Changes in ICU Mortality
Overall, ICU mortality continues to improve but there are reasons why mortality improvement is not faster
Renal Tubular Acidosis and Uraemic Acidosis
Metabolic acidosis can occur in both acute and chronic renal disorders; the anion gap may be elevated, due to uraemic acidosis; the anion gap may be normal, due to renal tubular acidosis (RTA)
Three Axis Alignment, Two Curve Theory and the Three Column Model
The ‘sniffing the morning breeze position’, better termed ‘ear-to-sternal notch’ positioning, is a combination of atlanto-occipital extension and neck flexion (neck flexion of 35° and face plane extension of 15° is cited as ideal) and is considered optimal for direct laryngoscopy
Surgical Cricothyroidotomy
Surgical Cricothyroidotomy; open procedure performed to secure the airway via an incision in the cricothyroid membrane - aka emergency surgical airway (ESA)
Sodium Bicarbonate and Diabetic Ketoacidosis
Sodium Bicarbonate and Diabetic Ketoacidosis. The correction of the acidaemia in DKA is achieved by correcting the underlying pathophysiology with fluid replacement and insulin
Stridor
Stridor = sound on inspiration associated with airway narrowing; stridor at rest implies a reduction in airway diameter of >50%
Lactate and Lactic Acidosis
Lactate and Lactic Acidosis. Product of anaerobic glycolysis which reflects type A (oxygen delivery) or type B (altered metabolism) causes
Urinary Anion Gap
Urinary Anion Gap = [Na+]+ [K+] - [Cl-]
Rapid Sequence Intubation (RSI)
Rapid sequence intubation (RSI) is an airway management technique that produces inducing immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent) and is the fastest and most effective means of controlling the emergency airway
Sodium Bicarbonate Use
Sodium Bicarbonate Use. metabolic acidosis leads to adverse cardiovascular effects. bicarbonate must be administered in a solution as sodium bicarbonate
Respiratory Compensation in Metabolic Disorders
The extent of respiratory compensation for a metabolic disorder is determined by the balance between the abnormality in the pH (hence the drive to change) and how hard it is to get there (eg. work of respiratory muscles in hyperventilation)
Intubation, Hypotension and Shock
A modified rapid sequence intubation (RSI) approach is usually preferred in hypotensive, shocked patients