An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
A few days ago I discussed how the resuscitator, BVM, aka "the ambu" could provide extremely high volumes, up to 1600cc if you get every last cc of O2 out of there, and therefore cause harm to your patient. A new buddy of mine via instagram, Matt, sent me a link to this article discussing this …
Continue reading Pediatric BVM/resuscitator bags in adults? Could this possibly work?
The quick and easy answer to how much volume is in the BVM ventilation bag (the part you squeeze) in an adult resuscitator is 1600ml.You hear the alarm go through the hospital "CODE BLUE in room XYZ". You, like me, are an ambulance chaser and want to get there as soon as possible to either …
Continue reading How much volume is in an adult resuscitator (BVM)? 1600ml
Is there a doctor on the airplane? I will start off by stating that this is not a call that should only be responded to by someone with an MD or a DO behind their name. I know of many seriously good critical care nurses who push away physicians who freeze in a tough situation …
Continue reading Is there a doctor on the airplane? What to expect in an emergency
The article I'm referencing in this post is titled: An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy. It was published in the American Journal of Respiratory and Critical Care Medicine in June of 2019. We see this every day in the intensive care unit. A patient with pneumonia sucking wind. Tachypenic. Slightly …
Continue reading High Flow Nasal Cannula: Does my patient need to be intubated?
Do you as a nurse spend any part of your day checking for residual tube feeds on your patients who are on mechanical ventilation and receiving tube feeds/enteral feeding? Did you know that since 2016, the ASPEN guidelines have recommended against this? Now may be your opportunity to present this data to the powers that …
Continue reading Don’t always check Residuals on Mechanically Ventilated Patients
Full disclosure. I did not learn these nuances about oscillometric blood pressure cuffs and mean arterial pressure (MAP) until I was a fellow in Critical Care Medicine. It is not widely taught. Do not feel bad that you did not know this. All I ask is for your help to share this with others so …
Continue reading BP Measurements in the ICU: Trust the MAP in Oscillometric Devices!
These are the ASPEN guidelines on enteral nutrition that were published in 2016. They were created to assist us in providing patients with appropriate enteral nutrition while they recover from critical illness. This paper is free and although the 53 pages seem intimidating, the last 11 pages are the references. Also, the font is large …
Continue reading ASPEN Guidelines on Enteral nutrition in the ICU
I've had very similar patients with very similar infections where one was out of the ICU in a short amount of time and the other died in flames. Many variables in play, of course, but you get my point. Could the gut microbiome hold a key regarding which patients do well and which patients don't …
Continue reading The gut microbiome alters immunophenotype and survival from sepsis
In the ICU, we are at times obsessed with making our patients “euboxic” or, more clearly stated, all labs values within normal ranges. That being said, electrolytes are something we replete every day and our nurse friends often have protocols which instruct them on how to manage and correct these derangement to hopefully optimize the …
Continue reading Replace/Correct the Magnesium Deficiency Before Potassium (Hypokalemia)!
Generally speaking, one has a gut feeling of how long a patient is going to be on mechanical ventilation. Usually around day 7 or 8 I start warning families that a tracheostomy may be in the near future for their loved one and ask if that is something that if the patient knew full and …
Continue reading Tracheostomy Outcomes After One Year from Acute Respiratory Failure