Tasty Morsels of Critical Care

Welcome back to the tasty morsels of critical care podcast . It is with trepidation that I approach any topic that involves the negative feedback loops of endocrine control as I really struggle to keep it all straight in my head, but today I’m going to try and cover the basics of calcium in the critically ill from Oh Chapter 63. We’ll start from some very basic physiology. 99% of the c...

Welcome back to the tasty morsels of critical care podcast . Condensing all of “inotropes and vasopressors” into a single 5 minute podcast is of course doomed to fail but that’s never stopped me before. The main reference for this is Oh’s Manual Chapter 92 by John Myburg who is known to me  for describing adrenaline as “God’s own inotrope” and in the same...

Welcome back to the tasty morsels of critical care podcast . In a further scandalous departure from Oh’s Manual today we’re going to look at a chapter of verified Irish Critical Care legend, Martin Tobin’s huge mechanical ventilation textbook. I have made it through about 5 chapters of this beast and it is undoubtedly comprehensive. Anyhow, today will be nitric oxide, covering To...

Welcome back to the tasty morsels of critical care podcast . Today we’re going to talk about a fairly rare and niche issue in critical care – gas embolism. The venerated stone tablets of Oh’s Manual do not mention it in any great detail but my alternative and go to textbook has been Irwin & Rippe’s weighty tome/deadweight, and chapter 177 here is dedicated to gas emboli...

Welcome back to the tasty morsels of critical care podcast . With extreme brevity we are going to try and cover Oh’s Manual Chapter 38 on respiratory monitoring. This is something of a hodge podge i must admit. I’ll start by looking at the lung mechanics section. The first useful point is that the pressures recorded by the vent are usually interpreted as reflecting the compliance of th...

Welcome back to the tasty morsels of critical care podcast . This is part of Oh’s Manual Chapter 77 on head injury and we covered ICP monitoring before in number 20. A key principle here is cerebral perfusion pressure or CPP. This is easily calculated at the bedside as MAP-ICP. Of course this is only easy if you actually have an ICP monitor.  The CPP should probably be around 60-70 which ass...

Welcome back to the tasty morsels of critical care podcast . A meandering monologue through critical care fellowship exam preparation. Oh’s Manual chapter 104 has a decent chapter on the intensive care aspects of lung transplant. A lot of this stuff will end up fairly centre specific but there is a good general overview to be had here. Lung transplants do reasonably well overall (most likely...

Welcome back to the tasty morsels of critical care podcast . A meandering monologue through critical care fellowship exam preparation. This week: serotonin syndrome. Much talked about, very common in an exam, quite rare in real life. It doesn’t really get much coverage in Oh’s manual so the following is prepared from the hodge podge of resources listed at the end. In normal circumstanc...

Welcome back to the tasty morsels of critical care podcast. A meandering monologue through critical care fellowship exam preparation. Today we’re talking a little about that most vital of gases – oxygen. This is going to be back to some very basic physiology from Oh’s Manual Chapter 28, that I probably should have learnt in medical school but honestly looking back I’m not s...

Welcome back to the tasty morsels of critical care podcast . A meandering monologue through critical care fellowship exam preparation. Today we’ll talk about CRRT timing. When should your critically ill patient take a spin on the green machine? From an exam point of view this can go a few directions. You can go core physiology or you can go down the literature route. I think both are worth c...

Welcome back to the tasty morsels of critical care podcast . A meandering monologue through critical care fellowship exam preparation. If you were tuning in to try and pick up some core exam level content then this is probably not it. However, it is what came up in my non-random, semi alphabetical by system, trawl through my notes that forms the basis for the order I write these in. We’re go...

Welcome back to the tasty morsels of critical care podcast . A meandering monologue through critical care fellowship exam preparation. Today we’re looking at Oh Chapter 64 covering some of the absolute basics of pre eclampsia. ICU level pre eclampsia is rare. In Ireland most of it is managed in separate obstetric hospitals by the obstetricians and the anaesthetists. And given that the defini...

