Sometimes medicine behaves like the stock market; a whole bunch of enthusiasm followed by a realistic pullback. This has now occurred with the concept of using one ventilator for multiple patients. I agree that we need to use some ingenuity in this crisis, but this one never sat well with me, hence me not commenting …
COVID-19 Extubation Protocol (in the works)
Many questions on how to extubate these patients. There's no right answer yet. I've read of a high reintubation rate for these patients and cardiac arrest after extubation we need to be prepared for that. This is a living, breathing document. I would like to make changes as you all point out things that I have missed. Let's attempt …
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COVID-19: Don’t order an unnecessary nebulization!!
Colleagues, I know that lots of us have knee-jerk tendencies to order nebulizations on everyone who is on a ventilator, NIV, or any type of shortness of breath under the sun because it makes us feel warm and fuzzy inside where we say "I did something". This behavior needs to stop. We are potentially aerosolizing …
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US Ventilator Resources for COVID-19
I have purposefully kept quite and obtained data regarding the COVID-19 outbreak. I don't like to open my mouth or write unless I have a pretty good grasp on what is going on. My crew and I are going to be on the front lines when this thing hits, and I believe it's going to …
Upcoming Lectures
The following are places where I am going to be doing my lectures in the upcoming months:2020April 4: Ponte Vedra Beach, FL: Link to ProgramInnovations in Cerebrovascular Science Conference: Topic "Pulmonary Disorders in Acute Neurological Injury"Cancelled. May 14: West Palm Beach, FL: Link to Program Topics: Fluids and Metabolic Resuscitation, Lactic Acidosis, NIV and HFNCCancelled.May 25-29: Maui, …
Prone Positioning for ARDS: A Guide on How to Do It.
I am a huge fan of proning patients who are in ARDS. At one point or another I'll cover the data behind proning like the PROSEVA trial (no time today or until at least June). There are a variety of ways to prone patients which reflect the disposable income of the facilities where you work …
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Cardiac Arrest Survival Statistics
We’re getting better with our management of out of hospital cardiac arrest via quality bystander CPR. The majority of this credit should go to the organizations such as the AHA who puts together programs taught by firefighters, paramedics and EMT’s (forgive me if I screw up the semantics) to health care personnel and the lay …
Early Vasopressors in Septic Shock?
This is a question that is often asked. Do we give fluids until the patient no longer "responds to fluids" or start vasopressors early? Should we start early vasopressors in septic shock or wait until fluids resuscitation is complete?Here's my bias: I dislike arbitrarily pounding patients with fluids. It causes harm. We know this. I …
Dexamethasone in ARDS: DEXA-ARDS Trial Improved Outcomes
This is a big impactful study looking at administering Dexamethasone to patients with ARDS. I'm happy it came out, really happy. To start off a big hat tip to my colleagues in España who put this together. ARDS sucks. It's a b-word to treat and patients spend a frustratingly long time to come off of …
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Non-Invasive Ventilation (NIV/BPAP/BiPAP) Algorithm.
Not every patient reads the textbook, but you and I have to know where to start when managing our patients who have hypercapnic respiratory failure that we want to treat with non-invasive ventilation (or what you and I frequently call BiPAP). This NIV algorithm is taken from the British Thoracic Society/Intensive Care Society Acute Hypercapnic …
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