Clik here to view.
Brief rant: Still no evidence that azithromycin increases mortality
IntroductionIt has long been known that some macrolides (e.g. erythromycin) cause torsade de pointes. However, azithromycin has a much lower affinity for cardiac potassium channels than erythromycin,...
View ArticleClik here to view.
Investigation Bias: The freakonomics of when industry choses to sponsor a...
Background: Publication biasOver the last several years, publication bias has received a considerable amount of attention. In its most blatant form, this is when a drug company sponsors several...
View ArticleClik here to view.
Treatment of hemodynamically stable new-onset AF in critical illness
Introduction with a clinical questionA 50-year-old woman with no prior medical problems was admitted to Genius General Hospital with severe influenza pneumonia and acute kidney injury. She was...
View ArticleClik here to view.
Magnesium infusions for atrial fibrillation & torsade
Introduction: Perpetual controversyThe use of magnesium for AF has been a controversial topic for decades. Magnesium is a normal electrolyte, so it is cheap and has an excellent safety profile....
View ArticleClik here to view.
2015 ACLS Guidelines: What happened to VSE?
IntroductionIn 2008 and 2013, two prospective RCTs from Greece reported benefits from the combination of vasopressin, steroids, and epinephrine (VSE) for in-hospital cardiac arrest. However, other...
View ArticleClik here to view.
Phenobarbital monotherapy for alcohol withdrawal: Simplicity and power
Case example A middle-aged man was admitted to the ICU for refractory alcohol withdrawal. Prior to arriving in the ICU he had been treated aggressively with an escalating regimen of IV diazepam,...
View ArticleClik here to view.
The SPLIT trial: Internal vs. external validity
IntroductionResuscitation with large volumes of normal saline (NS) causes hyperchloremic metabolic acidosis. Some evidence suggests that hyperchloremic metabolic acidosis may impair renal function,...
View ArticleClik here to view.
Recognizing and managing paradoxical reactions from benzodiazepines & propofol
A perplexing caseA young man with a history of seizures and alcoholism presented with a generalized seizure. His seizure responded to lorazepam, but he was intubated for airway protection and was...
View ArticleClik here to view.
Unconventional therapies for hyponatremia: Thinking outside the collecting duct
Case: An unusual ICU referralSome years ago at Genius General Hospital, the ICU was asked to accept a patient from the medicine ward with cirrhosis, confusion, and hyponatremia (Na 125 mM) for...
View ArticleClik here to view.
Taking control of severe hyponatremia with DDAVP
Introduction with a caseImagine an elderly patient presenting with hypovolemic hyponatremia (sodium of 115 mM) and moderate confusion. How would you treat this patient?The typical approach might be a...
View ArticleClik here to view.
Emergent treatment of hyponatremia or elevated ICP with bicarb ampules
Introductory caseA young 70-kg man was transferred to the Genius GeneralICU for management of stupor. He had been diagnosed with aortic valve endocarditis due to heroin abuse two weeks earlier, but...
View ArticleClik here to view.
The tale of six blind physicians and the elephant
An elderly man was admitted to the ICU and evaluated by six blind physicians.The blind cardiologist noted that the patient had a malignant pericardial effusion with tamponade. She recommended an...
View ArticleClik here to view.
Proposal: Early ventilator weaning to HFNC in hypoxemic respiratory failure
Case exampleA previously healthy 45-year-old man was transferred to the Genius General Hospital ICU for management of pneumonia. He was intubated prior to transfer due to hypoxemia (details...
View ArticleClik here to view.
Hypocaloric Nutrition: Theory, Evidence, Nuts, and Bolts
IntroductionUntil recently there has been little evidence regarding the caloric target for feeding critically ill patients. In the absence of evidence, it has been assumed that we should aim to meet...
View ArticleClik here to view.
Flash cigarette burns: To intubate or not to intubate?
Getting warmed up with a multiple-choice questionA 70-year-old man with oxygen-dependent COPD is admitted following a flash burn. He started smoking with his oxygen running, and the cigarette...
View ArticleClik here to view.
Dear NEJM: We both know that conflicts of interest matter.
IntroductionRecently the New England Journal of Medicine launched a media campaign challenging the negative perception of industry conflicts of interests (COI). This was surprising, because it is the...
View ArticleClik here to view.
Pneumonia, BiPAP, secretions, and HFNC: New lessons from FLORALI
IntroductionPneumonia is extremely common. Nonetheless, there is surprisingly little evidence about supporting pneumonia patients using bi-level positive airway pressure (BiPAP) or high-flow nasal...
View ArticleClik here to view.
Top 10 reasons to stop cooling to 33C
IntroductionFollowing the Nielsen study, many hospitals developed two protocols for temperature management after cardiac arrest (33C or 36C). For example, the 36C protocol could be used for patients...
View ArticleClik here to view.
Apneic ventilation using pressure-limited ventilation
IntroductionNoninvasive ventilation (i.e. BiPAP) is arguably the most powerful approach to optimize oxygenation and ventilation before intubation, given its ability to provide 100% FiO2, PEEP, and...
View ArticleClik here to view.
What is the evidence behind the IVC filter?
IntroductionUntil recently, recommendations regarding IVC filters have been based predominantly on a singleRCT (PREPIC-1). Last week, a second RCT was released in JAMA (PREPIC-2). This post will...
View Article![BLACKPINK – DEADLINE – EP [iTunes Plus M4A]](http://is1-ssl.mzstatic.com/image/thumb/Video211/v4/de/b3/b1/deb3b1d4-ba28-22e8-2428-ef97617b2a4b/90d54d743002a6d66308f217cd867947_Preview_Image_Intermediate_nonvideo_sdr_426725135_2574858051.png/316x316bb.webp)
