An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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
Those of us who have placed COVID-19 ICU patients on mechanical ventilation know that this is not a process that is going to resolve overnight. Patient with decompensated congestive heart failure with pulmonary edema? Better in 24-48 hours. Aspiration pneumonia in a young kid who partied a little too hard? Better in a few days. …
Continue reading ICU COVID-19 Patients Don’t Get Well Soon, Unfortunately
This page is a work in progress regarding anaphylaxis and was first updated on 4/26/21 and last updated on 4/22/22. Stay tuned for updates.Cite this post as: Eddy J. Gutierrez, "Anaphylaxis: Act Fast and Save a Life", eddyjoemd blog, April 26, 2021. Available at: http://eddyjoemd.com/anaphylaxis/. Citations for Anaphylaxis: (Updated 4/14/22) Li X, Ma Q, Yin …
Let's start off by defining double triggering. No, it's not saying two things interpreted as inflammatory to someone back to back while they lose their minds. These are strange times we live in. I digress. Double triggering is something that occurs to patients who are mechanical ventilation. The lay person would interpret this as the …
Continue reading Double Triggering and Ventilator Asynchrony/Dyssynchrony
I have quite a love-hate relationship with central lines. They sometimes give me the warm and fuzzies when my Emergency Medicine colleagues call me for a sick patient in the ED who is entirely appropriate for the ICU. I see a right internal jugular central venous catheter on the chest x-ray. In my practice, I …
Continue reading Peripheral Vasopressors: Are They Safe for our Patients?
Yesterday, in the Journal of Cardiothoracic and Vascular Anesthesia, there was a Letter to the Editor by a group of physicians in Italy were where they described the five reasons why people die of COVID-19. I found it quite interesting that this article was published in that particular journal. Given that the audience to my …
Continue reading The five reasons why COVID-19 causes death.
The pendulum has swung when it comes to deciding when to proceed with intubation of our COVID-19 patients when it comes to timing. The early data suggested early intubation was the way to go as we were all terrified or aerosolization of the virus caused by the high-flow nasal oxygen or different modes of non-invasive …
Continue reading Timing of Intubation in COVID-19 Patients: Early or Late?
I've always had a strong interest in Procalcitonin and how to use it appropriately for our hospitalized patients in the ICU. For that reason, I am creating this work-in-progress page to take a deep dive into all evidence-based clinical questions you and I may have regarding procalcitonin. This post will be continuously updated. Don't trust …
Continue reading Procalcitonin Levels: The Ultimate Guide for Use in Sepsis
Update: I will cover the I-TECH study published on 2/18/22 on Ivermectin in COVID-19 Patients soon. The link to the article (but not my thoughts just yet) is down below in the citations. I am on service this weekend and don't have time to tackle it appropriately. Spoiler alert: as much as this is a …
Continue reading Ivermectin Doesn’t Help Healthy Patients with COVID-19
I am not going to belabor this too much but we should stop using azithromycin in the community setting for COVID-19. The rationale for this recommendation was based on an article that was published on 4 March 2021 in the Lancet. The article is titled "azithromycin for community treatment of suspected COVID-19 in people at …
Continue reading Azithromycin in Outpatient COVID-19: Not Recommended