An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Cytokines tend to break things in critical illness.Pro-inflammatory cytokines cause vasodilation.Anti-inflammatory cytokines cause immunosupression.Inventing a way to get rid of those cytokines sounds like a good idea, right?Cytosorb has been on out the market and trialed in sepsis, ARDS, cardiac surgery or recovery after cardiac arrest in the ICU.It sounds expensive, but does it work?A …
Continue reading Cytosorb to Absorb Cytokines & Improve ICU Outcomes
We all know that nurse to nurse familiarity is important for teamwork and outcomes in critical care. This familiarity helps the cohesion of the unit and helps nurse retention when coupled with safe staffing ratios. Some things in medicine are known but it's still nice when reinforced by data.In October of last year year an …
Continue reading Nurse Familiarity: Working with Buddies Safely Saves Lives
I often hear people say that the patient, who has fluid overload with significant edema, is intravascularly depleted.Despite significant reading on the matter I have not been able to find a suitable explanation.Thankfully, this paper was published a few days ago with the best explanation I've read.Hat tip to the authors, read these data for …
Continue reading Fluid Overload but Intravascularly Depleted: What does this mean?
Should we be using amiodarone or lidocaine for patients who go into cardiac arrest due to ventricular tachycardia or ventricular fibrillation while in the hospital? The ACLS guidelines support the use of either. I have personally noted far more use of amiodarone over lidocaine for this issue. These data published in the May 2023 issue …
Continue reading Amiodarone or Lidocaine for In-Hospital Cardiac Arrest?
Fluid responsiveness is defined as "as the ability of the left ventricle to increase its stroke volume (SV) in response to fluid administration". There are multiple strategies to define fluid responsiveness in patients who are on mechanical ventilation such as PPV, SVV, EEOP. Positive end-expiratory pressure (PEEP) can decrease cardiac output in mechanically ventilated patients. …
Continue reading PEEP-Test for Fluid/Volume Responsiveness in Resuscitation
When I lauched my website (eddyjoemd.com) several years ago, I used Bluehost. At first, I started with Adsense but then transitioned to Ezoic as my page grew. Despite there being some hiccups along the way, the relationship between Bluehost and Ezoic was pretty simple. The relationship was fine. Recently, Bluehost has significantly increased the price …
Continue reading Bluehost to Ezoic Hosting Website Migration: Step by Step Guide
Welcome to the blog post version of the Saving Lives Podcast. In this post, I'm going to be discussing the aortic pulsatility index. Chances are you've never heard of this before. The reality is that I honestly had never heard of this before either. I ran into it been going down my rabbit hole of …
Continue reading Aortic Pulsatility Index (API): Optimizing Cardiogenic Shock Management
A definite hat tip to my buddy Matt Siuba (zentensivist.com) and his colleagues for this great review on the management of right ventricular (RV) dysfunction in patients with ARDS. I plan on elaborating further on this paper but the bottom line is that we need more data. For now, head down to the citations to …
This page is dedicated for those attending my lecture on lactate/lactic acid. These are the citations for studies I used for my lactate presentation. For further information on the topic, check THIS POST. Jung B, Rimmele T, Le Goff C, Chanques G, Corne P, Jonquet O, Muller L, Lefrant JY, Guervilly C, Papazian L, Allaouchiche …
Continue reading Lactate: The Boogeyman or an Alarm? Citations
I have to admit the glucocorticoids are amongst my favorite medications that we use regularly in the ICU. Whether it be hydrocortisone, dexamethasone, or methylprednisolone, I have order sets built into my EMR with the dosing for the respective indications. The indications appear to be endless. Today, I am going to be discussing an article …
Continue reading Hydrocortisone for Severe Community-Acquired Pneumonia (CAP)
