An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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?
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 …
A common scenario that occurs daily, heck even perhaps hourly, in most emergency departments or intensive care units around the world including providing patient with IV fluids rapidly via fluid bolus to resuscitate hypotensive patients or those who are in shock. In order to mitigate said hypotension/shock, the most common response by clinicians is to …
Continue reading Fluid Bolus in Resuscitation: Pressure Bag vs. 999ml/hr on the IV Pump
This page is a work in progress as a IV Fluid guide and will continue to grow throughout the years. Last updated on 3/3/22. This page is quite the mess right now if I am being honest. I will get it together at some point. Just many projects running simultaneously. Table of Contents for the …
Continue reading The IV Fluid Guide: 0.9% NaCl, Ringers Lactate, Plasmalyte & Albumin
This post will be a compendium of all things and questions we ask ourselves regarding lactate/lactic acid in sepsis and other critically ill patients. We have become a culture where, as soon as a person hints at being sick, we check a stat lactate/lactic acid. If we understand our enemy, we won't be frightened by …
Continue reading Lactic Acid/Lactate in Sepsis & the Critically Ill: The Ultimate Guide
I have covered many things on this page, including resuscitation and fluid responsiveness. Fluid responsiveness is a patient being given a certain amount of fluid, or a passive leg raise to assess how that will increase the cardiac output/index or stroke volume. This post will discuss stroke volume variation (SVV) and how it predicts fluid …
The blood pressure is low, give a bolus of fluids. Many times that leads to a "nurse dose" as many of us joke about. But are we causing harm? I keep reiterating that fluid responsiveness is when you achieve an increase in cardiac index/output or an increase in stroke volume due to that fluid or …
Continue reading IV Fluid Overload: Don’t Drown your Patients!
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
Passive leg raising (PLR) is a technique I am going to cover extensively as I am writing a lecture where this will be a hot subtopic. I've covered it before on my blog and instagram. It's all in the effort to NOT drown our patients in IV fluids when they're hypotensive. Turns out that performing a …
Continue reading Resuscitation & Passive Leg Raise: Don’t use the blood pressure
I need to eat my words on this one, because now there's data to show that there's a benefit to rechecking lactate levels in septic patients, but not for the reasons why one would think. During my rounds over the course of the weekend, I recall telling several nurses that there's no data to suggest …
Continue reading Lactic Acid is an Alarm, not a Treatment in Sepsis and Septic Shock