Down with the Afterload!

“Is this the intensive care unit?” asked Alice in a reverent whisper.

“It says so doesn’t it,” said Dr. Rabbit pointing to the writing on the glass doors which said “TINU ERAC EVISNETNI” backwards though because they were now inside the unit looking out.

“These patients are the sickest you ever saw. These doctors are the smartest in the world. These nurses know more than the doctors; well, they know a lot more than I do. Here technology triumphs over disease. Facts, not guesses. Nouns are better than adjectives. Numbers are the best kind of nouns. Here we can measure everything. With measurements we can do calculations. With calculations we can do logarithms. With logarithms we can solve any clinical problem.”

If you are new to intensiveland and find yourself bamboozled by all the numbers, indices and machines that go ping. There is only one reference you need turn to:

• Bartlett RH. Alice in intensiveland. Being an essay on nonsense and common sense in the ICU, after the manner of Lewis Carroll. Chest. 1995 Oct;108(4):1129-39.

Using this paper you can learn the art of presenting an ICU patient to your peers:

Alice was very impressed by this scholarly presentation. It seemed to her that Dr. Rabbit had explained what was wrong with Mr. Hatter by describing all the things which he did not have. She thought how very difficult it must be, no, she thought how it was not easy, to develop this unusual method of syntax. Everyone on rounds seemed quite content, no, not uncontented with the presentation.

You will finally understand the relationship between oxygen delivery and the production of reactive oxygen species thanks to Dr Dumpty’s editorial titled ‘Jabberwoxy’. Its starts as follows:

Twas septic and the slimy rods
Did gyre and gimble in the blood.
All mimsy were the neutrophobs
More air to fuel the flaming flood.

You will learn to master ventilation from Dr. Knight:

“I’ve been practicing and practicing with mechanical ventilators to try to make the blood gases normal. It’s not too hard if you just use enough pressure and enough oxygen.”

“I do believe you are getting the hang of it Knight,” said Dr. Queen. “What’s that plastic tube sticking into his side?”

“He had a pneumothorax a few days ago, so we put in a chest tube. I didn’t mention that we had to turn the tidal volume to 900 mL to get our 700 mL exhaled tidal volume.”

And you will be able to make up your own mind about whether or not Dr. Queen is correct when he exclaims:

“Down with the Afterload!”