Tag Archives: critical care

What is the sensitivity of CT to determine appendicitis?

The Bottom Line: The diagnostic accuracy of noncontrast CT for the diagnosis of acute appendicitis in the adult population is adequate for clinical decision making. Reference: Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD.  Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review.  Ann Emerg … Continue reading

Posted in Diagnosis, Grady | Tagged

For patients with gastrointestinal bleeding, how do you decide which patients to send to the floor & which to send to the ICU?

BLEED tool Kollef MH, et al. BLEED: a classification tool to predict outcomes in patients with acute upper and lower gastrointestinal hemorrhage. Crit Care Med. 1997 Jul;25(7): 1125-32. B visualized red blood (hematemesis, nasogastric lavage, or per rectum other than … Continue reading

Posted in EUH, EUHMidtown, Prognosis, VA | Tagged ,

How can you assess respiratory muscle function at the bedside?

Bottom line:  Measuring maximum inspiratory pressure and maximum expiratory pressure can provide information on respiratory muscle weakness and can be used at the bedside for monitoring patients who may be at risk for respiratory failure. Table 24-10. In:  Murray and … Continue reading

Posted in Background question, Diagnosis, EUH | Tagged , ,

What blood pressure goals are recommended for a patient with acute aortic dissection?

Bottom line:  Acute management includes blood pressure goal of < 120mm Hg systolic or lowest BP that maintains end organ perfusion. Summary: Joint guidelines (ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM) on managing aortic dissection recommends goal of systolic BP < 120 mm Hg or lowest … Continue reading

Posted in Background question, EUH, Therapy | Tagged , ,

How are aortic dissections classified?

Bottom line:  Aortic dissections are classified according to location, nature and extent of tear.  The Stanford system is widely used, and describes tears according to involvement of ascending aorta, regardless of the origin of the tear. Summary:  Thoracic aortic aneurysm … Continue reading

Posted in Background question, Diagnosis, EUH | Tagged ,

How can bicarbonate be used in management of rhabdomyolysis?

Bottom line: Although there is no good evidence to support this strategy, bicarbonate is employed by some clinicians to force alkaline dieresis after initial resuscitation with saline. Summary:  For an overview of current opinion, see Rhabdomyolysis in DynaMed (Treatment Section.) Also, see Bench-to-bedside review: … Continue reading

Posted in EUH, Therapy | Tagged ,

What is the algorithm for early goal-directed therapy for patients in septic shock and does it reduce mortality?

Bottom line: Use of early goal-directed therapy for management of septic shock or severe sepsis can reduce in-hospital mortality. Summary:  Rivers E, et al.  Early goal-directed therapy in the treatment of severe sepsis and septic shock.  N Engl J Med. 2001 … Continue reading

Posted in EUH, Therapy | Tagged , ,