An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Your patient suffered a cardiac arrest and we have achieved ROSC.They are hypotensive and need vasopressors.What MAP should we target in patients after cardiac arrest?The surviving sepsis campaign likes for us to shoot for 65 in septic shock patients.Other studies have shown that patients who are chronically hypertensive could do better with 75.Current guidelines also …
Continue reading MAP (Mean Arterial Pressure) Goal/Target After Cardiac Arrest
Your patient has thrombocytopenia (low platelet count) but also needs a central line (CVC).We do not want to do harm to our patient and cause them a bleeding complication.But what is the magic platelet count to safely perform the procedure?The authors performed a multicenter randomized controlled trial with 338 patients to find out.Hat tip to …
Continue reading Thrombocytopenia & CVC Placement: What’s the Platelet Count Threshold to Transfuse?
It is my personal opinion that sepsis-induced cardiomyopathy has been under recognized and understudied. Our current practice pattern of starting patients on norepinephrine is good. But automatically going to vasopressin, then either phenylephrine or epinephrine as they continue to deteriorate overlooks the fact that they may have sepsis-induced cardiomyopathy. Going down the typical route we …
Continue reading Sepsis Induced Cardiomyopathy: A Forgotten Factor in Septic Shock
We've all noted the Modified Early Warning Score in our daily workflows.But is this MEWS better than our clinical gestalt at predicting clinical illness?That's what these authors sought to sort out.Hat tip to the authors. Read these data for yourself.They performed a multicenter, prospective observational trial of all patients who presented to the ED via …
Continue reading Is the Modified Early Warning Score (MEWS) Superior to Physician & Nurse Judgement?
Cytokines tend to break things in critical illness.Pro-inflammatory cytokines cause vasodilation.Anti-inflammatory cytokines cause immunosupression.Inventing a way to get rid of those cytokines sounds like a good idea, right?Cytosorb has been on out the market and trialed in sepsis, ARDS, cardiac surgery or recovery after cardiac arrest in the ICU.It sounds expensive, but does it work?A …
Continue reading Cytosorb to Absorb Cytokines & Improve ICU Outcomes?
We all know that nurse to nurse familiarity is important for teamwork and outcomes in critical care. This familiarity helps the cohesion of the unit and helps nurse retention when coupled with safe staffing ratios. Some things in medicine are known but it's still nice when reinforced by data.In October of last year year an …
Continue reading Nurse Familiarity: Working with Buddies Safely Saves Lives
I often hear people say that the patient, who has fluid overload with significant edema, is intravascularly depleted.Despite significant reading on the matter I have not been able to find a suitable explanation.Thankfully, this paper was published a few days ago with the best explanation I've read.Hat tip to the authors, read these data for …
Continue reading Fluid Overload but Intravascularly Depleted: What does this mean?
Should we be using amiodarone or lidocaine for patients who go into cardiac arrest due to ventricular tachycardia or ventricular fibrillation while in the hospital? The ACLS guidelines support the use of either. I have personally noted far more use of amiodarone over lidocaine for this issue. These data published in the May 2023 issue …
Continue reading Amiodarone or Lidocaine for In-Hospital Cardiac Arrest?
Fluid responsiveness is defined as "as the ability of the left ventricle to increase its stroke volume (SV) in response to fluid administration". There are multiple strategies to define fluid responsiveness in patients who are on mechanical ventilation such as PPV, SVV, EEOP. Positive end-expiratory pressure (PEEP) can decrease cardiac output in mechanically ventilated patients. …
Continue reading PEEP-Test for Fluid/Volume Responsiveness in Resuscitation
When I lauched my website (eddyjoemd.com) several years ago, I used Bluehost. At first, I started with Adsense but then transitioned to Ezoic as my page grew. Despite there being some hiccups along the way, the relationship between Bluehost and Ezoic was pretty simple. The relationship was fine. Recently, Bluehost has significantly increased the price …
Continue reading Bluehost to Ezoic Hosting Website Migration: Step by Step Guide