haldol icu

Haldol (Haloperidol) in the ICU: One-Minute Journal Club

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 …

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insanity

Insanity.

There are very powerful people who do not want us to be informed.There are people who do not want us to have the ability to have different thoughts.Several days ago I posted research that was conducted in Boston.Research that I found concerning. Research that many experts find concerning.Knowing that the powers-that-be use very powerful technology …

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appreciating nurses

Appreciating Our Nurses: Role of the ICU Physician

The last couple years have been challenging for all health-care personnel.Improving morale is something that I have worked on substantially in my practice. Many of us could do more in appreciating our nurses. Nurse retention is a problem everywhere.I am married to an ICU nurse for some additional context.A paper looking at this was published …

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pancreatitis fluids

Resuscitation in Acute Pancreatitis: IV Fluids

A paper regarding to acute pancreatitis was published in the New England Journal of Medicine on 15 September of 2022. It is titled "aggressive or moderate fluid resuscitation and acute pancreatitis". Hat tips to the authors. I would tell you to read this article for yourself but, unfortunately, it is hidden behind the pay wall …

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basics trial

BaSICS Trial: Plasmalyte vs. 0.9% NaCl in the Critically Ill

In patients who need IV fluids, we can either provide "normal saline" or balanced salt solutions.Balanced salt solutions include Lactated Ringer's and Plasmalyte.There have been several trials trying to answer this question. The data hasn't been as rock solid as we'd like to convince our biases.The BaSICS trial is a recent landmark trial.As always, I …

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deresuscitation

How Strong Is Your Deresuscitation Game in Sepsis Patients?

As much as I am not a huge fan of bombarding septic shock patients with IV fluids, I understand there is a role for fluid resuscitation.When our patients get better, though, it is time to get rid of these fluids.That is what we call deresuscitation.It is part of the 4 D's in fluid therapy: drug, …

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cardiogenic shock classification

Cardiogenic Shock: SCAI Stage Classification

With a close to 50% mortality rate for cardiogenic shock, we all need a do a better job of caring for these patients. A cardiogenic shock classification would help identify who needs the most help.This is created for anyone caring for cardiogenic shock including physicians, APPs and nurses.We are all in this together. The earlier …

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dka saline lactated

Saline or Lactated Ringers/Plasma-lyte for DKA Resuscitation?

When patients present to the ED in DKA, should we resuscitate them with 0.9% sodium chloride (saline) or balanced salt solutions such as plasma-lyte or lactated ringers?Many DKA order sets use 0.9% sodium chloride "aka normal saline" as their initial fluid of choice.We know these patients are dry when they arrive to the ED.They need …

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cardiogenic shock norepinephrine epinephrine

Norepinephrine or Epinephrine in Cardiogenic Shock: Is One Better?

Which should be the first-line vasopressor between norepinephrine and epinephrine in cardiogenic shock?Your patient had an MI and is now in cardiogenic shock.They are hypotensive and need a vasopressor.To clarify, The Crit Doc of Tik Tok aka CriticalCareNow aka Haney Mallemat likes epinephrine as an inotrope, not a vasopressor.This was a pilot study, meaning that …

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