Sleep, I often say, is the elusive treasure of a hospital stay. Indeed, when hospitalized, there are many things that need to be done to the patient: diagnostic tests, laboratory studies, multiple visits from multiple clinicians, to name a few. So, …
“Why Medicine?” Why go into a career that takes several years - and costs hundreds of thousands of dollars - to complete? And, it is still a very demanding job at the end of that long, expensive path. So, why do it? Many, including mys…
In the classic sleep deprivation experiments, two rats were placed on a disk that can rotate over water. They had as much food and drink as they wanted, and if the experimental rat fell asleep or entered a prohibited sleep stage, the disk started to…
On April 5, 2025, a second child died of measles in Texas. According to the Texas Department of State Health Services, both children were otherwise healthy. If you have never lost a child, then you cannot know - and I wish you will NEVER come to kn…
I am a man of deep faith, striving to live a life of righteousness to the best of my ability. While never imposing my religious belief on anyone, especially not my patients, I am still quite comfortable in the sphere of faith and speaking the langua…
Many ICU patients suffer from anemia. Some are chronically anemic, and others develop anemia due to their acute illness (such as bleeding, for example). Multiple specialty societies have developed guidelines over when to transfuse red blood cells, a…
In my conversation with Dr. Elaine Chen of Rush University Medical Center, who is both an Intensive Care and Palliative Care physician, I asked her how being a Palliative Care specialist has helped her as a Critical Care physician. The thing that st…
I recently sat down with Dr. Sergio Zanotti, Chief Medical Officer for Sound Critical Care and had a wonderful conversation (link at the end of the post) about the pandemic, healthcare, and medicine in general. One of many insights he gave me that t…
As I do my appeal letter work, I frequently come across a justification for the denial that says something like this: “A payer may use its own criteria to establish a diagnosis.” And the cite an AHA Coding Clinics article from Q4 2016, p…
It is a very common theme in art (movies, books, etc) to feature a doctor who thinks he is God. We doctors, especially those of us who practice in the Intensive Care Unit, make life and death decisions in a matter of seconds. Many times, the d…
I have lost count of the number of times I have had patients with advanced cancer who get critically ill with any number of illnesses: infections, blood clots, collapse of lungs, among others. And more often than not, it falls to me, as the critical…
In August 2024, an article was published in the New England Journal of Medicine entitled, “Cognitive Motor Dissociation in Disorders of Consciousness.” It showed that 25% of patients who were deemed “unresponsive” actuall…
I had a patient who presented to my emergency department after suffering a seizure. The workup showed that his sodium level was dangerously low, and that was the most likely cause. How did this happen? He rode his motorcycle, helmet on,…
Hemothorax is a collection of blood in the thoracic cavity. Many times, this occurs in the setting of chest trauma, either penetrating (i.e., gun shot wounds) or blunt (i.e., a car accident). When a significant collection of blood occurs in the …
Critical illness is the scariest moment in someone’s life. All of the sudden, frequently without warning, a person can go from normal to fighting for their very survival. Combating this type of illness is the honor of a lifetime for me, and it…
It has long been established that, for people have chronic hypoxic respiratory failure, supplemental oxygen is beneficial. I have known this for my entire career. And, for many patients, that oxygen needs to be delivered continuously - 24 hours per …
I recently sat down with Austan Lundeen, Digital Marketing Manager for Sound Physicians, and asked him for tips on developing a social media strategy. Austan is an award-winning Marketing expert, who has Marketing literally in his blood. His tips we…
Vaccine skepticism is growing in our country, and with the new nominee for Secretary of Health and Human Services, Robert F. Kennedy, Jr., I fear this will only worsen with time. This is not because I believe we need to be vaccinated against every s…
Cardiac arrest is one of the most feared clinical situations both in and out of the hospital. When a patient suffers cardiac arrest, it is of the utmost importance to get access into the veins so that medications can be injected to try to help t…
Insurance companies frequently deny medical claims submitted by hospitals. One type of denial payers will use is the "DRG Denial." Here, the insurance company - frequently through a third party service - will go through a chart after the claim h…
Of all the things about which I am called as a critical care specialist, I think I am called/notified about serum potassium levels the absolute most. For some reason, if the serum potassium level is below 4.0, I am expected to do something about…
Sepsis is a life-threatening bodily reaction to an infection. It is the most common diagnosis we see in the ICU. The definition of sepsis (previously known as septicemia) has gone through many iterations throughout the years. In…
There are times when a patient cannot maintain an adequate oxygen or carbon dioxide level, and they need a mechanical ventilator. The procedure to place a patient on invasive mechanical ventilation is intubation, which means placing a plastic tu…
It is quite typical that we critical care physicians place patients who are on invasive mechanical ventilation on acid suppression to prevent stress ulcer bleeding. It is usual practice. This is because critically ill patients are at risk for bl…