Critical Care Wizard

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I have watched this a few times and every time it breaks my heart into a thousand pieces. I occasionally work in a relatively small COVID floor but the gut-wrenching scenario is awfully and hauntingly familiar. For those who have doubts as to the devastating effects of the 'Rona, may this enlighten you. My deep respect to those of my co-nurses who are in the thick of the pandemic. Kudos to all of you!

COVIDLAND: A Film About Survival and Hope in the ICU "The people that survive this keep giving me hope." A critical care physician allows a filmmaker to shadow her in the COVID ward of the ICU. Watch now.

The Frequency and Cost of Treatment Perceived to Be Futile in Critical Care

Importance Physicians often perceive as futile intensive care interventions that prolong life without achieving an effect that the patient can appreciate as a benefit. The prevalence and cost of critical care perceived to be futile have not been prospectively quantified read more...
archinte.jamanetwork.com/article.aspx?articleid=1735897

JAMA Network | JAMA Internal Medicine | The Frequency and Cost of Treatment Perceived to Be... Importance Physicians often perceive as futile intensive care interventions that prolong life without achieving an effect that the patient can appreciate as a benefit. The prevalence and cost of critical care perceived to be futile have not been prospectively quantified.

The Future of Antibiotics and Resistance

In its recent annual report on global risks, the World Economic Forum (WEF) concluded that “arguably the greatest risk . . . to human health comes in the form of antibiotic-resistant bacteria. We live in a bacterial world where we will never be able to stay ahead of the mutation curve. A test of our resilience is how far behind the curve we allow ourselves to fall.”1

Traditional practices in infection control, antibiotic stewardship, and new antibiotic development are cornerstones of society's approach to combating resistance and must be continued. But the WEF report underscores the facts that antibiotic resistance and the collapse of the antibiotic research-and-development pipeline continue to worsen despite our ongoing efforts on all these fronts. If we're to develop countermeasures that have lasting effects, new ideas that complement traditional approaches will be needed.
http://www.nejm.org/doi/full/10.1056/NEJMp1215093

The Future of Antibiotics and Resistance — NEJM Perspective from The New England Journal of Medicine — The Future of Antibiotics and Resistance

Critical Review of the Ankle Brachial Index

Ankle brachial index (ABI) has been utilized in the management of peripheral arterial disease (PAD).ABI is a surrogate marker of atherosclerosis and recent studies indicate its utility as a predictor of future cardiovascular disease and all-cause mortality. Even so, this critical test is underutilized. The purpose of this review is to summarize available evidence associated with ABI methodology variances, ABI usage in the treatment of PAD, and ABI efficacy in predicting cardiovascular disease. This review further evaluates how ABI is used in the prognosis and follow-up of lower extremity arterial disease.We reviewed the most current American College of Cardiology guidelines for the management of PAD, the Trans Atlantic Intersociety Consensus (TASC) working group recommendations, and searched the Medline for the following words: ankle brachial index, ABI sensitivity and specificity, and peripheral arterial disease.

The ABI is a simple, noninvasive clinical test that should not only be applied to diagnose PAD, but also to provide important prognostic information about future cardiovascular events. Although the ABI has been employed in clinical practice for some time, our review of various studies reveals a lack of standardization regarding both the method of measuring ABI and the cutoff point for abnormal ABI. It is extremely important that we understand all aspects of this crucial test, as it is now being recommended as part of a patient’s routine health risk assessment. read more...
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779349/

Critical Review of the Ankle Brachial Index Ankle brachial index (ABI) has been utilized in the management of peripheral arterial disease (PAD).ABI is a surrogate marker of atherosclerosis and recent studies indicate its utility as a predictor of future cardiovascular disease and all-cause mortality. Even so, this critical test is underutiliz...