An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
The concept of metabolic resuscitation has been around for several years. Unfortunately, the data for using ascorbic acid, thiamine, and glucocorticoids has not been as robust as we would like. There have been challenges replicating the miraculous data seen in the first trial in every subsequent trial performed after that. There have been numerous limitations …
Continue reading Hydroxocobalamin (Vitamin B12) for Septic Shock
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 …
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
The intention of this post is going to be to take a deep dive into the states of vasopressors using the best evidence based practices available. It will be routinely updated. This is a work-in-progress blog post on vasopressors. Last updated 02/25/2022.If you find this blog post useful, and you want to cite it in …
Many think that the interest in IV thiamine in septic shock is a relatively novel idea after Paul Marik's paper was published in CHEST back in 2017. It actually goes a lot further than that. We've actually known that 20% of critically ill patients have a thiamine deficiency upon presentation to the ICU. More recent …
Continue reading IV Thiamine: Can it Help Critically Ill Septic Shock Patients?
This article is hot-off-the-press regarding vitamin C, thiamine and hydrocortisone in refractory septic shock. This regimen is known as HAT therapy in some corners of the world. It was actually published today, 5/5/20. It is NOT a randomized control trial but at least they went through the trouble of conducting a propensity matched, before-after, case …
Continue reading IV Vitamin C in Sepsis with Thiamine and Hydrocortisone
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
Your patient is in septic shock. They've gotten the correct source control, antibiotics, fluids, vasopressors. They remain hypotensive. Getting worse, actually. Could they have relative adrenal insufficiency or one of these fancy-termed conditions such as "critical illness-related corticosteroid insufficiency" (CIRCI)? Some clinicians insist on checking cortisol levels in patients who are in septic shock. Should …
Continue reading Cortisol Levels: Check prior to SDS in Septic Shock?
The VITAMINS trial looking at IV Vitamin C didn’t pan out was not a positive study as it was conducted. It was surprising as intravenous (IV) Vitamin C in sepsis should help decrease vasopressor dose and duration. My contention with that study is that they took too long to initiate the study drug. A median …
Continue reading IV Vitamin C in Sepsis: It Should Decrease Vasopressor Dose & Duration
You’re following along on my page bc you know I’m trying to find the most cutting-edge treatments and therapies for my critically ill patients. I hope to keep on pumping out eye catching content such as this article on melatonin for sepsis. Please share with you’re nerdy friends who would also find this nerdy content …
Continue reading Melatonin for Sepsis: The potential benefits to improve outcomes
