Category: Critical Care
Posted: 8/3/2010 by Mike Winters, MBA, MD
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Hypocapnia and Brain Injury
Curley G, Kavanagh BP, Laffrey JG. Hypocapnia and the injured brain: More harm than benefit. Crit Care Med 2010; 38:1348-59.
Category: Critical Care
Posted: 7/27/2010 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
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Drug-Induced Thrombocytopenia
Priziola JL, Smythe MA, Dager WE. Drug-induced thrombocytopenia in critically ill patients. Crit Care Med 2010; 38(S):S145-54.
Category: Critical Care
Posted: 7/19/2010 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
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ICU Acquired Weakness
Griffiths RD, Hall JB. Intensive care unit-acquired weakness. Crit Care Med 2010; 38:779-87.
Category: Critical Care
Posted: 7/13/2010 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
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Drug-Drug Interactions in the Critically Ill
Papadopoulos J, Smithburger PL. Common drug interactions leading to adverse drug events in the intensive care unit: Management and pharmacokinetic considerations. Crit Care Med 2010;38(S):S126-S135.
Category: Critical Care
Posted: 7/6/2010 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
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Asthma, Peak Pressures, and the Ventilator
Manthous CA. Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation. JEM 2010; 38:622-31.
Category: Critical Care
Posted: 6/29/2010 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
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Pre-existing acidosis and mechanical ventilation
Manthous CA. Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation. JEM 2010; 38:622-31.
Category: Critical Care
Posted: 6/22/2010 by Evadne Marcolini, MD
(Updated: 2/17/2025)
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Acute renal failure occurs in 1-25% of critically ill patients, with an associated mortality of 28 - 90%.
The RIFLE Criteria represent the first consensus definition of acute renal failure used to classify critically ill patients as to their kidney function. Notably, we use the worst possible classification according to the criteria, which measures either serum creatinine, urine output or both.
Rinaldo Bellomo1, Claudio Ronco, John A Kellum, Ravindra L Mehta, Paul Palevsky and the ADQI workgroup
Acute Renal Failure - definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group.
Critical Care 2004, 8:R204-R212 (DOI 10.1186/cc2872)
This article is online at: http://ccforum.com/content/8/4/R204
Category: Critical Care
Posted: 6/15/2010 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
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Hypotension after intubation and initiation of mechanical ventilation
Manthous CA. Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation. JEM 2010; 38:622-31.
Category: Critical Care
Posted: 6/8/2010 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
Click here to contact Mike Winters, MBA, MD
Platelet Transfusions in the Critically Ill
Netzer G, Hess JR, Shanholtz C. Use of blood products in the intensive care unit: Concepts and controversies. Contemporary Critical Care June 2010;8(1):1-12.
Category: Critical Care
Posted: 6/1/2010 by Evadne Marcolini, MD
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Marino P. The ICU Book. 3rd ed. Lippincott
Category: Critical Care
Posted: 5/25/2010 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
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Postcardiac Arrest Syndrome: Controlled Reoxygenation
Nolan JP, Soar J. Postresuscitation care: entering a new era. Curr Opin Crit Care 2010;16:216-22.
Category: Critical Care
Posted: 5/11/2010 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
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PRBC Transfusions in Neurocritical Care
Netzer G, Hess JR, Shanholtz C. Use of blood products in the intensive care unit: Concepts and controversies. Contemporary Critical Care June 2010;8(1):1-12
Category: Critical Care
Posted: 5/3/2010 by Evadne Marcolini, MD
Click here to contact Evadne Marcolini, MD
In the ICU, diabetes insipidus (DI) develops in patients with pituitary surgery, brain trauma, intracranial hypertension and brain death. Criteria include the following:
In the ICU, patients are typically unable to consume free water to compensate for urinary losses, and dehydration, hypotension and hypernatremia occur. Clinical signs may not appear until sodium levels surpass 155-160 mEq/L or serum osmolality surpsses 330 mOsm/kg.
Symptoms include confusion, lethargy, coma, seizures and cerebral shrinkage associated with subdural or intraparenchymal hemorrhage.
Treatment includes
Fink MP, Abraham E, Vincent JL, Kochanek PM, eds. Textbook of Critical Care. 5th ed. Philadelphia, PA: Elsevier/Saunders; 2005.
Category: Critical Care
Posted: 4/27/2010 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
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PRBC Transfusion Threshold for Patients with Cardiac Disease
Netzer G, Hess JR, Shanholtz C. Use of blood products in the intensive care unit: Concepts and controversies. Contemporary Critical Care June 2010;8(1):1-12.
Category: Critical Care
Posted: 4/20/2010 by Evadne Marcolini, MD
(Updated: 2/17/2025)
Click here to contact Evadne Marcolini, MD
It is true, 1/3 of Americans are obese. There is conflicting evidence regarding the mortality risk of obesity (defined as BMI>30 kg/m2) in critically ill patients.
