Creating a new arteriovenous fistula (AVF) generates a major hemodynamic shift. Connecting a high-resistance artery to a low-resistance vein increases venous return, lowers systemic vascular resistance, and forces the heart to sustain a chronic high-flow load. Many patients adapt, but those with limited reserve can decompensate quickly with dyspnea, edema,…
Candida auris (C. auris) has become a significant challenge in critical care across the country. It spreads across surfaces, equipment, and even skin, allowing outbreaks to take hold long before they are detected. These infections tend to appear in patients with comorbidities like advanced age, diabetes, kidney disease, malignancy, dialysis…
Tramadol (Ultram) is often prescribed for analgesia because it’s easy to write for (especially at hospital discharge); however, its pharmacology makes it unreliable for pain control. The parent compound has only weak affinity for the mu opioid receptor, so most of the meaningful opioid effect comes from its active metabolite…
As with any procedure, cardiac surgery carries risks that are explained to patients by their surgical team. The Society of Thoracic Surgeons Short-Term Operative Risk Calculator provides clinicians with a way to anchor these discussions. It uses data from hundreds of thousands of cardiac operations to estimate the chance of…
Gerbode defects create an abnormal communication between the high-pressure left ventricle (LV) and the right atrium (RA), thereby completely bypassing the right ventricle. That pathway sets up a distinctive left-to-right shunt with hemodynamics that can be subtle or profoundly destabilizing, depending on the size of the communication and the clinical…
The NxStage System One continuous renal replacement therapy (CRRT) system provides convective and diffusive clearance through a simplified cartridge system. It has an interface centered on three large, color-coded numeric fields that offer the most essential information for therapy. When I’m rounding in the CVICU, I often look at these…
Acetaminophen (Tylenol) is routinely administered in IV and PO (pill) forms in perioperative and critical care medicine, but the debate of which route of administration is superior comes up all the time, despite the evidence being consistent for years. TLDR – once both formulations are absorbed, the analgesic effect is…
Isopropyl alcohol (IPA) aromatherapy by means of inhaling the vapors from an IPA pad has been a simple bedside practice used to relieve nausea. Several studies suggest that IPA inhalation can provide a quick, modest reduction in nausea severity in an inexpensive, safe, and easy-to-administer intervention. However, other trials and…
As a cardiac anesthesiologist and intensivist, vasoplegia following cardiopulmonary bypass is an issue I often face in the OR and ICU. This distributive shock phenotype is characterized by low systemic vascular resistance, despite preserved or elevated cardiac output, primarily driven by dysregulated nitric oxide (NO) and guanylate cyclase signaling, which…
Mentors shape us in ways we often don’t appreciate until much later. They see potential when we doubt ourselves, offer perspective when we feel lost, and guide us through the moments that define our careers. Dr. George Williams wasn’t just my leader… he was the heart of our team, the…