cardiac arrest cath lab

When to Take Cardiac Arrest Patients to the Cath Lab

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 …

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glucocorticoid

Rethinking Corticosteroid/Glucocorticoid Dosing in COVID-19

SARS-CoV-2 is a virus that kicks off an inflammatory disorder in certain individuals. That's what data says and that's what most of us have seen. Inflammatory markers through the roof on the sicker patients, those who end up in my ICU. We start glucocorticoid therapy such as dexamethasone or methylprednisolone and the inflammatory markers drop, …

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cardiogenic shock swan

Cardiogenic Shock & Swan-Ganz/Pulmonary Artery Catheters

Mortality for patients in cardiogenic shock is finally improving to be less than 50%. It had been hovering at 50% for decades. Would floating a Swan Ganz catheter, also known as a Pulmonary Artery Catheter improve outcomes in Cardiogenic Shock? The ESCAPE trial took the winds out of the sails of the Swan-Ganz enthusiasts in …

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pulmonary artery pulsatility index

Pulmonary Artery Pulsatility Index (PAPi)

In an effort to not fly blind in patients with advanced heart failure or cardiogenic shock, certain equations exist to help us manage our patients. This helps us identify who is not doing well and act on their deterioration before it really hits the fan. To measure how the left heart is doing, we use …

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bicarb dka

Bicarb in Diabetic Ketoacidosis (DKA): One Minute Journal Club

This is a one minute journal club. This is not medical advice. The full breakdown in below this snippet.Read the data for yourself.Should we provide our DKA patients with sodium bicarbonate (bicarb) to improve their pH?We want to make the numbers pretty.We want to fix the acidosis faster, but does this work?The first thing people …

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milrinone dobutamine

Milrinone or Dobutamine in Cardiogenic Shock?

Is your institution a milrinone shop or a dobutamine shop? Or do you have a mixed shop?It seems that most institutions are accustomed to use mostly one or the other in cardiogenic shock.Some argue that milrinone is better.Some argue that dobutamine is better.But do we know the answer?This was answered late in 2021 in the …

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nitric oxide Epoprostenol

Nitric Oxide and Epoprostenol (Flolan) Use in Cardiac Surgery

We all wish that every patient who goes into cardiac surgery would be a straight-forward fast track case. Unfortunately, the issues that lead most patients to need cardiac surgery also put them at risk for complications. Some patients present with pulmonary hypertension that is discovered in the operating room once the pulmonary artery catheter is …

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classic trial

CLASSIC Trial: IV Fluids for Septic Shock in the ICU

We often overload our septic shock patients with IV fluids.The CLASSIC trial looked at the fluids we give in the ICU after resuscitation in the ED.This is not medical advice. Read the article for yourself.Almost 1600 patients were enrolled in either the standard or restrictive IV fluid group.Before arriving to the ICU, these patients received …

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vox index

VOX Index: Predicting HFNC Failure (One-Minute Journal Club)

This is a one-minute journal club.This is not medical advice. Read the full free article for yourself (link below).Hat tip to the authors.Link in my stories for the next 24 hours.How do you predict whether a patient on high-flow will need to be intubated?Eyeballing your patient is not quite good enough.The ROX index is a …

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night shift nurses

Night Shift Nurses: Is your Health at Risk? One-Minute Journal Club

This is a one-minute journal club.Check out the link to download the full free article.I recommend you read this article for yourself.This is not medical, nor professional advice.Hat tip to the authors.Do you work or are you considering working night shift?For 24 years they followed over 46,000 night shift nurses in this prospective cohort study.Unfortunately, …

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