Tasty Morsels of Critical Care

Welcome back to the tasty morsels of critical care podcast . Welcome back to what I hope will be the final little segment (boom boom) on liver transplant. Part 1 lives here . Though at this stage I certainly can’t rule out an ongoing process somewhat akin to the great Douglas Adams’ increasingly inaccurately named Hitch Hiker’s Guide to the Galaxy trilogy that ended up at 5 parts...

Welcome back to the tasty morsels of critical care podcast . Today we’re covering Oh’s Manual Chapter 103 looking at liver transplant. There are two types of liver disease that might put you in line for a transplant acute liver failure chronic liver failure I’ll confess before studying for my fellowships that I had a very poor understanding of the very important distinctions betw...

Welcome back to the tasty morsels of critical care podcast . Today we have one of the jewels of critical care exam preparation. Not only does this involve niche clinical contexts, the gamma glutamate cycle but also everyone’s favourite acid base mnemonic CAT MUDPILES . The referral to critical care services will likely go something like this. Usually a phone call from a surgical service abou...

Welcome back to the tasty morsels of critical care podcast . So, from the ultra broad topic of AKI in the last podcast to the super specific question of when we should pursue an open lung biopsy in an ICU patient. The answer is probably – very rarely. But while this podcast is intended to be brief even I feel I owe the listener something more than this. When would you consider such an invasi...

Welcome back to the tasty morsels of critical care podcast . This is a somewhat basic and general episode, even for this podcast which indulges in frequent generalisation and summaries of pre existing summaries. It covers Oh’s Manual Chapter 47 looking at Acute Kidney Injury. While hardly the most exciting topic in the world, there a few important pearls here perhaps worth emphasising. Oh le...

Welcome back to the tasty morsels of critical care podcast . In a break from the not quite established tradition on this show, I’ve split this into two parts. Number 13 covers the process of putting them in. This one focusses more on some physiology and when to take it out. Some useful points on anatomy  and physiology 18-22 rings cricoid to carina about 11cm compared to normal breathing, tr...

Welcome back to the tasty morsels of critical care podcast . In a breaking from what could only loosely be described as tradition at this point, this podcast is going to be in 2 parts. Intensivists have embraced the tracheostomy as an ICU procedure. It’s one of the most invasive and one of the riskier procedures we do. There is a substantial ANZICS document on tracheostomy that forms the str...

Welcome back to the tasty morsels of critical care podcast . This is a mammoth topic that listening to 5 mins of me rambling will in no way seriously prepare you to either practice clinically or write a semi coherent exam answer. That being said here we go. In terms of reasons to sedate someone in the ICU the following would seem a reasonable selection of reasons as treatment for disease process (...

Welcome back to the tasty morsels of critical care podcast . Thanks to the wonders of preemptive rasburicase (which i have a tendency to associate with Rasputin at this point) I don’t think this as common as it used to be. But that is wild speculation on my part as someone who’s only ever looked after cases in the single digits. The basic premise here goes something like this. Chemothe...

Welcome back to the tasty morsels of critical care podcast . Critical illness in pregnancy is remarkably rare given the somewhat bonkers system for reproduction that we seem to have evolved over the past million or years. Improved care of complex cardiac conditions has led to improved survival of women with an ability to procreate and pose what can only be described as challenging conditions for t...

Welcome back to the tasty morsels of critical care podcast . As an EM trainee doing intensive care I will confess that I struggle to work up the enthusiasm to cover a nutrition guideline. With my deepest apologies to all the great ICU dieticians I have worked with, I just struggle to get excited over this stuff. Part of the reason for this is that our dieticians are so good I have cognitively outs...

Welcome back to the tasty morsels of critical care podcast . Just to be clear up front we’re going to be talking about taking the lid off for stroke, NOT taking the lid off for TBI. I will get to TBI but they are really quite different topics. This is not something that is done commonly but if you work in a neuro centre you will see it happen. We’re talking about the malignant MCA synd...

Welcome back to the tasty morsels of critical care podcast . Pneumocystis Jriovecii Pneumonia, the infection formerly known as Pneumocystis Carinii Pneumonia The official change in name from Carinii to Jirovecii was in the late 1990s to emphasise the distinct organism that infected humans and named after a chap called Otto Jirovec. it seems that there was just one “i” when the name fir...

Welcome back to the tasty morsels of critical care podcast . Today we’re talking about chylothorax, not something I’ve not had the joy of managing as yet. Chyle is produced through digestion and absorption of emulsified fats from the small intestine. It consists of triglycerides, white cells, and these wonderful things called chylomicrons . Chyle is not generally meant to be in the tho...

Welcome back to the tasty morsels of critical care podcast . One would think that the term drowning should be relatively straightforward, however there have been a plethora of descriptions including wet drowning, dry drowning and near drowning. These have all been officially retired and the Utstein guidance on the matter describes drowning as “a process resulting in primary respiratory impai...

Welcome back to the tasty morsels of critical care podcast . All of these posts are simplifications of much more complex topics but when it comes to the immunosuppressants used in solid organ transplant I’m wading out of my depth even more than I usually do. This summary is basically enough to get by but perhaps not enough to say anything sensible about. All of them are of course immunosuppr...

Welcome back to the tasty morsels of critical care podcast . DKA is bread and butter for critical care providers. In fact the combination of bread and butter in the absence of insulin is a core part of the pathophysiology of the disease. An exam worthy summary of the pathophys might go as follows. lack of insulin stimulates lipase which leads to the production of free fatty acids from lipid stores...

Welcome back to the tasty morsels of critical care podcast . In the main we get excited about systolic dysfunction. We obsess over the ejection fraction with numbers like EF of 12% being reproduced recurrently in handover sheets. But this is to neglect what constitutes the vast majority of the time of cardiac cycle in those with sensible heart rates. It has become clear that a lot of cardiac dysfu...

Welcome back to the tasty morsels of critical care podcast . TTP is a lovely ICU diagnosis. Not so much for the patient but it’s one of those ones that is niche enough to not have been picked up via the usual filters of ED, medical team to the ward. There is a definitely a chance to shine and make the diagnosis. This is  form of MAHA (microangiopathic haemolytic anaemia). Best to avoid detai...

At this stage (Oct 2020), PGY17 and still in training I have done a fair number of exams and I feel that now, pushing 40 and vowing never to do another exam, I may have finally perfected my examination technique. But that’s for another post. I have accumulated a large number of summarised and truncated notes across two specialties (three if you include the echo stuff…) and they exists...