theMednetRegister

Internal Medicine

Critical Care   

Questions discussed in this category

In a patient with severe hyponatremia and acute kidney injury in the setting of hypovolemic shock, would fluid resuscitation take precedence over the rate at which sodium is corrected?
3 Answers available
Which biomarkers or diagnostic tools do you prioritize to support the decision to start antifungal treatment in septic patients with no clear source of infection but at high risk for fungal infections?
2 Answers available
Do you use steroids in the management of PJP pneumonia with severe hypoxia in HIV negative patients?
Data on the role of steroids in HIV negative patients with PJP has been conflicting.
2 Answers available
Do you use or recommend clinical severity scores or other parameters in helping prognostication in patients with refractory status epilepticus?
1 Answer available
What is your hemoglobin target for PRBC transfusion in cases of acute brain injury?
Have recent trials (TRAIN trial and HEMOTION trial) influenced your approach? 
1 Answer available
What are some important considerations for use of ACE inhibition in scleroderma renal crisis patients who require dialysis?
For example, is captopril dialyzable? 
1 Answer available
Do you recommend early oral nutrition when managing diabetic ketoacidosis?
Some data showed early enteral nutrition improves outcomes in DKA. Some thought that enteral nutrition could counteract the insulin gtt.
1 Answer available
Do shorter door-to-balloon (D2B) times impact outcomes in STEMI, if it's already less than 90 minutes, and to what degree (i.e., 30 vs 60 minutes would have a more significant impact)?
1 Answer available
What is your blood pressure or mean arterial pressure goal in a critically ill patient with acute kidney injury?
1 Answer available
What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?
1 Answer available
What is the upper limit of blood glucose target in hyperglycemic critically ill patients?
The new SCCM guidelines suggest an upper limit of 200 compared to the conventional 180.
1 Answer available
How do you identify which patients are at highest risk for decompensation and most likely to benefit from NIV for pre-oxygenation prior to intubation?
2 Answers available
Does the experience level of the intubation operator affect outcomes related to pre-oxygenation with NIV versus an oxygen mask?
2 Answers available
Does the use of NIV for pre-oxygenation delay the time to intubation?
2 Answers available
What factors do you consider for patients on an individual basis when establishing a post-cardiac arrest MAP goal after ROSC is achieved, considering some may benefit from higher MAP goals for optimal cerebral perfusion?
1 Answer available
What blood pressure targets do you enforce in the first 24-48 hours in a patient who develops an intracranial hemorrhage after mechanical thrombectomy?
Blood pressure targets for ischemic stroke and intracerebral hemorrhage are described in several guidelines. However, in patients with acute stroke wh...
2 Answers available
What recommendations do you have regarding the use of dronabinol to prevent cannabis withdrawal in an inpatient medical or psychiatric setting?
1 Answer available
What are the logistical challenges and time constraints of implementing NIV for pre-oxygenation in emergency settings compared to oxygen masks?
1 Answer available
Would bag-mask ventilation with a PEEP valve be a reasonable alternative to NIV for pre-oxygenation prior to intubation in settings where NIV is not easily accessible?
1 Answer available
Is there a subset of patients in whom pre-oxygenation with NRB or BVM could be safely pursued?
1 Answer available
Do you administer calcium to patients with K > 6.5 without EKG changes?
3 Answers available
When attempting PEEP titration, how long do you wait after decrements or increments to assess for a change in driving pressure?
2 Answers available
Do you routinely perform echocardiography in patients with Staphylococcus aureus bacteremia deemed low risk for metastatic infection, or do you selectively omit it based on specific clinical criteria?
Hendriks, et al., PMID 38576380
2 Answers available
What are first-line choices for vasopressors/inotropes to use in hypotensive patients with Eisenmenger Syndrome?
1 Answer available
How do you approach determining appropriateness for extubation in a patient with acute respiratory failure in the setting of known chronic neuromuscular disease?
1 Answer available
Do you use absolute random cortisol levels or delta cortisol levels after ACTH stimulation to diagnose adrenal insufficiency in the critically ill?
2 Answers available
Do you ever start a ketogenic diet in patients who present with status epilepticus admitted to the ICU?
1 Answer available
In which cases would you consider early transition to DOAC (within 72 hours) for hospitalized patients with intermediate or high risk PE?