Welcome back to the tasty morsels of critical care podcast . A meandering monologue through critical care fellowship exam preparation. Today’s podcast is mostly taken from Oh’s manual Chapter 96 covering critical care nutrition. Something we all know and love deeply for exams and then immediately outsource to our dieticians the moment we get the chance. Perhaps the first take home figu...

Welcome back to the tasty morsels of critical care podcast . A meandering monologue through critical care fellowship exam preparation. GBS management can be nicely split into disease specific management and ICU supportive care. In terms of specific treatment this is something that has a reasonable evidentiary basis at this stage. The menu on offer is similar in appearance to many of the immune med...

Welcome back to the tasty morsels of critical care podcast . A meandering monologue through critical care fellowship exam preparation. GBS is a clinically important diagnosis for both the emergency department and the ICU. Its rareish but common enough that you will at least suspect it often enough in the ED and many ICUs will have one long stay ICU patient with GBS every few years and a short stay...

Welcome back to the tasty morsels of critical care podcast . A meandering monologue through critical care fellowship exam preparation. We see C. Diff in the ICU in a couple of contexts. Firstly the poor unfortunate soul who starts with a benign illness and gets some antibiotics and develops a fulminant colitis and shock needing colectomy and an ICU admission. Secondly we have the frequent dilemma...

Welcome back to the tasty morsels of critical care podcast . A meandering monologue through critical care fellowship exam preparation. HIV in the ICU is becoming a bit of a rare beast as the ID docs seem to have it so well controlled that it becomes a chronic co-morbidity rather than the cause of their presence in the ICU. There are of course exceptions – typically in the poor soul in diffic...

Welcome back to the tasty morsels of critical care podcast . Plasmapheresis (or PLEX) is one of the machines we tend not to have responsibility for in the ICU. Unlike CRRT we tend to defer to another specialty to do this. As a result we don’t need to know the same level of detail we need for CRRT, however we do need to know the basics and in particular where it might be indicated (and indeed...

Welcome back to the tasty morsels of critical care podcast . SBS is not a common thing to find in the ICU and the most likely context here is going to be receiving someone from the operating theatre who has had rather more bowel removed than one would like. There are some poor souls who as a result of SBS are dependant on long term TPN who may also appear in ICU from time to time and a working kno...

Welcome back to the tasty morsels of critical care podcast . The commonest time we think of adrenocortical insufficiency in the ICU is probably in sepsis. This post will definititely not cover the beast that is steroid use in the intensive care unit or its novel, all purpose moniker of CIRCI (Critical Illness Related Corticosteroid Insufficiency) Our natively produced steroids have their origins i...

Welcome back to the tasty morsels of critical care podcast . A meandering monologue through critical care exam preparation. The aminoglycosides see themselves as a bit special. Not content with producing deafness and killing kidneys they’ve also demanded awkward dosing schedules, a need for regular levels and even their own section on most drug kardexes that I’ve seen. They are the div...

Welcome back to the tasty morsels of critical care podcast . Cardiac pacing comes in a variety of flavours in critical care but a reasonable list of class I indications for permanent pacing might include: 2nd/3rd block with symptoms and bradycardia, pauses or in people with NM disease ( who are a bunch of patients oddly prone to collapse of the conduction system ) sinus node dysfunction and bradyc...

Welcome back to the tasty morsels of critical care podcast . Continuing along a theme of words with with too many i’s in them, (see TM 007 for more) today we look at necrotising fasciitis or “nec fasc” to its friends. What clinical signs might help us find this? necrotic skin bullous changes dishwater coloured drainage from the bullae/tissue everyone’s favourite: POOP or pain out...

Welcome back to the tasty morsels of critical care podcast . Ventilators remain one of the dark arts and hidden mysteries of critical care. Intensive care is a fairly generalist specialty overall and we share our core knowledge with a lot of other specialties. But when it comes to ventilators you enter the niche world of intensive care where arcane knowledge of boutique ventilators from the late 7...

Welcome back to the tasty morsels of critical care podcast . Like most spaces within the body, the contents within the cranium are under a certain degree of pressure. The skull being a rigid box can accommodate pressure much less than many other compartments in the body. The idea is that a modest increase in the volume of the box leads to a rapid increase in ICP. This is Monroe-Kellie 101. It make...