An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Which should be the first-line vasopressor between norepinephrine and epinephrine in cardiogenic shock?Your patient had an MI and is now in cardiogenic shock.They are hypotensive and need a vasopressor.To clarify, The Crit Doc of Tik Tok aka CriticalCareNow aka Haney Mallemat likes epinephrine as an inotrope, not a vasopressor.This was a pilot study, meaning that …
Continue reading Norepinephrine or Epinephrine in Cardiogenic Shock: Is One Better?
Mortality for patients in cardiogenic shock is finally improving to be less than 50%. It had been hovering at 50% for decades. Would floating a Swan Ganz catheter, also known as a Pulmonary Artery Catheter improve outcomes in Cardiogenic Shock? The ESCAPE trial took the winds out of the sails of the Swan-Ganz enthusiasts in …
Continue reading Cardiogenic Shock & Swan-Ganz/Pulmonary Artery Catheters
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
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?
There are few options when it comes to right ventricular support for patients who are in right heart failure from a multitude of etiologies. At the time of this writing, we are limited to two temporary percutaneous right ventricular assist devices (RVAD) to assist our patients with this problem: the Impella RP and the Protek …
Continue reading Protek Duo Right Ventricular Assist Device (RVAD) ProtekDuo
Let's start off with the basics. ECMO is the medical abbreviation for Extra Corporeal Membrane Oxygenation. This means that the system takes blood out of your body run its through a circuit, and puts oxygen into it. It can obviously do other things which I will cover below. There are two types of ECMO, VA …
You've heard all these fancy terms, mixed venous blood gas, ScvO2, SvO2, thrown around the ICU all the time. Here, I explain what they are. Regardless of whether you're a nurse, respiratory therapist, medical student, resident, or even a fellow, these terms may sometimes be quite confusing as everyone talks about them like, "duh, you're …
Continue reading SvO2 and ScvO2 to Guide Resuscitation in Septic & Cardiogenic Shock
This is my first of many posts on the Impella system by Abiomed. It is going to be part of my "Cardiogenic Shock: Rise of the Machines" lecture for Portland in August 2020. I am planning on covering LVADs, RVADs, ECMO, TandemHeart, etc. in the upcoming months but one does not need to work at …
Continue reading Impella Medical Device: Using the Detroit Cardiogenic Shock Protocol
There are four types of shock: cardiogenic, distributive, obstructive, and hypovolemic. The study that I am taking apart here compared the NICOM monitor to a Swan-Ganz (Pulmonary artery) catheter in patients with cardiogenic shock. I routinely make a big deal of volume resuscitation regarding septic shock which obviously falls under the distributive shock type. Part …
Continue reading Cardiogenic Shock: NICOM vs. Swan-Ganz Catheter