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 ventilation c/o multiorgan failure)

MONITOR

  • ICP monitoring for severe hepatic encephalopathy
  • CVP (number, waveform)
  • cardiac output monitoring (high Q, low SVR)

EQUIPMENT

  • Senktstaken-Blackmore tube
  • blood in nasogastric

QUESTION SPECIFIC EXAMINATION

  • hands -> head -> chest -> abdo -> feet -> back

-> cardiovascular
-> respiratory
-> abdominal (organomegally, ascites)

  • neurological

-> paralysed
-> quick examination
-> unconscious
-> conscious

  • chronic liver disease signs
  • IV track marks
  • liver size
  • splenomegaly
  • lymphadenopathy

RELEVANT INVESTIGATIONS

  • U/S
  • hepatotoxics
  • glucose measurements
  • urine output
  • PR (blood, haemorrhoids)
  • ABG
  • haematology
  • biochemistry
  • coagulation (prior to coagulation factors)

OPENING STATEMENT

  • State whether acute, chronic or acute on chronic
  • List clinical evidence for precipitation

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

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

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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