An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
I am constantly reading and educating myself in an attempt to gain whatever edge I possibly can for my patients. Their survival and quality of life is what I have personally dedicated my life to. Being someone who is following along on my journey, I can safely assume you're doing the same. I have become …
Continue reading Vitamin D Supplementation in Critically Ill ICU Patients
These are the 2019 European Society of Cardiology and European Respiratory Society Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism. I must say, these are my favorite guidelines for PE and they came out just a few weeks ago on August 31st. It seems as if PE is just on every differential, as …
I am going to be all over the place with this takedown. I’m a bit upset at what may happen as a result of this publication. I really wanted it to be a good study but it’s not. You’ll see why shortly when we analyze the HYPERION trial about targeted temperature management. The good news …
Continue reading HYPERION: 33 vs 37 for Targeted Temperature Management
When starting my medical training, I had yet to learn the difference between a Cordis and a MAC introducer. I used to hear these words called out in an emergency as follows: Quick! We need to resuscitate this patient with blood, STAT! Call for the massive transfusion protocol, and grab me a Cordis STAT! Do …
Continue reading Cordis vs. MAC Introducer: What’s the Difference?
I have to credit Dr. Rishi Kumar for inspiring me on this ionized calcium in the ICU post this today. His post on instagram regarding total versus ionized calcium made me recall this article that was transformative for me when it was published in CHEST in December of 2015. I know that the official article …
Full disclosure. I did not learn these nuances about oscillometric blood pressure cuffs and mean arterial pressure (MAP) until I was a fellow in Critical Care Medicine. It is not widely taught. Do not feel bad that you did not know this. All I ask is for your help to share this with others so …
Continue reading BP Measurements in the ICU: Trust the MAP in Oscillometric Devices!
Generally speaking, one has a gut feeling of how long a patient is going to be on mechanical ventilation. Usually around day 7 or 8 I start warning families that a tracheostomy may be in the near future for their loved one and ask if that is something that if the patient knew full and …
Continue reading Tracheostomy Outcomes After One Year from Acute Respiratory Failure
Hyperkalemia, that dreaded page at 4am that makes our hearts race and we rush to our EMR where we click every single order on the order set. We should really be better at getting an EKG on ourselves and thinking through the whole process. Is the sample hemolyzed? Is the patient already on CRRT and …
Since I've started working at my new institution, I've placed two brachial arterial lines and an axillary line. As any intensivist will admit, if you're looking elsewhere from the radial, it means that the patient is pretty sick and you need some results quickly. While performing this procedure, I've received strange looks from the nurses …
Continue reading Brachial Arterial Line: A Systematic Review of Sorts
Lithium toxicity is something we confront in the intensive care unit. (Hypothetical) Case scenario: Patient comes in, accidental overdose of lithium, HD stable, physical exam unremarkable, labs pristine, lithium level of 2.x. Poison control called. ED interventions performed flawlessly. Nephro consulted in the ED and recommends HD if level is above (insert arbitrary number here). …
Continue reading Lithium Toxicity: Dialyze or Monitor these Patients?
