EM/IM Sessions

EM/IM Sessions: VANISH Trial

Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial. Gordon, AC, et al. JAMA 2016 [paper] Why I chose this article The kidney is painfully fragile, often one of the first organs to fail in septic shock. According to the last several iterations of the Surviving Sepsis Campaign Guidelines,

EM/IM Sessions

EM/IM Sessions: Assessing Fluid Responsiveness

Bentzer P, Griesdale DE, Boyd J, MacLean K, Sirounis D, Ayas NT. Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?. JAMA. 2016;316(12):1298-1309. [paper] Why I chose this article We ask this question for every critically ill patient who remains hypotensive after what we believe is adequate fluid resuscitation. Knowing techniques to reassess these

Critical Care

We Have No Beds: Ventilator Series

We Have No Beds: Ventilator Series Noninvasive Ventilation Part 2 Remember our 60 yo male with COPD who has been on NIV for about an hour, he was looking a little less sick, let’s check back in with him. (If you missed the last post click here) Our initial settings for the BiPAP: rate 8,

Critical Care

We Have No Beds: Ventilator Series

We Have No Beds: Ventilator Series Noninvasive Ventilation Part 1 It’s a busy night in the ED and in comes… …a 60 y/o male with OSA and COPD in extremis, sitting up on the gurney gripping the side rails, huffing and puffing, struggling to breathe.  You are informed that he has not used his CPAP in

EM/IM Sessions

Journal Club: Addition of Indapamide to Frusemide Increases Natriuresis and Creatinine Clearance, but not Diuresis, in Fluid Overloaded ICU Patients.

Bihari, Shailesh, Andrew W. Holt, Shivesh Prakash, and Andrew D. Bersten. “Addition of Indapamide to Frusemide Increases Natriuresis and Creatinine Clearance, but Not Diuresis, in Fluid Overloaded ICU Patients.” Journal of Critical Care 33 (2016): 200-06.  PMID: 26948252 Two caveats before we get started.  Frusemide in the title is not a misprint but rather the Australian

EM/IM Sessions

Journal Club – Treating Fever in the ICU – HEAT Trial Discussion

Interest Nurses, families, and consultants often request that we treat our patients’ fevers. We often reflexively answer, “Yeah, sure, give ’em a gram of acetaminophen, why not.” Occasionally we might take the high road, instead replying “Why would I blunt the body’s response to infection, let it fight!” Is there a benefit to calming the inflammatory response