Critical care education one page at a time. Simple, free, & open source.
Nick Mark’s OnePager guides to critical care topics.
In-Flight Medical Emergencies
#criticalCare #leadership #aviation
Over 2 billion people travel by commercial aircraft every year. When they become unexpectedly sick, it is essential to understand what to do in the austere aerospace medical environment. This OnePager covers the ethics/legality of volunteering, the physiology of the aerospace environment, the resources available (crew, equipment, ground communications) as well as an overview of common medical emergencies seen among passengers on commercial flights.
Current version 1.0 (originally posted 2023-10-14).
Care of the person in the criminal legal system
#criticalCare #Leadership
People in the custody of law enforcement deserve respectful & ethical care, particularly during critical illness. Critical care providers should be aware of their patients right and the law. This ICU OnePager discusses important topics including Privacy (disclosing information in front of LEO can violate HIPAA), Restraints (restraints can cause injury and you can request removal), Surrogate decision makers (patients have a right to choose surrogates), Testing, Visitation rights, and Compassionate Release.
Visit Scopes & Shields for more on this important topic.
Current version 1.1 (originally posted 2023-09-07).
Impella
#criticalCare #ICUEquipment #hemodynamics
Impellas are temporary percutaneous cardiac devices assist used for hemodynamic support in patients with severe heart failure. This OnePager explains the function & physiology of LVADs as well as the settings and potential complications. Understanding how to interpret the placement signals is essential.
Current version 1.0 (originally posted 2023-05-29).
Running a Code:
#criticalCare #Resuscitation #Leadership
Cardiac arrests can be chaotic. Leading resuscitation is a complex skill, involving both a mastery of the knowledge & a structured approach to lead a team. This ICU OnePager presents a framework for clinicians to use: how to assign roles & crucial tasks physically in the room and how to structure events temporally. The goal is a smooth team based resuscitation.
Current version 1.0 (originally posted 2022-11-27).
Hemophagocytic lymphohistiocytosis (HLH)
#pulmonary #rheumatology #criticalCare #hematology
Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome due to aberrant activation of macrophages. It can be challenging to diagnose & often leads to critical illness with multiple organ system failure. This ICU OnePager reviews the etiology, diagnostic criteria, and treatment approach to this complex illness.
Current version 1.1 (originally posted 2022-12-15).
Approach to Undifferentiated Shock
#criticalCare #shock #hemodynamics #POCUS
Rapidly determining the etiology of shock is a core ICU skill, requiring integration of physiology, history, exam, and POCUS. This ICU OnePager provides a framework for thinking about shock that you can use to categorize it.
Current version 1.0 (originally posted 2021-05-11).
Also available in 🇫🇷 French (PDF, PNG, PPT) 🇪🇸Spanish (PDF, PNG, PPT), 🇷🇴 Romanian (PDF, PNG, PPT), 🇩🇪 German (PDF, PNG, PPT), and 🇮🇩 Indonesian (PDF, PNG, PPT)
Cardiac Arrest on Mechanical Circulatory Support
#criticalCare #Resuscitation #ICUEquipment
Patients undergoing mechanical circulatory support (MCS) are at high risk for cardiac arrest due to their the underlying illness. But when these patients experience cardiac arrest, resuscitation protocols need be modified to reflect device & clinical context. This ICUOnePager describes how to adjust resuscitation in the presence of ECMO, IABP, Impella, or LVAD and what to do in the perioperative setting.
Current version 1.0 (originally posted 2022-11-28).
Oxygen Delivery by Masks
#criticalCare #ICUequipment #oxygenation #waveforms
Masks are a common method of delivering supplemental oxygen. This OnePager explains the differences between the different masks used in the ICU: Simple (Hudson) Mask, Face Tent, Venturi Mask, and Non-rebreather Mask.
Current version 1.0 (originally posted 2022-08-11).
Left Ventricular Assist Devices
#criticalCare #ICUEquipment #hemodynamics
Left Ventricular Assist Devices (LVADs) are implanted cardiac devices used for hemodynamic support in patients with severe heart failure. This OnePager explains the function & physiology of LVADs as well as the settings and potential complications. (spoiler: this is one time when it’s normal to not have a pulse!)
Current version 1.0 (originally posted 2022-07-01).
Acid Base Made Easy
#criticalCare #pulmonary #acidBase #ABG #VBG
Acid base abnormalities are ubiquitous in the ICU, and sometimes multiple can coexist at the same time. This OnePager outlines a stepwise approach and differential diagnosis for each acid base abnormality (RAGES for NAGMA, GOLDMARKeT for AGMA, BLVD PLACE for metabolic acidosis, etc). It also includes those handy formulas & rules so you can figure out if more than acid-base disturbance is present.
Current version 1.4 (originally posted 2020-10-04, updated 2022-06-10)
Capnography Explained
#criticalCare #ICUEquipment #ventilation #waveforms #monitors
Measuring exhaled carbon dioxide (End Tidal CO2, ETCO2) is an important ICU technology that can used to confirm ETT placement, to ensure safer procedural sedation, to guide ACLS/resuscitation, and to monitor cardiac and pulmonary physiology in realtime. This ICU OnePager describes the physiology, equipment, waveforms you will see with ETCO2 monitoring.
Current version 1.1 (originally posted 2020-11-15; updated 2020-11-18).
