An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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?
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 …
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 …
Continue reading Appreciating Our Nurses: Role of the ICU Physician
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 …
Continue reading Resuscitation in Acute Pancreatitis: IV Fluids
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
