Obstetric Critical Care Management

Review Article (J Intensive Care Med. 2006 Sep-Oct;21(5):278-86) Vent Stuff ↑ alveolar ventilation (20-40%), ↑ TV, ↑ RR Compensated hypocarbia (Normal 25-32 and normal bicarb 18-21) Mechanical ventilation- need to adjust for PaCO2 30-32 (compensated hypercarbia); no studies show harm with permissive hypercarbia Faster desaturation: ↑ O2 consumption + ↓ function residual capacity + ↑ […]

Cardiothoracic Surgical Intensive Care

best book: Manual of Perioperative Medicine by Bojar Post-CABG what was bypassed? discrete lesion vs. diffuse disease what was the graft material? art vs. vein, pedicle vs. free Looking for MAP 70-80 and DBP>50 First 6 hours, need CI>2.0 Hb 8.0 Fix acidosis CVP is actually a good monitor of RV failure Consider SWAN if […]

Oliguria and Urinary Electrolytes

Post from Nickson on Life in the Fast Lane USES Oliguria UNa+ low (<10mmol/L) – extravascular volume depletion UNa+ high (>20) – tubular damage Hyponatraemia UNa+ low (<10) – extra-renal losses UNa+ high (>20) – renal salt losing states, SIADH, diuretic therapy Fractional excretion of Na+ = 100 x UNa+ x PCr / PNa+ x […]

Rounding in the Intensive Care Unit

Fast Hug (Crit Care Med 2005;33:1225)   More daily goals     Medlist   Neuro CV Pulm Renal/Lytes GI ID Endo Heme/Onc Proph/FASTHUG     ABCDE AwakeBreathe (Spont)Choice of sedativesDelerium assess and rx Exercise and Early mobility(Crit Care 2010;14:157) ABCDE Bundle     On rounds, ask yourself Why was this patient admitted to intensive care […]

Bowel Function and Constipation

Alfred Bowel Protocol   Alvimopan: An oral, peripherally acting, µ-opioid receptor antagonist for the treatment of opioid-induced bowel dysfunction—A 21-day treatment-randomized clinical trial Journal of Pain March 2005 • Volume 6 • Number 3   oral narcan for opioid constipation (Pain 2000;84:105-109) 3-12 mg ngt tid start low to prevent withdrawal observational non-controlled study of […]

Intensive Care Unit Logistics and Design

Guidelines for intensive care unit design (Crit Care Med 2012;40:1586) Rationing of beds: Systematic Review (CCM Volume 32(7) July 2004  pp 1588-1597 Refusal due to no ICU bed availability lead to worse outcomes than pts who got ICU beds (Am J Resp Crit Care Med 2012;185:1081) the ethics of bed rationing (ccm 2006;34(4):958) Leapfrog staffing […]