The Seattle Intensivist’s Blog
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.
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).
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.
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 building was the first - and only - of its kind in the world: a hospital pressurized to 60 PSI that promised a panacea for its patients, able to cure a broad range of ailments ranging from diabetes to pernicious anemia to cancer. This was Dr. Orval Cunningham's Sanatorium, or “Timken's Tank,” after its benefactor, the “Baron of bearings” tycoon Henry H. Timken who bankrolled the $1,000,000 to build it. This unusual sphere was both an early hyperbaric hospital and a 900 ton monument to the dangers of unscientific medicine.
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.”)
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.
Dissipating The Myth of Shoe Covers
If you work in a hospital chances are you've put on shoes covers. This is a well intentioned practice largely predicated on a misunderstanding about the history of medicine. Originally, shoe covers were about preventing operating room fires not infections.
Is Critical Care becoming a Cargo Cult of Vitamin C?
Dozens of institutions have embraced the “metabolic cure” based upon evidence far flimsier than would be required for any “non-natural” medicine. Non-falsifiable theories ("this patient was saved by vitamin C”) are proffered as fact.
Whether the “metabolic cure” is truly a panacea or not remains to be rigorously tested. Whatever the outcome, the rituals practiced by the cargo cult of critical care must be questioned. Surely, if a plane did land on an Atoll, it was not brought there by magic.