Set 1 Question 1: A 50-year-old patient presents with dyspnea. fever, and cough. He started feeling poorly yesterday and has deteriorated steadily since then. His blood pressure is stable and he is requiring two liters of oxygen to maintain his saturation. This is the thoracic ultrasonography, starting at the diaphragm and moving upwards. This […]
green propofol urine
Answer: This is green urine due to a propofol infusion. It is a harmless curiosity that requires no intervention. The mistake here is to freak out about it and stop the propofol infusion, which is unnecessary. Other causes of green urine include pseudomonas infection and various other medications (e.g. promethazine, amitriptyline, indomethacin, various dyes). This […]
Tamiflu / Oseltamivir Evidence (or lack thereof)
Video you Must Watch
EEMCrit conference supplemental reading
Welcome to the supplemental reading around my talks at the EEMCrit Conference. If you have any unanswered questions or discussion points, feel free to comment. It would probably be ideal to comment within the comments section of the relevant blog, but you can put them below too. (1) LR vs. NS for hyperkalemia The initial […]
APRV Guideline
general philosophy Let’s admit it, nobody knows exactly how to set APRV. Numerous protocols and articles recommend different approaches. There has never been a human trial comparing two different APRV protocols, so it’s impossible to dogmatically say whether any protocol is better than any other protocol. The most successful clinical trial of APRV to date […]
Sepsis talk 2017
Welcome to the e-resources for my talk & subsequent panel discussion at the Northern New England Critical Care Conference 2017. Slides from the talk are located here here. Sorry they are black/white, it was the only way to reduce the file size enough to include it here. Full-color pictures of important figures are in the blogs […]
Shock
Set #1: Shock diagnosis Question 1: You are called to evaluate a patient in the emergency department with a terrifyingly huge pulmonary embolism on CT scan. The patient is a previously well 49 year old woman who developed severe gastroenteritis three days ago. She was having difficulty maintaining oral intake so she presented to the […]
Das SMACC Cric Station
In order to maximize hands-on learning time, please, please make it through at least the must-do section. We can’t wait to see you in Berlin. Must Do Learn the Anatomy: Watch Andy Neill’s incredible Surgical Airway Anatomy video so you know where to go Prepare your Brain: Review CricCon2 (we’ll discuss at the session) Learn […]
Platelet Reversal
PATCH Trial Lancet REBEL-EM on Patch
Tube Feed Cheat Sheet
Goal of the tube feed cheat sheet Probably the most important aspects of nutritional care in the ICU are (1) early initiation of enteral nutrition and (2) providing adequate protein. A barrier to these goals is the ability to design a tube feed regimen. If this is difficult, then it will end up on some […]
Doubling down: ultrasound confirms central line position
I reviewed ultrasonography to confirm central line position in 2015 here, reaching these conclusions: It’s OK if the line tip is in the right atrium, superior vena cava, bracheocephalic vein, or subclavian vein. The rapid flush test is adequate to confirm placement within a vein. Line position can be confirmed ultrasonographically as shown here: My experience […]
Update on post-extubation HFNC
Following extubation, noninvasive respiratory support might help patients avoid reintubation. To date, BiPAP is supported by the greatest volume of evidence in this situation. However, it’s often impossible to persuade patients to wear the BiPAP mask, making post-extubation BiPAP a logistic nightmare. It would be nice if there were a RCT comparing HFNC vs. BiPAP… Hernandez 2016-II: […]
Peripheral 3% and 23.4% Hypertonic Saline is Safe
Peripheral 3-7.5% Hypertonic Saline There are still pharmacies that believe that 3% Hypertonic Saline can only be given through a central line. The evidence would go against this assertion: Brenkert TE et al. Intravenous Hypertonic Saline Use in the Pediatric Emergency Department (Pediatr Emer Care 2013;29: 71Y73) Bulger, Eileen M, Susanne May, Karen J Brasel, […]
Archive of Squirts
Get the ECG for PCI CheatSheet
Smith/EMCrit PCI Cheat Sheet
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