Kevin Doerschug, MD

father, husband, animal lover, icu doc

[Kevin Doerschug, MD @KDoerschug]

@nickmmark @TheAirwaySite Or…use an 8.0 ETT as a suction catheter. If it ends up in the trachea, no bougie needed.

[Kevin Doerschug, MD @KDoerschug]

@IM_Crit_ This is actually the issue. Mean airway pressures are major determinants of oxygenation.ApRV creates high mean airway pressures with Phi. The uninformed think it is magic. Just turn up the PEEP. Both are ways to increase lung volumes

[Kevin Doerschug, MD @KDoerschug]

@kdsvector @csports1995 @IM_Crit_ Complete agreement regarding pushes although can turn NE up to ~0.8 mcg/kg/min —essentially a bolus. If this much shock, contractility likely impaired. Prefer epi>AVP despite heart rate. Studies show epi 10-30 mcg no more SVT than phenyl

[Kevin Doerschug, MD @KDoerschug]

@kdsvector @IM_Crit_ Good thoughts time permitting, but may not have time. Turn ne WAY up. Consider capnography or continuous hand on pulse to
Assess circulation. Push dose epi (commercially available) 10-30mcg.

[Kevin Doerschug, MD @KDoerschug]

@Sports_Fan7 I support always using POCUS, but argue the simple
Lesson is how to read a CXR (which you have explained).

[Kevin Doerschug, MD @KDoerschug]

@DrSpooky_ER Ummm. Old fashioned before, wine with dinner

[Kevin Doerschug, MD @KDoerschug]

@Rick_Pescatore In asthmaticus, phase III failure to plateau = not enough e-Time.

[Kevin Doerschug, MD @KDoerschug]

@Rick_Pescatore Can help identify physiology in complex patients. Normal capnograph= NOT COPD exacerbation. Upsloping linear phase III = mechanical obstruction. think it is useful in asthma. Downsloping phase III- ? Pneumothorax.

[Kevin Doerschug, MD @KDoerschug]

@Rick_Pescatore Agree capnography is not helpful universally, or even usually. But the waveform is still helpful in a non-trivial amount of patients. We turn the alarms down quite a bit (~10) to avoid nuisance alarms, still detects unrecognized vent disconnect.

[Kevin Doerschug, MD @KDoerschug]

@DanckersMD @accpchest @APCCMPD @atscommunity @FSUCoM @FIUMedicine @ABIMcert Another great group Mauricio!

[Elon Musk @elonmusk]

Major driver of healthcare cost

[Kevin Doerschug, MD @KDoerschug]

@AshleyGWinter “Do your own research”—worst medical advise ever. Not to be confused with being informed.

[Kevin Doerschug, MD @KDoerschug]

@cliffreid @doctimcook This is spot-on. Too many people just don't understand the difference. I'm just happy when they don't call it ETCO2.

[Kevin Doerschug, MD @KDoerschug]

@Dallas_Holladay And in the ICU

[Kevin Doerschug, MD @KDoerschug]

@emily_fri @gretchemaben Data suggest 1) one must have ~50 intubations to have a 90% success intubating easy, stable airway; 2) severe complications occur in 25-45% of ICU intubations. So, yes inexperienced fellows must be supervised (not necessarily by attending).

[Kevin Doerschug, MD @KDoerschug]

@ArielG_RRT @ventilacionmeca @DocMusician @DrMiguelIbarra1 @emireles_c @CCF_PCCM @MegriMohammed @_MSAMEED @OfVentilation @critconcepts @IM_Crit_ @RespiratorySCCM @ATC_Ventilator @SaudiRTs Flow starvation with inadequate pressure support. P0.1 indicates excessive drive. Flow increases during insp, indicating increased patient effort.

[Kevin Doerschug, MD @KDoerschug]

@amargreenberg @PulmCrit Agree that etomidate gives more reliable sedation than midaz, less hemodynamic effects, shorter duration. It’s my go-to

[Kevin Doerschug, MD @KDoerschug]

@nursekelsey EXCEPT re-tying wrist restraints on an icu patient. Instead, immediately notify the nurse that you untied them. The nurse WILL re-tie better than you.

[Kevin Doerschug, MD @KDoerschug]

@critconcepts @pulmtoilet Even with low positive pressure trans pulmonary pressure may be elevated, leading to global and/or regional overdistension (pendeluft)

[Kevin Doerschug, MD @KDoerschug]

@emily_fri How is Resp alkalosis harmful? Resp alkalosis balances the increased Resp drive from pain, low Vt, inflammation, many others. A little alkalosis decreases Resp drive and improves vent synchrony, decreases need for sedation.