Useful online educational resource for ICU covering, amongst other things, ECMO and echo.
All posts by Vishal Dhokia
Essay on ‘a good death’ – role of a doctor
Biggles FRCA. Anaesthesia is like flying a plane…
BIGGLES FRCA
by
Grant Hutchison
First published in Today’s Anaesthetist Vol.13 No.4 July/August 1998
https://oikofuge.com/biggles-frca/
Personal reflection – Cognitive bias
Case of acute and evolving intrinsic cord lesion in pregnancy presenting as unusually bizarre, but evolving neurology, referred as ‘cauda equina?’
When faced with an unusual presentation, particularly if it does not fit with anything ever seen before, and even if on probability it is very unlikely to be pathalogical, need to exclude the relevant and not be biased towards preliminary diagnosis planted by others. Consider Bayesian modelling.
Have an open mind and think broader than the problem presented. Is this something that we have neither yet considered nor ever seen before? How to prove/disprove this? Consider safety nets and worst case scenario. Accept uncertainty in an uncommon, undeclared situation rather than over-confidence. Observe evolution over time with multiple snap shots and opinions.
14th Annual Critical Care Symposium
Ventilation
6ml/kg, <30 cm H20, PEEP, SpO2 94-98%, recruit
Trials to review:
Recruitment, FEAT, FACTT, ACBIOS
Successful ward round
Patient, Doc, nurse, MDT
My name is (first name) to team, Dr xx to patient. call them by surname
Family present at WR. Adv: gain new info, open/honesty. Pre-claimer. Teach & treat. Will translate.
White board next to each patient with important info, plan details.
Start at same time everyday – good for MDT
Daily plan understood by all, nurse/junior repeats back. To do list. Check
Interactive, educational, professional, fun
Crit care practitioner
service need, fill rota gaps. crit care practitioner podcast
robust ciricullum, education, cpd + appraisal pathway/training. Some can prescribe. know your limits. consistency, permanent
P. paradoxus – downwards swing in pleth/BIP in SV patient on inspiration
Digital Meeting
Positive reporting in Datix
Education – twitter journal clubs
‘Rapid weaver’ – Mac based website development
Safety events/handoever every 12 hours
[c.f. neonates WR – learning point of the 24 hours/week]
ipad/screen next to ABG with learning message
Use raspberry Pi
Check out portsmouth crit care
Magnesium for analgesia
Loading dose: 50mg/kg
then 15mg/kg/hr
NB will potentiate neuromuscular blockade
Lung US
Summating B-lines to determine extra-vascular lung water
FALLS protocol
The transition from a-lines to b-lines = stop fluid bolus
From Sitzwhol & Lichtenstein, 14th Annual Critical Care Symposium
The 4 D’s of therapies…
Consider:
Drug
Dose
Duration
De-escalation
Applies to antibiotics, fluids and others!
On listening
CPET in a nutshell
Risk factors for increased morbidity & mortality:
- Peak VO2<15 ml/kg/min
- Anaerobic threshold <10-11 ml/kg/min
- Ventilatory equivalent (measured at AT) >35-40. Breathing hard to meet demands!
Link:
