Critical Care

Critical Cases - Boerhaave's Syndrome Emergency!

A patient boarding in the emergency department begins decompensating after a profound fit of retching and vomiting. Blood pressure is dropping and o2 sats are eyeball the patient from the door and he looks severely ill. No time to page the floor team...time to dive in and resuscitate!

Category (Day): 

Critically Appraised Topic: Post-Intubation Sedation

Most patients who undergo intubation will receive some sort of post-intubation sedative. In the ICU, over-sedation is common, and early deep sedation is associated with worse outcomes in mechanically ventilated patients – specifically, higher mortality. Does the choice of sedative affect mortality? 

Category (Day): 

Blood pressure management in acute intracerebral hemorrhage

Does intensive blood pressure lowering to a target of < 140 mm Hg versus < 180 mm Hg impact outcome after acute intracerebral hemorrhage? Are there risks associated with targeting a lower systolic blood pressure? 

Category (Day): 

Ventilator management of bronchopleural fistula

A 47-year-old man with COVID-19 pneumonia complicated by severe acute respiratory distress syndrome (ARDS) suddenly desaturates. Point-of-care ultrasound and chest x-ray are consistent with pneumothorax. After placement of a pigtail catheter, hypoxemia persists and a large continuous air leak is present. What are the next steps in management of a suspected bronchopleural fistula? 

Category (Day):