An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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)
We all like to make the numbers pretty in our critically ill patient. Euboxic is a term that is thrown out there. It's like there's a check box in our brains that we need to fill in when turning a lab value back to the default color rather than red in our EMR. But one …
Continue reading Bicarbonate for Respiratory Acidosis: Not So Fast
This is a difficult subject to discuss because we all have people we love who suffer from issues that have led to them having a higher weight than what they should and, in turn, carry the diagnosis of obesity. This post is not intended to shame anyone. But there's definitely a link between obesity and …
Continue reading Obesity in Critical Illness & COVID-19: A Very Bad Combination
Image by Dr. Gizzy, @physiciandoodles on Instagram. This post is a work in progress regarding everything you need to know regarding administering high-dose intravenous (IV) Vitamin C (ascorbic acid) to your critically ill patient. I will continue to work on this post regarding IV vitamin c as well as metabolic resuscitation as time allows and …
Continue reading IV Vitamin C & Metabolic Resuscitation in Septic Shock: Ultimate Guide
Some legendary names came out to play for this article regarding corticosteroids in COVID-19. Meduri is the author of the famous Meduri Protocol for methylprednisolone in ARDS and Villar is the author of the article I shared on February 13th (seems like forever ago, really) where they provided dexamethasone for ARDS and showed a mortality …
The WeVent team came together to create this respiratory management protocol to help us take care of patients with COVID-19. First of all, a big hat tip to the authors: Aurio Fajardo C; MD. Medicina Interna. Unidad de Paciente Crítico. MsC en Ventilación Mecánica, Universitat de València. MsC en Medicina Intensiva. Grupo Ventilación Mecánica Chile …
Continue reading Respiratory Management Protocol for SARS-CoV-2 by WeVent
Sometimes medicine behaves like the stock market; a whole bunch of enthusiasm followed by a realistic pullback. This has now occurred with the concept of using one ventilator for multiple patients. I agree that we need to use some ingenuity in this crisis, but this one never sat well with me, hence me not commenting …
I am a huge fan of proning patients who are in ARDS. At one point or another I'll cover the data behind proning like the PROSEVA trial (no time today or until at least June). There are a variety of ways to prone patients which reflect the disposable income of the facilities where you work …
Continue reading Prone Positioning for ARDS: A Guide on How to Do It.
This is a big impactful study looking at administering Dexamethasone to patients with ARDS. I'm happy it came out, really happy. To start off a big hat tip to my colleagues in España who put this together. ARDS sucks. It's a b-word to treat and patients spend a frustratingly long time to come off of …
Continue reading Dexamethasone in ARDS: DEXA-ARDS Trial Improved Outcomes
Here's my bias before I even read the article. I want to see a positive response in providing IV Vitamin C/ascorbic acid in patients who have Acute Respiratory Distress Syndrome (ARDS). Why? Because I want me patients to do better with treatments that are inexpensive and easy to manufacture rather than the latest immunologic that …
