An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
The following are the citations for my book "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals." If you stumbled upon this page via a search engine, you have several options to get a copy, as shown below the citations. Bernadich C, Bandi JC, Melin P, Bosch J. Effects of F-180, a new …
Continue reading Terlipressin Citations: The Vasopressor & Inotrope Handbook
Have you tried to use phenobarbital for your ICU patients with alcohol withdrawal syndrome?Typically, we use benzodiazepines such as ativan to treat this.Although the empiric data is quite compelling to make the switch.I personally use phenobarbital more often than benzodiazepines these days.The main question of course is the dosing.This single-center, pre-post protocol implementation study is …
Continue reading Phenobarbital for Alcohol Withdrawal: Reviewing the Evidence
Is red meat actually bad for us?Recently I was at a friends house for dinner.He was told by his physician to cut down on eating red meat.Note that this is a healthy dude in his 30's who was a college athlete.This really upset me as it seemed like the physician likely also promotes the original …
Your patient needs an airway. What is your go-to tool for endotracheal intubation? Do you reach for direct laryngoscopy (DL) and just get it over with? Or do you wait until the whole setup gets brought into the room to attempt a video laryngoscopy (VL)? The debate of DL vs. VL for intubation has persisted …
Continue reading Direct (DL) vs Video Laryngoscopy (VL) for Intubation? DEVICE Trial
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