Currently, three publications are available describing coronavirus outcomes among hospitalized patients in New York: Goyal et al: 393 patients at Cornell. Cummings et al: described 257 patients who were critically ill (among a total of 1,150 patients at Columbia and a community affiliate). Richardson et al: 5700 patients at Northwell Health System (including North Shore […]
Search Results for: ecmo
PulmCrit: A-lines in septic shock: the wrist versus the groin
Historically, emphasis has rested on the distinction between noninvasive versus invasive BP (e.g., cuff pressure vs. radial arterial pressure). Attention focused on whether noninvasive oscillometric BP monitoring is adequate. Meanwhile, it has been assumed that all invasive BP measurement sites are created equal.
PulmCrit: Remdesivir 5-day vs. 10-day trial raises some red flags?
So, Gilead’s first RCT on remdesivir was just published, and it’s very interesting.1 Gilead’s, you say? Yep. The study was designed, monitored, analyzed, and written by Gilead: Before getting into the study, let’s take a moment and think about what Gilead’s first RCT could look like. Gilead knows more about remdesivir than anyone (they built […]
Hypothermia and Post-Arrest Studies
The Biggies TTM Trial TTM Trial Hemodynamics Polderman Editorial on TTM HACA Trial (NEJM 2002;346(8):549) Bernard RCT (NEJM 2002;346(8):557) Meta-Analysis ILCOR Hypothermia Statement ILCOR Post-Arrest Care Statement Lancet Review by Kees Polderman Nuts & Bolts Review by Kees Polderman (Crit Care Med 2009;37(3):1101-1120) Mechanisms of Hypothermia by Kees Polderman Study by Oddi ( )-Included Asystole […]
PulmCrit – Preliminary report on NIAID trial of remdesivir (ACTT-1)
The preliminary report of the Adaptive COVID-19 Treatment Trial (ACTT-1), a multi-center, placebo-controlled RCT on remdesivir is here!1 The one we’ve all been waiting for! Patients Patients were recruited from 60 sites in several countries. Inclusion criteria were patients who were hospitalized due to COVID-19 with evidence of lower respiratory tract infection, defined in terms […]
PulmCrit – Is COVID-19 ARDS, pseudoARDS, L, or H? Physiology data from Boston
There has been considerable speculation in the literature regarding the physiology of intubated patients with COVID, but little actual data. A fresh study describing the physiology of intubated patients at Massachusetts General Hospital and Beth Israel offers to finally answer some questions. This is a retrospective case series involving 66 patients intubated during March 11-30. […]
Malignant Hyperthermia (MH)
CONTENTS Clinical presentation Differential diagnosis Management Podcast Questions & discussion Pitfalls causes & epidemiology Malignant hyperthermia (MH) can be caused by any inhalational anesthetic, other than nitrous oxide.(29600483) MH usually occurs intraoperatively or in the very early postoperative period (up to an hour after finishing anesthesia).(29600483; 32305961) Succinylcholine rarely can cause MH. Patients with central […]
Unfractionated heparin (UFH), LMWH, fondaparinux, argatroban, and bivalirudin
CONTENTS Overview of indirect-acting anticoagulants (heparin & fondaparinux) Risk assessment Basic science – how these agents work Choice of agent Protamine for reversal of unfractionated or low molecular-weight heparin Unfractionated heparin (UFH) Dosing and monitoring of unfractionated heparin Heparin resistance Management Pseudo-heparin resistance Low molecular-weight heparin (LMWH) Various LMWH agents & dosing Enoxaparin dosing & […]
Pulmonary alveolar proteinosis (PAP)
CONTENTS Basics Epidemiology Clinical presentation Radiology Bronchoscopy Laboratory studies Diagnosis Treatment Questions & discussion abbreviations used in the pulmonary section: 7 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AFB: Acid fast bacilli AIP: Acute interstitial pneumonia (Hamman-Rich syndrome) 📖 ANA: Antinuclear antibody 📖 ANCA: Antineutrophil cytoplasmic […]
PulmCrit- Killer resuscitation: Abdominal hypertension as an occult driver of multiorgan failure
Introduction with a clinical conundrum A 66-year-old man is transferred from an outside hospital due to inability to be liberated from the ventilator. He presented a week earlier with pneumonia and sepsis. He received six liters of fluid initially, and has been running net positive 1-2 liters daily since then (for a total of about […]
PulmCrit- Top 10 reasons pulse oximetry beats ABG for assessing oxygenation
What does it mean if PaO2 and oxygen saturation seem to disagree? Do we need to measure an ABG if the oxygen saturation waveform is adequate? What is the best way to measure oxygenation?
Pulmonary & cardiac complications of pregnancy
CONTENTS GENERAL APPROACH History & symptoms Dyspnea Chest pain Cough Hemoptysis ➡️ Palpitations Peripheral edema Physical examination Laboratory tests Common laboratory tests ABG interpretation Radiology Pharmacologic issues in pregnancy Antibiotic ➡️ Anticoagulation & antiplatelets Cardiac medications Steroid Uterotonic medications SPECIFIC DISEASE STATES Airway Asthma Cardiac Acute coronary syndrome (ACS) Aortic dissection Arrhythmias SVT (supraventricular tachycardia) […]
Inhaled Pulmonary Vasodilators
CONTENTS Rapid Reference 🚀 Physiologic effects Specific agents Nitric Oxide (NO) Nitroglycerine Epoprostenol Milrinone Oxygen Contraindications & adverse effects Indications Overall concept – temporary bridge ARDS Pulmonary embolism Decompensated chronic pulmonary hypertension Right ventricular myocardial infarction Podcast Questions & discussion Pitfalls Inhaled pulmonary vasodilators yield three physiological advantages: #1) reduced pulmonary vascular resistance Pulmonary vasodilation […]
EMCrit 318 – SSC Guidelines 2021 – The Good, The Bad, & The Ugly and What You Need to Know in Sepsis Resuscitation
It has been a while since we did a sepsis and septic shock update, so the time has come! No better framework for the discussion than the most recent iteration of the Surviving Sepsis Campaign Guidelines. Foreshadowing: they don’t suck as hard as in prior years.
The Complexity of Simple – Bringing Order to Complex Systems by Chris Hicks
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