The four phases of intravenous fluid therapy: Manu Malbrain Manu Malbrain presents the four phases of intravenous fluid therapy. He takes you through the big questions of fluids – What, when, why and how? To Manu, there are four Ds of fluid therapy: Drug, dose, duration, and de-escalation Drug Fluids are drugs. This means, like…
Outcomes for elderly patients in Intensive Care by Camilla Strom Camilla Strom discusses the outcomes for elderly patients in the intensive care. Camilla recognises a persistent “negative vibe” when people talk about elderly patients. This is inappropriate. We should acknowledge older patients for what they are! They are survival masters. This group of people have…
Point of Care Intestinal Ultrasound by Lauren Westafer When looking into someone’s abdomen, the first thing you’ll notice is that it almost looks like there is nothing there. For Dr. Lauren Westafer, the gut looks like a black box. There’s a lot of gas which makes it hard to see arteries and organs. In this…
Command gradient error in Prehospital Care: Neil Jeffers Neil starts off by telling us a story about a plane that took off from JFK and flew to Portland. As they approached to land, they realised that they had a problem with the undercarriage. Instead of listening and taking advice from the flight engineer, who was…
Cognitive overload and prehospital emergencies by Stephen Hearns Everyone’s cognitive capacity is limited and it’s easy to become overloaded and for performance to be impacted. In medicine an overloaded cognitive capacity could be the difference between life and death. Retrieval medicine is unpredictable, critical and fast-paced. Let’s face it, multi-casualty incidents are the pinnacle of…
Persistent critical illness by Jack Iwashyna Jack Iwashyna discusses his research into persistent critical illness in the ICU. While much of resuscitation focuses on the dramatic early minutes to hours of critical illness, many patients stay for days or weeks in the ICU. Jack wants to know, why do patients get stuck in the ICU? …
The ethics of incidental findings: James Rippey Ultrasound is an incredibly useful tool for clinicians. According to James Rippey, there are two main groups of clinicians who use ultrasound. First, there are the POCUS providers, who have a specific, focused question and use the ultrasound machines accordingly. Then, there are the ultrasound experts, who look…
Critical Care survivors: Margaret Herridge In this podcast, Margaret Herridge considers this well-known quote from Nietzsche, “That which doesn’t kill us makes us stronger.” But… Does it? What about our patients who suffer from a critical illness? The continuum of critical illness and what lies ahead for recovery should not be underestimated. Post critical illness,…
Managing ICP in Traumatic Brain Injury: David Menon David Menon discusses the complex and fraught world of managing traumatic brain injury (TBI) in the ICU. In particular, David discusses the management of intracranial pressure and cerebral perfusion pressure in these patients. Although the Brain Trauma Foundation provides guidelines for the management of severe TBI, including…
Medical Simulation improving patient communication: Jon Gatward We regularly have difficult conversations in critical care. We deal with sick and complex patients who may be at the end of life. The families we talk to may be in a state of shock, unable to make important decisions. Moreover, patient safety incidents and other challenging issues…
