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Corticosteroids in Severe Community Acquired Pneumonia: Could CAPE COD catalyze a change in critical care management?

Background: Community-acquired pneumonia (CAP) can lead to pulmonary and systemic inflammation, resulting in impaired gas exchange, sepsis, organ failure, and an increased risk of death. Corticosteroids have excellent anti-inflammatory and immunomodulatory effects that could mitigate some of the inflammation caused ...

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The SQuID Protocol: SQ Insulin in DKA?

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. However, it is unclear if all degrees (mild, moderate, severe) of DKA require the same intensive treatment. Mild to moderate DKA represents a subgroup of ...

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Endocrine, Metabolic, Fluid, and Electrolytes

STREAM-2: Half-Dose Tenecteplase vs Primary PCI in Older Patients with STEMI?

Background: Primary PCI is the recommended reperfusion strategy in patients with STEMI and should be initiated within 2 hours after first medical contact.  In non-PCI-capable hospitals this goal is not always achievable due to delays in transfer.  In these cases, ...

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Cardiovascular

REBEL Core Cast 109.0 – Na Channel Blocker Poisoning

Take Home Points: In the context of poisoning, a “wide QRS” is anything greater than 100 milliseconds. A newly “wide QRS”, especially with hemodynamic instability, should prompt consideration of sodium channel blockade and not ventricular tachycardia. Treatment is guided by ...

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Toxicology

Clinical Conundrum: Should a Troponin Routinely be Ordered in Patients with SVT?

Bottom Line Up Top: Troponins should not be routinely sent in patients presenting with SVT. Rarely, they may be necessary if the patient has concerning ischemic symptoms that persist after conversion to sinus rhythm. Clinical Scenario: A 44-year-old man presents ...

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Cardiovascular
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