Assume thrombolytics are not indicated. Do you favor early DOAC transition after 24-48 hours of heparin gtt or do you favor LMWH for 10-14 days follow...
2 Answers available
How do you adjust your management strategy to address the unique needs of anuric end-stage kidney disease patients when treating diabetic ketoacidosis?
1 Answer available
In a patient with acute stroke/ICH/SDH/hyperammonemia at risk for rebound edema with new onset renal failure, do you prefer CRRT versus low and slow HD? How frequently do you monitor osmolarity?
1 Answer available
In drawing blood cultures from a central line to evaluate for CLABSI, do you advise drawing separate blood cultures from each port in case of dual or triple lumen line?
If yes, what is the rationale for doing that? 
3 Answers available
Do you continue to prone patients with severe ARDS after initiation of VV-ECMO?
1 Answer available
Can intra-abdominal pressure serve as a surrogate for pleural pressure to titrate PEEP in obese patients or those with intra-abdominal hypertension?
1 Answer available
Is the adage “If GCS <8, intubate” still relevant for non-TBI patients?
Do the findings of the NICO trial influence your stance?
2 Answers available
When do you consider ketamine to treat nonconvulsive status epilepticus?
1 Answer available
Is there still a role for direct laryngoscopy in the intubation of patients in the ICU?
Multiple recent trials have shown higher first pass success rate with VL over DL.
1 Answer available
Have you incorporated the use of linezolid in lieu of vancomycin plus clindamycin for empiric treatment of necrotizing fasciitis?
1 Answer available
Do you administer prophylactic antibiotics to prevent VAP following intubation in patients with acute brain injury?
Do the findings of the PROPHY-VAP trial influence your approach?
2 Answers available
Do you choose an antibiotic with CSF penetration, such as nafcillin over cefazolin, in the setting of MSSA endocarditis with septic emboli to the brain (assuming no concomitant meningitis or brain abscess)?
3 Answers available
Do you consider use of convalescent plasma early in disease course in COVID-19 induced ARDS in mechanically ventilated patients?
Do the results of the recent study (Misset et al., PMID 37889107) showing reduction in 28-day mortality in patients with high neutralizing antibody ti...
1 Answer available
Do you recommend careful correction of serum sodium to avoid osmotic demyelination syndrome in patients who are found to have isoosmolar hyponatremia in the setting of an elevated BUN level?
2 Answers available
What is your approach to withdrawal of ventilatory support at the end of life?
Do you favor gradual reduction in oxygen and pressure support with intermittent medication as needed or immediate extubation with peri-extubation medi...
1 Answer available
What is the expected timeframe one would expect to see paroxysmal sympathetic hyperactivity/sympathetic storming persist post-traumatic brain injury?
For example, in the setting of TBI, how do you guide the duration of the medical treatment?
2 Answers available
What is your approach to treatment of patients with fulminant C difficile infection who required ileostomy creation or colectomy?
Is there a role for oral vancomycin in these patients, or is oral vancomycin redundant if other routes of administration are being used (i.e intracolo...
1 Answer available
Do you recommend automatically starting CRRT anticoagulation when initiating CRRT if there are no medical contraindications to anticoagulation?
1 Answer available
Has your management of severe hyponatremia changed after a recent observational study described higher in-hospital mortality for sodium correction of <6 mEq/L compared to 6-10 mEq/L in the first 24 hours?
Seethapathy et al., NEJM
5 Answers available
How do you manage concurrent nonlife-threatening hemoptysis and acute pulmonary embolism?
Estimating blood loss from hemoptysis is not always reliable. The bleeding may be due to the PE itself. Is anticoagulation with any degree of hemoptys...
1 Answer available
For patients with suspected complement-mediated TMA, are there specific clinical or laboratory parameters that can help guide the decision for starting empirical treatment (e.g., eculizumab) while awaiting the results of complement testing?
1 Answer available
Is there a role for repeat surveillance blood cultures in patients with prosthetic valve endocarditis without associated cardiac abscess after a 6 week course of antibiotic treatment without surgical intervention?
1 Answer available
In what clinical scenarios do you utilize post-cardiac arrest targeted temperature management (TTM)?
In the span between the HACA trial and the Targeted Temperature Management in Out-of-Hospital Cardiac Arrest study (Dankiewicz et al., PMID 34133859),...
