An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
There are few options when it comes to right ventricular support for patients who are in right heart failure from a multitude of etiologies. At the time of this writing, we are limited to two temporary percutaneous right ventricular assist devices (RVAD) to assist our patients with this problem: the Impella RP and the Protek …
Continue reading Protek Duo Right Ventricular Assist Device (RVAD) ProtekDuo
Mortality in Cardiogenic shock, historically speaking, is around 50%. Everyone knows that we need to get better. An amazing push in sepsis management has significantly decreased the mortality of that pathology. The last decade has seen many advances towards improving mortality but without robust results, unfortunately. Inotropes and vasopressor have failed at saving lives. There …
Continue reading Impella vs. VA-ECMO for Cardiogenic Shock s/p Myocardial Infarction
This is a work-in-progress blog post for my lecture "Resuscitation and Fluid Responsiveness." In the lecture, I discuss fluid resuscitation in sepsis and volume responsiveness. After all, only 50% of critically ill patients are fluid responsive, and 66% of patients in septic shock are volume overloaded on hospital day 1 (Douglas et al.). Those are …
Continue reading Resuscitation in Sepsis using Fluid/Volume Responsiveness
Let's start off with the basics. ECMO is the medical abbreviation for Extra Corporeal Membrane Oxygenation. This means that the system takes blood out of your body run its through a circuit, and puts oxygen into it. It can obviously do other things which I will cover below. There are two types of ECMO, VA …
Part of the motivation of curating my Instagram account and my website to where it is today was to leverage the efforts of the nine lectures I am about to finish creating. These lectures are suitable for Continuing Medical Education, CME. They do not contain commercial bias. They should be eligible for AMA PRA Category …
Continue reading Continuing Medical Education Lectures in Critical Care
I am thrilled the Choosing Wisely Campaign has looked upon this data. Upon my first foray into the ICU as a PGY-1 many moons ago, we would not be able to go home until we put in orders for all of our patients. Amongst those things that we would order daily included chest x-rays for …
Continue reading Choosing Wisely: Daily Chest X-ray while on Mechanical Ventilation
Let me start off by saying that not every patient who is hypotensive is septic, contrary to what every medicine resident thinks. I could say that because I was a medicine resident at one point. There are 3 other types of shock that are not distributive. We are here to talk about the Cardiogenic kind …
Continue reading Cardiogenic Shock: Mechanical Circulatory Support; Rise of the Machines
Many think that the interest in IV thiamine in septic shock is a relatively novel idea after Paul Marik's paper was published in CHEST back in 2017. It actually goes a lot further than that. We've actually known that 20% of critically ill patients have a thiamine deficiency upon presentation to the ICU. More recent …
Continue reading IV Thiamine: Can it Help Critically Ill Septic Shock Patients?
How I use IV Vitamin C in my practice Since 2017, I have been providing the cocktail of intravenous (IV) vitamin c, thiamine, and stress dose steroids to my patients in septic shock. At my institution, we have complied many patients to whom we have given this regimen. We are looking to use this data …
Continue reading IV Vitamin C in Sepsis: Does it cause harm?
This page features a comprehensive collection of fun and exciting (to me, at least) FOAMed articles that I have shared on Instagram, X (formerly Twitter), LinkedIn, and Facebook. Many have been discussed on The Saving Lives Podcast. Consider subscribing to my monthly newsletter to receive everything I shared that month. Many articles were obtained from …