An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
A definite hat tip to my buddy Matt Siuba (zentensivist.com) and his colleagues for this great review on the management of right ventricular (RV) dysfunction in patients with ARDS. I plan on elaborating further on this paper but the bottom line is that we need more data. For now, head down to the citations to …
This page is dedicated for those attending my lecture on lactate/lactic acid. These are the citations for studies I used for my lactate presentation. For further information on the topic, check THIS POST. Jung B, Rimmele T, Le Goff C, Chanques G, Corne P, Jonquet O, Muller L, Lefrant JY, Guervilly C, Papazian L, Allaouchiche …
Continue reading Lactate: The Boogeyman or an Alarm? Citations
I have to admit the glucocorticoids are amongst my favorite medications that we use regularly in the ICU. Whether it be hydrocortisone, dexamethasone, or methylprednisolone, I have order sets built into my EMR with the dosing for the respective indications. The indications appear to be endless. Today, I am going to be discussing an article …
Continue reading Hydrocortisone for Severe Community-Acquired Pneumonia (CAP)
The concept of metabolic resuscitation has been around for several years. Unfortunately, the data for using ascorbic acid, thiamine, and glucocorticoids has not been as robust as we would like. There have been challenges replicating the miraculous data seen in the first trial in every subsequent trial performed after that. There have been numerous limitations …
Continue reading Hydroxocobalamin (Vitamin B12) for Septic Shock
Does IV contrast provided to hospitalized patients really cause contrast-induced nephropathy (CIN) and lead to acute kidney injury (AKI)? This is quite the controversial discussion at the moment (this was published on 02/24/23). Therefore, I have created this page to compile evidence on the topic. None of this is medical advice. Solely a review on …
Continue reading Contrast-Induced Nephropathy (CIN) & Acute Kidney Injury (AKI)
Today, we're going to be reviewing what some might consider to be a landmark study: the CLOVERS trial. The first thing most clinicians do when a patient is hypotensive is provide IV fluids. The surviving sepsis guidelines recommend 30cc/kg in patients who are in septic shock. It often bears reminding that the objective of providing …
Continue reading More Fluids vs. Vasopressors in the First 24h of Septic Shock (CLOVERS Trial)
When I was completing my fellowship I dabbled a bit at performing transesophageal echocardiograms in the CCU/CVICU. I did not receive any formal training at it, though. I've been in practice out of fellowship for 5 years now and have made it a point to add the skill to my arsenal. On this page, I …
Continue reading Transesophageal Echocardiography (TEE): Adding to the Skill Set
I have a question for you. I hope you answer it honestly.Now that ICU admissions are incredibly low from you-know-what we can take a look back and dig through the ashes to see what could we have done better.Recently, data was published from a certain institution where they reported that they had only 40% mortality …
Continue reading Mortality of Patients on Mechanical Ventilation: One-Minute Journal Club
After a patient suffers a cardiac arrest event, should we be giving them corticosteroids?This is not something I do currently in my practice so I am intrigued by these data.There's a ton of nuance to this brand new systematic review and meta-analysis so please read it for yourself.This is not medical advice. Hat tip to …
Continue reading Corticosteroids and Cardiac Arrest: One-Minute Journal Club
I really have to say that 2022 was a great year. No, everything is not always sunshine and roses, but I am an optimistic dude and tend to have a positive outlook on things. Focusing on the positive has been helpful for me throughout my life. 2022 was a year where many doors opened up …
