Daniel McClellan
@sunglassesdo.bsky.social
Intensivist in California, boarded in EM and CC. Doing primarily academic CTICU and community mixed ICU.
Does anyone ever manage to get hyperbaric O2 arranged before the patient’s CO level has improved enough to no longer justify it? Had a few in residency and it was always 4+ hours to sort out logistics, by which time the patient no longer had a level requiring it.
August 23, 2025 at 12:14 AM
Does anyone ever manage to get hyperbaric O2 arranged before the patient’s CO level has improved enough to no longer justify it? Had a few in residency and it was always 4+ hours to sort out logistics, by which time the patient no longer had a level requiring it.
How does that impact choices about LV venting for ecmo patients with expected return of native function (myocarditis, B-blocker toxicity, etc)?
August 19, 2025 at 12:12 AM
How does that impact choices about LV venting for ecmo patients with expected return of native function (myocarditis, B-blocker toxicity, etc)?
This is an interesting opinion to me, since I’ve had to give a repeat dose of sugammadex 1-2 hours after arrival to the icu for cardiac surgery patients who received it when they got to me and still “aren’t waking up”
June 17, 2025 at 5:57 PM
This is an interesting opinion to me, since I’ve had to give a repeat dose of sugammadex 1-2 hours after arrival to the icu for cardiac surgery patients who received it when they got to me and still “aren’t waking up”
The real trick is getting pharmacy to actually stock ketamine in ICUs or airway kits. Hard to get people on board with a drug that you have to wait 30 minutes for during an emergency.
June 17, 2025 at 7:01 AM
The real trick is getting pharmacy to actually stock ketamine in ICUs or airway kits. Hard to get people on board with a drug that you have to wait 30 minutes for during an emergency.
So they included a bunch of patients who probably did not need IV fluids in the first place, and excluded all the ones where we actually care about this debate. What was the point?
June 13, 2025 at 6:57 AM
So they included a bunch of patients who probably did not need IV fluids in the first place, and excluded all the ones where we actually care about this debate. What was the point?
Not sure what context you could place this into for it to be OK. Either your machine is not functioning or the patient is going to stop looking "fine" pretty soon.
May 21, 2025 at 6:56 AM
Not sure what context you could place this into for it to be OK. Either your machine is not functioning or the patient is going to stop looking "fine" pretty soon.
Heck of a lot of time to set all that up in advance though. Not often I encounter an intubation for which it is reasonable to wait that long.
April 26, 2025 at 2:46 AM
Heck of a lot of time to set all that up in advance though. Not often I encounter an intubation for which it is reasonable to wait that long.
Also, where is the drive for these X-rays coming from? No amount of educating (blaming) trainees is going to change the practice of the ct surgeons who want them.
April 8, 2025 at 2:54 AM
Also, where is the drive for these X-rays coming from? No amount of educating (blaming) trainees is going to change the practice of the ct surgeons who want them.
Small study with what seems to me like high cross over. Also, I am used to IABPs being used in patients not anticipated to transition to long term mechanical circulatory support or transplant. Those generally get an Impella. Not sure what they were hoping for if the trial had been positive.
April 1, 2025 at 8:46 PM
Small study with what seems to me like high cross over. Also, I am used to IABPs being used in patients not anticipated to transition to long term mechanical circulatory support or transplant. Those generally get an Impella. Not sure what they were hoping for if the trial had been positive.
In an ED setting I could likely get away with that, but unless I can demonstrate that is the "standard" in a large number of hospitals, I do not think I can get our ICU director to agree.
April 1, 2025 at 8:18 PM
In an ED setting I could likely get away with that, but unless I can demonstrate that is the "standard" in a large number of hospitals, I do not think I can get our ICU director to agree.
The PAWSS score has a lot of data to support its use for this purpose. https://www.mdcalc.com/calc/10102/prediction-alcohol-withdrawal-severity-scale
Prediction of Alcohol Withdrawal Severity Scale
The Prediction of Alcohol Withdrawal Severity Scale (PAWSS) predicts the severity risk of alcohol withdrawal syndrome.
www.mdcalc.com
March 19, 2025 at 2:48 AM
The PAWSS score has a lot of data to support its use for this purpose. https://www.mdcalc.com/calc/10102/prediction-alcohol-withdrawal-severity-scale