Esteban Mery-Fernandez, MD

Should we push Bicarbonate in patients with Acidemia?

Acidemia is a serious condition that leads to hemodynamic repercussions if unattended. Acidemia decreases cardiac output by affecting myocardial contractility and reducing afterload, also causes a relative tachycardia, which decreases the filling time of the ventricle. However, the evidence to give bicarbonate is not that robust. For example, should we give bicarbonate during cardiac arrest? … Read more

Focus on the Core

Diagnosing, treating, monitoring, and transitioning our patients are core skills for hospitalists. We work in a high risk, high reward environment. The risk is taken by the patient. For us, the risk is medico-legal. The reward of recovery from illness goes to the patient. For us, the reward is professional and personal satisfaction. In order … Read more

Do You Love Your Job?

There was a time in our lives where all we can think about was dreaming, imagining, fantasizing about our role as health care professionals. I certainly remember mine vividly. I can pinpoint the day I decided to follow my call in medicine, I have no shame in admitting that I was at home, wearing a … Read more

Code Blue From What?

A 56-year-old man was admitted to the hospital with a small bowel obstruction. The patient is an alcoholic, who lives in the streets of your city. On day 6 of admission, internal medicine is consulted to take over his care, because electrolytes are being hard to control despite aggressive repletion. On your evaluation, you find … Read more

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