This topic comes up so frequently in my ICU. I’m surprised I didn’t think to write about this earlier. Shout out to our clinical pharmacist (T.A.) for being such an effective steward in our antibiotic choices, lab tests, anticoagulation and more!

I would say the majority of our patients end up having fevers and hypotension or some kind of hemodynamic instability to trigger “sepsis thoughts” in our head. Maybe we see a CXR read that says b/l pulmonary edema/infiltrates, cannot rule out superimposed pneumonia/pneumonitis, etc, etc. Then we start treating for CAP or HCAP. Then we jump to the sputum…

This is my second and last post while being in San Diego, CA. Will continue once I head back to my NYC apartment! The famous TTM 2 Trial was just published in the NEJM on June 17, 2021 and is a follow up to the TTM 1 Trial. I’m a little behind on the ball so let’s get straight into it. The data I present is directly from the papers along with info from smarter people who are better at analyzing and challenging this stuff than I am.

Briefly, TTM 1 in 2014 compared cooling patients to 33C versus 36C…

It has been a while since my last post and surprisingly my first one while on the west coast. I landed in San Diego on June 26, 2021 and today is July 5, 2021 — it’s about time I wrote about something.

This is also a very practical question in the critical care world that we all pose: What is our MAP goal?

Before we attempt to answer this question (as there is no good answer), there are a few concepts and guidelines we should review.

MAP = (CO x SVR) + CVP

Also that perfusion pressure (such as CPP…

In the intensive care world we deal with shock of all kinds. In the cardiac world we usually deal with cardiogenic shock and add a bit of vasodilatory shock like sepsis and post cardiac surgery shock. Lately in our CCU we’ve been observing tons of shock that we initially believe to be cardiogenic of nature but end up being a mix of vasodilatory as well.

For example, 70 yo male comes in with LVEF 30% and is cold and wet. Atrias and IVC are dilated, LV isn’t moving too well and your RV is hypokinetic. LA 4. Float your swan…

It’s been a while since my last post. I ran out of things that I thought were worth talking about in terms of personal and medical thoughts. This post isn’t medical related.

First thing is yesterday I rode the subway again. It is, I think, the first time in almost two years since I’ve gone on it. The reasons were a combination of me living at home in LI and not needing it, to COVID-19 spreading, to asian hate crimes. I was and still am fearful of being targeted on the train of getting beat up, hit with an object…

I had a nice FaceTime call with a childhood friend of mine yesterday. She is about to complete her didactic year and enter her clinical year of PA school (way to go, you!). After chatting with her, she mentioned that it might be a good idea to write a post about some of the tips I offered her. So here it is — let’s get into it, shall we?

I’m not sure when PRVC started being so widely used but it definitely snuck up on me and our unit. Perhaps it’s an old friend from COVID days (but I remember using tons of PC during that time). 4/5 intubated patients on my floor are usually on PRVC but why? When did we start navigating away from our old friend VC, an almost standard of care ventilator mode?#nonewfriends. Most of my colleagues also choose PRVC nowadays. Well, this is the perfect topic to go over on this post.

What is my practice now? When I see PRVC, I’ll switch back…

Another day off means another post! Let’s make this a quick one on something I pretended to understand but really don’t:

Pulmonary artery catheter waveforms! Don’t you always hate it when the heart failure attending or fellow starts saying yeah the CVP isn’t the one projected in the parenthesis and then starts staring at the screen and says A-wave, V-wave, etc?

Here are the basics first as a reminder. 10–15cm to the subclavian. I like the rule of 6’s; you can use the dimes one too. Up to you. This is all derived from the manufacturer, Edwards, page.

RA: 6

Who would ever have thought that Darren would write a book review? And for fun? The last time I wrote something like that was in ELA or my AP English class back in high school. Actually I’m not sure if you’d find it surprising since I’m writing all these posts about medicine. Anyways, I’m so happy I finished a book; it took me about four months to finish because I’m not a good reader. And this is the first book I likely finished front to end since the days of my reading Harry Potter and Tuesday’s With Morrie.

It has been 10 days since my last story. That must mean I’ve been working a lot of shifts in the CCU because I enjoy this newfound writing and reading during my mornings. But then again, inspiration for writing content has been harder to discover recently. The purpose of this blog wasn’t to rediscover the wheel but to really touch upon things I do in the ICU constantly that I personally didn’t deeply understand and find evidence behind the practice. Again, it was to challenge myself to take what people say with a grain of salt (not because they’re wrong…

Darren Kang, PA

Darren is a physician assistant specializing in Cardiac Critical Care in New York City. Passionate about resus, shock, PE, cooking & coffee.

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