Icu Rounds

The Surviving Sepsis Campaign (SSC) is concensus document that attempts to provide the best evidence to assist in the care of the septic patient.  All providers who provide care to the septic patient should be aware of the contents of the SSC. 

In this week's Journal of the American Medical Association a meta-analysis was published that concluded that use of hemoglobin based blood substitutes result in an increased morbidity and mortality.  Included in the same journal is an editorial critical of the method the research has been regulated by the US FDA.  

There is a large emphasis on intensive control of blood glucose in the ICU, but how accurate are the monitors we use to follow glucose?  This episode reviews someof the limitations of deploying an instrument designed for control of outpatient diabetes management to tight control of blood glucose in the ICU. 

Clostridium difficile colitis is a problematic complication of antibiotic theraoy in hospitalized and critically ill patients.  It is increasing in frequency and can be lethal. 

Fluid resuscitation done poorly can result in significant complications to the patient.  This episode will present some of the newer considerations in fluid resuscitation in traumatic shock. 

Patients are often admitted to the ICU with an entire list of home medications.   In this episode I talk about the implications and dangers of polypharmacy. 

Prolonged QT is the most common reason why medications are restricted or removed from the US market.   This episode will explain what it is and why you should look for it in your ICU patients. 

The results of the CORTICUS trial are discussed. 

Atrial fibrillation is a common problem in ICU patients, but it is a problem with many potential causes, and not always a well defined treatment. 

Pediatric burns: all burns are serious, both big and small.   This episode reviews the objectives of burn care to result in the best functional outcome.  Also, burn is a very common method of child abuse and we detail how these children are injured and what to look for to identify possible abuse.

This is a basic introduction of some of the drugs used in various forms of shock.  

In this episode we discuss that ICU care of the patient with sepsis.  This includes an introduction to various vasopressors.

Sepsis is a common cause of death in the intensive care unit.  In this episode I present some of the statistics on septic deaths, introduce the definitions, and present the basic science.  Part 2 will cover fluid and drug therapy for septic shock. 

Large numbers of patients in ICUs are on heparin and what is this complication of heparin induced thrombocytopenia? 

The onset of cold weather will bring with it an increase in structure fires.  The leading cause of deaths in fires is complications from the inhalation of smoke-- not burns.  Learn why smoke is so deadly as well as what are the appropriate methods to treat smoke related asphyxiation.  

Blood products:   pRBCs, fresh frozen plasma, platelets, cryoprecipitate when and how should we use it?  What are the risks?  You may order them like IV fluids but do you really know how these potentially deadly products are to be used. 

A great deal is being presented and published on control of blood sugar in the ICU as well as the postoperative period.   How much control is enough and what is the data?

Why do we choose the antibiotics that we do?   How long do we continue the course of therapy?   Should we use some antibiotics together?  These topics are covered in the episode. 

Earthquakes are horrible natural events causing loss of lives in the thousands.   Following earthquakes, building collapses, and cave-ins, large number of victims will suffer from renal failure and death following crush syndrome. 

An introduction of the biology of thermal injuries and the initial care of the patient with thermal injuries in critical condition.