1 Answer available
Do you routinely use 3% sodium chloride and desmopressin to correct hypovolemic hyponatremia in an asymptomatic patient with serum sodium of less than 120 mEq/L?
3 Answers available
In patients being evaluated for brain death, which abnormal movements are definitively known to still be consistent with brain death and which are possibly consistent with brain death but lack definitive evidence?
What are the sources for this and are they reliable by today’s standards? Numerous case series report various abnormal movements but how reliabl...
1 Answer available
Should checking a urinalysis with reflex to culture be part of the standard work up for fever in an ICU patient with a urinary catheter?
2 Answers available
What patient factors, if any, would lead you to extubate a patient at high risk of extubation failure to AVAPS rather than BIPAP?
1 Answer available
What factors do you consider while selecting high risk patients for prophylactic NIV after planned extubation?
1 Answer available
What is your preferred mechanism for venting the left ventricle in patients on VA-ECMO?
2 Answers available
What would be your second pressor of choice if patients with LVOT obstruction remain persistently hypotensive on phenylephrine?
1 Answer available
Do you use FVIII levels to differentiate between DIC and coagulopathy of liver disease?
Common thought is that FVIII may be used for differentiating coagulopathy in liver disease (normal to increased, from reduced clearance of VWF/FVIII) ...
4 Answers available
Do you perform PEEP titration while patients are proned?
1 Answer available
Do you add fludrocortisone to hydrocortisone when starting stress dose steroids in a patient with septic shock?
Though there is data to support using both hydrocortisone and fludrocortisone, it seems to be used rarely in clinical practice. A review publishe...
1 Answer available
Does your approach to extubating obese patients differ from your approach in non-obese patients?
1 Answer available
Do you routinely use vasopressin in the management of RV failure leading to shock state in the absence of an obvious treatable cause such as infarction or PE?
2 Answers available
What are best practices in management of severe acute infusion reaction from infliximab?
Patient became acutely flushed, developed severe and prolonged hypotension with brief loss of consciousness, dizziness, nausea, dry heaves and headach...
1 Answer available
When do you consider the use of corticosteroids in patients diagnosed with EVALI?
1 Answer available
What is your approach to volume resuscitation in patients with obvious septic shock but also with a component of suspected cardiogenic shock?
4 Answers available
Do you increase sedation or consider the use of neuromuscular blockade to prevent potential self-induced lung injury in patients with high respiratory drive?
2 Answers available
Do you attempt more aggressive PEEP titration to improve the P/F ratio prior to proceeding with proning in patients with ARDS and P/F <150?
1 Answer available
Do you discontinue proning due to a perceived lack of response to intervention in a patient with ARDS?
2 Answers available
What strategies do you employ to prevent post-intubation hypotension in a profoundly hypoxic patient given a paralytic for intubation?
1 Answer available
Do you use continuous or intermittent bronchodilator therapy in severe airway obstruction?
1 Answer available
Do you routinely start full dose anticoagulation in new onset atrial fibrillation in the ICU?
2 Answers available
Do you transfuse platelets prior to central line placement in patients with platelet counts less than 50,000?
1 Answer available
What is your approach to PEEP titration in the management of a morbidly obese patient with ARDS?
1 Answer available
Do you routinely use inhaled pulmonary vasodilators in the management of patients with ARDS with refractory hypoxemia?
1 Answer available
Do you start steroid therapy in a patient with pure ARDS without septic shock, or would you only consider steroids only in those with severe community acquired pneumonia?
To help interpret clinical applications of the CAPE COD (2023) and DEXA ARDS (2020) trials.
2 Answers available
What is your threshold to start stress dose steroids in the management of patients with septic shock?
Do you do start therapy at a certain vasopressor requirement?
2 Answers available
What is your perspective on the role of respiratory therapists in managing a patient who is dyssynchronous on their current mode of mechanical ventilation?
Do your respiratory therapists independently adjust ventilator settings without direct physician involvement?
2 Answers available
Do you use steroids in patients with respiratory failure who are infected with both influenza and COVID-19?
How do you approach which risk to accept given that steroids have evidence for use in COVID-19 while is suggestion for harm in using steroids in influ...
1 Answer available
How do you complete brain death testing in patients who cannot tolerate apnea testing and are unable to transport for ancillary testing?
