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  • Which cancer patients need prophylaxis for DVT and pulmonary embolism? August 16, 2014
    People with cancer have the highest rates of deep venous thrombosis (DVT) and pulmonary embolism (PE). However, the risk of venous thromboembolism varies widely by cancer type and between patients. Daily anticoagulant use can reduce the risk of DVT and pulmonary embolism, but at a cost of increased bleeding risk, patient inconvenience and discomfort, and cos […]
  • What are Ventilator-Associated Events (and why should you care)? July 30, 2014
    Have you heard of ventilator-associated events (VAEs)? Like it or not, this neologism of healthcare-speak is coming to an ICU near you soon. Here’s the lowdown on VAEs and why they matter to the practicing intensivist. What are Ventilator-Associated Events? Ventilator-associated events are an invention of the Centers for Disease Control and Prevention (CDC), […]
  • PulmCCM Roundup #5 July 21, 2014
    The PulmCCM Roundup gathers all the best in pulmonary and critical care from around the web.  Browse all the PulmCCM Roundups. Statins Fail for COPD, ARDS Statins have been optimistically tested as a tonic for everything from diabetes to dementia — so far, without success. That consistency was maintained in 2 recent trials showing statins’ [... read more] Th […]
  • Inspiratory collapse of the inferior vena cava: What is it telling us? July 17, 2014
    image: EM Ultrasonography Inspiratory collapse of the inferior vena cava: What is it telling us? Jon-Emile S. Kenny M.D. With the dissemination of small, portable, ultrasound devices [or SPUDs], it seems that it is every house-officer’s dream to own the ability and wherewithal to place an ultrasound probe on a patient and find something meaningful; [... read […]
  • Prone positioning reduces ARDS mortality by 26%: meta-analysis July 11, 2014
    Image: Rotoprone Acute respiratory distress syndrome (ARDS) injures the lungs in a heterogeneous pattern, and the damaged areas are particularly vulnerable to further ventilator-induced lung injury. This is why a lung-protective ventilator strategy using low tidal volumes reduces mortality from ARDS, experts believe. Tidal volumes of 6 mL/kg ideal body weigh […]
  • Using bronchoalveolar lavage to evaluate ILD July 8, 2014
    Using BAL Cellular Analysis in Interstitial Lung Disease The role of bronchoalveolar lavage (BAL) in diagnosing and managing patients with interstitial lung disease (ILD) has always been uncertain and controversial. BAL findings are usually nonspecific, suggesting rather than proving the existence of any particular noninfectious condition (including intersti […]
  • Azithromycin for COPD exacerbations: 2014 Update June 27, 2014
    Azithromycin to Prevent COPD Exacerbations: What’s New? By Abhishek Biswas, MD Multiple previous studies have suggested likely benefits from using azithromycin as an immunomodulator for cystic fibrosis, bronchiectasis, diffuse panbronchiolitis, post-transplant obliterative bronchiolitis and COPD. This month, a new Cochrane analysis and clinical review in JAM […]
  • CPAP better than oxygen for obstructive sleep apnea June 26, 2014
    About half of people diagnosed with obstructive sleep apnea (OSA) can’t or won’t use the most effective therapy, overnight continuous positive airway pressure (CPAP). Most people with untreated OSA experience multiple episodes of hypoxemia — sometimes hundreds per night. For many patients declining CPAP treatment, their doctors provide overnight oxygen, in t […]
  • PulmCCM Roundup #4 June 8, 2014
    All the best in pulmonary and critical care from around the web. Browse all the PulmCCM Roundups. Asthma Childhood obesity increases the risk for asthma, and obesity is also strongly associated with asthma in adults. The mechanisms are likely multiple, complex and interdependent (pro-inflammatory mediators, etc.), not simply causative. Losing weight does see […]
  • Tenecteplase for submassive PE: more conflicting evidence (TOPCOAT) June 5, 2014
    By Parth Rali, MD and Marvin Balaan, MD Submassive pulmonary emboli (PE) are those that are severe enough to produce right ventricular dysfunction on echocardiogram or elevated biomarkers (mainly troponin), but not hemodynamic instability (i.e., systemic blood pressure and cardiac output are preserved). The management of the patient with submassive PE is a m […]
  • N-acetylcysteine: no benefit in idiopathic pulmonary fibrosis May 30, 2014
