An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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 …
A patient with no access had a cardiac arrest in the field, aka OHCA (outside of hospital cardiac arrest).Our trusty EMS (emergency medical services) teams who we all really appreciate show up at the scene.Access to administer life-saving medications need to be obtained.Should they attempt to obtain IV (intravenous) access?Or should they attempt to obtain …
Continue reading Access in Out-Of-Hospital Cardiac Arrest (OHCA): Which is Best? IV or IO?
I have posted data regarding nursing burnout.Many times I receive feedback that Respiratory Therapists (RT) are suffering from burnout, too.It wasn't that I was ignoring RT's, but rather this hadn't been studied.That doesn't mean that there isn't significant RT burnout.Recently, there was a study published on the matter titled "Burnout among Respiratory Therapists and Perception …
Haldol is an antipsychotic that we frequently use in the ICU for delirium.But the truth is that the data behind using it is not as robust as we would like.Earlier today, there was a paper published in the NEJM that attempted to find its effects on delirium.Hat tip to the authors. Read these data for …
Continue reading Haldol (Haloperidol) in the ICU: One-Minute Journal Club
There are very powerful people who do not want us to be informed.There are people who do not want us to have the ability to have different thoughts.Several days ago I posted research that was conducted in Boston.Research that I found concerning. Research that many experts find concerning.Knowing that the powers-that-be use very powerful technology …
The last couple years have been challenging for all health-care personnel.Improving morale is something that I have worked on substantially in my practice. Many of us could do more in appreciating our nurses. Nurse retention is a problem everywhere.I am married to an ICU nurse for some additional context.A paper looking at this was published …
Continue reading Appreciating Our Nurses: Role of the ICU Physician
A paper regarding to acute pancreatitis was published in the New England Journal of Medicine on 15 September of 2022. It is titled "aggressive or moderate fluid resuscitation and acute pancreatitis". Hat tips to the authors. I would tell you to read this article for yourself but, unfortunately, it is hidden behind the pay wall …
Continue reading Resuscitation in Acute Pancreatitis: IV Fluids
If you have come onto this site, I would first of all like to thank you for attending one of my lectures. I believe that anyone who speaks has the potential of accidentally misquoting or misinterpreting a study. Therefore, I present to you the citations of my Crystalloid Journey work so that you could read …
In patients who need IV fluids, we can either provide "normal saline" or balanced salt solutions.Balanced salt solutions include Lactated Ringer's and Plasmalyte.There have been several trials trying to answer this question. The data hasn't been as rock solid as we'd like to convince our biases.The BaSICS trial is a recent landmark trial.As always, I …
Continue reading BaSICS Trial: Plasmalyte vs. 0.9% NaCl in the Critically Ill
As much as I am not a huge fan of bombarding septic shock patients with IV fluids, I understand there is a role for fluid resuscitation.When our patients get better, though, it is time to get rid of these fluids.That is what we call deresuscitation.It is part of the 4 D's in fluid therapy: drug, …
Continue reading How Strong Is Your Deresuscitation Game in Sepsis Patients?