An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
A patient has a cardiac arrest and ROSC was achieved.They present to the ER or ICU.Suspicion is high that this was a cardiac insult.The EKG, though, does not show a STEMI.Troponins are elevated. The patient has a cardiac history.Have you ever wondered why intensivists never ask cardiology to take the patient to the cath lab …
Continue reading When to Take Cardiac Arrest Patients to the Cath Lab
This is a one minute journal club. This is not medical advice. The full breakdown in below this snippet.Read the data for yourself.Should we provide our DKA patients with sodium bicarbonate (bicarb) to improve their pH?We want to make the numbers pretty.We want to fix the acidosis faster, but does this work?The first thing people …
Continue reading Bicarb in Diabetic Ketoacidosis (DKA): One Minute Journal Club
For historical context, today is 05.11.22 and I am going to start compiling the data showing the benefits of having a palliative care team in the ICU. This post will be updated regularly as time permits. I have been fortunate to work, and have worked, with some great people on these teams during the course …
Many people over the years have asked me how I stay up to date with the medical literature. Particularly, they tend to mean how I stay up to date in critical care. Hopefully, this post will explain things. Several years ago I created a youtube video which is linked below. I value staying up to …
Continue reading How to Stay Up To Date with the Critical Care Medical Literature
My love for ACLS goes back far in my career. I fondly recall taking an ACLS/BLS course after completing medical school and prior to starting residency. It was a small class, just a couple students. The instructor was a charismatic firefighter (who I remain friends with to this day) who noted that I was particularly …
Continue reading Vasopressin & Methylprednisolone: Time to Add Them to ACLS Protocols?
We all like to make the numbers pretty in our critically ill patient. Euboxic is a term that is thrown out there. It's like there's a check box in our brains that we need to fill in when turning a lab value back to the default color rather than red in our EMR. But one …
Continue reading Bicarbonate for Respiratory Acidosis: Not So Fast
For over 100 years, hyperbaric chambers have been used as an evidenced based treatment for diving emergencies. However, hyperbaric indications are typically not common knowledge outside of diving and outpatient wound care fields. This primer is intended to help intensivists understand hyperbaric oxygen therapy (HBOT) indications and challenges relevant to critical care. Cite this post …
Continue reading Hyperbaric Oxygen Therapy (HBOT) for Intensivists- by Kurt Laipple
CODE BLUE! Run! Run! Arrive and the patient has no IV access. What should we do next? Place a peripheral IV or place an intraosseous access? Which will lead to better outcomes? These authors took a retrospective look at in-hospital cardiac arrest at one center. They looked at a total of 1039 patients when it …
Continue reading In-Hospital Cardiac Arrest! No Access. Place an IV or an IO?
Way back when I was just a baby intern, I remember placing these large IJ cannulas in the patients who suffered cardiac arrests to proceed with hypothermia. Later in my training, in December of 2013, the NEJM published the Targeted Temperature Management (TTM trial) looking at 33°C versus 36°C after Cardiac Arrest. The paradigm began …
Continue reading Hypothermia (33°C) vs. Normothermia (37.5°C) in Cardiac Arrest – TTM2
This page is a work in progress regarding anaphylaxis and was first updated on 4/26/21 and last updated on 4/22/22. Stay tuned for updates.Cite this post as: Eddy J. Gutierrez, "Anaphylaxis: Act Fast and Save a Life", eddyjoemd blog, April 26, 2021. Available at: https://eddyjoemd.com/anaphylaxis/. Citations for Anaphylaxis: (Updated 4/14/22) Li X, Ma Q, Yin …
