Category CCC

The LITFL Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care.

CCC Critical Care compendium 340

Cannula cricothyroidotomy

Reviewed and revised 21 July 2021 OVERVIEW airway rescue procedure allowing transtracheal oxygenation aka needle cricothyroidotomy INDICATIONS “can’t intubate, can’t oxygenate’ scenario occasionally performed semi-electively if difficult intubation and/or preoxygenation is anticipated CONTRA-INDICATIONS local infection non-identifiable anatomy (e.g. severe obesity), distortion due…

CCC Critical Care compendium 340

Acute Aortic Syndrome

OVERVIEW Chest pain with ischemic symptoms and haemodynamic compromise can occur acutely due to a spectrum of aortic pathologies known as the acute aortic syndrome the rate of aortic rupture is higher in penetrating atheromatous ulcer (42%) and intramural hematoma…

CCC Critical Care compendium 340

Strong Ion Difference

Strong Ion Difference - The quantitative approach to acid-base chemistry is also known as the physicochemical method or the Stewart approach
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Hyponatraemic Seizures

Seizures and hyponatremia in a 10 year-old boy - can you answer the questions and find the solutions to the case-based questions in this laboratory tester?
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Young and Yellow

Fulminant hepatic failure is defined as the appearance of hepatic encephalopathy in a patient with acute deterioration of liver function with no previous history of liver disease.
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Ammon Anyone?

You've just been handed over a patient who has an altered mental status when the phone rings. It's the lab - you're told that your patient has a serum ammonia level of 250 umol/L (reference range, 11-35 umol/L). WTF?
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Pregnant and Acidotic

A pregnant patient has pneumonia. There are also concerns that she has a metabolic acidosis. Can you solve this metabolic muddle?
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76 year old male living alone. Found obtunded at home by neighbours. Breathing rapidly and muttering incoherently. No other history available. CATMUDPILES?


Unlearning is the process of abandoning or giving up knowledge, values or behaviour either unconsciously or deliberately
CCC Critical Care compendium 340

Pyroglutamic Acidosis

Pyroglutamic acidosis is a rare cause of high anion gap metabolic acidosis (HAGMA). When glutathione levels are low, the activity of γ-glutamyl cyclotransferase is increased, resulting in pyroglutamic acid accumulation in glutathione-depleted states
CCC Critical Care compendium 340

D-Lactic acidosis

D-Lactic acidosis aka D-lactic encephalopathy. Rare cause of high anion gap metabolic acidosis (HAGMA), typically occurs in patients short bowel syndrome or following jejuno-ileal bypass surgery