When a patient bleeds they lose whole blood, but we also see a reduction in Hb concentration. The reason for this is apparently ‘transcapillary filling’ which always sounded to me like it could be bullshit (see earlier post).
When a doctor diagnoses atrial fibrillation, 'the guideline' says that a CHA2DS2VASc and HAS-BLED score should be calculated, and depending on the outcome an anticoagulant given. We see a lot of AF in the critical care (not as much as in CICU but that’s a different game), but we don’t follow the guidance. Or at least I don’t, but why?
This has to be in the running for the best title of a presented abstract “Ambitious but hopeless Anaesthesiologist: Case Study” (it’s abstract no 59 if you’re interested). In it, the somewhat angry authors describe a colleague (for whom there appears to be little respect) attempting to insert a haemodialysis catheter into the subclavian vein.
Massive PE causes haemodynamic collapse up to and including cardiac arrest. Although the evidence is unlikely to be strong, the recommendation is that thrombolysis should be given.
But what about the patient who has not collapsed, but shows signs of a struggling RV (raised Tn, strain on echo). Should they be thrombolysed?
Two papers for your perusal this month, each looking at throwing all medicine has to offer at two diseases with potentially awful outcomes – cardiac arrest and ischaemic stroke.
The TTM trial is important for several reasons. Firstly, by instituting therapeutic hypothermia you will be subjecting the family of the patient to an increased period of uncertainty about neurological outcome and for that you need to believe the intervention is beneficial. The second reason you should know about this trial is that other people do – your colleagues in EM, cardiology and medicine will all expect that you have an intelligent opinion about how this paper might change your management.
Does the use of cardiac output monitoring make a difference? NICE seem to think so, the Cochrane group are less certain. What we needed was a large, well conducted trial and this is what we got...
This paper looks at whether inserting an IABP just before or after PCI for patients with cardiogenic shock due to an acute MI improves 30 day mortality.
The Surviving Sepsis Guidelines use a mixed venous oxygen saturation of 70% as a resuscitation target, but where does the 70% come from?
This point-prevalence study asked what proportion of patients in ICU would be suitable for cardiac output monitoring using pulse pressure variation (PPV). For a bit of background, have a look at the review article.:
This is a collection of blog posts written about new research or topics of interest.
This site is written for healthcare professionals. Nothing on it constitutes medical advice, and opinions expressed are those of the authors.
Dr Peter Hersey & Dr Laura O'Connor