Icu Rounds

Review of a recent publication from Annals of Surgery

Following the recent crash of the US Airways in the Hudson River, it is an appropriate time to discuss the clinical manifestations and treatment of hypothermia.

Peak inspiratory pressure (PIP) the center of a great deal of discussion of ventilator management.   Knowing the factors that increase or decrease PIP are important to those managing critically ill patient.  This podcast is steeped in physiology and perhaps more difficult than my typical podcasts.  PIP=  [Tv/ (Compliance Lung & Thorax)] + (Resistance of airway + flow )

Hyperkalemia is a very common and potentially dangerous electrolyte disorder that commonly occurs in ICU patients.

A brief discussion regarding some of the commonly used values obtained from a pulmonary artery catheter. 

Therapeutic Hypothermia following cardiac arrest has been demonstrated to improve outcomes.  Starting Jan 1, 2009 Ney York City EMS will dorect patients to those hospitals able to delivery such care. 

The US government last week released a report that the threat of a nuclear device used in an act of terrorism is high in the next couple of years. In this episode we discuss the some concepts of the medical care required to those exposed to radiation as well as blast injuries. I hope this is information that none of you will ever need.

This episode explores what is needed to make surgery safer for the patient with cardiovascular disease. 

Tight glucose control has been widely introduced into critical care. This meta-analysis, recently published in JAMA, critically evaluates the effects of these trials in reduction of sepsis as well as mortality. The results might surprise you.

This is the second installment of this topic. In this episode we talk about the role of angioplasty and role of various medications in the treatment of the patient having an MI.

It is Sunday 8.31.08 and for hurricane Gustav is bearing down on the city of New Orleans.  This podcast will discuss the basic elements of disaster planning and management. (This was reposted due to some technical problems with the server.)

Crush syndrome is a common cause of death following earth quakes, mine and building collapses. Traumatic rhabdomyolysis may also be seen following electrical injury or severe trauma. (This is a reposting due to some previous technical problems with the server.)

Myocardial Infaction (Part 1): This episode will discuss the diagnosis of MI, STEMI, and non-STEMI.  We then discuss the indications and types of thrombolytic agents.

The management of pain is a key element of the care of all patients-- ICU or not.  Often providers have little understanding of the concepts and medications of pain management. This episode serves as an introduction. 

A potentiallylife-threatening electrolyte problem that commonly finds its way into the ICU as well as on exams.

Getting patients comfortable on the ventilator is not an easy task.  This podcasts focuses on methods to make patients synchronize with the ventilator as well as a discussion of spontaneous breathing and awake trials

In regards to ventilator care, all the focus has been on low tidal volume and level of peak inspiratory pressure.  What level of PEEP shoud we be using to avoid shear trauma and ventilatory induced lung injury.

A discussion of the physiology and presentation of abdominal compartment syndrome.

A limb-threatening complication that might be overlooked by the inexperienced provider.

We continue our discussion of the Surviving Sepsis Campaign (SSC).  This includes fluids types, steroids, rhAPC (Xigris), and blood sugar control.