As a cardiothoracic anesthesiologist, lung isolation (selectively ventilating only one lung) is an important technique I utilize for pneumonectomies, video-assisted thoracoscopic surgeries, sternum-sparing left ventricular assist device (LVAD) implantation, open thoracoabdominal aortic aneurysm repair, etc. As an intensivist, I rarely utilize lung isolation in the ICU to protect a healthy…
“Wind, water, wound, walking, wonder drugs” are described as the “Ws” of post-operative fevers (atelectasis, UTI, wound infection, DVTs, and drug fevers, respectively). As a medical student, all of these made sense to me except the mechanism by which atelectasis, something applicable to ALL patients under general anesthesia, causes a…
When discussing options for hypoxemia, there seem to be so many noninvasive oxygen delivery systems! Nasal cannula, high flow nasal cannula (HFNC), non-rebreathers (NRB), and more are routinely used in the settings I’ve worked in.
Assist-control (AC) ventilation is traditionally categorized into two types: pressure-control (PC), where an inspiratory pressure is set, and volume-control (VC), where a target tidal volume is set. Both styles of ventilation allow parameters like the fraction of inspired oxygen (FiO2), respiratory rate (RR), and positive end-expiratory pressure (PEEP) to be…
Here’s a free reference sheet (front and back) with “high-yield” information in critical care and perioperative medicine. I’m well-suited to pursue this educational endeavor, given my training as a physician who works in both settings, and I hope that many of you will benefit from the information. Now some details:
As an anesthesiologist, I’ve placed nasogastric/orogastric tubes (NGTs/OGTs) in patients who will remain intubated post-operatively to decompress the stomach and to provide a short-term enteral route of administration while the patient remains on mechanical ventilation. As an intensivist, I more commonly place NGTs to deliver nutrition (i.e., tube feeds) and…
Whenever my residents/fellows or I place central venous catheters (CVCs) in the operating room for a case involving intraoperative transesophageal echocardiography (TEE), I always place the TEE probe beforehand. I obtain a midesophageal bicaval view looking for preexisting hardware in the patient’s right atrium (RA), such as ICD wires, PICC…
In pursuit of evidence-based rationales for my hatred of dopamine, I turned to PubMed and queried the database for “dopamine shock” filtered for meta-analyses, randomized controlled trials, and systematic reviews in adult patients since 2009. I then ventured into the PubMed black hole. :razz:
Pharmacokinetic models describe the rate of absorption, distribution, metabolism, and elimination of a particular drug. This can vary significantly based on properties of the drug itself, varying levels of metabolism in the context of organ impairment or enzyme polymorphisms, plasma protein binding, and other patient factors (ie, obesity).
