Part 1 The Acid Base Series For the next part of the series, you will need a print out of this sheet: EMCrit Acid-Base Sheet This lecture discusses a quantitative approach to acid base management. This is also known as the Fencl-Stewart approach, the strong-ion approach or the physicochemical approach. It provides explanations for […]
Fantastic Twitter Thread on VEXUS
Gear for Video Conferencing, Podcasting, and Zoom
Here are the recommended mics for podcasters On a Budget Audio Technica ATR2100USB This probably the least expensive of the excellent microphones out there–none better for bang-for-the-buck. It can be used as plug & play USB and then when you become more advanced, it can plug into a mixer with XLR. If you will be […]
Pulse Oximetry Questions!
#1) Match the oxygen titration curves below with the following five patients: (a) Carboxyhemoglobin poisoning. (b) Methemoglobinemia. (c) Aspirated foreign body completely occludes the right lower lobe bronchus. (d) Asthma exacerbation. (e) Bronchopneumonia, with CT scan showing some areas of mildly affected lung and some areas of completely consolidated lung. #2) List situations in which […]
Error in capnography infographic
Question: What is the error in this infographic? According to the infographic, cardiac arrest causes a sudden complete loss of waveform. This isn’t correct. Cardiac arrest will cause a prompt downtrending etCO2 tracing (the pattern shown in the bottom right box). This is clinically important because if a patient in cardiac arrest is intubated, there […]
AF with high VCO2 due to thyroid storm
Question: a patient presents with AF, eventually leading to intubation. is this a primary cardiac problem, or is the AF secondary to an underlying disease? The answer is hiding on this ventilator screen! Answer: The key finding here is the volumetric capnography data at the bottom right of the ventilator screen showing a VCO2 to […]
COVID 19 ICU/stepdown management
CONTENTS: Management of COVID-19 patients admitted to stepdown or ICU Link to full chapter here (more complete – but longer). Preamble & caveats Initial tests to guide management Organ support Cardiovascular Respiratory Noninvasive respiratory support Invasive mechanical ventilation Infectious disease – antibiotics Renal Hematology Neurology Immunomodulation Steroid Tocilizumab Baricitinib Things that don’t work Remdesivir Convalescent […]
COVID 19 Complete Chapter
CONTENTS Basic biology Infection control Transmission Personal protective equipment (PPE) Diagnosis Signs & symptoms Labs Imaging CXR & CT scan Lung ultrasonography General approach to imaging Bronchoscopy Diagnostic approach for admitted patients Treatment: General protocols ED patients getting admitted to the hospital Inpatient management of hypoxemic, non-intubated patients Intubated patients Treatment: Specific anti-viral & immunosuppressive […]
Blood Pressures for Stroke Syndromes
Dueling pacemakers
A stable ICU patient had the following two EKGs obtained within minutes of each other. Can you guess what is going on? Answer: The EKG in sinus rhythm reveals a LAD occlusion status post reperfusion in the cath lab. There are some Q-waves and a wee bit of residual ST elevation. T-wave inversion reflects reperfusion. […]
Mystery Post-Arrest EKG
Clinical Challenge: A patient presents to Genius General Hospital status post cardiac arrest with the following EKG. What do you think is going on? What would your next management steps be? Answer: The cause of the ST elevation here […]
EKG answer – hyperkalemia and hypercalcemia
The patient has hyperkalemia (7.1 mM) and hypercalcemia (total calcium 13.1 mg/dL). Hyperkalemia is suggested by the somewhat peaked T-waves. A bit subtle, but I think it’s there (exactly when T-waves become peaked seems to be in the eye of the beholder). Hypercalcemia is suggested by the short ST segments (in some leads, the QRS […]
Hydroxychloroquine in COVID-19
general description Hydroxychloroquine is typically used for treatment of malaria, SLE, or rheumatoid arthritis. It has anti-viral activity in vitro, as well as anti-inflammatory activities. mechanism of action appears similar Multiple mechanisms of anti-viral activity, including: Interference with the cellular receptor ACE2 (potentially making it particularly effective against SARS and COVID-19). Impairment of acidification of […]
COVID Links
Hopkins COVID Map Stanford COVID Evidence Page Rural Environs CrisisEM
How to configure viral filters on a CPAP or BiPAP circuit
I’ve received several questions on twitter about this. There are a variety of ways to do it, depending on available materials… (1) Filter attached directly to the mask The simplest way to achieve this is to attach the filter directly to the mask, as shown below. This should work well – provided that the filter […]
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