For instance, if the patient doesn’t tolerate apnea testing, is too unstable to go for ancillary testing outside the ICU, and TCDs/EEG are unava...
5 Answers available
What steroid regimen do you employ prior to extubating a patient who does not have a suitable cuff leak?
2 Answers available
What steroid regimen do you use in patients with both septic shock and ARDS?
Do you use hydrocortisone 200 mg/day as studied in ADRENAL/APROCCHSS or dexamethasone 20 mg/day as studied in DEXA-ARDS?
2 Answers available
What are your preferred ventilatory settings/mode(s) for patients with acute hypoxic respiratory failure presenting with severe biventricular dysfunction in cardiogenic shock?
1 Answer available
How would you manage immune check point inhibitor induced capillary leak syndrome refractory to IVIG monotherapy?
1 Answer available
Do you ever employ the use of prolonged periods of pressure support ventilation as means of "weaning" in the management of patients with acute respiratory failure?
1 Answer available
Do you employ the use of external chest compression with sandbags in the management of patients with severe ARDS who are not candidates for proning?
1 Answer available


Papers discussed in this category

JAMA,
Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project.
Crit Care, 2021 Jul 28
Improving lung compliance by external compression of the chest wall.
Chest, 2010-05
Extubation of patients with neuromuscular weakness: a new management paradigm.
Chest, 1996 Dec
Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure. A different approach to weaning.
Journal of critical care, 2011 Jan 26
Prevention of extubation failure in high-risk patients with neuromuscular disease.
The Journal of clinical endocrinology and metabolism, 2022 Jun 16
Critical Illness-induced Corticosteroid Insufficiency: What It Is Not and What It Could Be.
JAMA cardiology, 2016-09-01
Practice Patterns and Outcomes Associated With Use of Anticoagulation Among Patients With Atrial Fibrillation During Sepsis.
Revista Brasileira de terapia intensiva, 2022 Jan 24
Super-refractory status epilepticus and ketogenic diet in intensive care: a series report.
Journal of clinical medicine, 2021 Feb 22
Pearls and Pitfalls of Introducing Ketogenic Diet in Adult Status Epilepticus: A Practical Guide for the Intensivist.
Hepatology, 1996 Jun
Coagulation factor V levels as a prognostic indicator in fulminant hepatic failure.
Hepatology, 1986 Jul-Aug
Multivariate analysis of prognostic factors in fulminant hepatitis B.
Gut, 1992 Jan
Coagulation factor V and VIII/V ratio as predictors of outcome in paracetamol induced fulminant hepatic failure: relation to other prognostic indicators.
The New England journal of medicine, 2002-02-21
Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.
N Engl J Med, 2013 Nov 17
Targeted temperature management at 33°C versus 36°C after cardiac arrest.
Cureus, 2022 Sep 11
Targeted Temperature Management After Cardiac Arrest: A Systematic Review.
Crit Care, 2020 Jan 06
High Quality Targeted Temperature Management (TTM) After Cardiac Arrest.
JAMA, 2005-10-05
Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial.
Trials, 2016 Jul 22
Evaluating the efficacy of dexamethasone in the treatment of patients with persistent acute respiratory distress syndrome: study protocol for a randomized controlled trial.
N Engl J Med, 2023 Mar 21
Hydrocortisone in Severe Community-Acquired Pneumonia.
Circulation, 2015 Sep 15
Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association.
The Annals of thoracic surgery, 2017 Feb 04
Surgical Versus Medical Therapy for Prosthetic Valve Endocarditis: A Meta-Analysis of 32 Studies.
European heart journal, 2023 Oct 14
2023 ESC Guidelines for the management of endocarditis.
The American journal of gastroenterology, 2003 Jun
The incidence and management of infusion reactions to infliximab: a large center experience.
The Journal of rheumatology, 2015 Jun 15
Incidence and Management of Infusion Reactions to Infliximab in a Prospective Real-world Community Registry.
The American journal of medicine, 2016-05
Diagnosing and Treating the Syndrome of Inappropriate Antidiuretic Hormone Secretion.
Clinical journal of the American Society of Nephrology : CJASN, 2018-07-06
Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia.
Journal of critical care, 2023 May 13
Effects of correction rate for severe hyponatremia in the intensive care unit on patient outcomes.
