An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
In this post which will be updated continuously, I will be examining the clinical questions regarding ICU nutrition. These data do not apply to the non-ICU patients. The first thing that we need to acknowledge is that nutrition in the critically ill is not one size fits all nor set it and forget it in …
Continue reading Nutrition in the Critically Ill/Intensive Care Unit (ICU)
I covered this topic about hypophosphatemia in the critically ill back in the infancy of my Instagram account on 4/19/2019. Seems like an eternity ago. I know it's not very Zentensivist of me to have this as part of my practice, but this is something I actively chase in my patients. Phosphorus, generally speaking, is …
Continue reading Phosphorus/Hypophosphatemia in the Critically Ill: Let’s Correct it!
We've gotten quite good at putting today negative pressure rooms for our patients who are hospitalized with COVID. We've gotten our PPE sorted out. We're pretty solid with our donning and doffing. But when should we discontinue contact precautions on these patients? Should they be on isolation for their entire hospitalization? When can family members …
Continue reading Discontinuing Contact Precautions in COVID-19 Patients
Here's my bias on 8/22/2020. I don't think that Remdesivir is a game-changer by any stretch of the imagination. This is subject to change with future studies. I could be wrong. To me, it is a pharmacologic agent looking for an indication. Gilead has spent $2.45 million dollars lobbying (per NPR) Congress in the first …
Continue reading Remdesivir: $3120 worth of “uncertain clinical importance”
Those of us who take care of COVID patients in the ICU wonder what is the best for our patients regarding intubation. We learned early in the course of the pandemic that proceeding with early intubation was not beneficial to our patients. You all have also see the patient who has a PaO2 of 55 …
Continue reading Intubation of COVID-19 Patients: Does Timing Change Outcomes?
Did you know that zinc is the second-most abundant trace metal in the human body? A quick reminder that iron comes in first place. Zinc is an essential component of protein structure and function. It enables gene transcription and is a "catalytic component of approximately 2000 enzymes" (Read, et al). Could we use zinc for …
Continue reading Zinc for Metabolic Resuscitation in Critical Illness
I wish this was a positive study regarding hydroxychloroquine (HCQ) for postexposure prophylaxis but unfortunately it is not. Let's start off with a bit of a head scratcher. I'm struggling with how they worded the study "Postexposure prophylaxis". Prophylaxis, by definition, means "action taken to prevent disease" per the Oxford dictionary. But if you are …
Continue reading Hydroxychloroquine (HCQ) for Postexposure Prophylaxis in COVID-19
Bias alert. I am bullish on Vitamin C. Aren't things easier when you don't have to wonder these things? I digress. The article cited for this post was published in the journal Nutrition on 7/25/2020. Obviously, the title of the paper "Vitamin C as prophylaxis and adjunctive medical treatment for COVID-19?" caught my attention. Hat …
Continue reading Vitamin C for COVID: Possible Prophylaxis & Adjunctive Therapy
Check out the addendum from 10/19 at the end of this post. COVID IS SOOOOO FRUSTRATING TO TREAT! Another tool taken out of the tool box with this COVACTA study looking at tocilizumab in COVID-19. Several weeks ago, I covered tocilizumab and cytokine storm in this post. Check it out for further details. I am …
Continue reading Does Actemra/Tocilizumab Actually Work? Update to the COVACTA Study
Does hydroxychloroquine, azithromycin, and zinc help non-hospitalized/outpatient COVID patients in the community? The short answer is that we don't know. If you are convinced 100% that it is a "cure" or 100% that it kills everyone, you need to take a step back and take a deep breath. Your emotions got the best of you. …
Continue reading Hydroxychloroquine, Azithromycin and Zinc in Outpatient Medicine