An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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
Our curiosity is what drove is to our respective fields in medicine. As an intensivist, I LOOOOVE trending numbers and analyzing the minutia of the details to predict in what direction my patient is going. There is a difference, though, between utilizing labs to better serve your patient and using labs to satisfy your academic …
Link to EBM images. The evidence based medicine pyramid is an illustration to help us understand the hierarchy of medical literature and its interpretation. Like this some yahoo such as myself can't give expert opinion that supersedes a randomized controlled trial. I am thrilled that my page has gotten a few people turned on to …
We are all trying to combat delirium by all possible means. Getting pts their glasses and hearing aides. Keeping the lights on during the day. Having family around to speak to them. We’ve also had recent trials which have been quite disappointing using medications. Could there be a good cheap medication to prevent #delirium? This …
Continue reading Melatonin on Delirium in Hospitalized Patients
I originally posted this article on 6/21/19 while preparing my NIV/BiPAP lecture. During that process, I learned and shared on IG about using a helmet rather than a mask for NIV (non-invasive ventilation). Looking at the footage that has been coming out of Italy and other parts of the world, you can catch a glimpse …
High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure (FLORALI Trial) I first shared this article in June of 2019 on Instagram when my account had a mere 2500 followers. Since then the amount of followers to my account have skyrocketed and I could not have done it without the help of each and …
Continue reading High-Flow Nasal Cannula in Respiratory Failure: FLORALI Trial
To my knowledge, this is the second article looking at central venous pressure (CVP). It was published back in 1962. This paper piggybacks off of, what I believe to be the first paper on CVP that I covered here. Ultimately, I read all these papers as I was creating a lecture that is titled "Resuscitation …
Continue reading Central Venous Pressure (CVP): Known Limitations in 1962
I’m working on a talk where I take a trip through memory lane regarding resuscitation. We were all trained to use central venous pressure or right atrial pressure (CVP or RAP) to guide resuscitation and it remains on the Surviving Sepsis guidelines today. This post is about the origin of central venous pressure.Where does the …
Continue reading Central Venous Pressure/Right Atrial Pressure: The Origin