High-Flow Nasal Cannula Therapy in Do-Not-Intubate Patients With Hypoxemic Respiratory Distress

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Transcatheter aortic valve replacement

A special shout out to the author of this article, Melody, who is one of the kick-ass nurses I have the pleasure of working with in the CVICU at my shop.

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Cardiogenic Pulmonary Edema: Does Non-Invasive Ventilation work for this?

Link to the Abstract

This happens every single day at every shop I’ve worked at. Patient comes in with a CHF exacerbation sucking wind. You feel you have a little bit of wiggle room and don’t have to intubate them, while at the same time they’re too sick for nasal cannula or high flow. What do you reach for? The “BiPAP” machine! Now, just for clarification, the nomenclature is all wonky for this machine and its settings which is a different post all in itself. BiPAP is when you have a difference between the IPAP and EPAP settings while CPAP is when the IPAP and EPAP settings are the same. Being a good clinician; #physician or #respiratorytherapist, what you need to do is spend some time at the bedside hanging out with your patient to make sure you find the sweet spot that’s comfortable for them. Sometimes it’s easy, sometimes it’s impossible and they need to be intubated. This meta-analysis shows that pts who get placed on the #CPAP setting do better than those placed on #BiPAP setting with decreased mortality. A 🎩 tip to the authors.

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Bolus intermittent vs. continuous infusion of furosemide in heart failure

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As a critical care doc, a good chunk of the consults I receive for acute hypoxemic respiratory failure are from pulmonary edema. So I do my thing, intubate when necessary, and place these patients on a BiPAP setting that’s comfortable for them. Airway, check! Now it’s time to diurese them to a potato chip. I know there are suggested dosing that you may find in the literature, and the fact the IV vs. PO dosing of #furosemide is different. Clinical practice is always an art, though, as using an exact flow every time can get your patient into trouble. Prior studies as to whether to give #lasix as a bolus or a drop were negative studies, but this one favored providing drip. The bolus arm used q12 dosing which raises my eyebrows, though, as I usually use q8 dosing in my practice. @codyperrigo and I used a drip on a pt the day after this study came out with some phenomenal results! That’s empiric data and is worthless, though 😉. Anyway, a big 🎩 tip to the authors.

-EJ

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Evidence-Based Medicine Pyramid

Link to EBM images.

I am thrilled that my page has gotten a few people turned on to evidence based medicine. I refuse, though, to try to teach statistical analysis, though, as I don’t think I’m very good at it. I am sharing this pyramid which is easy to understand and helps one see why I feel that some studies are better than others and why some studies get published in not-so-good journals and others get published in NEJM and The Lancet. As noted at the bottom of the image, my opinion from practical observation is 💩which is why you should always read data for yourself and not trust what I write and say. I hope I don’t upset the copyright gods bc stealing someone’s image.

-EJ

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The effect of melatonin on delirium in hospitalised patients: A systematic review and meta-analyses with trial sequential analysis

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We are all trying to combat delirium by all possible means. Getting pts their glasses and hearing aides. Keeping the lights on during the day. Having family around to speak to them. We’ve also had recent trials which have been quite disappointing using medications. Could there be a good cheap medication to prevent #delirium? This paper on using #melatonin is a strong meta analysis that looks into this and could potentially change my practice... but not for the reasons on the surface. I’ve even recently heard of using melatonin for sepsis, but that’s a discussion for another day and something else I’m going to dig into. Either way, a 🎩 tip to the authors.

-EJ

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Hyperkalemia in patients with kidney disease: how to manage it

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Full Free PDF

#hyperkalemia, a daily issue for the #intensivist, #emergencymedicine docs, and #nephrologist. It’s really not that hard to manage once you check your own pulse. This tasty little algorithm definitely puts the adrenaline in check after you see that number called in as a critical from the lab and shows up glowing red on your computer screen telling you to just do something! A 🎩 tip to the authors.

-EJ

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Adjunctive Intermittent Pneumatic Compression for Venous Thromboprophylaxis

Link to Abstract. Not a free article. :(

This is a question I would always ask myself as I would check off the boxes on admission orders as a resident, not as a fellow because the residents do it, and sometimes now as an attending. I always thought it was a waste of resources and uncomfortable to the patients to not only inject them with pharmacological DVTs prophylaxis, but also burden them with those SCDs. I’m really grateful for my colleagues in Saudi Arabia for putting together this study and sealing the deal for me as to how to manage this moving forward. A definite 🎩 tip to them

-EJ

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Mortality rate and other clinical features observed in Open vs closed format intensive care units

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Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome

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Although great care has been taken to ensure that the information in this post is accurate, eddyjoemd, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.