Grand Rounds: Hypoxia & Hypoxemia
A grand round lecture about Hypoxia & Hypoxemia
Seattle Intensivist's Blog - ICU One Pager
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My ICU Reading List
An annotated list of my favorite critical care books.
Let’s Abolish Daylight Savings Time Already!
A brief history of daylight savings time, why it’s literally killing us, and how we should get rid of it!
Lecture: Making the Most of Social Media in Medical Education
Why should I use social media as part of medical education? Here’s a talk I presented at CHEST2023 about the benefits and some strategies for success.
Lecture: Social Media in MedEd: A Two-Edged Sword
This is a Thought Leader Session I gave at SCCM2023 . (January 22, 2023) A comparison of different modes of traditional and SoMe Enhanced MedED: Moving from traditional to SoMe enhanced MedEd: A framework for how we can inoculate & protect people from the harms of misinformation & disinformation spread on SoMe: What actions can health care providers take on Social Media to combat misinformation?…
Mini-Lecture: When Pressors Fail
Vasopressor refractory shock is a life threatening emergency with up to 60% mortality. What can we do for patients who remain vasoplegic despite high doses of multiple vasopressors? The answer is vasopressors scavengers: hydroxycobalamin (CyanoKit) and methylene blue (ProvayBlue).
WTS Lecture: COVID Therapeutics
In just two years we’ve gone from a dearth of knowledge to a wealth of therapeutics for COVID. How can we choose which ones to use and for whom? This lecture reviews the outpatient & inpatient therapeutics that we have available as well as the pivotal studies.
From ZOO to ICU: How understanding animal physiology can make us better intensivists
How can understanding animal physiology make us better intensivists? This grand rounds lecture summarizes how we can use an understanding of comparative vertebrate physiology in the ICU.
Grand Rounds: Keep Calm & Omicron
Grand Rounds lecture delivered at UC Denver NJH on 2021-12-17. Covers the origins of the Omicron variant, the significance of its mutations, the preliminary information about severity. Also the important question of how to pronounce Omicron (AH-MUH-KRAN or OH-MI-KRON).
Magnanimous Monikers: Medical Eponyms Named For Patients
While most medical eponyms honor the physician who first (or most prolifically) described the disease, a minority are named for the location of description (e.g., Lyme disease, Warfarin, Nystatin) [1] , the causative exposures (e.g., coal miner's lung, Legionnaire’s disease), or for biblical (Job’s syndrome), mythological (Ondine’s curse), or even literary associations (Lady Windermere syndrome,…
Grand Rounds: Debunking Ivermania
Grand Rounds Lecture Debunking Ivermania. From in vitro & pharmacology to clinical studies, this lecture reviews (and thoroughly debunks) the evidence for ivermectin in COVID19.
Debunking Ivermectin: A Complete Guide
I’ve watched in horror as ivermectin went from a pet theory to a cultish fringe belief and a “vaccine alternative”. I put together a comprehensive post summarizing the in vitro, clinical, and epidemiological evidence and why it does NOT support use of ivermectin outside of a clinical trial.
Cruelty Won't End This COVID Groundhog Day: Why viewing misinformation as a comorbidity makes empathy easier
(this article appeared in Medpage Today on 8/9/2021) When I was in residency, Dave Park, MD, an intensivist who I greatly admired, observed that “the trauma ICU is filled by man’s cruelty to man, and the medical ICU by man’s cruelty to himself.” Without the use of tobacco, alcohol, and opioids, there would be less COPD, cirrhosis, and endocarditis. Without dietary indiscretions, there would be…
Talk: Debunking the Myth of Ivermectin
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Spherical Sanitarium: What can a 900 ton steel sphere teach us about bad medicine
In 1928, the residents of Cleveland, Ohio watched in wonder as a unique structure was erected along the shores of Lake Erie. Over months a huge steel ball took shape, some 64 feet in diameter containing five stories. When it was completed it held 38 rooms, 350 portholes to provide natural light, an elevator, and an ornate recreation room replete with crystal chandeliers. This strange spherical…
An Even More Skeptical Guide to Vitamin C in Sepsis
Since the first publication of vitamin C for sepsis, several randomized controlled trials have been completed, and more are ongoing. I review the 6 large RCTs and provide a meta-analysis. (Spoiler alert: it doesn’t look good for the “metabolic cure.”)
Evidence based treatment of “the dwindles” (persistent mild hypotension)
(This post was also published at CriticalCareNow on 11/1/2020) In many ways de-escalating critical care is more challenging than initiating it. Approximately 27% of ICU patients require vasopressors during their stay, and for many, it can be a barrier to discharge. One term in the medical patois -'The Dwindles’ - aptly describes this clinical scenario: a patient who is ostensibly recovering from…
Steroids in COVID19: The Pendulum Swings Back
(This article appeared on CriticalCareNow on 9/11/2020) The benefit of corticosteroids in the critically ill is a perennial subject of debate, and over the last two decades the pendulum has swung several times. It should come as no surprise that this debate has been reinvigorated by COVID19. In the early days of the pandemic it was uncertain if steroids would be beneficial of harmful. On one hand,…
A Skeptic’s Guide to Vitamin C in Sepsis
Since the first publication of vitamin C for sepsis, several randomized controlled trials have been completed, and more are ongoing. I review the 6 large RCTs and provide a meta-analysis. (Spoiler alert: it doesn’t look good for the “metabolic cure.”)
Tactile Fremitus: Lost in Translation
Mark Twain said “Be careful reading medical texts, you may die of a misprint” Perhaps he should have also warned about mis-translations too. One conspicuous example of a mistranslation turned myth is when students are instructed to have a patient repeat “ninety nine” while feeling for tactile fremitus.