Welcome back to the tasty morsels of critical care podcast. Today we cover an incredibly common inpatient issue – hypnatraemia. We’ll often find 1 or 2 of these in our high dependency unit at any given time, mainly due to the requirement for frequent testing of Na levels that seems beyond the remit of normal ward level care. The approach I describe here is neither comprehensive or especially robust but it is how I approach it. Caveat emptor and all that. The over bearing demyelinating elephant in the room in hyponatraemia is the risk of osmotic demyelinating syndrome (the pathology formerly kn ..read more

Welcome back to the tasty morsels of critical care podcast. Today we’ll cover some key exam content, all be it not something you’re likely to run into in the ICU too often. The thyroid is a deceptive little organ, tucked in the neck, quietly secreting hormones and interfering in negative feedback loops. It usually restricts its mischief to outpatient clinics by running hot or cold on a chronic basis, occasionally hypertrophying and interfering with its more important neighbour the airway. But every now and then in a pique it decides it’s fed up of this low level mischief and uses its deeply em ..read more

Welcome back to the tasty morsels of critical care podcast. Today we’ll talk about one of the niche and shall I say “advanced” in inverted commas therapies in intensive care practice. ECMO. And to be precise we’ll be talking about VV ECMO. Indeed saying that you are “putting someone on ECMO” is a woefully incomplete sentence as the support and physiological difference between venovenous ECMO and venoarterial ECMO is really rather profound. The post will be an intentionally broad description of the therapy and perhaps less on the nuances of managing a patient on VV ECMO, as at fellowship exam l ..read more

Welcome back to the tasty morsels of critical care podcast. Way back in the way back in tasty morsel number 43 we discussed inotropes and vasopressors but there was a noticeable AHD analogue shaped hole in that post that i promised to discuss at a future stage. Well, that time has come and it’s time to run through vasopressin. You probably first encourntered vasopressin when you heard about ADH in medical school. Anti diruetic hormone, named for what it stops Its discussion in medical school involved delving into the world of endocrinology and negative feedback loops. Something we will be stud ..read more

Welcome back to the tasty morsels of critical care podcast. Today we’re going to verge into challenging territory for an audio podcast in that we’re going to the discuss the very visual topic of dynamic LV outflow tract obstruction. This is something fairly dependent on echocardiography for diagnosis which as you can imagine translates poorly to audio format.  This also means you’ll be denied my interpretative dance as i simulate the mitral valve leaflets being pulled over towards the septum via the Venturi effect. But alas i digress. In essence dynamic LVOTO occurs when the closure point ..read more

Welcome back to the tasty morsels of critical care podcast. Following hot on the heels of tasty morsel number 72 on cardio renal syndrome is its partner in nephron injury: hepatorenal syndrome. This gets covered in a sub section of Oh’s manual chapter 44 on liver issues but there are a variety of other sources mentioned at the end that are worth a read. It can be a little tricky to pin down this diagnosis. A lot of that comes because it is a “syndrome”, ie a collection of clinical findings that someone has put into a big bucket and mixed around without paying too much attention to hard core di ..read more

Welcome back to the tasty morsels of critical care podcast. Today we tackle a somewhat nebulous syndrome. Something we throw around with a few hand wavy explanations but often light on detail. Hopefully in a few minutes you’ll at least have a few morsels more of information to stave off all the trainees who are undoubtedly much smarter than you on the ward round. But perhaps I’m getting too autobiographical already. This does not appear with any great frequency in Oh’s manual but there is a nice scientific statement from the AHA that is referenced below. Though when you call it a statement you ..read more

Welcome back to the tasty morsels of critical care podcast. Oh Chapter 37 is dedicated to NIV in the ICU and is probably worth some time given that this is a common respiratory support both in the ICU and throughout the hospital. Many of the benefits of NIV are similar to those seen with ventilation with the blue plastic tube through the vocal cords.For example you still get: positive airway pressure which recruits alveoli and improves oxygenation improved alveolar ventilation which improves minute volume and lowers CO2 reduction in work of breathing as the machine is doing some of the work s ..read more

Welcome back to the tasty morsels of critical care podcast. Nestled towards the end of Oh Chapter 51 we have a section dedicated to SAH. Given that a lot of ICU bed days are given over to managing SAH, I felt it might have warranted its own chapter. Indeed, looking at its prevalence in fellowship examinations it does seem that a fair deal of attention should be given to SAH. It stands apart from the usual intracranial bleeding where the typical  treatment and discussions are all focussed on supportive care and the the nuance only comes in when you get to BP management. Whereas in SAH you ..read more

Welcome back to the tasty morsels of critical care podcast. Today we are going to talk about triggering on the ventilator. Now given the ubiquity of the word “triggering” in contemporary discourse I must confess that i do find it quite “triggering” to walk up to a vent and see the pressure support set at 11 or some other horror show like a PEEP of 7… I mean, who would do such a thing. But let me clear we are talking about a very different type of triggering. If i was on a ventilator and somewhat engaged in the process of respiration at least at a brainstem level, I would feel a much more conte ..read more