An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Have you tried to use phenobarbital for your ICU patients with alcohol withdrawal syndrome?Typically, we use benzodiazepines such as ativan to treat this.Although the empiric data is quite compelling to make the switch.I personally use phenobarbital more often than benzodiazepines these days.The main question of course is the dosing.This single-center, pre-post protocol implementation study is …
Continue reading Phenobarbital for Alcohol Withdrawal: Reviewing the Evidence
Your patient has thrombocytopenia (low platelet count) but also needs a central line (CVC).We do not want to do harm to our patient and cause them a bleeding complication.But what is the magic platelet count to safely perform the procedure?The authors performed a multicenter randomized controlled trial with 338 patients to find out.Hat tip to …
Continue reading Thrombocytopenia & CVC Placement: What’s the Platelet Count Threshold to Transfuse?
We've all noted the Modified Early Warning Score in our daily workflows.But is this MEWS better than our clinical gestalt at predicting clinical illness?That's what these authors sought to sort out.Hat tip to the authors. Read these data for yourself.They performed a multicenter, prospective observational trial of all patients who presented to the ED via …
Continue reading Is the Modified Early Warning Score (MEWS) Superior to Physician & Nurse Judgement?
Cytokines tend to break things in critical illness.Pro-inflammatory cytokines cause vasodilation.Anti-inflammatory cytokines cause immunosupression.Inventing a way to get rid of those cytokines sounds like a good idea, right?Cytosorb has been on out the market and trialed in sepsis, ARDS, cardiac surgery or recovery after cardiac arrest in the ICU.It sounds expensive, but does it work?A …
Continue reading Cytosorb to Absorb Cytokines & Improve ICU Outcomes?
We all know that nurse to nurse familiarity is important for teamwork and outcomes in critical care. This familiarity helps the cohesion of the unit and helps nurse retention when coupled with safe staffing ratios. Some things in medicine are known but it's still nice when reinforced by data.In October of last year year an …
Continue reading Nurse Familiarity: Working with Buddies Safely Saves Lives
I often hear people say that the patient, who has fluid overload with significant edema, is intravascularly depleted.Despite significant reading on the matter I have not been able to find a suitable explanation.Thankfully, this paper was published a few days ago with the best explanation I've read.Hat tip to the authors, read these data for …
Continue reading Fluid Overload but Intravascularly Depleted: What does this mean?
Should we be using amiodarone or lidocaine for patients who go into cardiac arrest due to ventricular tachycardia or ventricular fibrillation while in the hospital? The ACLS guidelines support the use of either. I have personally noted far more use of amiodarone over lidocaine for this issue. These data published in the May 2023 issue …
Continue reading Amiodarone or Lidocaine for In-Hospital Cardiac Arrest?
A definite hat tip to my buddy Matt Siuba (zentensivist.com) and his colleagues for this great review on the management of right ventricular (RV) dysfunction in patients with ARDS. I plan on elaborating further on this paper but the bottom line is that we need more data. For now, head down to the citations to …
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
A patient with no access 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 …
Continue reading Access in Out-Of-Hospital Cardiac Arrest (OHCA): Which is Best? IV or IO?