It has been shown that abdominal fat has greater consequences than peripheral obesity, and based on this, a recent study has utilized the sagittal abdominal diameter (SAD) in ICU patients to show that abdominal obesity (as differentiated from BMI) poses an independent risk of death. The SAD detects visceral fat, which has been shown to have metabolic and immune health consequences, including the following:
-incidence and severity of certain infections is higher
-excess adipocytes are associated with elevated levels of proinflammatory factors that favor insulin resistance, diabetes, dyslipidemia and hypertension, all of which lead to microcirculatory dysfunction
-rates of required renal replacement therapy and abdominal compartment syndrome correlate to increased SAD
-there is also a trend toward a longer length of ventilator weaning
See you at the gym.
Paolini JM et al: Predictive value of abdominal obesity vs. body mass index for determining risk of intensive care unit mortality. Crit Care Med 2010; 38:1-7
Category: Critical Care
Posted: 4/13/2010 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
Click here to contact Mike Winters, MBA, MD
Type B Lactic Acidosis
Vernon C, LeTourneau JL. Lactic acidosis: Recognition, kinetics, and associated prognosis. Crit Care Clin 2010; 26:255-83.
Category: Critical Care
Posted: 4/6/2010 by Evadne Marcolini, MD
(Updated: 2/17/2025)
Click here to contact Evadne Marcolini, MD
Magnesium depletion has been described as "the most underdiagnosed electrolyte abnormality in current medical practice"
Important for electrically excitable tissues and smooth muscle cells, Mg is mostly located in bone, muscle and soft tissue. Because only 1% is located in blood, your patient can be Mg depleted with normal serum levels.
65% of ICU patients are magnesium depleted (and may not be hypomagnesemic). Because labs are unreliable, consider predisposing causes, such as diuretics, antibiotics (aminoglycosides, amphotericin), digitalis, diarrhea, chronic alcohol abuse, diabetes and acute MI (80% of AMI patients will have magnesium depletion in the first 48 hours).
Mg depletion is typically accompanied by depletion of other electrolytes (K, Phos, Ca), and can cause arrhythmias (especially torsades) and promote digitalis cardiotoxicity.
Hypermagnesemia is less common, and can be caused by hemolysis, renal insufficiency, DKA, adrenal insufficiency and lithium toxicity. Clinical findings include hyporeflexia, prolonged AV conduction, heart block and cardiac arrest. Treatment includes fluid and furosemide, calcium gluconate and dialysis.
Marino P. The ICU Book. 3rd ed. Lippincott Williams & Wilkins, 2007:625-638.
Category: Critical Care
Posted: 3/30/2010 by Mike Winters, MBA, MD
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Ventilator Pearls for H1N1 Influenza Virus
Ramsey CD, Funk D, Miller RR, Kumar A. Ventilator management for hypoxemic respiratory failure attributable to H1N1 novel swing origin influenza virus. Crit Care Med 2010; 38(Suppl):e58-65.
Category: Critical Care
Posted: 3/23/2010 by Evadne Marcolini, MD
Click here to contact Evadne Marcolini, MD
Catheter-related bloodstream infections occur in 3-8 percent of insertions, and are the highest cause of nosocomial bloodstream infections in the ICU.
The most effective measures to prevent catheter-related infections are as follows:
Especially applicable to those of us placing these lines in the ED or in the ICU is the last recommendation, based on a prospective study from Greece
-adequate knowledge and use of care protocols
-qualified personnel involved in changing and care
-use of biomaterials that inhibit microorganism growth and adhesion
-good hand hygiene
-use of an alcoholic formulation of chlorhexidine for skin disinfection and manipulation of the vascular line
-preference for subclavian route for placement
-use of full barrier protection during placement
-removal of unnecessary catheters
-use of ultrasound for placement of central lines
Frasca D, Dahyot-Fizelier C, Mimoz O: Prevention of central venous catheter-related infection in the intensive care unit. Crit Care; 2010; 14:212
Karakitsos D, Labropoulos N, De Groot E: Real time ultrasound guided catheterisation of the internal jugular vein: A prospective comparison with the landmark technique in critical care patients. Crit Care 2006; 10(6):175.
Category: Critical Care
Posted: 3/16/2010 by Mike Winters, MBA, MD
(Updated: 2/17/2025)
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Warfarin and ICH
Rincon F, Mayer SA. Clinical review: Critical care management of spontaneous intracerebral hemorrhage. Crit Care 2008; 18:237.
Goldstein JN, Rosand J, Schwamm LH. Warfarin reversal in anticoagulant-associated intracerebral hemorrhage. Neurocrit Care2008; 9:277-83.