How do you stop hydrocortisone once septic shock has resolved?

I tend to be an abrupt discontinuation kind of person, stop as soon as the pressors are off rather than taper (unless it’s been a prolonged course)

Restrospective evidence 👇

journals.lww.com/ccejournal/f...

Answer: #2 normotensive cardiogenic shock

It’s sneaky, easy to miss but important to identify, diagnose cause, manage and admit to ICU—not the floor tele unit

Occurs in about 12% of CS patients

Mortality 17%

www.jacc.org/doi/10.1016/...

Which has a higher mortality?

1. Patient with EF 30% BP 80/56 with lactic acid 1.8, normal LFTs, and warm extremities

OR

2. Patient with EF 30% BP 100/70 with lactic acid 3.8, elevated LFTs and cool distal extremities

Excited to share our updated review of ECMO for the emergency clinician! Grateful for my excellent co-authors who shared their extensive expertise & time: @skylerlentz.bsky.social, Cameron Upchurch, Jenelle Badulak, Brit Long, and @mgottliebmd.bsky.social

authors.elsevier.com/a/1lFOI2dHVQ...

“the PaO2/FiO2 ratio was significantly lower in the group treated with lower tidal volumes on days 1 and 3” (ARDSnet)

But as we know 28 day mortality was eventually higher in the larger tidal volume group

I wonder what we’re doing now in medicine that is similar?

What in critical care medicine do you think makes the patient look better in the short term but is actually worse in the longer term?

25 yrs ago we might have said look my patient with ARDS and 12 ml/kg tidal volume is oxygenating better, so it must be superior to 6 ml/kg

Intensivists and Respiratory Therapists: 🫁

What’s your go to tidal volume for the patient without ARDS and why?

6 ml/kg PBW
8 ml/kg PBW
10 ml/kg PBW
Something else?

What’s the highest IPAP you’ll use with NIV in a patient with COPD and respiratory failure?

Before this trial I’d stop at ~ 20 cmH20, and think about intubating if not improving

After this trial:

Now up to 30 cmH20 may safely avoid intubation

jamanetwork.com/journals/jam...

The pro argument

www.annemergmed.com/article/S019...

What’s the role of the osm gap in identifying toxic alcohol poisoning?

The con: We say it’s limited and all about the history and clinical course

www.sciencedirect.com/science/arti...

What’s the highest temperature you’ve seen in clinical practice and what was the cause?

🫀What happens when epinephrine is given before defibrillation in VT/VF arrest

journals.lww.com/ccmjournal/a...

Failed extubation?

I like to think of it as an intubation vacation