An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Disclaimers before we get this started. The following is my opinion. This article has not been peer-reviewed. I am going to attempt to be said peer. A hat tip to the folks at the University of Nebraska Medical center who have looked into trying to determine if COVID-19, or SARS-CoV-2 (the virus that causes COVID-19) …
Continue reading COVID: Let’s call it airborne already. UPDATED on 4/1/2020 and 9/21/2020
Several days ago I posted about the FDA approval to start clinical trials to see how convalescent plasma of patients who had already beat COVID-19 would hopefully help patients who are currently suffering from COVID-19. This was now published in JAMA. This paper on plasma in COVID was published in JAMA yesterday states that there …
Continue reading Convalescent Plasma for COVID-19: First Update in JAMA
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 …
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 …
Continue reading COVID-19 Extubation Protocol (in the works)
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 …
Continue reading COVID-19: Don’t order an unnecessary nebulization!!
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 …
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, …
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 …
Continue reading Prone Positioning for ARDS: A Guide on How to Do It.
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 …
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 …