Rising Lactate & the Art of Venous Blood Gas Interpretation

A 23 year old woman is admitted with severe abdominal pain following 5 days of profound non-bloody diarrhea and 72 hours of recalcitrant non-bloody emesis.  She has lost 7 pounds in this time frame and has been unable to maintain oral hydration.  Her eyes are sunken and her vital signs are notable for a heart [... read more]

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FAQ: How To Study for the Critical Care Medicine Board Examination?

"Let the wild rumpus start!" -Maurice Sendak Many of you are preparing for the Critical Care Medicine Board Examination; thank you to those who have downloaded my free review notes.  I often receive a question or two about the exam and how germane my notes were, in retrospect.  This is a difficult question to answer [... read more]

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IDSA Guidelines 2016: HAP, VAP & It’s the End of HCAP as We Know It (And I Feel Fine)

“It is important to realize that guidelines cannot always account for individual variation among patients.  They are not intended to supplant physician judgement with respect to particular patients or special clinical situations.” -IDSA/ATS Guidelines 2016 A 73 year old man is admitted from a nursing home for an NSTEMI and is treated on the telemetry [... read more]

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Intra-abdominal Pressure and Renal Function

"An' it ain't no use in turnin' on your light, babe, I'm on the dark side of the road ..." -Bob Dylan A 44 year old man with cryptogenic cirrhosis is admitted with large ascites and acute kidney injury.  A 50 mL, diagnostic paracentesis reveals 12 PMNs and he is admitted from the emergency department for further [... read more]

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A Free & Open-Access Hemodynamic Physiology Curriculum

“A rising tide lifts all boats.” -John F. Kennedy Two years ago, heart-lung.org went live – a project borne out of my deep interest of the inter-connectedness of the cardiovascular and respiratory pumps.  I have been truly amazed and deeply appreciative of the kind words which I have received from around the world; indeed, I [... read more]

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