpful in DKA
- Oximetry beats PaO2 for assessing oxygenation
- Converting a VBG into an ABG
ARDS & oxygenation
- ARDS physiology: what is our oxygenation goal?
- Definition issues: ARDS vs. pseudoARDS
- Proning the non-intubated patient
- Oxygen-ICU trial & lower oxygen targets
- APRV: resurrection of the open lung
Extubation
- Cuff leak & extubation
- Nocturnal extubation is OK
- Dexmedetomidine & extubating the agitated patient
- Post-extubation HFNC
NIV & high-flow nasal cannula (HFNC)
- Overview: mastering dark arts of HFNC & BiPAP
- Dexmedetomidine to facilitate noninvasive ventilation
- Post-extubation HFNC
- HFNC for apneic oxyventilation (more about this under Airway above)
- HFNC for hypoxemic respiratory failure
PE
- Diagnosis: EKG patterns of PE that mimic MI
- IVC filters: where is the evidence?
- Thrombolysis
- Submassive PE 2014: PEITHO, MOPETT, ULTIMA, TOPCOAT
- 2016: Controlled thrombolysis I: deconstructing CDT
- 2016: Controlled thrombolysis II: rationale & protocol
- 2017: New paradigm: Getting 'em off the cliff
- Should we monitor fibrinogen during full/half-dose lysis?
- OPTALYSE-PE: We're dosing tPA wrong
- Contraindication checklist for thrombolysis
- Resuscitation: Eight pearls for the crashing PE patient
- Inhaled pulmonary vasodilators: iNope trial
Pleural disease & thoracentesis
Pneumonia
- Community-onset PNA
- Influenza PNA: triple therapy?
- Metabolic resuscitation for severe pneumonia?
- Double-coverage for VAP unnecessary
Respiratory muscle weakness & respiratory drive & hypercapnia
- Tx in Guillain-Barre & Myasthenia
- Optimizing respiratory drive to avoid failure
- Extracorporeal CO2 removal: Putting the cart ahead of the horse
Upper airway disease
⇒ more pulmonology at iBookCC
rheumatology
Angioedema due to ACE-inhibitors
⇒ more rheumatology at iBookCC
toxicology
Insulin poisoning refractory to glucose
Lithium intoxication: dialyze if chronic & asymptomatic?
Osmolal gap dogmalysis
⇒ more cardiology at iBookCC
methodology & miscellaneous
Methodology & statistics
- Type-I error
- Type-II error: Power & inconclusive trials
- Mythbusting sensitivity & specificity
- The fallacy of time-to-intervention studies
Bias
Endpoints
- Chasing mortality endpoints is a fool's errand
- Secondary endpoints: separating wheat vs. chaff
- The inherent myopia of science
Fragility
Philosophy of critical care
- Errors of commission vs. omission
- Why most diagnostic procedures aren't beneficial
- The tale of six blind physicians and the elephant
- Graduation speech: why we resuscitate
Conference notes
- Northern New England Crit Care 2017 (Sepsis)
- Montreal Hospitalist & Resuscitationist Conference 2018
- Northern New England Crit Care 2018 (Delirium)
Translation to other languages
- German (translated by Urban Bromberger)
- French