An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
There are very powerful people who do not want us to be informed.There are people who do not want us to have the ability to have different thoughts.Several days ago I posted research that was conducted in Boston.Research that I found concerning. Research that many experts find concerning.Knowing that the powers-that-be use very powerful technology …
The last couple years have been challenging for all health-care personnel.Improving morale is something that I have worked on substantially in my practice. Many of us could do more in appreciating our nurses. Nurse retention is a problem everywhere.I am married to an ICU nurse for some additional context.A paper looking at this was published …
Continue reading Appreciating Our Nurses: Role of the ICU Physician
A paper regarding to acute pancreatitis was published in the New England Journal of Medicine on 15 September of 2022. It is titled "aggressive or moderate fluid resuscitation and acute pancreatitis". Hat tips to the authors. I would tell you to read this article for yourself but, unfortunately, it is hidden behind the pay wall …
Continue reading Resuscitation in Acute Pancreatitis: IV Fluids
If you have come onto this site, I would first of all like to thank you for attending one of my lectures. I believe that anyone who speaks has the potential of accidentally misquoting or misinterpreting a study. Therefore, I present to you the citations of my Crystalloid Journey work so that you could read …
In patients who need IV fluids, we can either provide "normal saline" or balanced salt solutions.Balanced salt solutions include Lactated Ringer's and Plasmalyte.There have been several trials trying to answer this question. The data hasn't been as rock solid as we'd like to convince our biases.The BaSICS trial is a recent landmark trial.As always, I …
Continue reading BaSICS Trial: Plasmalyte vs. 0.9% NaCl in the Critically Ill
As much as I am not a huge fan of bombarding septic shock patients with IV fluids, I understand there is a role for fluid resuscitation.When our patients get better, though, it is time to get rid of these fluids.That is what we call deresuscitation.It is part of the 4 D's in fluid therapy: drug, …
Continue reading How Strong Is Your Deresuscitation Game in Sepsis Patients?
With a close to 50% mortality rate for cardiogenic shock, we all need a do a better job of caring for these patients. A cardiogenic shock classification would help identify who needs the most help.This is created for anyone caring for cardiogenic shock including physicians, APPs and nurses.We are all in this together. The earlier …
Continue reading Cardiogenic Shock: SCAI Stage Classification
When patients present to the ED in DKA, should we resuscitate them with 0.9% sodium chloride (saline) or balanced salt solutions such as plasma-lyte or lactated ringers?Many DKA order sets use 0.9% sodium chloride "aka normal saline" as their initial fluid of choice.We know these patients are dry when they arrive to the ED.They need …
Continue reading Saline or Lactated Ringers/Plasma-lyte for DKA Resuscitation?
Which should be the first-line vasopressor between norepinephrine and epinephrine in cardiogenic shock?Your patient had an MI and is now in cardiogenic shock.They are hypotensive and need a vasopressor.To clarify, The Crit Doc of Tik Tok aka CriticalCareNow aka Haney Mallemat likes epinephrine as an inotrope, not a vasopressor.This was a pilot study, meaning that …
Continue reading Norepinephrine or Epinephrine in Cardiogenic Shock: Is One Better?
A patient has a cardiac arrest and ROSC was achieved.They present to the ER or ICU.Suspicion is high that this was a cardiac insult.The EKG, though, does not show a STEMI.Troponins are elevated. The patient has a cardiac history.Have you ever wondered why intensivists never ask cardiology to take the patient to the cath lab …
Continue reading When to Take Cardiac Arrest Patients to the Cath Lab
