A discussion of the physiology and presentation of abdominal compartment syndrome.

A limb-threatening complication that might be overlooked by the inexperienced provider.

We continue our discussion of the Surviving Sepsis Campaign (SSC).  This includes fluids types, steroids, rhAPC (Xigris), and blood sugar control.

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.

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.

A common problem in the ill or injured patient is a metabolic acidosis.   In this episode we will review the common etiology of a metabolic acidosis as well as some lesser known causes.  

Bomb and blast injuries:  In the past blast injuries were limited to the battlefield of a rare industrial accident.  The events of the past week are a reminder that civilian population centers are targets for bombing attacks.   Most civilian providers has no to limited knowledge or experience treating patients with such injuries.   This episode is dediacated to a discussion of some of the unique properties and injuries associated with blast injuries.  In the event of a terrorist attack, like those attempted in London this past week, the injuries will be in the hundreds. 

Early surgical excision is likely to be the most significant individual variable to imporve the outcome of a patient (adult or child) with a critical burn.  Nevertheless, many nonburn physicians still want to apply to 1970 treatment paradigms to this population of injured patients.   This episode will hopefull replace these falsehoods with fact supported in the literature. 

Not feeding an injured or ill patient is not that same as a normal individual who is fasting.   A pound of weight loss in the stress patient is significantly different than a pound of weight loss in someone on a diet.  A basic understanding of stress metabolism is needed prior to a discussion of nutrition. 

When should a patient receive a transfuse of blood? What is an acceptable hemoglobin concentration in an ICU patient and should we use EPO?   Summer is a time when the blood banks often have a single day's worth of blood.  Perhaps with more conservative transfusion practices we can avoid or certainly help with some of the blood shortages.   Everyone wants to put patients on Epo, but does it increase the hemoglobin concentration enough to off set its high cost?

Excessive fluid resuscitations lead to horrible complications such as abdominal compartment syndrome. This article takes a critical look and challanges many of our practices in fluid resuscitation of burn patients. 

Renal replacement therapy (RRT) is rather a confusing topic.  What do all those initials mean and why use one therapy over another?  This podcast will explain the difference between intermittent and continous.   What are the various forms of continuous and how do they differ?   What are the concepts of ultrafiltration, diffusion, and convection?  These questions will be answered in this introduction to renal replacement. 

Intraosseous vascular access was was developed for use in adult trauma patients over 80 years ago.  Only recently has this technique regained popularity for rapid and safe access to the vascular space in patients in extremis. 

Don't wean people from their ventilators-- liberate them!!  When are people ready to come off the ventilator?  What are weaning parameters?  How does one do a spontaneous weaning trial?   What is the role of noninvasive ventilation (NIV)?

Acute renal failure is a dreaded complication in the ICU.  This podcast will review the various types of acute renal failure, the etiology, as well as acute management. 

Airway pressure release ventilation (APRV) is not a new mode of mechanical ventilation, but it seems to be gaining a great deal of popularity lately.  Many people find this mode very complicated and thick that it is reserved only for the very ill.   Neither one of these assumptions are corrrect.  This mode is very easy to learn and use.  Furthermore, this mode is very physiological and tolerated by all types of patients. 

Virtually all patients on ventilators are on PEEP.  PEEP has several interactions with various organ systems and some can result in profound complications. An understanding of PEEP and auto-PEEP are required before we can understand modes of ventilation like APRV (Bi-Vent)

All surgical residents know that glutamine is the amino acid known as the fuel for the gut. But what is all the fuss about?  The episode will look at the data on glutamine. Does glutamine improve outcomes, and if so and in who?   How much should we use and what are the hazards?  Enteral versus parenteral.  www.burndoc.com

Lightning injuries are rare, but when you do treat a patient they can have facinating presentations.   This lecture follows a patient we treated at Vanderbilt.   The patient present to a local ED with stroke like symptoms following the lightning strike.   Initially, physicians were confused by the presentation, but in this lecture you will learn that his presentation was near textbook. www.burndoc.com

 

A discussion of ventilation, oxygenation, and the role of PEEP.

A discussion of the various types of ventilators with a focus on the various ventilator modes and types of ventilator cycles.  Also presented is the topic of pressure support ventilation (PSV)

What is the role of giving an adult steroids to prevent stridor or reintubation following extubation.    This epidose looks at the data.