Detrimental effects are due to impaired cardiac output and organ perfusion and oxygen delivery
- oliguria -> ATN -> cortical necrosis -> ARF
- cerebral ischaemia -> confusion -> decreased LOC -> infarction
- myocardial ischaemia -> cardiogenic shock -> heart failure
- gastrointestinal ischaemia and hepatic failure
- limb ischaemia
- lactic acidosis
-> single most important cause of hypotension and ICU morbidity
- early detection (education of the clinical features: tachycardia, hypotension, oliguria and confusion)
- looking for features that may mask hypovolaemia: drugs (beta-blockers), pre-existing conditions (autonomic dysfunction), ‘normal’ physiology (elite athlete, pregnancy, young)
- use dynamic measures not just isolated numbers (CVP, PAOP)
- fluid responsiveness: 10mL/kg bolus, raise legs -> response to haemodynamic variables
- don’t use diuretics as response to oliguria
- basal crepitation don’t preclude a fluid challenge
- use invasive monitoring in complex cases (PAC, Echo, Lines, PiCCO, Oesophageal Doppler)
- develop protocols to involve fluid challenges in resuscitation
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.