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You are here: Home / PulmCrit Table of Contents (TOC)

PulmCrit Table of Contents (TOC)

TOPICS

  • airway & procedures
  • cardiology
  • endocrinology
  • gastroenterology
  • hematology/oncology
  • infectious diseases
  • nephrology
  • neurology
  • pulmonology
  • rheumatology
  • toxicology
  • methodology & miscellaneous

airway & procedures

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Airway pharmacology
  • Medication sequence: rocketamine vs. keturonium
  • Ketamine-tolerant patient
  • Catastrophic complications, ROC vs. SUX
Arterial lines:  wrist versus the groin?
Cricothyrotomy in asphyxial cardiac arrest
Difficult airway communication via allergy list
Drowned airway
  • Large-bore suction strategies & devices
  • Drowned airway algorithm: cut to the chase
ETT depth calculator
  • Endotracheal tube depth
  • Online calculator
Laryngoscopy
  • Pearls from Levitan Airway Course
  • Facial hair & airway management
Preoxygenation, apneic oxygenation, apneic ventilation
  • High-flow nasal cannula
    • 1: preoxygenation using a nasal cannula
    • 2: physiology of apneic oxyventilation
    • 3: disagree with RCT by Vourc'h et al. 4/15
  • 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
    • Update on ultrasonography for line confirmation 10/16
  • Rapid sequence intubation & procedurization
  • Shrug technique for US-guided subclavian lines

cardiology

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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
    • #1: Alternative viewpoint on phenylephrine infusions
    • #2: Oral vasopressors to accelerate liberation from ICU
    • #3: Why we fail at hemodynamics: cognitive errors
    • #4: Epinephrine responsiveness & challenge 
  • Phenylephrine & epinephrine can be infused peripherally
  • Empty IVC & LV doesn't prove volume depletion
  • Central venous oxygen saturation = noise
  • Killer resuscitation: abdominal compartment syndrome
  • Fluid boluses
    • Myth-busting the fluid bolus
    • Fluid boluses before intubation?  PREPARE trial
  • 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
  • 33 vs. 36
    • Top 10 reasons to stop cooling to 33C
    • Pragmatic comparison 33C vs. 36C
  • VSE (vasopressin / steroid / epinephrine)
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

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DKA
  • DKA pearls
  • Dominating the acidosis in DKA
  • ABG/VBG unhelpful in DKA
  • Early basal insulin in DKA (local data)
Insulin poisoning refractory to glucose
⇒ more endocrinology at iBookCC

gastroenterology

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Abdominal compartment syndrome & fluid overload
Cirrhosis
  • Coagulopathy management in cirrhosis
  • Secondary bacterial peritonitis
  • Ultrasound-guided blakemore tube placement
Hematochezia
  • CT angiogram for evaluation of hematochezia
  • New evidence: Jacovides et al 5/15
Nutrition
  • New guidelines simplify ICU nutrition
  • Hypocaloric feeding & tube feed cheat sheet
Pancreatitis
  • Please stop the drowning
  • Hypertriglyceridemic pancreatitis
Stress ulcer prophylaxis (SUP-ICU)
⇒ more gastroenterology at iBookCC

heme/onc

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Coagulation & TEG
  • 1) Coagulopathy management in the bleeding cirrhotic – fundamentals
  • 2) Validation of TEG to guide coagulation management in cirrhosis
WBC count vs. NLR
  • NLR:  Free upgrade to your WBC
  • CBC to diagnose septic shock
Sepsis-associated DIC
TXA
  • CRASH3:  Tranexamic acid for traumatic brain injury

 

