An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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
Haldol is an antipsychotic that we frequently use in the ICU for delirium.But the truth is that the data behind using it is not as robust as we would like.Earlier today, there was a paper published in the NEJM that attempted to find its effects on delirium.Hat tip to the authors. Read these data for …
Continue reading Haldol (Haloperidol) in the ICU: One-Minute Journal Club
In patients who need IV fluids, we can either provide "normal saline" or balanced salt solutions.Balanced salt solutions include Lactated Ringer's and Plasmalyte.There have been several trials trying to answer this question. The data hasn't been as rock solid as we'd like to convince our biases.The BaSICS trial is a recent landmark trial.As always, I …
Continue reading BaSICS Trial: Plasmalyte vs. 0.9% NaCl in the Critically Ill
Which should be the first-line vasopressor between norepinephrine and epinephrine in cardiogenic shock?Your patient had an MI and is now in cardiogenic shock.They are hypotensive and need a vasopressor.To clarify, The Crit Doc of Tik Tok aka CriticalCareNow aka Haney Mallemat likes epinephrine as an inotrope, not a vasopressor.This was a pilot study, meaning that …
Continue reading Norepinephrine or Epinephrine in Cardiogenic Shock: Is One Better?
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
Mortality for patients in cardiogenic shock is finally improving to be less than 50%. It had been hovering at 50% for decades. Would floating a Swan Ganz catheter, also known as a Pulmonary Artery Catheter improve outcomes in Cardiogenic Shock? The ESCAPE trial took the winds out of the sails of the Swan-Ganz enthusiasts in …
Continue reading Cardiogenic Shock & Swan-Ganz/Pulmonary Artery Catheters
To not fly blind in patients with advanced heart failure or cardiogenic shock, certain equations exist to help us manage our patients. This allows us to identify who is not doing well and act on their deterioration before it really hits the fan. We use cardiac power output (CPO), which I have dissected in THIS …
Continue reading Pulmonary Artery Pulsatility Index (PAPi): Principles & Calculation
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
Is your institution a milrinone shop or a dobutamine shop? Or do you have a mixed shop?It seems that most institutions are accustomed to use mostly one or the other in cardiogenic shock.Some argue that milrinone is better.Some argue that dobutamine is better.But do we know the answer?This was answered late in 2021 in the …
Continue reading Milrinone or Dobutamine in Cardiogenic Shock?