November 3, 2016

Submassive pulmonary embolism (PE) is responsible for approximately 20% of all PEs.  Although the in-hospital mortality has been reported as about 5%, there is significant morbidity associated with this diagnosis such as chronic pulmonary hypertension, impaired quality of life, persistent right ventricular disfunction, and recurrent venous thromboembolism.  The literature suggests that systemic thrombolytics can improve morbidity and maybe mortality, but this comes at the risk of increased major bleeding and intracranial hemorrhage (2 - 3%) when compared to anticoagulation alone.

October 31, 2016

Background: The most recent surviving sepsis campaign recommends the use of hydrocortisone in patients with refractory septic shock (i.e. vasopressor dependent).  However, the use of hydrocortisone in severe sepsis without shock still remains a very controversial topic. Recommendations for hydrocortisone are mostly based on 2 randomized clinical trials (i.e. Annane et al [2] and CORTICUS [3]), but subsequent meta-analyses had more mixed results.  Shock reversal was consistently improved irrespective of disease severity; however, mortality outcomes were not as consistent.  Therefore, it has been hypothesized that early hydrocortisone administration could prevent shock by attenuating patient’s inflammatory response.

October 24, 2016

Background: Syncope is a very frustrating chief complaint for many in the medical field.  There is no gold standard test and no validated decision instrument. It represents about 3 – 5% of ED visits, 1 – 6% of hospital admissions, and in patients over the age of 65 years it is the 6th most common cause of hospitalization [2][3]. Additionally, both ED and inpatient work ups are notoriously low yield for finding significant pathology. Pulmonary embolism is one of the myriad of diagnoses included in the differential diagnosis of syncope, but there is little information looking at its prevalence amongst hospitalized patients. Fast forward to Oct. 20th, 2016 and there is now some evidence just published in the NEJM: The PESIT Trial.

October 20, 2016

This years ACEP 2016 conference took place in Las Vegas, NV from Oct 16th - 19th.  There was greater than 350 courses, labs, and workshops given throughout the week.  It was impossible to make all of these great lectures, but I was able to take away some very important clinical pearls that I wanted to share with our readers. 

October 15, 2016

For those of us who have been lucky enough to attend one of the first four SMACC conferences, I think we would agree that this is one of the highest quality, academic meetings in the world. One of the main reasons for this is the enormous and inspiring energy of the critical care community itself. A community that crosses traditional hierarchies, professional barriers and international borders. This is a community dedicated to innovation, teaching and learning. A community based around the pursuit of excellence in patient care, and a passion for sharing this as widely as possible.  Well, the Social Media and Critical Care Conference (SMACC) is back with its 5th iteration of the conference in Berlin, June 26th - 29th, 2017.
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