The Journal of urology, 1992-06
Functional obstructive uropathy: a significant factor in the hyponatremia of psychogenic polydipsia?
Journal of the American Heart Association, 2024 Jan 19
Impella Versus Intra-Aortic Balloon Pump in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: An Observational Study.
Perfusion, 2021 Jul 28
Veno-arterial extracorporeal membrane oxygenation with concomitant Impella versus concomitant intra-aortic-balloon-pump for cardiogenic shock.
Current problems in cardiology, 2022 Sep 26
Impella Versus Extracorporeal Membranous Oxygenation (ECMO) for Cardiogenic Shock: A Systematic Review and Meta-analysis.
JAMA internal medicine, 2023 May 01
Comparative Effectiveness of Fludrocortisone and Hydrocortisone vs Hydrocortisone Alone Among Patients With Septic Shock.
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2013-04
Hypertonic saline and desmopressin: a simple strategy for safe correction of severe hyponatremia.
Critical care (London, England), 2021 Aug 31
To prone or not to prone ARDS patients on ECMO.
Neurocritical care, 2005
Brain death-associated reflexes and automatisms.
Clinical neurophysiology practice, 2022 May 16
Spinal reflexes and brain death.
Respirology (Carlton, Vic.), 2018 Jul 16
Pulmonary infarction: A disease of the (mostly) young.
The Journal of infectious diseases, 1980 Mar
A study of cephalothin and desacetylcephalothin in cerebrospinal fluid in therapy for experimental pneumococcal meningitis.
Antimicrobial agents and chemotherapy, 1976 Sep
Pharmacological study of cefazolin during intermittent and continuous infusion: a crossover investigation in humans.
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2020 May 08
Should we reconsider cefazolin for treating staphylococcal meningitis? A retrospective analysis of cefazolin and cloxacillin cerebrospinal fluid levels in patients treated for staphylococcal meningitis.
The Lancet. Infectious diseases, 2020 Dec 14
Effectiveness of adjunctive clindamycin in β-lactam antibiotic-treated patients with invasive β-haemolytic streptococcal infections in US hospitals: a retrospective multicentre cohort study.
Open forum infectious diseases, 2023 Nov 24
Comparison of Adjuvant Clindamycin vs Linezolid for Severe Invasive Group A Skin and Soft Tissue Infections.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2009-07-01
Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America.
Open forum infectious diseases, 2024 May 02
Should Blood Cultures Be Drawn Through an Indwelling Catheter?
Journal of palliative medicine, 2003 Oct
Ventilator withdrawal protocol.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2018-05-17
Detecting Infections Rapidly and Easily for Candidemia Trial, Part 2 (DIRECT2): A Prospective, Multicenter Study of the T2Candida Panel.
JAMA, 2023 Dec 19
Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning: A Randomized Clinical Trial.
The New England journal of medicine, 2013-09-05
Door-to-balloon time and mortality among patients undergoing primary PCI.
The Lancet. Haematology, 2021 Aug 04
Early switch to oral anticoagulation in patients with acute intermediate-risk pulmonary embolism (PEITHO-2): a multinational, multicentre, single-arm, phase 4 trial.
Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 2023 Jan-Dec
Retrospective Analysis of Direct-Acting Oral Anticoagulants (DOACs) Initiation Timing and Outcomes After Thrombolysis in High- and Intermediate-Risk Pulmonary Embolism.
The New England journal of medicine, 2024 Jun 13
Noninvasive Ventilation for Preoxygenation during Emergency Intubation.
Critical care medicine, 2019 Apr
Compared Efficacy of Four Preoxygenation Methods for Intubation in the ICU: Retrospective Analysis of McGrath Mac Videolaryngoscope Versus Macintosh Laryngoscope (MACMAN) Trial Data.
European journal of anaesthesiology, 2015 Dec
Preoxygenation by spontaneous breathing or noninvasive positive pressure ventilation with and without positive end-expiratory pressure: A randomised controlled trial.
The American journal of emergency medicine, 2016 May 28
The utility of noninvasive nasal positive pressure ventilators for optimizing oxygenation during rapid sequence intubation.
Diabetes care, 2024 Aug 01
Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.

Related Topics in Internal Medicine

Copyright © 2024 theMednet
All Rights Reserved.