An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Yesterday in Instagram and Twitter, I posted the post and caption regarding my curiosity as to when are we going to know the origins of COVID. As one can expect when discussing the origin of COVID, the comments section was quite entertaining. I do have to tip my hat to the several folks who provided …
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
So there's little to no formal documentation from the perspective of an Intensivist on how to manage a CABG patient who is coming out of the CVOR to the CVICU. I'm sure some brilliant anesthesiologist or other intensivist has done this before, but I just haven't found it. Let's start. By the way, this is …
Continue reading Recovering CABG & Cardiac/Heart Surgery Patients in the CVICU
For over 100 years, hyperbaric chambers have been used as an evidenced based treatment for diving emergencies. However, hyperbaric indications are typically not common knowledge outside of diving and outpatient wound care fields. This primer is intended to help intensivists understand hyperbaric oxygen therapy (HBOT) indications and challenges relevant to critical care. Cite this post …
Continue reading Hyperbaric Oxygen Therapy (HBOT) for Intensivists- by Kurt Laipple
I have mentioned that I am not a fan of medicine by press release, most recently when covering molnupiravir. Earlier today, 11/5/21, Pfizer put out a press release with the headline in all caps "PFIZER’S NOVEL COVID-19 ORAL ANTIVIRAL TREATMENT CANDIDATE REDUCED RISK OF HOSPITALIZATION OR DEATH BY 89% IN INTERIM ANALYSIS OF PHASE 2/3 …
Continue reading Paxlovid (PF-07321332/ritonavir) for Outpatient COVID: EPIC-HR Trial
A common scenario that occurs daily, heck even perhaps hourly, in most emergency departments or intensive care units around the world including providing patient with IV fluids rapidly via fluid bolus to resuscitate hypotensive patients or those who are in shock. In order to mitigate said hypotension/shock, the most common response by clinicians is to …
Continue reading Fluid Bolus in Resuscitation: Pressure Bag vs. 999ml/hr on the IV Pump
Unfortunately, delirium in ICU and critically ill patients is a quite common problem that we are having trouble making progress on controlling. It is quite frustrating when I am caring for a patient who has recovered from their main life-threatening insult to be left encephalopathic and the family constantly asking "what's wrong". The most common …
Continue reading Delirium in the ICU & Critically Ill Patients
Standard of care for patients who have acute COPD exacerbations with hypercapnia is to provide the patients with steroids, nebulizations, supplemental oxygen, and positive pressure. What if I were to tell you that one could potentially with the high flow nasal cannula systems to treat COPD exacerbations? Well, that's why you're here on this page. …
Continue reading COPD & Nasal High Flow/High-Flow Nasal Cannula (NHF, HFNC, HFO)
There are numerous methodologies that we can utilize to determine fluid responsiveness in our critically ill patients in the emergency department or in the intensive care unit. In this post, I will be taking a deep dive into pulse pressure variation, PPV as the shorthand. For details about the other methods for determining fluid responsiveness, …
Continue reading Pulse Pressure Variation (PPV) for Fluid/Volume Responsiveness
What is end-expiratory occlusion testing? It is a method we can use at the bedside to determine whether a patient is fluid-responsive. We have actually known about this since 2009 when Monnet et al. explored this concept in a not-free article. The full description of the heart-lung interaction that allows this to work is beyond …
Continue reading End-Expiratory Occlusion for Fluid/Volume Responsiveness