An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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?
Team, I'll get to making this whole post prettier in the AM when I have some rest under my belt. I saw everyone chiming in on bedsideroundz’ page how they provide versed/midazolam for sedation in their critically ill patients and I had no choice but to put off my bedtime for a few hours and …
Continue reading Minimize Benzodiazepine Use for Sedation in the ICU
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