b12 septic shock

Hydroxocobalamin (Vitamin B12) for Septic Shock

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 …

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Contrast-Induced Nephropathy (CIN) & Acute Kidney Injury (AKI)

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 …

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clovers

More Fluids vs. Vasopressors in the First 24h of Septic Shock (CLOVERS Trial)

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 …

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tee

Transesophageal Echocardiography (TEE): Adding to the Skill Set

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 …

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Mortality of Patients on Mechanical Ventilation: One-Minute Journal Club

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 …

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corticosteroids cardiac arrest

Corticosteroids and Cardiac Arrest: 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 …

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OHCA access

Access in Out-Of-Hospital Cardiac Arrest (OHCA): Which is Best? IV or IO?

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 …

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RT burnout

RT’s Have Suffered Burnout, Too.

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 …

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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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