CCC Update 005

It’s that time again, time to recap what is new in the LITFL Critical Care Compendium (remember, the quick way to get there is to click on the CCC at the very top of every LITFL page).

However, first I must congratulate all those who succeeded at the recent FACEM and FCICM clinical examinations. It is particularly heartening to hear from people who have used LITFL and the CCC as their primary study resources for these daunting Fellowship examinations, and doing well.

As always, I’m very grateful to everyone who continues to send me comments and suggestions about what to correct, improve or add to the CCC. Again, there have been many great contributions from Sarah Yong. With everyone’s help this resource just keeps on getting better.

So, in addition to a hundreds of minor edits not worth mentioning, let’s recap what’s new in the CCC:


  • We usually see this in the context of external ventricular drains (EVDs) in ICU. It’s a tricky disorder to diagnose. Should the EVD come straight out?

Starvation response

  • Updated with a table comparing the starvation and stress responses as well as the consequences of underfeeding. This topic has popped up in the FCICM exam a couple of times and it looks like people find it tough…

Iron overdose

  • Another topic done poorly on the whole in a recent FCICM exam — this CCC entry will enable you to ‘own’ the next iron OD you see! (whether in the exam, FACEM or FCICM, or in real life)


  • The section on adverse effects and oxygen toxicity has been reworked.

Validity of Clinical Research

  • Can’t tell your internal from your external? Look here, with extended list of factors affecting external validity.

Surrogate outcomes

  • The cynic would say that surrogate outcomes are a blessing for researchers who want to get their trials done, but a curse for clinicians who want to really help patients. Know the pros and cons.


  • This page has been completely reworked, and the originally separate viral encephalitis page has been discarded. Includes an approach to viral and other infective causes, as well as auto-immune causes.
  • Has links to separate pages on HSV encephalitis and Anti-NMDA receptor encephalitis.

Hyperthermia associated toxidromes

Don’t get caught out by toxidromes that cause hyperthermia. Not all fever is infection. This page compares and contrasts the key aspects of the most important pyrexial toxidromes that do this such as anticholinergic, serotonergic, and sympathomimetic toxidromes, as well as neuroleptic malignant syndrome and malignant hyperthermia.

That’s all for now.

Vive la FOAM.

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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