    NAC for IPF: Fail (PANTHER-IPF Wrap-Up) Long ago, when pulmonologists were more ingenuous (in 2000), flawed clinical trials convinced the American Thoracic Society to recommend prednisone and either azathioprine or cyclophosphamide in its consensus guideline for some patients with idiopathic pulmonary fibrosis (IPF). By not including a true control arm, the […]
  • Nintedanib protects lung function, prevents exacerbations of idiopathic pulmonary fibrosis (INPULSIS) May 27, 2014
    In 2011 PulmCCM reported the findings of the phase 2 TOMORROW study, showing Boehringer Ingelheim’s tyrosine kinase inhibitor code-named BIBF 1120 reduced lung function decline and prevented exacerbations in people with idiopathic pulmonary fibrosis (IPF). At the 2014 American Thoracic Society annual meeting and in the New England Journal of Medicine, invest […]
  • Pirfenidone prolongs survival, preserves lung function in idiopathic pulmonary fibrosis (ASCEND) May 23, 2014
    For idiopathic pulmonary fibrosis treatment pirfenidone, the third time wasn’t the charm; the fourth was. After reducing decline in forced vital capacity over one year in a Japanese trial of 275 IPF patients, pirfenidone went one-and-one in the multinational CAPACITY trials (n=779), meeting the primary outcome of FVC preservation in one but not the other. [. […]
  • Medicare bucks USPSTF, denies coverage for lung cancer screening May 22, 2014
    The Centers for Medcare and Medcaid Services sent lung cancer screening’s forward momentum into a tailspin last month, when Medicare’s advisory panel shocked observers by voting  against covering lung cancer screening with annual low dose chest CT as a standard benefit. The U.S. Preventive Services Task Force (USPSTF) had already recommended lung cancer scre […]
  • How to provide nutrition for critically ill patients (Review) May 16, 2014
    Nutritional Support During Critical Illness This PulmCCM topic review will be periodically updated and expanded as new research is published. Originally published 22 September 2013. Most recent update: 16 May 2013. During critical illness, catabolism (breakdown of muscle protein, fat and other complex molecules) occurs faster than anabolism (synthesis of the […]
  • Red blood cell transfusions increase hospital-acquired infections (meta-analysis) May 8, 2014
    Red Cell Transfusions Increase Risk for Nosocomial Infection: Meta-Analysis Transfusing blood to anemic patients has an almost irresistible intuitive and theoretical appeal both to physicians and the patients who get transfused. It’s perhaps the archetypal example of the “find it – fix it” approach to doctoring: correct all laboratory abnormalities and ipso […]
  • FDA approves implantable tongue-buzzer for obstructive sleep apnea treatment May 7, 2014
    Image: Inspire Med Systems Hypoglossal Nerve Stimulation for Sleep Apnea Wins FDA Approval The U.S. Food and Drug Administration approved Inspire Medical Systems’ pacemaker-like hypoglossal nerve stimulator for patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure (CPAP). The Inspire device sti […]
  • N-acetylcysteine for COPD: another trial shows benefit (PANTHEON) May 3, 2014
    Image: Can N-acetylcysteine help prevent exacerbations of chronic obstructive pulmonary disease (COPD)? Another randomized trial says yes. N-acetylcysteine, or NAC, is a nutritional supplement with antioxidant and anti-inflammatory properties. After ingestion, N-acetylcysteine is metabolized into glutathione, a key antioxidant with effects thr […]
  • Diaphragmatic ultrasound could predict extubation success May 2, 2014
    Source: Diaphragmatic Ultrasonography to Assess Readiness for Extubation By Muhammad Adrish, MD Weaning a patient from mechanical ventilation is a challenge that intensivists face routinely. Clinical examination and objective measurements like minute ventilation, respiratory rate, maximal inspiratory pressure, and ratio of respiratory rate t […]
  • Thrombolytics (tPA) improve intermediate risk PE outcomes, with a few head bleeds (PEITHO Trial) April 18, 2014
    The use of thrombolytics for pulmonary embolism is not controversial — that is, if the PE is massive with hypotension (give thrombolytics) or mild, with normal blood pressure and right ventricular function (don’t give them). It’s the patients with intermediate risk pulmonary emboli — with normal blood pressure but with evidence of right ventricular dysfuncti […]

