Tasty Morsels of Critical Care

Welcome back to the tasty morsels of critical care podcast . Nestled towards the end of Oh Chapter 51 we have a section dedicated to SAH. Given that a lot of ICU bed days are given over to managing SAH, I felt it might have warranted its own chapter. Indeed, looking at its prevalence in fellowship examinations it does seem that a fair deal of attention should be given to SAH. It stands apart from...

Welcome back to the tasty morsels of critical care podcast . Today we are going to talk about triggering on the ventilator. Now given the ubiquity of the word “triggering” in contemporary discourse I must confess that i do find it quite “triggering” to walk up to a vent and see the pressure support set at 11 or some other horror show like a PEEP of 7… I mean, who woul...

Welcome back to the tasty morsels of critical care podcast . Today we are going to do our best to charm the yellow snake of the intensive care unit and cover the pulmonary artery floatation catheter. Like a lot, indeed practically all of these topics, I do not in any way consider myself to have great expertise in the topic but I have had to upskill as much as I possibly can in lieu of the typical...

Welcome back to the tasty morsels of critical care podcast . The subject of solid tumours in the ICU gets a whole chapter in Oh’s hallowed pages, number 46. I suppose the term solid is in place to distinguish it from the “liquid” tumours of the bone marrow and domain of the haematologists, something we covered in tasty morsel number 58 Historically the idea of admitting people to...

Welcome back to the tasty morsels of critical care podcast . This time we look at Oh Chapter 52, focused on cerebral protection. There is, I must admit some repetition and cross over here, particularly with tasty morsels 20 and 39 respectively which cover more with regards to TBI. But in all honesty a little repetition is often very helpful for such subjects. We talk a lot about cerebral protectiv...

Welcome back to the tasty morsels of critical care podcast . In yet another departure from the stone tablets of Oh’s manual, today we’ll talk a little about one of favourite gram +ve cocci: staphylococcus aureus. Diagnosis and management of infections with this bug are a common occurence in the ICU and it behoves us to have a working knowledge of some of the complexities of its investi...

Welcome back to the tasty morsels of critical care podcast . Today we’re not so much looking at a chapter of Oh’s manual but at the physiologic concept of respiratory compliance. I approach this with a degree of trepidation as the probability of screwing this up is infinitely higher than simply translating Oh’s manual into podcast form. Compliance is relatively simply defined as...

Welcome back to the tasty morsels of critical care podcast . Today we’re going to talk about some of the basics of some of our favorite drugs intensive care – the diuretics. As always this is planned to be a brief overview of the essentials rather than the deep dive. Click for source As a starter pretty much all diuresis is conducted by convincing the kidney to lose more Na. Lose the N...

Welcome back to the tasty morsels of critical care podcast . Today we’re looking at asthma. In reality I find this is much more commonly discussed than seen in real life. No doubt this is due in part, to an improvement in asthma care chronically which is of course a good thing. I think it gets discussed and comes up on exam papers so much partly because it is such a nice illustration of phys...

Welcome back to the tasty morsels of critical care podcast . Oh chapter 26 devotes a whole chapter to this and for those of us in cardiac units the arrival of several post cardiac surgery patients a day in your unit is a routine part of the day. At least it was pre-pandemic anyhow. As such it presents a fairly predictable work load and patient cohort for your ICU. Given the bewildering number of c...

Welcome back to the tasty morsels of critical care podcast . Today we’re talking about dead space. While it may sound like something from The Expanse, we’re actually talking about the physiological concept of dead space here. This is pretty core physiology that crops up in clinical practice all the time so I think it’s worth thinking about. As usual this represents a sort of idio...

Welcome back to the tasty morsels of critical care podcast . Of the many things I poorly understand, I suspect that haematology holds a special place. Knowing the intricacies of the haematological malignancies was not exactly core knowledge for emergency medicine and to be fair an exhaustive knowledge is hardly key to ICM either. However in ICM there is a need to have a broad understanding of what...

Welcome back to the tasty morsels of critical care podcast . Today we’re looking at a small section of Oh Chapter 58 covering myasthenia gravis. I don’t think I’ve ever looked after a true myasthenic crisis in the ICU. Likely because they’re well managed by their neurologists on an OPD basis or well managed from an anaesthetic perspetive when they need an operation done. I...

