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 […]
COVID19 Pulm Fellows Seminar
ESICM Seminar on COVID Ventilation Subtypes of COVID Mild Silent Hypoxemia (can cause iatrogenic injury) Indolent Fine then Not (Intubated or Not-Inflammatory Markers) Hyperacute Cytokine Storm / Hemophagocytic Lymphohistiocytosis (HLH) / DIC PathoPhys Loss of hypoxic vasoconstriction Micro-thrombotic disease Avoidance of Intubation tachypnea, hypoxemia, do not seem to be indication Mental […]
Anecdotal Evidence on EMCrit CPAP Set-Up
I will be posting any relayed cases of use of the EMCrit CPAP set-up here: from an ED Doc 3-25-20 This is such a game changer in my shop. I think it will truly save lives and unnecessary tubes/bed allocation. We used this today successfully on COVID Pt in our ED, with short extension […]
How should we manage COVID DIC??
This is a comments/discussion page for folks to weigh in on how they are managing COVID-19 DIC. The section in the IBCC discussing this can be found here. Whenever possible, please cite relevant literature and list your name/affiliation. Thanks for sharing your insights!
Lopinavir in COVID-19
This is some old material on lopinavir for COVID-19. I’ve removed it from the main chapter because it doesn’t appear to work. For the sake of interest, here it is: general description This is a combination of antiviral agents used in treatment of HIV (including post-exposure prophylaxis following needle-stick injury). Compared to remdesivir, lopinavir/ritonavir has […]
REBOA for Non-Traumatic (Medical) Cardiac Arrest
Literature Brede et al. Levis et al. Pilot Study Review Article Daley et al. How to educate for prehospital REBOA Other Posts Thinking CC on Medical Arrest REBOA EDECMO on Medical Arrest REBOA
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