An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
This is what I love about the community in social media. We all just push each other to be better. Rishi posted today about titratable Vasopressin and, me being the data junky that I am wanting to know every study I could possibly know under the sun, had two studies in my back pocket ready …
Continue reading Vasopressin: Titratable Doses? Monotherapy in Septic shock?
I've reviewed numerous mechanisms of action and functions of High Flow Nasal Cannula (HFNC) but I haven't touch on whether or not it works to help ventilate patients. I have discussed in the mechanisms of action that it does wash out the CO2 from the dead space in the nasopharynx, oropharynx, etc, but does that …
Continue reading High Flow Nasal Cannula (HFNC): Does it Ventilate COPD Patients?
It has been 7 years since this study came out, and many since. Here we are still using saline like it's benign. Part of the problem is that clinicians get set in their ways and just don't read. Sorry if that offends anyone, but it's true. Some say, "this has always worked and I haven't …
We all know the order sets for DKA, a bunch of 0.9% NaCl first boluses then drip, insulin drip, replace electrolytes, glucose gets to a certain number, change the fluids to 0.9% NaCl that contains dextrose, wait for the anion gap to close, give long acting insulin, wait a bit, turn off the drip, discharge …
Continue reading Diabetic Ketoacidosis (DKA): Balanced Salt Solutions vs. 0.9% Saline
Fortunately in the critical ill population, we do not necessarily have to abide by the saying that "if all you have is a hammer, everything looks like a nail". What I'm referring to is regarding utilizing high-flow nasal cannula in acute heart failure exacerbations. I already dissected how HFNC generated a "PEEP" equivalent airway pressure …
Continue reading High Flow Nasal Cannula in Acute Decompensated Heart Failure
What are your experiences with ketamine for intubation? I am really glad that I stumbled onto this article that was shared by @the_resuscitationist and @medicotactico. When you're dealing with airways and medications that have can concerning adverse effects, you really shouldn't trust me on anything and should read the article yourself. Link in bio. This one is …
Continue reading Ketamine for Rapid and Delayed Sequence Intubation
High-flow nasal cannula oxygen therapy in adults Some of you have asked what I mean every time I post something regarding high flow nasal cannula. Let's start by defining the flow in the different oxygen devices. Regular nasal cannula provides between 1-6 liters of flow. A simple face mask can get you flows between 6-10L/min. …
People worry about the potassium levels in Lactated Ringer's (Ringers Lactate), but what if I told you there's more hyperkalemia with saline? 0.9% saline is 154mmol/L of sodium and 154mmol/L of chloride. That's it. There's no potassium, calcium, magnesium, or buffering agent. Ringer's lactate, however, has 130mmol/L of sodium, 109mmol/L of chloride, 4mmol/L of potassium, …
Continue reading 0.9% NaCl vs. Ringer’s Lactate: Which Increases Potassium?
More than 50% of residents do not know how much sodium is in 0.9% NaCl. I know you do, though... it's 154mmol/L. Far more than our "normal" of 140mmol/L. You should know your IV fluid contents. Why do I nag so much with intravenous fluids and their contents? Truth be told, I did not know …
This study was the first randomized control trial looking at whether high-flow nasal cannula (HFNC) decreases the need for mechanical ventilation in the emergency department. In addition they looked at emergency department and hospital lengths of stays, 90 day mortality, adverse effects in the hospital, and patient experience. I sympathize for the authors of this …
Continue reading High Flow Nasal Cannula in the Emergency Department: Avoid Intubations