An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
The concept of metabolic resuscitation has been around for several years. Unfortunately, the data for the utilization of ascorbic acid, thiamine, and glucocorticoids has not been as robust as we would like. There have been challenges replicating the miraculous data seen in the first trial in every subsequent trial performed thereafter. There have been numerous …
Continue reading Hydroxocobalamin (Vitamin B12) for Septic Shock
Does IV contrast provided to hospitalized patients really cause contrast-induced nephropathy (CIN) and lead to acute kidney injury (AKI)? This is quite the controversial discussion at the moment (this was published on 02/24/23). Therefore, I have created this page to compile evidence on the topic. None of this is medical advice. Solely a review on …
Continue reading Contrast-Induced Nephropathy (CIN) & Acute Kidney Injury (AKI)
Today, we're going to be reviewing what some might consider to be a landmark study: the CLOVERS trial. The first thing most clinicians do when a patient is hypotensive is provide IV fluids. The surviving sepsis guidelines recommend 30cc/kg in patients who are in septic shock. It often bears reminding that the objective of providing …
Continue reading More Fluids vs. Vasopressors in the First 24h of Septic Shock (CLOVERS Trial)
When I was completing my fellowship I dabbled a bit at performing transesophageal echocardiograms in the CCU/CVICU. I did not receive any formal training at it, though. I've been in practice out of fellowship for 5 years now and have made it a point to add the skill to my arsenal. On this page, I …
Continue reading Transesophageal Echocardiography (TEE): Adding to the Skill Set
I have a question for you. I hope you answer it honestly.Now that ICU admissions are incredibly low from you-know-what we can take a look back and dig through the ashes to see what could we have done better.Recently, data was published from a certain institution where they reported that they had only 40% mortality …
Continue reading Mortality of Patients on Mechanical Ventilation: One-Minute Journal Club
After a patient suffers a cardiac arrest event, should we be giving them corticosteroids?This is not something I do currently in my practice so I am intrigued by these data.There's a ton of nuance to this brand new systematic review and meta-analysis so please read it for yourself.This is not medical advice. Hat tip to …
Continue reading Corticosteroids and Cardiac Arrest: One-Minute Journal Club
I really have to say that 2022 was a great year. No, everything is not always sunshine and roses, but I am an optimistic dude and tend to have a positive outlook on things. Focusing on the positive has been helpful for me throughout my life. 2022 was a year where many doors opened up …
A patient had a cardiac arrest in the field, aka OHCA (outside of hospital cardiac arrest).Our trusty EMS (emergency medical services) teams who we all really appreciate show up at the scene.Access to administer life-saving medications need to be obtained.Should they attempt to obtain IV (intravenous) access?Or should they attempt to obtain IO (intraosseous) access?There …
Continue reading Access in Out-Of-Hospital Cardiac Arrest (OHCA): Which is Best? IV or IO?
I have posted data regarding nursing burnout.Many times I receive feedback that Respiratory Therapists (RT) are suffering from burnout, too.It wasn't that I was ignoring RT's, but rather this hadn't been studied.That doesn't mean that there isn't significant RT burnout.Recently, there was a study published on the matter titled "Burnout among Respiratory Therapists and Perception …
Haldol is an antipsychotic that we frequently use in the ICU for delirium.But the truth is that the data behind using it is not as robust as we would like.Earlier today, there was a paper published in the NEJM that attempted to find its effects on delirium.Hat tip to the authors. Read these data for …
Continue reading Haldol (Haloperidol) in the ICU: One-Minute Journal Club
