RK.MD

Made a quick trip to COTA for the 2026 Formula 1 Grand Prix in Austin, with Porsche Carrera Cup and F1 Academy on the schedule too.

In January 2021, I moved my websites from Siteground to Cloudways as I stepped up from shared hosting to a managed virtual private server (VPS).

With each passing year, birthdays seem to feel “just like another day”, but despite my disdain for celebrating random days, this one was special as I recalled some major milestones.

The venous-to-arterial carbon dioxide difference (PCO₂ gap), defined as PcvCO₂ (taken from a central line blood gas) – PaCO₂ (taken from an arterial blood gas), answers a question that neither lactate nor ScvO₂ can typically answer directly.

Vitamin K (phytonadione) is an essential, fat-soluble cofactor for γ-carboxylation of clotting factors II, VII, IX, and X, as well as proteins C and S.

This post was last updated on 5/27/2026.

Mitral paravalvular leaks (PVL) occur when there is dehiscence between the prosthetic sewing ring and the native annulus, allowing blood to regurgitate around the valve rather than through it.

My homelab has gradually evolved into infrastructure I rely on every day.

One of the first things I look for when performing transesophageal echocardiography (TEE) for a mitral valve replacement is how the new valve is functioning as we prepare to separate from cardiopulmonary bypass.

Procalcitonin is a peptide precursor of calcitonin that becomes detectable in the setting of systemic bacterial infection, driven by cytokines and endotoxin released throughout the body rather than from the thyroid alone.

Total pneumonectomy (removal of the entire lung) is most commonly performed for centrally located lung cancer when sleeve resection or lung-sparing surgery is not feasible.

Today, I was notified by my department leadership of my promotion to Associate Professor of Anesthesiology, effective September 1, 2026.

As a physician, one of the most frustrating public takes is the claim that doctors don’t receive enough training in medical school about nutrition, as though that is the central reason chronic disease continues to overwhelm healthcare.

I never thought I would be the person cross-shopping a Tesla Model S Plaid and a Porsche Taycan Turbo S, let alone owning both.

Sometimes I’m asked by medical students and anesthesiology residents what a typical work schedule looks like for me as a dual-trained adult cardiac anesthesiologist and CVICU intensivist working in academic medicine.

Katie and I took a two-week vacation to Japan for the Japanese Grand Prix (my favorite track of the year) and to visit other popular tourist attractions.

Fibryga (human fibrinogen) is a concentrate designed to restore factor I (fibrinogen), the final substrate of clot formation.

In patients with extensive disease involving the aortic arch and proximal descending thoracic aorta, a frozen elephant trunk (FET) extends the repair distally by combining an open surgical ascending/transverse aortic arch replacement with deployment of a…

After endotracheal intubation for a general anesthetic, it is not uncommon for patients to report a sore throat in the recovery area.

This video walks through how I approach extubation for many of my postoperative patients in the CVICU, drawing directly from the same physiologic framework I use as a cardiac anesthesiologist in the operating room.

I’ve been renting apartments since my days as an anesthesiology resident; however, I didn’t discover the original Bilt card until very late in the game, and to be honest, it seemed a little too good to be true.

In August 2025, I transitioned my Eero-based networking hardware to Ubiquiti and have been extremely satisfied with the granular control I have over advanced networking features, metrics, and network performance.

I don’t normally deviate from medical/tech-related topics, but today was an important milestone in my life.

Chronic hypertension, medial degeneration, elastic fiber fragmentation, smooth muscle cell loss, and progressive aortic dilation are all mechanisms implicated in acute aortic dissection (AAD).

Maintenance of certification in anesthesiology (MOCA) evolved from an exam taken every decade to now having to complete 30 online questions every quarter, maintain an unrestricted license to practice medicine, obtain 250 category 1 continuing medical educ…

“Thiamine before glucose” is a bedside teaching that started with a sound physiologic concept and slowly hardened into dogma when dealing with patients with alcohol use disorder.

Premature atrial complexes (PACs) are something I’ve explained to trainees and patients for years, but about a week ago, I started having them following a really rough stretch in the CVICU.

Left ventricular (LV) thrombus is typically a result of stasis from myocardial hypokinesis/akinesis.

2025 was an interesting year for me as an academician.

High altitude pulmonary edema (HAPE) typically shows up in otherwise healthy patients after rapid ascent (e.g., mountain-climbing) with subsequent coughing, tachycardia, hypoxemia, and fatigue.

Olanzapine (Zyprexa) and quetiapine (Seroquel) are often discussed as if they are interchangeable sedating antipsychotics used to help with addressing facets of delirium (insomnia, emotional lability, etc.).

Andexanet alfa (Andexxa) will leave the US market on December 22, 2025, after AstraZeneca withdrew its biologics license application for commercial reasons.

Middle aortic (“mid-aortic”) syndrome (MAS) refers to a segmental narrowing of the distal thoracic or abdominal aorta, often with associated stenosis of the renal and visceral branches.

Every few years, I tweak RK.MD’s design to refresh my content and to leverage the latest technologies at that time.

Over the last month, I’ve been slowly refining a workflow that lets me run a private large language model (LLM) on my NVIDIA DGX Spark.

Creating a new arteriovenous fistula (AVF) generates a major hemodynamic shift.

Candida auris (C. auris) has become a significant challenge in critical care across the country.

Tramadol (Ultram) is often prescribed for analgesia because it’s easy to write for (especially at hospital discharge); however, its pharmacology makes it unreliable for pain control.

As with any procedure, cardiac surgery carries risks that are explained to patients by their surgical team.

Gerbode defects create an abnormal communication between the high-pressure left ventricle (LV) and the right atrium (RA), thereby completely bypassing the right ventricle.

The NxStage System One continuous renal replacement therapy (CRRT) system provides convective and diffusive clearance through a simplified cartridge system.

Rather than using a separate plugin or paid service, I used macOS’s Automator application to create a folder action that converts popular image and video file types to AVIF and WebM, respectively.

Acetaminophen (Tylenol) is routinely administered in IV and PO (pill) forms in perioperative and critical care medicine, but the debate of which route of administration is superior comes up all the time, despite the evidence being consistent for years.

Isopropyl alcohol (IPA) aromatherapy by means of inhaling the vapors from an IPA pad has been a simple bedside practice used to relieve nausea.

As a cardiac anesthesiologist and intensivist, vasoplegia following cardiopulmonary bypass is an issue I often face in the OR and ICU.

Mentors shape us in ways we often don’t appreciate until much later.

Aldosterone escape is the phenomenon where, despite persistently elevated aldosterone levels (endogenous or exogenous), the body prevents unchecked sodium retention and volume overload.

With the assistance of my department, I recently submitted my application for promotion to the rank of Associate Professor.

It’s been a few years since I last did a “What’s in my work bag?”

A eutectic mixture refers to a combination of two or more substances that, when mixed in a specific ratio, form a mixture with a lower melting point than any of the individual components alone.