Neuro Resus

There has been a potpourri of papers released in the last 12 months of interest to Intensivists. Some have solved the great mysteries of the universe, some have sparked the interest for more high-quality research and others have left us scratching our heads. This talk will give a snapshot of the Top 10 Critical Care papers of the last year.  

Basic bronchoscopy skills are considered a core component ability for all Intensive Care trainees. A few simple tricks to remember anatomy can make a relative bronch novice look like a seasoned pro. Remember 4 rules when looking down a bronchoscope:   W all s to the back   Every bronchus looks the same as every bronchus once you have already jumped in, so always identify the posterior wall to orie...

This short talk will focus on the who, why, how, what, and when of diagnosis and management of pulmonary hypertension and the right ventricle:   Who gets pulmonary hypertension?   Why is pulmonary hypertension important?   How do I diagnose pulmonary hypertension?   What are the most important practical management strategies?   When should I use advanced monitors and expensive pharmacotherapies?  ...

Acute liver failure for the intensivist by Dr David Anderson

The understanding around the metabolic response to the stress of critical illness has evolved rapidly over the past decade.   This involves a neuroendocrine and an inflammatory component, which results in perturbations within the sympathetic nervous system, the hypothalamo-pituitary axis and the immune system.   The clinical consequences are widespread and include changes in metabolic rate, altere...

What the boss wants: getting a consultant job by Dr Priya Nair & Dr Ray Raper

The Australian population away from metropolitan areas has the same health care needs and deserves the same level of care (within available resources) as urban residents: we can and should provide it. This short talk aims to explore work in a non-tertiary centre ICU as a career option and why it's worth considering.   It will look at what life and work are really like in non-metropolitan areas and...

To pass the Second Part Exam, your performance needs to be at the expected level for a junior consultant. You need to be able to rapidly synthesise clinical information from multiple sources to reach a differential diagnosis and appropriate management decisions. (And achieve this while feeling the equivalent of standing at the top of an Olympic downhill ski-run, simultaneously suffering from a sev...

Tips and tricks for getting through the first part: Examiner's perspective

10% of patients admitted to ICU die and, in some societies over 80% of people die during a hospitalization that included an ICU stay.   Most deaths in ICU are predictable and the overwhelming majority of patients are comatose for the last few days of their life.   Most communication by intensivists is directed at families rather than patients.   This talk will cover some scenarios where this isn't...

According to the World Health Organization Training Package for the Health Sector (2008), 'Children are not little adults' and  specialised  care must be targeted to pediatric patients  in order to  optimize outcomes. In a review of Australia and New Zealand  Paediatric  Intensive Care (ANZPIC) Registry data from 2006 to 2016, approximately 1600 children

You are called to see a 62-year old male now 3 hours post CABG x 4 with hypotension and escalating vasoactive requirements. As you arrive to the bedside, he arrests. How do you manage this situation?    This talk outlines the management of cardiac arrest in the intensive care unit post open heart surgery, as per the CALS (Cardiac Advanced Life Support) algorithm. Key differences from the standard ...

The prevalence of degenerative valvular disease is increasing in the context of an increasingly ageing population, and despite advances in medical and surgical interventions, is associated with a significantly worse outcome when compared with the general population. Data from the EuroHeart Survey (2003) suggests the commonest relates to native valve disease (predominantly aortic stenosis) however,...

The title of the talk is emblematic of the binary way that we have approached structural heart disease where cardiac surgery or an interventional procedure might be required – this thinking is now transitioning to an entirely different paradigm which is that of the "Heart Team".   Remarkable advances over the last decade have led to a plethora of interventional options for both coronary and struct...

CARDIAC REVASCULARIZATION SURGERY IN THE ELDERLY: AN EVIDENCE-BASED HEALTH ECONOMIC APPROACH     Background: Increasing prevalence of chronic disease in the context of an ageing society has led many to question the value of cardiac revascularization surgery and associated intensive care in elderly (octogenarian) populations. However societal expectations of improved technology and its likely impac...

I ntroduction : Recent times have witnessed almost half, or sometimes more cardiac surgical procedures are performed in patients above 75 years of age. Traditionally, the EuroSCORE II and STS risk scoring systems have been widely used across the globe. Extensive reviews have shown that EuroSCORE II probably overestimates the perioperative risk at lower score levels while the STS score tends to und...

"The real benefit to the patient [of echocardiography] is not the technical skill, but rather the application of intellectual input... information, communication and teamwork are essential" Jos Roelandt, 1993 Of all the imaging techniques used in intensive care, echocardiography has come to the fore, in particular due to its accessibility, immediate availability and applicability as a point-of-car...

The goal of hemodynamic monitoring is to assess the cardiovascular state of the patient, define their reserve and monitor response to treatments and time.  Resuscitation efforts are essentially aimed at restoring and sustaining tissue wellness through maintaining an adequate amount of oxygenated blood flow to the metabolically active tissues. We need to monitor pressure, flow and function. To acco...

Many   tools  are  nowadays   available  to monitor  patients'  hemodynamics  in  the intensive care unit (ICU) and in the operating room (OR) settings .  Some   monitoring  tools   are invasive  such  as the  pulmonary   artery   catheter  (PAC) ,  some   others  are  less  invasive  such  as  transpulmonary   thermodilution  (TPD)  systems ,  some   others   are  called   minimally  invasive  su...

With increasing survival comes morbidity . Pulmonary hypertension in the critical care population represents a secondary disease of myriad pathologies for children and adults. Whilst often  cardiac failure or respiratory disease complicated by pulmonary hypertension ,  the  exact  aetiology of  secondary  pulmonary hypertension can be a diagnostic challenge . Yet an u nderstanding  of  the  pathop...

The right ventricle (RV) is not important, until it is.  Under normal conditions  RV function  merely keeps central venous pressure low and delivers all the venous return per beat into the pulmonary circulation under low pressure. If pulmonary artery pressures increase due to pulmonary vascular disease (embolism, ARDS, COPD), over-distention (COPD, asthma) or ischemia (embolism, pulmonary hyperten...

The two major causes of acute right ventricular (RV) failure in ICU patients are acute cor pulmonale (ACP) during acute respiratory distress syndrome (ARDS) and ACP during acute massive pulmonary embolism (PE).    The increase in pulmonary vascular resistance (PVR) in ARDS can be secondary either to « structural » mechanisms related to lung injury  per se  and to « functional » mechanisms related ...

The use of extracorporeal membrane oxygenation (ECMO), and ventricular assist devices (VADs) for both short-term and long-term management of advanced cardiac (and respiratory) failure is increasing. Both thrombotic and haemorrhagic complications are common in patients receiving mechanical support, and such complications are associated with increased morbidity and mortality. Risks of bleeding and o...

Venous thromboembolism (VTE) is one of the most preventable complications in hospitalised patients. Critically ill patients are at risk of VTE due to coexisting of multiple risk factors but, at the same time, often at risk of bleeding. Though not common, fatal pulmonary embolism (PE) continues to occur [1] – due to the alignment of failures (or 'holes') in each defensive layer according to the Swi...

Survival in patients with advanced heart failure (AHF) has improved over the last 2 decades. An increasing number of patients however, are dying  with  progressive heart failure over the same duration. Optimal utilization of medical therapies and devices like implantable defibrillators and biventricular pacemakers are the likely reasons patients are surviving longer albeit with progressive HF.   ...