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The venous-to-arterial carbon dioxide difference (PCO₂ gap), defined as PcvCO₂ (taken from a central line blood gas) – PaCO₂ (taken from an arterial blood gas), answers a question that neither lactate nor ScvO₂ can typically answer directly. Whereas ScvO₂ focuses on the balance between oxygen delivery and consumption, the pCO₂ gap asks whether blood flow […]
Vitamin K (phytonadione) is an essential, fat-soluble cofactor for γ-carboxylation of clotting factors II, VII, IX, and X, as well as proteins C and S. This post-translational modification allows these proteins to bind calcium and participate in coagulation. In vitamin K deficiency or during warfarin therapy, the liver continues to synthesize these factors, but they […]
This post was last updated on 5/27/2026. Between the operating room, ICU responsibilities, education, research, content creation, app development, administrative work, and everything else life throws at me, I realized fairly early on that there are not enough hours in the day to simply “work harder” forever. During medical training, I stopped asking, “How can […]
Mitral paravalvular leaks (PVL) occur when there is dehiscence between the prosthetic sewing ring and the native annulus, allowing blood to regurgitate around the valve rather than through it. The prosthesis itself may function normally, while a high velocity eccentric jet produces significant physiologic consequences. These leaks are often associated with annular calcification, endocarditis,…
My homelab has gradually evolved into infrastructure I rely on every day. VPN access, dashboards, containers, AI workloads, monitoring, and remote services all quietly sit behind the scenes, powering my life. Unfortunately, when the Internet drops, the entire ecosystem feels broken. To add some redundancy, I just installed the UniFi 5G Backup alongside my UniFi […]
One of the first things I look for when performing transesophageal echocardiography (TEE) for a mitral valve replacement is how the new valve is functioning as we prepare to separate from cardiopulmonary bypass. A mechanical mitral valve is engineered for crisp, nearly effortless leaflet excursion; however, the following 3D TEE view of a mechanical On-X […]
Procalcitonin is a peptide precursor of calcitonin that becomes detectable in the setting of systemic bacterial infection, driven by cytokines and endotoxin released throughout the body rather than from the thyroid alone. Levels rise over 12-24 hours with bacterial sepsis and fall as the inflammatory signal resolves. This time course, combined with the sparing in […]
Total pneumonectomy (removal of the entire lung) is most commonly performed for centrally located lung cancer when sleeve resection or lung-sparing surgery is not feasible. Less common indications include severe bronchiectasis, invasive infection, massive hemoptysis, or traumatic destruction of the lung. Unlike lobectomy, pneumonectomy abruptly removes half of the pulmonary vascular bed, leaving…
Today, I was notified by my department leadership of my promotion to Associate Professor of Anesthesiology, effective September 1, 2026. As an attending physician in academic medicine, progress is often measured in milestones, publications, promotions, and titles, but there’s a tremendous amount of work that goes into achieving those. For me as a cardiac anesthesiologist […]
As a physician, one of the most frustrating public takes is the claim that doctors don’t receive enough training in medical school about nutrition, as though that is the central reason chronic disease continues to overwhelm healthcare. It’s an easy accusation because it sounds thoughtful on the surface… especially when it comes from people who […]
