An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
I am constantly reading and educating myself in an attempt to gain whatever edge I possibly can for my patients. Their survival and quality of life is what I have personally dedicated my life to. Being someone who is following along on my journey, I can safely assume you're doing the same. I have become …
Continue reading Vitamin D Supplementation in Critically Ill ICU Patients
A sentinel event is one where, amongst other different outcomes, leads to death. In critical care, anesthesia, and emergency medicine, we often deal with emergent airways on patients who are on the brink of death unless we intervene expediently. Despite having performed many intubations in my young career, I have the utmost respect for every …
Continue reading Pre-oxygenation: High flow nasal cannula vs. BVM
I'm certain that the entirety of this post will not fit in the character limit on IG so you'll have to head over to my website to read it completely (don't blame you if you don't! 😉) Time to take a deep breath: 20,000 Instagram followers. When I was approaching 10,000 instagram followers, I was …
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 …
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 …
Continue reading Impella Medical Device: Using the Detroit Cardiogenic Shock Protocol
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) …
Continue reading Ketamine & Catecholamine-dependent Heart Failure: Be Careful
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 …
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 …
Continue reading Magnesium for Sedation in Mechanically Ventilated Patients?
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 …
Continue reading Cardiogenic Shock: NICOM vs. Swan-Ganz Catheter
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 …
Continue reading Spontaneous Breathing Trials: How Does Your Shop Handle This?