⇒ more heme/onc at iBookCC

infectious diseases

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Antibiotic allergy
  • PCN allergy: strategy
  • Ranking antibiotics in order of allergenicity
  • Validation of test-dose strategy for beta-lactam allergy
Antibiotics – specific drugs
  • Azithromycin
    • Azithromycin doesn't cause torsade or cardiac death
    • Brief rant: still no evidence azithro increases mortality
  • Double-coverage?
    • Fluoroquinolone not helpful for double-coverage
    • Double-coverage unnecessary for VAP
  • Fluoroquinolones unhelpful in ICU
  • Piperacillin-tazobactam isn't nephrotoxic
  • Vancomycin pharmacokinetics:  Making vanco great again
  • Antibiotics & delirium (brief rant)
Bacteremia
  • Microarray technology & antibiotic algorithms for bacteremia
Pneumonia
  • Community-onset PNA
    • MRSA coverage: when needed?
    • Treatment overview of severe CAP
    • Ultrasonographic patterns of CAP
    • Comments on new CAP guidelines 2019
  • Influenza PNA: triple therapy?
  • Metabolic resuscitation for severe pneumonia?
  • Ventilator-associated PNA
    • Double-coverage for VAP unnecessary
Sepsis
  • Definitions & guidelines
    • Sepsis 3.0
      • 10 problems with sepsis 3.0 definitions
      • qSOFA fails validation
    • Sepsis 4.0: sepsis-HLH overlap syndrome
    • Mythbusting the Surviving Sepsis 2016 guidelines
    • Petition to retire the surviving sepsis guidelines
    • The Surviving Sepsis 1-hour guidelines are… back?
  • Overview
    • Concept: Renoresuscitation & avoidance of chronic sepsis
    • Strategy: Accelerated goal directed therapy
  • Fluids
    • Myth-busting the fluid bolus
  • 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?
    • CITRIS-ALI:  Can a secondary endpoint stage a coup d'etat?
  • Vasopressors
    • Angiotensin-II:  caveat emptor
    • Epinephrine
      • Epinephrine & significance of lactate
      • Epinephrine challenge in sepsis
    • High-dose vasopressors: never surrender
    • Norepinephrine…early to stabilize MAP
    • Peripheral infusions of phenylephrine, epinephrine
    • Vasopressin
      • Vasopressin… & renal microvascular hemodynamics
      • Vasopressin, vepinephrine, & VANISH
      • VANCS trial: vasopressin for post-CABG shock
Toxic shock syndrome
  • Diagnosis
  • Treatment
⇒ more infectious diseases at iBookCC

nephrology

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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?
Diuresis
  • Diuretic resistance & natriuresis
  • Furosemide stress test to clarify resuscitative goals
  • Furosemide failure:  metolazone vs. IV chlorothiazide (3T trial)
  • Hyperdiuresios: Using hypertonic saline to facilitate diuresis
Hyperkalemia
  • LR is safe in hyperkalemia
  • Management of severe hyperkalemia
  • BRASH syndrome: hyperK + AV blocker
Hyponatremia
  • Emergent tx with bicarb ampules
  • Taking control with DDAVP
  • Unconventional tx with lactulose
  • Controlled aquaresis:  Oral urea
⇒ more nephrology at iBookCC

neurology

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10 dubious beliefs in neurocritical care
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 & post-arrest management
  • 33 vs. 36
    • Top 10 reasons to stop cooling to 33C
    • Pragmatic comparison 33C vs. 36C
    • HYPERION trial:  33C vs… 37C?
  • VSE (vasopressin / steroid / epinephrine)
  • Prophylactic antibiotics after cardiac arrest?  ANTHARTIC study
Antipsychotics
  • Are haloperidol allergies real?
  •  Olanzapine
    • Intravenous olanzapine
    • Update: IV olanzapine & combo vs. mono-tx
  • No more antipsychotics for delirium?
Brain death & flow scans
CNS infections
  • Meningitis can benefit from neurocritical care
  • Encephalitis rule-out: who needs acyclovir?
Delirium
  • Delirium prevention with melatonin?
  • Sleep-protective monitoring
Gag reflex dogmalysis
ICP elevation
  • Hypertonic saline infusion: rant
  • ICP elevation & ocular sonography
Status epilepticus
  • Rapid-sequence termination (2014)
  • Resuscitationist's guide to status
  • All conventional 2nd line anti-epileptics are equally bad:  ESETT trial
Stroke
  • The fragility index of the NINDS trial 
  • Thrombectomy + Thrombolysis for ischemic CVA?
⇒ more neurology at iBookCC

pulmonology

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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

