Recent content by souljah1

ProCESS and ARISE randomized after a solid fluid bolus and early/appropriate antibiotics, which means that most of what drives a patient's outcome was done prior to randomization. This is in stark contrast to the Rivers study where fluids and antibiotics occurred after randomization. Given that...

ScvO2 is low in septic shock most often on presentation due to concomitant hypovolemia. You can prove this to yourself by fluid bolusing these patients and checking a ScvO2 before and after. Watch the fluid bolus improve your C.I. ScvO2 can also be low in septic shock after adequate fluid...

I'd need to see the ref in order to interpret this. Were those excluded patients less sick? They were excluded pre randomization so its possible we are comparing apples (6cc in sick people) to organges (10cc in healthy people). Cannot make comparisons between those that went on to get randomized...

Trying to predict the market is a loser's endeavor. You have to realize that if you decide to try and time the market you are competing against hedge funds and investment firms who spend millions on trying to research companies to leverage insider information. You stand no chance to "get in...

I would take a few months and read to get a better sense of investing. Here's several of my favorites and would read them in this order: 1. The Boglehead's Guide to Retirement 2. William Bernstein (physician) - The Four Pillars of Investment 3. Rick Ferri - Asset Allocation 4. Larry Swedroe -...

I agree with you about the degree of benefit. Stated that above. There's always some that are early adopters and some that are late adopters (or never adopters). I'm, in this case, in the camp of early adopters for those patients with severe hypoxemia despite lung protective ventilation. I think...

I absolutely cannot stand vent settings of RR 12 Vt 500. They are a reflection of thoughtlessness. If someone is breathing > 40 times per minute and has increased work of breathing due to ARDS/severe hypoxemia you have to consider their minute ventilation in your initial ventilator settings...

Hern, I think there's good reason to consider proning those with very severe ARDS. I just had to give a talk to our division on this topic. We're currently writing a protocol and have started proning patients with pretty good results though our "n" is currently too small to say anything...

Nope, not a UW person. Met her when she was Brigham's program director (Partner's). As a visitor, I was very impressed with her approach to medical education. She led a fantastic conference where she would present a case and ask the attendings in the room what they would do. Fellows just sat...

Yes, we cover hospital-acquired sepsis landing you in the ICU with two different GNR antibiotics as well as empiric coverage for MRSA. The choice of cefepime and an amino is based on our local bug resistance patterns. We don't empirically cover C dif unless there's a story that includes...

If Trish Kritek is involved over at UW then I would seriously consider ranking them highly and would push hard to have her be your clin ed mentor. She's a phenomenal adult education - motivated clinical educator.

Exposure to all areas of pulmonary and critical care from a clinical standpoint is important if you are still somewhat totipotent, which it seems that you are. Some of the bigger places mentioned above will definitely be able to do this for you. As far as a clinical educator track is...

Agree with this. Hospital acquired septic shock gets MRSA coverage (Vanc) and double coverage for GNR. We usually do cefepime/tobra based on local biograms. For the simpletons, we have an electronic order entry called the sepsis bundle which helps speed up the delivery of optimal care in...

I would not say that tachyarrythmias are highly unlikely on milrinone. They definitely happen.

Thanks, Hernandez.