An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Many find reading medical journal articles overwhelming. There was a point where I was like this as well, I wasn't born knowing how to read this nerdy stuff. Here's a quick tip to get you started and to share with your friends. This is by no means an all encompassing review. There are many ways …
Continue reading Beginners Guide: Appraising Medical Articles & 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