Neuro Resus

Hepatic resections are complex surgical procedures harboring a significant risk for complications. In line with the continued development of liver surgery, hepatic resections tend to be more complex and extensive, with to this associated enhanced risk for post-hepatectomy liver failure (PHLF). Despite these improvements in outcome after major liver resection, PHLF remains one of the most serious a...

Management of the patient with decompensated liver disease is clearly more straightforward in specialist centres with multi-disciplinary input, access to liver transplantation teams and advanced technology. Bioartificial extra-corporeal liver support systems are undergoing evaluation and include the extra-corporeal liver assist device (ELAD developed by Vital Technologies). ELAD is an investigatio...

The patient with chronic liver disease presents a range of potential challenges when a severe intercurrent illness occurs or major surgery is required. Even well-compensated liver cirrhosis in high functioning patients renders such individuals vulnerable to a myriad of problems when physiological stressors occur. Severe acute liver failure is another clearly defined sydrome in which extremely rapi...

Despite the publication of a number of studies over recent years looking at energy delivery and outcomes in the critically ill population we remain uncertain how best to determine optimal calorie delivery for our patients. The concept that energy delivery should match energy consumption is plausible and intellectually attractive bu Broadly speaking clinicians can be divided into 3 categories accor...

by Professor Jas Samra

Role of endoscopy in upper GI bleeds by Professor Michael Bourke

According to a quote variably attributed to Niels Bohr, Yogi Berra, Albert Einstein, Mark Twain and others 'prediction is difficult; especially about the future'. Nevertheless, in an era of evidence-based medicine, one might surmise that the future of management of GI bleeding in the ICU will be informed by large-scale high quality RCTs. There are a number of such trials on the horizon that give u...

Peptic ulcer bleeding (PUB) carries a 10% risk of death within 30 days and accounts for 36–46% of emergency upper gastrointestinal bleedings (UGIBs). The annual incidence of hospitalization due to PUB is 19–57 per 100,000 persons. Most of these patients undergo esophago-gastro-duodenoscopy (EGD), estimated to 2000 patients in Denmark alone every year. The poor prognosis in PUB is partly due to the...

At this year's CICM ASM in Hobart, Tasmania, there will be the second CICM trainee symposium. This is a day of lectures and discussions targeted specifically at CICM ICU trainees and immediately precedes the CICM ASM meeting itself. More details are here .

Acute liver failure - what tomorrow might bring? by  Professor Julia Wendon

The second is major hepatectomy which is increasingly used in patients with colorectal liver metastases (CRCLM) and cholangiocarcinoma and the recent figures for postoperative morbidity and mortality suggest wide safety margins. The limits of resection are, however, continuously tested and extended hepatectomy is used to remove larger and larger proportions of liver parenchyma. Finally many studie...

That the gastrointestinal tract exerts an important, but unseen role in the pathogenesis of human disease has been a recurring theme over recorded human history. The Egyptians believed that a factor from the gut known as "ukhedu", or "something disgusting", was a factor in disease. At the turn of the century, and based on the ideas of Elie Metchnikoff, the gut was held responsible for the process...

Resilience and Sustainable Work Practices by Dr Bronwyn Avard

Landing a consultant job, requires a different mind set than any job interview you have had prior. As well as your brand new, hard won, consultoid clinical skills, you will now have to interact with HR and Administration. This talk addresses tricks and tips for the interview process. Hints on what to say, and more importantly ...what not to say..

Clearing the C-Spine

Thrombocytopenia is frequently encountered in the ICU. It is important to have an understanding of the common and important causes of TP as well as to have a simple framework to approach this problem. A simple approach is to identify if TP is expected or unexpected and work through the management that way. Platelet transfusions or repeating the FBC is not always the right approach. Heparin induced...

How I manage delirium by Dr Nudrat Rashid

How I manage Traumatic Brain Injury by Associate Professor  Ian Seppelt

Whirl wind tour through DCD

Running CRRT in the ICU presents challenges. To ensure optimum dose of dialysis there are several tricks that can be employed to ensure the dialysis machine runs smoothly. Citrate anticoagulation, pre-dilution, reducing the blood flow and providing a reliable vascath are key to achieving good flow through the dialysis machine.

Obstetric emergencies

Paediatrics for the general intensivist