PulmCrit Instagram Links

Welcome to the PulmCrit Instagram page. This has recent posts with links for further information. –Cheers, josh

HYPERION trial on therapeutic hypothermia for patients with non-shockable cardiac arrest: Link to PulmCrit blog.

CITRIS-ALI: Fresh multi-center RCT of vitamin C in sepsis-induced ARDS: Link to PulmCrit blog

The crashing asthmatic with Leo Stemp: Link to fresh PulmCrit blog.

Anion Gap Metabolic Acidosis (AGMA) – Link to fresh IBCC chapter

CBC case puzzler: Answer to the case here.

Submassive & Massive PE: Link to fresh IBCC chapter

Anticoagulation Reversal: Link to fresh IBCC chapter

How to use IV epinephrine for anaphylaxis: Link to fresh PulmCrit post.

Tumor Lysis Syndrome: Link to fresh IBCC chapter

Vaping Associated Lung Injury (VAPI): Link to IBCC chapter

All things magnesium:

Link to IBCC chapter on hypomagnesemia
Link to IBCC chapter on hypermagnesemia

Large volume thoracentesis: Can we drain 'em dry? Link to fresh PulmCrit post.

Septic Shock: Link to fresh IBCC chapter.

All things angioedema: Link to a fresh IBCC chapter

Reconceptualizing bradykinin-mediated angioedema as a universal vicious spiral: Link to a short PulmCrit post.

Early basal insulin in DKA: Link here to a fresh PulmCrit blog.

Massive hemoptysis: Link here to fresh IBCC chapter

Heat stroke and hyperthermia: Link to new IBCC chapter.

All things alcohol withdrawal: Link to new IBCC chapter

Evidence update on Phenobarbital for Alcohol Withdrawal: Five studies released in the past year: Link to fresh PulmCrit post.

Ascending cholangitis & calculus cholecystitis (community-acquired biliary sepsis): Link to fresh IBCC chapter.

Clostrioides difficile: Link to fresh IBCC chapter.

Rigorous versus lenient spontaneous breathing trials: The answer at last? Link to fresh blog.

Fluid selection & pH-guided resuscitation: Link to fresh IBCC chapter.

TEG to guide transfusion in the coagulopathic cirrhotic: Link to PulmCrit post.

Serotonin Syndrome: Link to fresh IBCC chapter.

Tick-borne illness in the ICU: This will generally mimic sepsis – how can we diagnose it early?

Link here to IBCC chapter.

Myth-busting fluid boluses: This is a common practice, but is it evidence-based?

Link here to PulmCrit blog.

Severe Hepatic Encephalopathy: An organized strategy & agressive approach.

Link here to fresh IBCC chapter.

The Neutrophil/Lymphocyte Ratio (NLR): Free upgrade to your white blood cell count

Link here to fresh PulmCrit blog on the NLR

Rhabdomyolysis: What is really known and what is dogma?

Link here to fresh IBCC chapter.

A pair of new IBCC chapters on all things phosphate:

A patient is admitted in transfer with a kinked introducer catheter (shown above). Does this catheter need to be removed, or can it somehow be salvaged?

Answer here.

Does contrast nephropathy exist? Vigorous debate has been ongoing about this dating back to 2013. Hundreds of studies on the topic ultimately reveal no convincing evidence that contrast nephropathy exists. However, it's unethical to perform a prospective RCT, so it's impossible to ever prove this. This has left us in an evidentiary limbo – we don't really believe that contrast nephropathy exists, but simultaneously we are also afraid of it.

Link to IBCC chapter: The myth of contrast nephropathy

Endocarditis is a classic disease of emergency medicine, inpatient medicine, and critical care. The opioid epidemic has caused a surge of endocarditis diagnoses, reminding us of the myriad ways that this disease can present itself. However, diagnosis remains challenging, as patients with endocarditis may manifest with wholly different presentations (e.g. one patient with a stroke, another patient with cardiogenic pulmonary edema, and a third with septic shock). This chapter focuses a bit on the selection of empiric antibiotic therapies, which is admittedly a grey area (one which most guidelines tend to shy away from).

Link to IBCC chapter: Endocarditis

In order for a diagnostic procedure to actually benefit a patient, more conditions need to be met. This may explain why diagnostic procedures generally cannot be proven to cause clinical benefit in the ICU (e.g. Swan-Ganz catheterization). Alternatively, fewer conditions need to be met for a therapeutic procedure to cause benefit. Overall this implies that exposing a patient to similar peri-procedural risks may be better justified for therapeutic procedures, rather than diagnostic procedures.

Link to PulmCrit post: Why most diagnostic procedures aren't beneficial

fresh chapter on ventricular tachycardia storm (a.k.a. electrical storm). This is a rare and extremely dangerous situation wherein a patient keeps reverting into ventricular tachycardia. ⛈🌩⛈

Link to the IBCC chapter on VT storm

new conceptualization of metformin toxicity: MILA, MALA, & MULA 🤮

Link to the IBCC chapter on metformin poisoning.

do all intubated patients really need a blood gas? for selected patients, end tidal CO2 might be all that is necessary. 💨

Link to slides & links from my talk today about this.

Emerging evidence suggests that we’ve been thinking about penicillin allergy incorrectly for decades.

Link to IBCC chapter on beta-lactam allergies.

case of refractory hypercapnia (pCO2 373 mm!) stabilized with bicarbonate. casts some shade on the use of ECMO for purely hypercarbic respiratory failure 😷

Link to further discussion of the principles behind this crazy case.

Link to the article this case was taken from.