A 44 year old female with HTN, DM, and psychiatric disease presents with non-traumatic pain and vision loss in her right eye for 12 hours.  She has a right sided throbbing headache. On exam she has a 5mm R pupil which is sluggish to react, 3mm L pupil that is fully reactive. Her R eyeRead more

A 50 year old man presents with agitation and delirium.  He has sinus tachycardia to 120bpm but his vital signs are otherwise within normal ranges. He answers some questions, but is disoriented, illogical and rambling.  He is picking at “ants” crawling on his skin.  On physical exam you find bilaterally dilated pupils and his skinRead more

The FALLS-protocol

In critically ill septic shock patients, assessments of hemodynamic function, fluid status and improvement of clinical status are challenging.  As a consequence of critical illness and large volume administration of crystalloids as recommended by Early Goal-Directed Therapy, comes the potential of acute (respiratory distress/failure) and long-term sequelae  (ARDS, prolonged endotracheal intubation, anasarca, bedsores, poor IVRead more