Category Archives: Intensive Care

PERCUTANEOUS TRACKIES NOT SO SAFE AFTER ALL…

Posted on November 23, 2013 by K

A literature review in crit care reminds me of how ICU percutaneous tracheostomies are potentially dangerous and is associated with significant mortality. This mortality needs to be weighed in when deciding wether to make the hole in the neck or … Continue reading →

Posted in Airway management, Intensive Care | 2 Comments

THERAPEUTIC HYPOTHERMIA – NOT SO COOL

Posted on November 18, 2013 by K

A recent study published in New England Journal of Medicine has created a splash in EM social media. While it acknowledges that temperature control is important, it also suggests therapeutic cooling of cardiac arrest survivors does not work.

Posted in Cardiology, Emergency Medicine, Intensive Care | 5 Comments

CPR ON STEROIDS

Posted on August 20, 2013 by Thomas D

Vasopressin has been advocated in and out of the CPR algorithm. Adrenaline is still hanging in there. And now the Greeks want to add steroids?! In this pretty solid multi center trial, they randomised cardiac arrest patients to standard adrenaline … Continue reading →

Posted in AHLR, Emergency Medicine, Intensive Care | 3 Comments

CENTRAL VS PERIPHERAL PRESSURE

Posted on July 18, 2013 by Thomas D

Monitoring of a patient in severe septic shock and with high dose pressor infusions. We happened to have two intra-arterial blood pressures, shown as the red tracings and numbers on the monitor. A central pressure from a PiCCO line in … Continue reading →

Posted in Anesthesia, Emergency Medicine, Intensive Care | 8 Comments

ECMO AND IMPELLA

Posted on July 15, 2013 by Thomas D

ECMO or Impella, or ECMO and Impella? With increased focus on mechanical support for acute severe heart failure and cardiac arrest, there’s more research looking into which type of mechanical assistance that’s most appropriate. Each type of assist device has … Continue reading →

Posted in ECLS, ECMO, Intensive Care | 1 Comment

TRACMAN

Posted on June 9, 2013 by K

The TracMan trial was recently published in JAMA. TracMan is a randomised trial comparing early vs late tracheostomy in ICU patients. Which just happens to be one of the big current controversies in intensive care.

Posted in Intensive Care | 2 Comments

DAILY SEDATION INTERRUPTION STILL CONTROVERSIAL

Posted on April 27, 2013 by K

 The average intensive care patient spends 40% of her/his ICU time being weaned from the ventilator. Reduced weaning times means freeing up an enormous amount of floor-space, manpower and resources. Two important causes for prolonged weaning are over-hydration and excessive … Continue reading →

Posted in Intensive Care | Leave a comment

RINGER’S A LOUSY VOLUME EXPANDER

Posted on April 18, 2013 by Thomas D

With colloids being miscredited by Cochrane and synthetic colloids being hammered by RCTs, it might seem we’re left with crystalloids. So how good is our standard crystalloid, Ringer’s Lactate, at volume replacing a volume depleted patient? This study withdrew blood … Continue reading →

Posted in Anesthesia, Emergency Medicine, Intensive Care | 5 Comments

CODE BROWN: CENTRAL LINE GOES WRONG

Posted on March 15, 2013 by Thomas D

This one I got from a colleague of mine at a Scandinavian hospital, and it’s a scary reminder of the dangers of central cannulations. Placement of a large dialysis catheter went wrong – very wrong.

Posted in Code Brown, Intensive Care | 26 Comments

NOREPINEPHRINE AND CO

Posted on March 5, 2013 by K

A small study in Crit Care Med reminds me how it is really hard to anticipate the effects of systemic vasoconstrictors. Norepinephrine/noradrenaline is more likely to reduce cardiac output than maintain it.

Posted in Anesthesia, Emergency Medicine, Intensive Care | 1 Comment