I covered the 2015 version of meta-analysis back in April when I couldn't get my hands on this one, the 2018 version. I appreciate the Cochrane Library for making this free. You could get to it from my website. The last time I posted about Lidocaine was in April when I had fewer than 1500 …
Impella Medical Device: Using the Detroit Cardiogenic Shock Protocol
This is my first of many posts on the Impella system by Abiomed. It is going to be part of my "Cardiogenic Shock: Rise of the Machines" lecture for Portland in August 2020. I am planning on covering LVADs, RVADs, ECMO, TandemHeart, etc. in the upcoming months but one does not need to work at …
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Ketamine & Catecholamine-dependent Heart Failure: Be Careful
The Ketamine kick continues! I am not going to pretend I knew everything about everything as I've created this page over the last several months. People who walk around saying things like they were born with that knowledge sometimes need to be checked. We all had that one eye-opening day where it was like, "(explicative) …
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Pregabalin as Opioid Sparing Therapy
I’m hard at work on a protocol for my shop to decrease opioid usage as well as preparing my lectures on opioid sparing medications. Amongst those are the gabapentinoids. You’ve seen them often, I’m sure, mostly to treat neuropathic pain such as diabetic neuropathy as well as trigeminal neuralgia but what about for actual painful …
Magnesium for Sedation in Mechanically Ventilated Patients?
This is cool, really cool. We need more data, but this is a great start. I would not call this the most robust study I have ever seen regarding the care of patients in the intensive care unit. I learned a lot of basic science from reading the introduction as well as discussion on this …
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Cardiogenic Shock: NICOM vs. Swan-Ganz Catheter
There are four types of shock: cardiogenic, distributive, obstructive, and hypovolemic. The study that I am taking apart here compared the NICOM monitor to a Swan-Ganz (Pulmonary artery) catheter in patients with cardiogenic shock. I routinely make a big deal of volume resuscitation regarding septic shock which obviously falls under the distributive shock type. Part …
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Spontaneous Breathing Trials: How Does Your Shop Handle This?
There has been quite a bit of variation regarding pressure support trials, spontaneous breathing trials, liberation trials, whatever you want to call it. I recently looked at the data for my academic curiosity and would like your input as to how you do it at your shop. I’d like to apologize in advance if I …
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Lactate Measurements: Venous or Arterial Samples?
This is a question I remember asking myself quite a bit during my training when I used to check/trend lactate levels more than I do today. Does it really matter whether I check it from an arterial line or from a venous stick? This study which was a prospective study of 100 patients who had …
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Lactic Acid has a WIDE Differential Diagnosis (not just Sepsis)
There's a pendulum in medicine. Some things are over recognized and aggressively treated, some things are under appreciated (like subtle decreases in serum bicarb showing that the patient is becoming more acidotic and no one notices because the patient has obesity hypoventilation syndrome and their baseline bicarb is 34 and now has a bicarb of …
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Lactic Acid is an Alarm, not a Treatment in Sepsis and Septic Shock
I need to eat my words on this one, because now there's data to show that there's a benefit to rechecking lactate levels in septic patients, but not for the reasons why one would think. During my rounds over the course of the weekend, I recall telling several nurses that there's no data to suggest …
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