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Derek Isenberg
Worked at Chester Crozer Medical Center
Attended Ridgewood High School
Lives in New Jersey
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Derek Isenberg

Discussion  - 
 
I attended my first critical care meeting today.  The MICU uses the vigileo monitor and flotrac device. Is this something worth trying to bring "downstairs" and training the docs and nurses to use? Or is ultrasound just as good in the ED?
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EMCrit's profile photoMatthew Siedsma's profile photo
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Seems like there's better data out there for the NICOM Cheetah monitor but many places were enchanted by Edwards and the Vigileo / Flotrac and don't have the budget these days to shell out for another expensive cardiac output monitor.  US is just as good so if you're confident in your bedside US skills (and your patient's body habitus is amenable to ultrasound) it's probably an even better surrogate for determining "fluid responsiveness" which Vigeleo does by giving you an SVV (stroke volume variation). US is probably also preferable in that you can get even more information from it.
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Derek Isenberg

Discussion  - 
 
My colleagues and I are attempting to convince the ICU to adopt the new SCCM guidelines for the sedation of intubated patients in the ICU (fentanyl + propofol/Dexmedetomidine). They are still using versed + fentanyl. We propose to start this sedation in the ED (upstairs care downstairs) and have the nurses in the ED use the RASS to titrate sedation. 

I reviewed the SCCM guidelines in depth and they are actually pretty weak in evidence for their recommendations. There are 2 articles that they relied on for their recommendations. Their meta-anaylsys showed a 0.57 reduction in ICU length of stay.

How would you make the case with the ICU?

Carson SS, Kress JP, Rodgers JE, et al: A randomized trial of inter- mittent lorazepam versus propofol with daily interruption in mechani- cally ventilated patients. Crit Care Med 2006; 34:1326–1332

Jakob SM, Ruokonen E, Grounds RM, et al; Dexmedetomidine for Long-Term Sedation Investigators: Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: Two randomized controlled trials. JAMA 2012; 307:1151–1160
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Derek Isenberg

Emergency Medicine  - 
 
My colleagues and I are attempting to convince the ICU to adopt the new SCCM guidelines for the sedation of intubated patients in the ICU (fentanyl + propofol/Dexmedetomidine). They are still using versed + fentanyl. We propose to start this sedation in the ED (upstairs care downstairs) and have the nurses in the ED use the RASS to titrate sedation. 

I reviewed the SCCM guidelines in depth and they are actually pretty weak in evidence for their recommendations. There are 2 articles that they relied on for their recommendations. Their meta-anaylsys showed a 0.57 reduction in ICU length of stay.

How would you make the case with the ICU?

Carson SS, Kress JP, Rodgers JE, et al: A randomized trial of inter- mittent lorazepam versus propofol with daily interruption in mechani- cally ventilated patients. Crit Care Med 2006; 34:1326–1332

Jakob SM, Ruokonen E, Grounds RM, et al; Dexmedetomidine for Long-Term Sedation Investigators: Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: Two randomized controlled trials. JAMA 2012; 307:1151–1160
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Have him in circles
19 people
Vincent McDonough's profile photo
John Makopoulos's profile photo
Joseph Alonso's profile photo
Rob Rogers's profile photo
raluca isenberg's profile photo
Michael Pasirstein's profile photo
stacey wigent's profile photo
Ultrasound Podcast's profile photo
Jordan Gleason's profile photo
Work
Occupation
Emergency Physician
Skills
Emergency Medicine, Prehospital medicine, Medical education, EMS medical direction
Employment
  • Chester Crozer Medical Center
    MD
    Associate Program Director Emergency Medicine Residency
Places
Map of the places this user has livedMap of the places this user has livedMap of the places this user has lived
Currently
New Jersey
Links
Story
Tagline
Emergency Physician Helping to Build an new EM residency
Introduction
I am an attending physician at Chester-Crozer Medical Center and associate program director for the new emergency medicine residency.
Education
  • Ridgewood High School
    1991 - 1995
  • Duke University
    Classical Languages, 1995 - 1999
  • Tulane University
    Medicine, 2001 - 2005
  • Yale University
    Emergency Medical Services, 2008 - 2009
Basic Information
Gender
Male