What do you do if your septic patient now has a lactate of 12 and a pH of 7.00? You’ve already started your fluids, antibiotics, pressors, and have ruled out any unaddressed source. Intuitively, your patient’s acidosis should be corrected by providing a base – specifically sodium bicarbonate. This is a common approach, although as […]

The current Surviving Sepsis Campaign guidelines recommend starting either dopamine up to 10mcg/kg/min or epinephrine 0.05 mcg/kg/min for pediatric patients suffering from fluid-refractory septic shock. There is a significant lack of evidence as to which of the two agents is most beneficial, however, until a recent study published in Critical Care Medicine attempted to address […]

Although clinical practice may differ, vagal maneuvers are still the first step in attempting to convert supraventricular tachycardia (SVT) to sinus rhythm prior to adenosine. The reason why they are rarely attempted is because of relatively low (5-20%) success rates. A recent study published in The Lancet describes a method of Valsalva maneuver which has improved […]

Your patient with respiratory failure was successfully intubated and admitted to the MICU. Two weeks later he comes back to the ED complaining of persistent hoarse voice and dysphagia. He states he was extubated 1 week prior and was told his symptoms would resolve but they hadn’t. What could be going on?

Serum sickness is an often overlooked entity when considering the differential diagnosis of a febrile patient. This is a brief overview on the history and management of a patient who presents with signs and symptoms of this disorder: