CCC Update 006

The LITFL Critical Care Compendium is a living resource built around the knowledge base needed for the FCICM exam, but extends far beyond those conservative boundaries.

Here is a quick summary of what is new and what has been significantly revised:

Brain impact apnoea

  • A still neglected cause of morbidity and mortality in traumatic brain injury (TBI) that mandates immediate prehospital intervention.
  • Apnoea – along with catecholaminergic surge – is part of the ‘critical phase’ of TBI. This condition inspired the GoodSam app. We recently discussed this in RAGE Session Four.


  • You don’t see it often, but when you (in the FCICM exam for instance) you need to know what to do!

Digoxin toxicity and Digibind

  • These pages have needed a tidy for some time – now it is done!

Haemophagocytic lymphohistiocytosis (HLH)

  • You suspect severe sepsis, but no source identified? Send off a ferritin and think of HLH.

Intrinsic PEEP

  • An explanation of PEEPi or autoPEEP, otherwise called ‘gas trapping’ which can result from dynamic hyperinflation or ‘breath stacking’. What it is, how to measure it, the causes and consequences.

Sleep in ICU

  • Sedation is not sleep. Sleep disturbance is ubiquitous in ICU, and is probably a major contributor to ICU delirium. Know what causes sleep disruption in the critically ill and how to minimise it.

Speaking up

  • Health professionals are expected to speak up about their concerns to ensure patient safety. Yet we’re not very good at it. This page outlines the importance of speaking up, the barriers, how to do it, and how we can facilitate it.

Remember there is a CCC quick link in the menu bar at the top of every LITFL page. As always, I want to know of any errors, clarifications or requests for topics/ updates so that I can make the CCC even better. Just leave a comment at the bottom of this post or the ‘offending’ CCC page.

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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