An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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 …
SARS-CoV-2 is a virus that kicks off an inflammatory disorder in certain individuals. That's what data says and that's what most of us have seen. Inflammatory markers through the roof on the sicker patients, those who end up in my ICU. We start glucocorticoid therapy such as dexamethasone or methylprednisolone and the inflammatory markers drop, …
Continue reading Rethinking Corticosteroid/Glucocorticoid Dosing in COVID-19
How do you define a last-ditch effort to save someone's life from COVID-19? Perhaps giving tPA to a severe COVID patient? At this point, I am certain many of us have attempted, with informed consent of course, therapies for our patients that may make theoretical sense but have no evidence to support its use. At …
Continue reading tPA for Critically Ill ICU Patients with COVID-19: Does Alteplase Help?
It bears repeating that I am quite the fan of inexpensive, readily available therapies to help save the lives of our patients. When I received this article from Caroline Welch, Pharm D. I was excited because I was hoping it would be a positive study. Unfortunately, it did not pan out and based on these …
Continue reading Atorvastatin for ICU COVID Patients: Not Ready for Prime Time
Yesterday in Instagram and Twitter, I posted the post and caption regarding my curiosity as to when are we going to know the origins of COVID. As one can expect when discussing the origin of COVID, the comments section was quite entertaining. I do have to tip my hat to the several folks who provided …
I have mentioned that I am not a fan of medicine by press release, most recently when covering molnupiravir. Earlier today, 11/5/21, Pfizer put out a press release with the headline in all caps "PFIZER’S NOVEL COVID-19 ORAL ANTIVIRAL TREATMENT CANDIDATE REDUCED RISK OF HOSPITALIZATION OR DEATH BY 89% IN INTERIM ANALYSIS OF PHASE 2/3 …
Continue reading Paxlovid (PF-07321332/ritonavir) for Outpatient COVID: EPIC-HR Trial
Yesterday (10/01/21 for historical context), there was quite a stir after a press release by Merck Pharmaceuticals after reports that their new antiviral medication, molnupiravir. They claim it shows benefits in early COVID-19. In this post, I plan on updating the newest data that comes out regarding this medication using real data. For now, all …
Continue reading Molnupiravir: From Press Release to Practice
Now that tocilizumab is so difficult to obtain (written on 9/2/21 and obviously subject to change), we need another therapy to help improve outcomes in patients with COVID-19 who are hospitalized and critically ill. Baricitinib has entered the chat. Wow, I am all full of stupid meme references these days. Baricitinib is a Janus kinase …
Continue reading Baricitinib: Suppressing the Inflammation in COVID Patients
Here are some of the issues with COVID-19 patients when they are hospitalized. First, they receive high doses of corticosteroids which have an association to GI bleeds. Second, they are (in some institutions) receiving full-dose anticoagulation with heparin, enoxaparin, or a DOAC. This has led many to just go ahead and pull the trigger on …
Continue reading COVID-19 & Proton Pump Inhibitors (PPI): Are they Friends or Foes?
I have been asked about pregnancy and COVID-19 on numerous occasions and I have deferred answering the question because I honestly had not looked much into it. Recently, I was challenged with the task and have stepped up to the occasion of looking into the data of how pregnancy is affected by COVID-19. These are …
Continue reading Pregnancy and Severe COVID-19: Separating the Facts from the Fiction