Intensive Care

Death

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Death is defined variably (or not defined at all) in jurisdictions around the world, but are mostly similar. What follows below are the two types of determination of death, as recommended in the ANZICS Statement on Death and Organ Donation Neurological Determination of Death Preconditions Clinical testing Cranial Nerves Tested (II – X) Reflex Afferent … Read more

Pleural Fluid

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Ok, so classically we talk about transudates vs exudates by pleural fluid analysis. I’ll reframe this (I’m sure it’s already obvious to you, but hey) as ‘how can we diagnose an exudate, and the cause’ Protein & LDH Differential Glucose pH Amylase Cholesterol

Good Guidance

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Locations of major topic guidelines, in alphabetical order by subject Death & Organ Donation: ANZICS Statement DKA (adult): JBDSIC (3ed) 2022 ECMO Guidance: ELSO Guidelines Extracorporeal treatments in toxicology: EXTRIP Recommendations Resuscitation: ARC Guidelines TBI: BTF Guidelines (4ed) 2016 Patient Transport: ACEM/ANZCA/CICM Guidance British Thoracic Society: BTS Guidelines

C-spine imaging

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There are really 3 types of thing to image when we are talking about C-spine injury The modality of choice depends on the structure of interest: Various features favour one over the other: Feature CT MRI Availability Widely available Limited availability Gold standard for: Bony injury Soft tissue & neural injury Radiation Some (potentially vulnerable … Read more

Reverse Halo Sign

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Great little article on a DDx flowchart for the Reverse Halo Sign on CT. Godoy MC, Viswanathan C, Marchiori E, Truong MT, Benveniste MF, Rossi S, Marom EM. The reversed halo sign: update and differential diagnosis. Br J Radiol. 2012 Sep;85(1017):1226-35. doi: 10.1259/bjr/54532316. Epub 2012 May 2. PMID: 22553298; PMCID: PMC3487053.

Platform Trials

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Explain it to me. Also known as Umbrella trials, or Basket trials (but Platform trial sounds cooler), they focus on the disease of interest, and are based on a master protocol which allows for varying groups for analysis against a control group. Technically, they are a type of Adaptive, Multi-arm, Multi-stage trial (but even better) … Read more

Management of high ICP: The SIBICC Algorithm

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Hawryluk, G.W.J., Aguilera, S., Buki, A. et al. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med 45, 1783–1794 (2019). https://doi.org/10.1007/s00134-019-05805-9 Tier ZERO – Basic neuroprotective care, irrespective of ICP Tier ONE ICP-lowering techniques Targets Actions Tier TWO ICP-lowering techniques Targets as above, except: Actions Tier … Read more