Tag Archives: critical care

ADRENAL trial – to steroid or not to steroid in septic shock

The original:

http://www.nejm.org/doi/full/10.1056/NEJMoa1705835

An excellent summary:

http://www.thebottomline.org.uk/summaries/icm/adrenal/

Should we still be trying to modify the dysregulated immune response in sepsis? An interesting evolutionary perspective:

https://evolutionmedicine.com

My verdict:

Although not improving (or worsening) mortality, if steroids reduce duration of shock and length of ICU stay then they are probably worth a go, given that the absolute possible increase in risk of noteworthy adverse outcomes is very low, although this must be borne in mind.  Could still argue it either way though. When we can genotype patients we may be able to identify those specific individuals in whom steroid may do significant benefit or harm. Or maybe not!

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