Welcome back to the tasty morsels of critical care podcast . Today we look at everyone’s favorite mould – aspergillus. We see a number of fungal infections in the ICU, most commonly it’ll be the yeasts – forms of candida. Yeasts are single celled organisms. The moulds, of which aspergillus is a member are multicellular organisms. To continue into a brief foray of wikipedia...

Welcome back to the tasty morsels of critical care podcast . This time round we’ll look at an oldie but a goodie: salicylate poisoning. I have not seen one of these in quite some time but it is a classic tox question for exams in both EM and ICM. Oh Chapter 90 has the ambitious task of covering all poisonings so unsurprisingly it’s a little brief but this post is supplemented by a few...

Welcome back to the tasty morsels of critical care podcast . This time round we’re going to have a look at some chest wall injuries you should know about. The main reference here is Oh’s manual chapter 79. The vast majority of what we see here is going to be simple pneumothoraces and the elderly patient with some rib fractures and contusions or a developing pneumonia. That kind of thin...

Welcome back to the tasty morsels of critical care podcast . Usually the topics here follow the well trodden path of Oh’s manual, but we’re looking at something primarily because it is  an ideal question for a fellowship exam. In this type of scenario you will almost be guaranteed to find that Deranged Physiology has already covered it comprehensively and in great detail. So as expecte...

Welcome back to the tasty morsels of critical care podcast . There’s not a huge amount of notes on procedural stuff that I accumulated for the exams but I did collect some interesting bits on bronchoscopy, particularly because it was so novel to me as an EM trainee who really had no experience with bronchoscopy prior to starting to my critical care fellowship. After 2 years of frequent, if n...

Welcome back to the tasty morsels of critical care podcast . Sometimes the tasty morsels are exam sized snippets of my knowledge on a given topic. More frequently they are literally all I know on the subject. Today’s topic of parenteral nutrition is a good example of this. I have no doubt there is a lot more I should know about what goes into those plastic shrouded bags at the end of the bed...

Welcome back to the tasty morsels of critical care podcast . This is number 50, so for all 7 of you out there, well done for making it this far especially when you can’t even get CPD points for it. Today we’ll look at Oh’s Manual Chapter 80 written by the one and only Oli Flower of SMACC and CODA fame. Like TBI we can split up spinal cord injury into primary and secondary injury....

Welcome back to the tasty morsels of critical care podcast . Today we’ll look at everyone’s favourite yeast – Candida. Firstly, remember the distinction between yeasts and moulds. Yeasts, like Candida species are single celled critters whereas moulds like aspergillus are multicellular. Candidiasis is common in ICU patients. It grows commonly in our BAL samples, it grows in our ur...

Welcome back to the tasty morsels of critical care podcast . Today we look at anaphylaxis. Oh’s Manual 67 forms the basis for most of this. In many ways this is fairly straightforward. You give adrenaline and they get better. However once you get into the pathophys behind it you start to realise why immunologists are much smarter than you are. Oh starts with a few nice descriptions of what i...

Welcome back to the tasty morsels of critical care podcast . This week we’ll make a fly by at part of Oh Chapter 100 looking at haemostatic failure. The understanding of the haemostatic system seems a little like the universe at times with our knowledge, and the gaps in our knowledge expanding away from us quicker than can we track. As a result this summary will be necessarily superficial, b...

Welcome back to the tasty morsels of critical care podcast . This week we’re looking at the other ACS, the surgical ACS, the old abdominal compartment syndrome. This is common, especially in the surgical population and does not always immediately jump to the front of our cerebral hemispheres when it should do. Believe it or not there is a World Society of abdominal compartment syndrome that...

Welcome back to the tasty morsels of critical care podcast . Oh dedicates an entire chapter, number 88 to CBRN issues. While not commonly seen you can rest assured that critical care will be expected to turn up and manage these patients if an incident does occur so it is something we need to know fairly well. I will cover the content of chapter 88 here but I will borrow from a lecture I gave at th...