Multi-organ Failure Hot Case
GENERAL APPROACH
- Initial illness and response to treatment
- Diagnosis correct
- Organ failures and support for each organ
- Complications of stay – nosocomial infection…
INTRODUCTION
CUBICLE
- number of organs being supported
INFUSIONS
- resuscitation fluid being administered
- noradrenaline (sepsis)
- sedation and neuromuscular blocking agents
- albumin
- diuretics
VENTILATOR
– level of support
– level of oxygenation (FiO2, PEEP)
– disease specific questions (ARDS: plateau pressure)
MONITOR
- temperature
- tachycardia (SIRS)
- ETCO2 (lung injury)
- arterial trace (pressure, swing, pulsus paradoxus, hypotension)
EQUIPMENT
- dialysis
- IABP
- ICC’s (swing, bubbling, blood)
- intra-abdominal drains
- urine (output, myoglobinuria)
- MARS
- ECMO
- oscillation
QUESTION SPECIFIC EXAMINATION
- hands/arms -> head -> chest -> abdo -> legs/feet -> back
-> cardiovascular
-> respiratory
-> abdominal
- neurological
-> paralysed
-> quick examination
-> unconscious
-> conscious
- what was the initiating process causing the organ failure and is it responding to treatment?
- trends in organ support
- trend in cardiovascular support
- evidence of renal recovery
- evidence of haematological recovery
RELEVANT INVESTIGATIONS
- radiology: CXR, CT
- haematology: WCC, coagulopathy
- microbiology: positive cultures, specimens, resistance of organisms
- liaising with other appropriate teams
OPENING STATEMENT
- “I believe this patient has multi-organ failure from… and is… ”
- Showing slow improvement OR Very unlikely to survive
- This is evidenced by….
Critical Care
Compendium
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