Hyperkalaemia Management
Hyperkalaemia is a life-threatening emergency. Basic overview of hyperkalemia management
Category CCC
The LITFL Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care.
Hypercalcaemia
Ca2+ exists in the extracellular plasma two states: (1) free ionized state and (2) bound to other molecules (mostly albumin, rest – beta-globulins, phosphate, citrate)
ionized Ca2+ concentration is inversely related to pH -> an increase in pH results in a decrease in ionized Ca2+
Clostridium difficile and PMC
Pseudomembranous colitis (PMC); acute inflammatory disease of colon commonly associated with antibiotic use; C. difficile implicated as a causative organism in 1970’s
Portopulmonary syndrome
Portopulmonary Syndrome is NOT considered contraindication to liver transplantation; affects ~20% of pre-transplant patients; usually due to increased blood flow through the lungs without increased resistance
Cuff Pressure Gauge
Cuff pressure gauge aka cuff manometer; allows safe inflation of the cuff seal of low pressure endotracheal and laryngeal tube cuffs by measuring the cuff pressure
Transplant Patient Hot Case
GENERAL APPROACH Considerations Transplant – liver, heart, lung, heart-lung, bone marrow, renal, pancreatic Phase of care – immediate post op, sepsis, rejection, respiratory failure, renal failure Surgery – graft function, anatomy, anastomoses (leaks and occlusion) Infection – bacterial (early), opportunistic:…
Shock Hot Case
GENERAL APPROACH Find the shock (is it PROVED?) Pump, rate/ rhythm = Cardiogenic – myocardial, valves, rhythm, pericardium, left and right sided (signs: cool peripherally, shut down, bounding pulse, narrow pulse pressure, inotropes, high CVP, low SvO2, low Q, crackles…
Post Cardiac Surgery Patient Hot Case
GENERAL APPROACH Type of surgery Emergency or Elective Post-operative complications (bleeding, tamponade, graft occlusion, CVA) Shock assessment Causes and type of heart disease INTRODUCTION CUBICLE short or long term patient tracheostomy organ support INFUSIONS vasoactives haemostatic agents (tranexamic acid, blood…
Polyuria Hot Case
GENERAL APPROACH Causes Alcohol induced diuresis Osmotic diuresis (mannitol therapy) Cerebral salt wasting Diabetes insipidus Hypertonic saline administration Hypertensive diuresis Appropriate response to fluid therapy Hyperglycaemia Volume statusComplicationsTreatment INTRODUCTION CUBICLE INFUSIONS inotropes/vasopressors to maintain CPP IVF boluses hypertonic saline osmotherapies…
Long-Stay Patient Hot Case
Long-Stay Patient Hot Case
Jaundice Hot Case
GENERAL APPROACH Acute, Chronic or Acute on Chronic Liver Disease Pre Intra Post INTRODUCTION CUBICLE dialysis machine – evidence of multi-organ failure Level 1 infuser – significant bleeding malena INFUSIONS blood products octreotide 10% dextrose terlipressin VENTILATOR strategy (protective lung…
TRALI
Transfusion related acute lung injury (TRALI) is defined as hypoxia and bilateral pulmonary edema occurring during or within 6 h of a transfusion in the absence of other causes such as cardiac failure or intravascular volume overload