COPD:  Is metoprolol dangerous?  C'mon…

Extubation
  • Cuff leak & extubation 
  • Nocturnal extubation is OK
  • Dexmedetomidine & extubating the agitated patient
  • Rigorous vs. lenient spontaneous breathing trials
  • Post-extubation HFNC
    • HFNC to avoid reintubation
    • HFNC for early ventilator weaning
    • Hernandez 2016-I: low-risk patients
    • Hernandez 2016-II: high-risk patients
NIV & high-flow nasal cannula (HFNC)
  • Overview:  mastering dark arts of HFNC & BiPAP 
  • Dexmedetomidine to facilitate noninvasive ventilation
  • Post-extubation HFNC
    • HFNC to avoid reintubation
    • HFNC for early ventilator weaning
    • Hernandez 2016-I: low-risk patients
    • Hernandez 2016-II: high-risk patients
  • HFNC for apneic oxyventilation (more about this under Airway above)
  • HFNC for hypoxemic respiratory failure
    • HFNC for pneumonia & FLORALI study
    • Does HIGH trial debunk HFNC?
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
  • Pulmonary vasodilators
    • Inhaled pulmonary vasodilators: iNope trial
    • Nebulized nitroglycerine:  The stealth pulmonary vasodilator
  • Resuscitation: Eight pearls for the crashing PE patient
Pleural disease & thoracentesis
  • Post-thoracentesis pneumothorax
  • Large volume thora
    • Large-volume thoracentesis #1
    • Large volume thora 2019: yes we can
  • Ultrasound diagnosis of hemopneumothorax
Pneumonia
  • Community-onset PNA
    • MRSA coverage: when needed?
    • Treatment overview of severe CAP
    • Ultrasonographic patterns of CAP
  • Influenza PNA: triple therapy?
  • Metabolic resuscitation for severe pneumonia?
  • Double-coverage for VAP unnecessary
Respiratory muscle weakness & respiratory drive & hypercapnia
  • Extracorporeal CO2 removal:  Putting the cart ahead of the horse
  • Respiratory drive!
    • Optimizing respiratory drive to avoid failure
    • The crashing asthmatic with Leo Stemp, Weingart's response, Followup comments
  • Tx in Guillain-Barre & Myasthenia
Upper airway disease
  • Angioedema due to ACE-inhibitors
  • Flash cigarette burns: is early intubation needed?
⇒ more pulmonology at iBookCC

rheumatology

(back to contents)


Angioedema due to ACE-inhibitors

How to use IV epinephrine for anaphylaxis

⇒ more rheumatology at iBookCC

toxicology

(back to contents)


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
Insulin poisoning refractory to glucose
Lithium intoxication: dialyze if chronic & asymptomatic?
Osmolal gap dogmalysis
⇒ more cardiology at iBookCC

methodology & miscellaneous

(back to contents)


Methodology & statistics
  • Type-I error
    • Demystifying the P-value
    • Fragility Index & the NINDS trial
    • Interpreting a 2×2 table: P-value, fragility & Bayes
    • 0.050 shades of grey in p-value cutoffs
  • Type-II error: Power & inconclusive trials
  • Mythbusting sensitivity & specificity
  • Timing problems
    • The fallacy of time-to-intervention studies
      • Sepsis research rant:  More fake news
    • Correlation confounded by timing
Bias
  • Investigation bias
  • Conflicts of interest, guidelines, and review articles
Endpoints
  • Chasing mortality endpoints is a fool's errand
  • Secondary endpoints: separating wheat vs. chaff
  • The inherent myopia of science
Fragility
  • The fragility index of the NINDS trial 
  • The hidden fragility of meta-analyses
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
  • Rare catastrophic complications fly under the radar
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)
    • Adrenaline vs. atropine in bradycardic periarrest
    • Therapy for hyperkalemia in the post-kayexalate era
    • BRASH syndrome
    • Lactated ringers is safe in hyperkalemia
    • Dominating the pH in DKA
    • Get SMART:  Balanced crystalloids vs. saline
  • French
    • Lactated ringers is safe in hyperkalemia (@nfkb)

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