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, 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