An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
CODE BLUE! Run! Run! Arrive and the patient has no IV access. What should we do next? Place a peripheral IV or place an intraosseous access? Which will lead to better outcomes? These authors took a retrospective look at in-hospital cardiac arrest at one center. They looked at a total of 1039 patients when it …
Continue reading In-Hospital Cardiac Arrest! No Access. Place an IV or an IO?
Yesterday (10/01/21 for historical context), there was quite a stir after a press release by Merck Pharmaceuticals after reports that their new antiviral medication, molnupiravir. They claim it shows benefits in early COVID-19. In this post, I plan on updating the newest data that comes out regarding this medication using real data. For now, all …
Continue reading Molnupiravir: From Press Release to Practice
There's a lecture that I have shared with audiences looking at opioid-sparing medications for pain and sedation in the intensive care unit that I have been working on for several years. In this post, I will be sharing this content with you all with the citations you everyone can better their practices and we can …
Continue reading Non-opioid Pain/Sedation Management in the ICU
Now that tocilizumab is so difficult to obtain (written on 9/2/21 and obviously subject to change), we need another therapy to help improve outcomes in patients with COVID-19 who are hospitalized and critically ill. Baricitinib has entered the chat. Wow, I am all full of stupid meme references these days. Baricitinib is a Janus kinase …
Continue reading Baricitinib: Suppressing the Inflammation in COVID Patients
Here are some of the issues with COVID-19 patients when they are hospitalized. First, they receive high doses of corticosteroids which have an association to GI bleeds. Second, they are (in some institutions) receiving full-dose anticoagulation with heparin, enoxaparin, or a DOAC. This has led many to just go ahead and pull the trigger on …
Continue reading COVID-19 & Proton Pump Inhibitors (PPI): Are they Friends or Foes?
I have been asked about pregnancy and COVID-19 on numerous occasions and I have deferred answering the question because I honestly had not looked much into it. Recently, I was challenged with the task and have stepped up to the occasion of looking into the data of how pregnancy is affected by COVID-19. These are …
Continue reading Pregnancy and Severe COVID-19: Separating the Facts from the Fiction
On 8/9/21 I put out a tweet discussing (in a certain limited number of characters) how difficult it is to get a patient who is intubated and placed on mechanical ventilation because of severe COVID-19 ARDS. I used the analogy of landing an airplane in a hurricane. Definitely not easy. Something came over me where …
Continue reading Expectations for Families of COVID-19 Patients on the Ventilator
Patients placed on mechanical ventilation carry a certain mortality by default. Obviously it is not a good thing to end up intubated in the ICU. It's one thing to set up a patient on mechanical ventilation and then just twist the knobs to get a pretty arterial blood gas that's satisfactory to keep the patient …
Continue reading Driving Pressure in ARDS: Improving Survival By Any Means Necessary
This is a difficult subject to discuss because we all have people we love who suffer from issues that have led to them having a higher weight than what they should and, in turn, carry the diagnosis of obesity. This post is not intended to shame anyone. But there's definitely a link between obesity and …
Continue reading Obesity in Critical Illness & COVID-19: A Very Bad Combination
Way back when I was just a baby intern, I remember placing these large IJ cannulas in the patients who suffered cardiac arrests to proceed with hypothermia. Later in my training, in December of 2013, the NEJM published the Targeted Temperature Management (TTM trial) looking at 33°C versus 36°C after Cardiac Arrest. The paradigm began …
Continue reading Hypothermia (33°C) vs. Normothermia (37.5°C) in Cardiac Arrest – TTM2