An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
The blood pressure is low, give a bolus of fluids. Many times that leads to a "nurse dose" as many of us joke about. But are we causing harm? I keep reiterating that fluid responsiveness is when you achieve an increase in cardiac index/output or an increase in stroke volume due to that fluid or …
Continue reading IV Fluid Overload: Don’t Drown your Patients!
Dinosaurs still roam the earth, I know this. They are slowly and surely retiring, though. I trained in the days where Manny Rivers and the Surviving Sepsis Campaigns pushed for Early-Goal Directed Therapy were king. Hey, there was a reason why it was so successful, EGDT decreased in-hospital mortality from 46.5% to 30.5% in that …
You've heard all these fancy terms, mixed venous blood gas, ScvO2, SvO2, thrown around the ICU all the time. Here, I explain what they are. Regardless of whether you're a nurse, respiratory therapist, medical student, resident, or even a fellow, these terms may sometimes be quite confusing as everyone talks about them like, "duh, you're …
Continue reading SvO2 and ScvO2 to Guide Resuscitation in Septic & Cardiogenic Shock
This post is regarding using passive leg raising and stroke volume to determine fluid responsiveness in patients who need resuscitation. Check out far more in depth data regarding all this HERE. Don't think that I'm anywhere close to being finished on discussing fluid resuscitation and when to stop, I think I could spend a whole …
Continue reading Passive Leg Raising + Stroke Volume for Fluid/Volume Responsiveness
Passive leg raising (PLR) is a technique I am going to cover extensively as I am writing a lecture where this will be a hot subtopic. I've covered it before on my blog and instagram. It's all in the effort to NOT drown our patients in IV fluids when they're hypotensive. Turns out that performing a …
Continue reading Resuscitation & Passive Leg Raise: Don’t use the blood pressure
Taking a quick COVID break, we've had enough of that for now. Let's get back to some simple critical care basics: measuring blood pressure in the ICU. We do this on all of our patients at least hourly for the stable patients. It is performed continuously on our unstable patients. Ultimately, though, we need to …
Continue reading Standard Blood Pressure Measurements in the Critically Ill ICU population
There are four types of shock: cardiogenic, distributive, obstructive, and hypovolemic. The study that I am taking apart here compared the NICOM monitor to a Swan-Ganz (Pulmonary artery) catheter in patients with cardiogenic shock. I routinely make a big deal of volume resuscitation regarding septic shock which obviously falls under the distributive shock type. Part …
Continue reading Cardiogenic Shock: NICOM vs. Swan-Ganz Catheter
Ultrasound assessment of the inferior vena cava for fluid responsiveness: easy, fun, but unlikely to be helpful This is where I stand on the matter today, November 3rd, 2020. I am open to changing my mind with new data. Guiding fluid responsiveness, as I’ve covered here, is a huge pain in the butt. But giving …
Continue reading Inferior Vena Cava (IVC) POCUS for Resuscitation
To my knowledge, this is the second article looking at central venous pressure (CVP). It was published back in 1962. This paper piggybacks off of, what I believe to be the first paper on CVP that I covered here. Ultimately, I read all these papers as I was creating a lecture that is titled "Resuscitation …
Continue reading Central Venous Pressure (CVP): Known Limitations in 1962
I’m working on a talk where I take a trip through memory lane regarding resuscitation. We were all trained to use central venous pressure or right atrial pressure (CVP or RAP) to guide resuscitation and it remains on the Surviving Sepsis guidelines today. This post is about the origin of central venous pressure.Where does the …
Continue reading Central Venous Pressure/Right Atrial Pressure: The Origin
