An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Those of us who are in the ICU, especially those of us taking care of the patients caught up in this pandemic have learned that certain patients can be quite challenging to oxygenate and ventilate. For the uninitiated, the whole purpose of mechanical ventilation is to be a band-aid of sorts for patients who we …
Continue reading Hypercapnic Respiratory Failure: Tricks for Ventilator Management
Believe it or not, there is not a lot of data regarding using noninvasive ventilation, also called NIV or BiPAP to care for patients with acute asthma exacerbations. The data is actually quite limited, unfortunately. This paper published a few days ago in the AJRCCM took a retrospective look at a large number of patients …
Continue reading Noninvasive Ventilation (NIV/BiPAP) in Acute Asthma Exacerbations
We all know what the standard of care is for adults who come in with acute asthma exacerbations. They receive supplemental oxygen to keep sats >92%, bronchodilators, anticholinergics, steroids, with possibly some bonus magnesium. In addition, we obtain a series of labs, chest films, and an arterial blood gas. The really sick patients have findings …
Continue reading High Flow Nasal Cannula (HFNC) in Acute Severe Asthma Exacerbations
Check out the podcast with my take Convalescent Plasma from this article. See the article used for 4/1/22 update in the citations. https://youtu.be/9Jyk2MEtGYc Check out my other COVID-19 related posts HERE. Citations for Convalescent Plasma Simonovich VA, Burgos Pratx LD, Scibona P, Beruto MV, Vallone MG, Vázquez C, Savoy N, Giunta DH, Pérez LG, Sánchez …
Continue reading Convalescent Plasma in COVID-19 Severe Pneumonia: PlasmAr
Could a CBC w/diff tell us who's going to do poorly with COVID? Using the neutrophil to lymphocyte ratio could be quite helpful. Can we identify who’s going to get incredibly ill and who isn’t from COVID? I know we struggle with this significantly as we make phone calls to family members every single day …
Continue reading Neutrophil to Lymphocyte Ratio (NLR): Predicting Outcomes in COVID
I always like to clarify that I am an ICU physician and not an outpatient physician. I personally have never written for fluvoxamine in my career and have never provided it to a COVID patient. That being said, I feel much of the help we need regarding therapies for COVID are to prevent these folks …
Continue reading Fluvoxamine & COVID: A Potential Outpatient Option
We have all had this patient. Someone who is in acute hypoxemic respiratory failure, let's just call it pneumonia of some sort or ARDS, and the regular nasal cannula or a venti-mask can't cut it. They're not at the severity where you can eyeball the patient and just know that they need to be intubated. …
Continue reading ROX Index: Predicting Who Is or Isn’t Going to Fly on HFNC
Addendum: As data changes, perspectives should change, too. This post on aspirin and COVID was initially posted on 10/25/20. Since then more robust data has been published. I have left my perspective up on this page for the sake of transparency. The original post starts now. Let's answer the first question these academic elites will …
Continue reading Aspirin & COVID-19: Does it Decrease the Severity of Illness?
The stories of COVID patients spontaneously meeting their demise in the non-ICU and non-stepdown units have decreased substantially during the course of the pandemic. My non-scientific rationale for this is that we're getting better at anti-coagulating our patients and therefore decreasing the incidence of the pro-thrombotic sequelae of COVID. That being said, when these patients …
Continue reading Cardiac Arrest & COVID: A Very Poor Combination
This page contains links to the different papers that have been published during the pandemic regarding the utilization of Tocilizumab in treating COVID. Citations for Tocilizumab papers Published on 12/17/2020Salama C, Han J, Yau L, Reiss WG, Kramer B, Neidhart JD, Criner GJ, Kaplan-Lewis E, Baden R, Pandit L, Cameron ML, Garcia-Diaz J, Chávez V, …
Continue reading Tocilizumab in COVID: The Data is Trickling Out