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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The Revised Starling Principle: Implications for Rational Fluid Therapy

“Doctrine once sown strikes deep its root, and respect for antiquity influences all men.” -William Harvey [1628] The use of hyperoncotic albumin to draw fluid from the interstitial space permeates dark corners of the critical care community.  The ‘pull and push’ of 25% albumin followed by furosemide remains somewhat of a cryptic lore – its [... read more]

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Blood Pressure Goals in Intracerebral Hemorrhage – ATACH II

“… it is a tale.  Told by an idiot, full of sound and fury, signifying nothing.” Macbeth: Act V, Scene V The results of the ATACH II trial are out; we have even more guidance when managing the blood pressure of hypertensive patients with supratentorial, intra-cerebral hemorrhage of less than 60 cm3 in volume.  The question: [... read more]

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