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  • Resuscitationist lessons from a self-protection master August 27, 2014
    “It’s better to have it and not need it, than to need it and not have it“ My great friend and fellow Brit Lee Morrison is in Sydney again, teaching people how to save lives. Like a resuscitationist. But Lee isn’t a health care worker. He is a professional self protection instructor and martial athlete. […]
  • Hexagonal storm on Saturn’s North Pole August 11, 2014
    Our solar system is amazing and beautiful and the wondrous discoveries continue. Watch this video from the NY Times on Saturn’s northern storm, shaped like a hexagon and larger than Earth: This line from the video is inspiring: “Rings of ice, in a dancing ribbon of Aurora, sitting smack on top of a six-sided hurricaine. […]
  • Not Your Average Conference August 3, 2014
    An amazing conference program, amazing speakers, in an amazing part of the world: Imagine a line-up that includes FOAM Master Joe Lex and Matt & Mike from the Ultrasound Podcast, and it isn’t even a SMACC event! I wish I was going, but I already committed to speaking at a great conference elsewhere! Listen to […]
  • Profound hypothermia and no ECMO? July 10, 2014
    Patients in cardiac arrest due to severe hypothermia benefit from extracorporeal rewarming, and it is often recommended that they are treated at centres capable of providing cardiopulmonary bypass or extracorporeal membrane oxygenation (ECMO). But what if they’re brought to a centre that doesn’t have those facilities? If you work in such a centre do you […]
  • When to Stop Resuscitation July 8, 2014
    My talk at the SmaccGOLD conference in March 2014 Cliff Reid – When Should Resuscitation Stop from Social Media and Critical Care on Vimeo. Here are the slides:
  • Down with “down” time! May 10, 2014
    A man in his 40s has a witnessed collapse and CPR is immediately started. Paramedics are on scene within 5 minutes and initiate advanced cardiac life support. He has refractory ventricular fibrillation which degenerates to asystole. He arrives in an emergency department where, with good ongoing CPR, he appears reasonably well perfused and even demonstrates [ […]
  • Emergency Medicine – A Great Job May 9, 2014
    I was asked to speak at the Australasian Conference for Emergency Medicine‘s Annual Scientific Conference in Adelaide in November 2013. The title they gave me was ‘What a great job’. It was a great opportunity for me to explore some of the literature around what makes people happy, and whether emergency medicine has the ingredients […]
  • Time to change thinking on ‘cricoid pressure’ April 21, 2014
    I don’t like cricoid pressure. Some people do. There is insufficient evidence that it is of any benefit. There is some consistent evidence that it worsens laryngoscopic view. In my clinical practice of critical care in and out of hospital, I can’t afford to risk delaying the securing of my patients’ airways with a procedure […]
  • Breaking with tradition in paediatric RSI April 8, 2014
    ‘Traditional’ rapid sequence induction of anaesthesia is often described with inclusion of cricoid pressure and the strict omission of any artifical ventilation between paralytic drug administration and insertion of the tracheal tube. These measures are aimed at preventing pulmonary aspiration of gastric contents although there is no convincing evidence base […]
  • Palpating neonatal tracheal tubes April 5, 2014
    After neonatal intubation, the incidence of malposition of the tip of the tracheal tube is fairly high. A technique was evaluated involving palpation of the tube tip in the suprasternal notch, which in this small study was superior to insertion length based on a weight-based nomogram. The suprasternal notch was chosen because it anatomically corresponds […]

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RSS Current Opinion in Critical Care – Featured Articles – Editor Picks

  • How to feed complicated patients after surgery: what's new? March 19, 2014
    Purpose of reviewThis clinical review focuses on the nutritional management of surgical patients with a severe postoperative complication. These patients having a succession of aggressions are at high risk of malnutrition. Our aim, following ICU patient studies, was to report the elements that could be applied for these patients. Recent findingsAlthough earl […]
  • The ideal fluid November 21, 2013
