An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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
I have extensively covered high flow nasal cannula, HFNC on this page due to a talk I'm creating on the matter. We've witnessed it first hand keep patients off of the ventilator. This article published in the American Journal of Respiratory and Critical Care Medicine, which as an aside is the highest impact factor publication …
Continue reading High Flow Nasal Cannula: Physiologic Effects
A little history lesson, my friends, regarding the origins of us calling 0.9% saline solution, aka 0.9% sodium chloride, "normal saline". We are all disappointed in ourselves. You've been calling it normal saline, I've been calling it normal saline, we just can't stop ourselves! Of course you know I am referring to 0.9% sodium chloride …
Continue reading Normal Saline: A History Lesson for the Inappropriate Name
THANK YOUUUUUU! It finally happened; my instagram account reached 10000 followers. I could not have done it without your support. Yeah, you. You're one of those 10,000. Thank YOU for following along in my craziness. First of all, I know there are plenty of Instagram accounts with many more followers than mine, but I have …
I have to credit Dr. Rishi Kumar for inspiring me on this ionized calcium in the ICU post this today. His post on instagram regarding total versus ionized calcium made me recall this article that was transformative for me when it was published in CHEST in December of 2015. I know that the official article …
Please note that I have sorted out this issue and the following rant is a rant on my thought process leading up to my eventual resolution looking at PEEP and high flow nasal cannula. I was trained, or maybe even made it up in my head, that for every 10L of flow increase on the high …
Continue reading HFNC/High Flow Nasal Cannula: Does it generate “PEEP”?
This topic is very dear to me because I am a huuuuuuuge proponent for appropriate end of life care. I'm an Intensivist after all and people unfortunately die on my service. We all are going to have our day. My goal with the patients I take care of is to make their passing to the …
Continue reading Do Not Resuscitate (DNR) does NOT mean you can’t use high flow.
Are soft drinks associated with increased mortality? This study is trying to tell me that soft drinks, whether they are diet or sweetened by sugar are associated with higher mortality? I honestly can't say I'm surprised. Glad I'm not investing in the Coca Cola company. I personally do not drink sodas but I do indulge …
Continue reading Soft drinks: are they associated with increased mortality?
Having an elevated lactate in septic acid on admission is bad. Trending it, as studies that I have shown on this page does not change mortality. Seeing the numbers downtrend do give us that warm and fuzzy feeling inside, though. We give off a sigh of relief when that number becomes "euboxic". This article was …
Continue reading Lactic Acidosis: Does it really mean Hypoperfusion?
Sometimes we need to make minor adjustments in what we do in the ICU to see a difference. I have been going off for several years now on my instagram account as well as YouTube channel regarding the importance of utilizing balanced crystalloids such as lactated ringers or plasma-lyte and I keep on hearing "there's …
Continue reading Does using Balanced Crystalloids vs. Saline improve mortality in sepsis?