Roadblock: AFib with RVR

Roadblock: AFib with RVR

In this paper we focus on strategies to bypass the most common pitfalls in our treatment algorithm when treating patients who present to the ED in atrial fibrillation with RVR. We all know the few medications in our toolbox... read more

CRT-targeted Fluid Resuscitation vs. Lactate-targeted in Septic Shock

CRT-targeted Fluid Resuscitation vs. Lactate-targeted in Septic Shock

Capillary refill time (CRT)-targeted fluid resuscitation in septic shock was not superior to a lactate-targeted one on early fluid administration or fluid balances. However, it was associated with comparable effects on regional... read more

Arterial pH with Hemodynamic Response Association to Vasopressin in Patients with Septic Shock

Arterial pH with Hemodynamic Response Association to Vasopressin in Patients with Septic Shock

Compared with higher arterial pH, patients with septic shock and low arterial pH had lower odds of vasopressin response and higher catecholamine doses after vasopressin initiation. Similar to other vasopressors, the clinical... read more

Respiratory Drive in Sepsis and Septic Shock Patients: Modulation by High-flow Nasal Cannula

Respiratory Drive in Sepsis and Septic Shock Patients: Modulation by High-flow Nasal Cannula

Patients with sepsis and septic shock of extrapulmonary origin present elevated respiratory drive and effort, which can be effectively reduced by high-flow nasal cannula. 25 nonintubated patients with extrapulmonary sepsis... read more

Outcome After Intubation for Septic Shock with Respiratory Distress and Hemodynamic Compromise

Outcome After Intubation for Septic Shock with Respiratory Distress and Hemodynamic Compromise

Intubation within 24 h of sepsis was not associated with hospital mortality but resulted in fewer 28-day hospital-free days. Although intubation remains a high-risk procedure, we did not identify an increased risk in mortality... read more

Pre-hospital suPAR, Lactate and CRP Measurements for Decision-making

Pre-hospital suPAR, Lactate and CRP Measurements for Decision-making

Pre-hospital suPAR measurements alone or combined with C-reactive protein (CRP) and/or lactate measurements could not predict the ED discharge or hospital admission of 109 non-urgent EMS patients with non-specific chief complaints... read more

Lactated Ringers is Safe in Hyperkalemia, and is Superior to NS

Lactated Ringers is Safe in Hyperkalemia, and is Superior to NS

The myth that LR should be avoided in hyperkalemia is not only incorrect, it is probably backwards. For a hyperkalemic patient in renal failure, Lactated Ringers (LR) should be preferred over normal saline (NS). LR has been... read more

Lactate = LactHATE

Lactate = LactHATE

Like many others who attended SMACC earlier this year I returned home dazed and confused about the significance of lactate in the septic patient. So like any good (aspiring to be) evidence-based medicine practitioner,... read more

Cytokine Adsorption Effect on Survival and Circulatory Stabilization in Patients Receiving ECPR

Cytokine Adsorption Effect on Survival and Circulatory Stabilization in Patients Receiving ECPR

Even after the introduction of extracorporeal cardiopulmonary resuscitation (ECPR), survival after cardiac arrest remains poor. Excess release of vasoactive cytokines may be a reason for cardiovascular instability and death... read more

Validation of a Point-of-Care Capillary Lactate Measuring Device

Validation of a Point-of-Care Capillary Lactate Measuring Device

Lactate Pro 2 had good agreement with the reference method using arterial blood but poorer agreement using venous blood. Our results show the potential for overestimation of the lactate values in haemodynamically compromised... read more

What’s Working for COVID-19 Patients in the Epicenter

Our large tertiary care ED in Queens, NY, usually sees more than 100,000 adults a year. As we write this, we have 850 COVID-19-likely or -positive patients (several hundred above our bed capacity just one month ago), more... read more

Epinephrine Challenge in Sepsis: An Empiric Approach to Catecholamines

Epinephrine Challenge in Sepsis: An Empiric Approach to Catecholamines

The critical care world is obsessed with fluid. Meanwhile, little attention has been given to the concepts of vasopressor responsiveness and vasopressor challenge. This is a missed opportunity, because vasopressor challenges... read more

Serum Lactate Level and Mortality in Metformin-associated Lactic Acidosis Requiring RRT

Serum Lactate Level and Mortality in Metformin-associated Lactic Acidosis Requiring RRT

This study suggests that predialysis level of serum lactate level is an important marker of mortality in MALA patients requiring renal replacement therapy (RRT) with a linear dose-response relationship. To better evaluate... read more

Lactate and Stepwise Lactate Kinetics Used to Guide Resuscitation

Lactate and Stepwise Lactate Kinetics Used to Guide Resuscitation

Lactate is an important parameter for monitoring tissue perfusion at present. Lactate kinetics are particularly important to evaluate the response of ICU patients. Therefore, lactate can be the starting point for resuscitation,... read more