    Purpose of reviewThe characteristics of an ideal intravenous fluid in the critically ill patient are discussed. Recent findingsIntravenous fluids are the most frequent drug administered to patients. Questioning the use of commonly administered intravenous fluids has resulted in an increased focus on their efficacy and safety. Discrimination between fluids cu […]

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RSS Emergency Medicine Ireland

  • An Irish Emergency Physician in Australia August 13, 2014
    [Ed: Cian is a friend and recent graduate from EM training in Ireland and below are his reflections on his current gig in Geelong, Australia.] This is my first attempt at writing a blog post. To borrow advice from Mark Twain, I’m going to write what I know and what I do everyday at work, […] The post An Irish Emergency Physician in Australia appeared first o […]
  • Recent controversies in sepsis August 4, 2014
    Below is a recent talk I prepared for a teaching meeting for the ICU and ED staff. Unfortunately I was still on my train when I was due to give it so here it is online instead. MMUH ICU ED teaching sepsis from Andrew Neill References: Annane D. Effects of Fluid Resuscitation With Colloids vs […] The post Recent controversies in sepsis appeared first on Emerg […]
  • CEM FOAMed network July 16, 2014
    The College of Emergency Medicine is the body responsible for training all the wonderful UK emergency medicine trainees and represents the speciality in the UK. The trainees in Ireland do the UK exams so the specialties in both countries have a fairly close relationship. The college’s main online educational presence in recent years has been the ENLIGHTENme […]
  • Tasty Morsels of EM 041 – Acute Urinary Retention July 7, 2014
    [Featured Image: Frivadossi, Wikimedia Commons] As always, this is from the ever expanding google doc on bits and bobs I read and learn from. This time: ED Management of acute urinary retention. EB Medicine Causes Men – think prostate Women – bladder masses, gynae surgery and prolapse Drugs: calcium channel blockers (i didn’t know this), […] The post Tasty M […]
  • IAEM 2014 July 7, 2014
    The Irish Association for Emergency Medicine are hosting their annual scientific meeting this year in Dun Laoghaire. They’ve just launched the website for the event where you can find all the info you need. This year’s event is being hosted by one of former hospitals, St Vincent’s University Hosptial Dublin where both this site’s own David […] The post IAEM […]
  • Tasty Morsels of EM 040 HSV in Kiddies July 2, 2014
    [Featured Image: Ben Tillman, Wikimedia Commons] Another review from the EB Medicine series of publications. Remember this comes free with EMRA membership if you’re a trainee. Along with EM:RAP, Emergency Medical Abstracts and lots of other good stuff. This time it’s Paeds: Pediatric Herpes Simplex Virus Infections: An Evidence-Based Approach To Treatment. P […]
  • Tasty Morsels of EM 039 BradyDysrhythmias June 22, 2014
    [Featured image via LITFL] Approach to BradyDysrhythmias EB Medicine Article [free via EMRA if you're a member. About 70 dollars a year. Well worth it.]   On a FOAMed note, it’s interesting that all the ECGs in the article are taken from LITFL. Another sign that FOAMed is not providing a marginal, niche resource, but […] The post Tasty Morsels of EM 039 […]
  • IEMTA Summer Meeting June 19, 2014
    IEMTA (Irish Emergency Medicine Trainees Association) is running its summer meeting on Friday 27th June at 18.30 in RCSI. This is a free meeting and is usually well attended as both an academic and a social event for anyone interested in EM in Ireland from med students to consultants. The flyer is below. Hope to […] The post IEMTA Summer Meeting appeared fir […]
  • EMS Gathering Review June 16, 2014
    It’s been a month since the Irish EMS Gathering conference that I had the pleasure of speaking at. This was the second year and it’s a pretty unique event. It’s main focus is naturally pre hospital care and it’s great to see a medical conference that isn’t just doctors talking about how awesome doctors are… […] The post EMS Gathering Review appeared first on […]
  • The LINC trial June 13, 2014
    I wouldn’t regard myself as a total nihilist when it comes to cardiac arrest but I’m usually not on the optimistic side. I work in a typical inner city setting where outcomes from OOHCA are on the poor side. I suspect are numbers are polluted by the fact that our local EMS system only occasionally stops […] The post The LINC trial appeared first on Emergency […]