Critical Care

Critical Care Controversies! Vitamin C+Thiamine+Hydrocortisone for Severe Sepsis and Septic Shock

Can cheap, safe infusions of vitamins really succeed where so many hundreds of novel therapies have failed? The recent article in Chest by Dr. Paul Merik has taken the critical care world by storm, with reported mortality rates of 8.5% in patients treated with a simple vitamin C/thiamine cocktail (with none of the deaths directly attributable to sepsis). The skepticism and push-back have been nearly unprecedented, especially on #FOAMed. Whether you're a skeptic or an early adopter, you need to understand the basis for the debate by checking out this high-yield summary.

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Back to Basics: Open & Depressed Skull Fractures

This post is not intended to be a comprehensive review of skull fracture types and management, but rather a discussion of two subtypes of skull fracture – open and depressed fractures.  I chose this topic because it’s something I saw frequently during my recent elective working in an emergency department in Kumasi, Ghana.  In the United States at trauma centers these patients are frequently managed immediately by neurosurgery; however, with few consultants available, I was able to be more involved in the prolonged care of these patients. If faced with these types of severe head/skull injuries in a community hospital, it is important to feel comfortable with the initial management.  

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Advanced Procedures: How to Create a Pericardiocentesis Model

Pericardiocentesis is a rarely performed, but potentially life-saving procedure. Commerical models are prohibitively expensive, but students and residents (and critical care fellows) still need to learn the mechanics, ideally with an ultrasound compatibile model. This week's post gives a step by step guide towards making a cheap, easy to fabricate phantom based on this fantastic paper published in the Journal of Emergency Medicne 2012: https://www.ncbi.nlm.nih.gov/pubmed/21925818

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