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Hyperlactatemia in Critical Illness: History, Mechanisms, and the “Great Debate"
Since the turn of the century, lactate has become a mainstay in emergency medicine and critical care laboratories. Some clinicians may hate it, others may love it, but very few can feign apathy on the subject. The utility of lactate in the emergency department and the ICU in guiding resuscitations, predicting mortality, or identifying occult critical illness continues to be discussed in the literature, most fervently in the realm of sepsis. But what are the humble beginnings of this molecule? Most fundamentally, how is lactate generated in the setting of critical illness? And how did it come to be so firmly embedded in our understanding of the pathophysiology of critically ill patients?
Grand Rounds Summary 9.13.17
'Twas a fantastic grand rounds. Drs. Banning and Golden started it off taking us through the most recent evidence for management of sub-massive and massive PE, as well as presenting their algorithm to be published on Emergency KT. This was followed by a global health lecture given by Dr. Lagasse, which covered a range of re-emerging infectious diseases. Next, Dr. Bryant took us through multiple pediatric cases, and discussed her approach in determining whether to discharge, transfer, or treat pediatric patients with common / representative complaints. Dr. Adeoye then took us through the history and development of our current approach to the management of acute ischemic stroke. Dr. LaFollette then took us through an evidence based approach to removing things from where they shouldn't be in his edition of mastering minor care, discussing approaches to removing retained objects from ears and skin. We then finished the conference with two interesting cases: One presented by Dr. Sabedra that was followed by a discussion on the diagnosis and management of massive hemoptysis, and the other presented by Dr. Dang illustrating the differences and similarities hyperthermic toxidromes including NMS and serotonin syndrome as well as their management.
Angle Closure Glaucoma
For many emergency physicians, ophthalmologic complaints are seemingly shrouded in mystery and pose a distinct diagnostic and therapeutic challenge. What the heck is gonioscopy? Which eye does OU refer to again? Does latanoprost really change the color of your iris? In this case, we join Dr. Murphy-Crews as he parses the enigma of acute closure glaucoma, its pathophysiology, and the appropriate management in the emergency department.