An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
To not fly blind in patients with advanced heart failure or cardiogenic shock, certain equations exist to help us manage our patients. This allows us to identify who is not doing well and act on their deterioration before it really hits the fan. We use cardiac power output (CPO), which I have dissected in THIS …
Continue reading Pulmonary Artery Pulsatility Index (PAPi): Principles & Calculation
This is a one minute journal club. This is not medical advice. The full breakdown in below this snippet.Read the data for yourself.Should we provide our DKA patients with sodium bicarbonate (bicarb) to improve their pH?We want to make the numbers pretty.We want to fix the acidosis faster, but does this work?The first thing people …
Continue reading Bicarb in Diabetic Ketoacidosis (DKA): One Minute Journal Club
Is your institution a milrinone shop or a dobutamine shop? Or do you have a mixed shop?It seems that most institutions are accustomed to use mostly one or the other in cardiogenic shock.Some argue that milrinone is better.Some argue that dobutamine is better.But do we know the answer?This was answered late in 2021 in the …
Continue reading Milrinone or Dobutamine in Cardiogenic Shock?
We all wish that every patient who goes into cardiac surgery would be a straight-forward fast track case. Unfortunately, the issues that lead most patients to need cardiac surgery also put them at risk for complications. Some patients present with pulmonary hypertension that is discovered in the operating room once the pulmonary artery catheter is …
Continue reading Nitric Oxide and Epoprostenol (Flolan) Use in Cardiac Surgery
We often overload our septic shock patients with IV fluids.The CLASSIC trial looked at the fluids we give in the ICU after resuscitation in the ED.This is not medical advice. Read the article for yourself.Almost 1600 patients were enrolled in either the standard or restrictive IV fluid group.Before arriving to the ICU, these patients received …
Continue reading CLASSIC Trial: IV Fluids for Septic Shock in the ICU
This is a one-minute journal club.This is not medical advice. Read the full free article for yourself (link below).Hat tip to the authors.Link in my stories for the next 24 hours.How do you predict whether a patient on high-flow will need to be intubated?Eyeballing your patient is not quite good enough.The ROX index is a …
Continue reading VOX Index: Predicting HFNC Failure (One-Minute Journal Club)
This is a one-minute journal club.Check out the link to download the full free article.I recommend you read this article for yourself.This is not medical, nor professional advice.Hat tip to the authors.Do you work or are you considering working night shift?For 24 years they followed over 46,000 night shift nurses in this prospective cohort study.Unfortunately, …
Continue reading Night Shift Nurses: Is your Health at Risk? One-Minute Journal Club
This is a one minute journal club-ish on Sepsis Deaths. This is not medical advice. Read the FREE article for yourself and do not trust me.Hat tip to the authors.This article was published in 2020 in the Lancet but is still relevant.Almost 49 million cases of sepsis were recorded in 2017.It is estimated that there …
This is a one minute journal club-ish. This is not medical advice. Read the article for yourself and do not trust me.Patients with severe, symptomatic aortic stenosis: what’s the best way to fix it, surgical AVR or a TAVR.TAVR and TAVI are the same thing.This is a non-inferiority trail meaning they didn’t think there would …
Continue reading TAVR vs. Surgical Aortic Valve Replacement (AVR): 1-Minute Journal Club
For historical context, today is 05.11.22, and I am going to start compiling the data showing the benefits of having a palliative care team in the ICU. This post will be updated regularly as time permits. I have been fortunate to work, and have worked, with some great people on these teams during the course …