An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
This post is regarding using passive leg raising and stroke volume to determine fluid responsiveness in patients who need resuscitation. Check out far more in depth data regarding all this HERE. Don't think that I'm anywhere close to being finished on discussing fluid resuscitation and when to stop, I think I could spend a whole …
Continue reading Passive Leg Raising + Stroke Volume for Fluid/Volume Responsiveness
Passive leg raising (PLR) is a technique I am going to cover extensively as I am writing a lecture where this will be a hot subtopic. I've covered it before on my blog and instagram. It's all in the effort to NOT drown our patients in IV fluids when they're hypotensive. Turns out that performing a …
Continue reading Resuscitation & Passive Leg Raise: Don’t use the blood pressure
Taking a quick COVID break, we've had enough of that for now. Let's get back to some simple critical care basics: measuring blood pressure in the ICU. We do this on all of our patients at least hourly for the stable patients. It is performed continuously on our unstable patients. Ultimately, though, we need to …
Continue reading Standard Blood Pressure Measurements in the Critically Ill ICU population
Some legendary names came out to play for this article regarding corticosteroids in COVID-19. Meduri is the author of the famous Meduri Protocol for methylprednisolone in ARDS and Villar is the author of the article I shared on February 13th (seems like forever ago, really) where they provided dexamethasone for ARDS and showed a mortality …
ELSO, the Extracorporeal Life Support Organization, is now doing free training course/modules/program on ECMO (extracorporeal membranous oxygenation), both VV and VA in this COVID-19 time. Take advantage! You need to register, of course. It has been over two years since I did ECMO and this is a good refresher course for me. Check it out …
Continue reading ECMO in Adults Training Course for FREE from ELSO
I typically appreciate guidelines. They do a pretty reasonable job to help us take care of our patients and standardize how we do things. Here, I break down the IDSA guidelines on COVID. With all due respect to the Infectious Disease Society of America (IDSA) , I do not like these guidelines. I'd rather they …
Could plasma exchange help save the lives of COVID patients? Let's straighten out some nomenclature first. We all have questions about what is what and there is much confusion. I personally like the say all these words roll off the tongue. Makes you sound smart when you say it. There's more to it than what …
If you continue reading on this page, you'll note that I have attempted to tackle the whole conundrum of anticoagulation in COVID patient with the pendulum swinging. My first post on the matter was back on 4/6/20 (when this post was initially created) and the second was on 4/12/20. My attempts to keep modifying my …
Continue reading VTE Prophylaxis or Anticoagulation in COVID: Visiting the Guidelines
Let's be quite clear here, there's no miracle drug for all this. I am personally not enthusiastic about Remdesivir in Severe COVID-19. I personally have zero experience with Remdesivir at this point in time. Hopefully you all can comment on whether you anecdotally think it works or not. This study was published earlier today in …
Summer, my favorite season. It can't get here soon enough. Will summer help us with the coronavirus/COVID and help terminate this thing sooner rather than later? This study was published on April 2nd out of Hong Kong in Lancet Microbe. I believe it may be some good news or I may be too optimistic. This paper …
Continue reading Summer heat may help us with COVID! (Hopefully!!)