An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
I am going to be all over the place with this takedown. I’m a bit upset at what may happen as a result of this publication. I really wanted it to be a good study but it’s not. You’ll see why shortly when we analyze the HYPERION trial about targeted temperature management. The good news …
Continue reading HYPERION: 33 vs 37 for Targeted Temperature Management
Here's my bias before I even read the article. I want to see a positive response in providing IV Vitamin C/ascorbic acid in patients who have Acute Respiratory Distress Syndrome (ARDS). Why? Because I want me patients to do better with treatments that are inexpensive and easy to manufacture rather than the latest immunologic that …
When starting my medical training, I had yet to learn the difference between a Cordis and a MAC introducer. I used to hear these words called out in an emergency as follows: Quick! We need to resuscitate this patient with blood, STAT! Call for the massive transfusion protocol, and grab me a Cordis STAT! Do …
Continue reading Cordis vs. MAC Introducer: What’s the Difference?
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. …