Also available in 🇪🇸🇦🇷 Spanish (PDF, PNG, PPT), 🇷🇴 Romanian (PDF, PNG, PPT), & 🇫🇷 French (PDF, PNG, PPT)
Blood Product Transfusion
#criticalCare #hematology #shock #transfusion
This OnePager reviews the basics of transfusion, the special types of blood products that can be ordered, and the transfusion reactions that can occur.
Current version 1.0 (originally posted 2021-07-10).
Non-invasive positive pressure ventilation
#criticalCare #ventilation #ICUequipment #oxygenation #waveforms
Non-invasive positive pressure ventilation (NIPPV) is a valuable technique to support oxygenation and ventilation in people with respiratory failure to potentially avoid intubation. This #OnePager reviews when to (and when not to) use NIPPV, as well as modes (CPAP, BiPAP/BiLevel, & AVAPS) and interfaces (nasal, partial face, full face, & helmet).
Current version 1.1 (originally posted 2020-01-02; updated 2020-05-30).
Also available in 🇪🇸Spanish (JPEG)
Hypoxia & Hypoxemia
#criticalCare #pulmonary #oxygenation #ventilation
Understanding Hypoxemia (low oxygen in the blood) & hypoxia (low oxygen in the tissues) is a fundamental part of critical care. This OnePager reviews all the key concepts (oxygen content & delivery, Aa gradient) and explains all FIVE causes of hypoxemia (low inspired O2, alveolar hypoventilation, V/Q mismatch, right to left shunt, and diffusion limitation) plus a bonus SIXTH cause which is often overlooked (low mixed venous O2).
Current version 1.0 (originally posted 2020-12-06)
Intra-Aortic Balloon Pumps
#criticalCare #ICUEquipment #hemodynamics
Intra-aortic balloon pumps are an important and widely used method of invasive hemodynamic support. This ICU OnePager explains how they work & the effect on the patients physiology. It also covers important concepts like augmentation, triggers, and timing.
Current version 1.0 (originally posted 2022-05-05).
Ketoacidosis Disorders: DKA, HHS, & more
#criticalCare #acidBase
Disorders of ketosis (DKA, HHS, AKA, etc) are very common in the ICU, but can have high morbidity if mismanaged. This OnePager covers the differences between these disorders & provides a differential to identify the underlying cause (the 5 I’s mnemonic: infection, ischemia, inflammation, intoxications, insulin deficiency). It also explains the 3 pillars of treating DKA/HHS: Insulin, IV fluids, and aggressive electrolyte replacement.
Current version 1.2 (originally posted 2022-05-25; updated 2022-07-24).
Enteral Nutrition in the ICU
#criticalCare #nutrition #ICUEquipment
Nutrition is one of the most important & most overlooked aspects of critical care medicine. This OnePager summarizes the goals of enteral nutrition (EN) in the ICU and answers some important questions like when should we start EN (early), for whom (almost everyone), and should we worry about gastric residuals (nope!). Also described the different tube feed formulas and how to calculate caloric needs.
Current version 1.0 (originally posted 2022-02-08). Also available in 🇩🇪 German (PDF, PNG, PPT)
Alcohol Withdrawal
#criticalCare #toxicology #withdrawal #delirium
The alcohol withdrawal syndromes (seizures, hallucinosis, and delirium tremens) are frequently either the reason for ICU admission or a complication of critical illness. Understanding this common but often undiagnosed & undertreated condition is essential. This ICU OnePager summarizes the timing & presentation of symptoms, how to evaluate them (PAWSS, CIWA, AWS), and provides an algorithm for how to treat with either benzodiazapines or phenobarbital.
Current version 1.0 (originally posted 2021-12-29).
“Hot & Bothered” Hyperthermic Toxidromes
#criticalCare #toxicology #fever
Five potentially life threatening toxidromes (sympathomimetic overdose, anticholinergic overdose, serotonin syndrome, neuroleptic malignant syndrome, and malignant hyperthermia) can all present with overlapping clinical features: hyperthermia, altered mental status/seizures, rhabdomyolysis. Careful history and physical exam are essential to differentiate and a combination of supportive care (ABCs, cooling, etc) and specific therapies can be life-saving. This OnePager reviews the features of each with historical/exam pearls to differentiate.
Current version 1.0 (originally posted 2021-10-20).
Neuromuscular Blockers, BIS & TOF Monitors
#criticalCare #ARDS #oxygenation #ventilation #ICUEquipment #monitoring
Neuromuscular blockers (NMBs) can be a useful adjunct to improve oxygenation and (maybe) reduce mortality in severe ARDS. This ICUOnePager describes the physiology of muscle relaxation in ARDS, explains how to safely use NMBs as well as some basics about associated monitoring equipment: EEG/Bispectral index (BIS) monitors are used to (maybe) reduce over- or under-sedation and Train of Four (TOF) monitors are used to avoid excess blockade. I also explain why I don't like to call em "paralytics!": it sounds scare for patient/families.
Current version 1.0 (originally posted 2021-11-01) Also available in 🇫🇷 French (PDF, PNG, PPT)
Percutaneous Dilational Tracheostomy
#criticalCare #airway #oxygenation #ventilation #procedures
Tracheostomies are airways inserted directly into the trachea, that can facilitate weaning from mechanical ventilation and sedation. Tracheostomy can be performed at the bedside, particularly in patients where it may be difficult to transport to the OR (such as we often see in COVID19). This #OnePager describes the indications, contraindications, and details of performing of percutaneous dilational tracheostomy (PDT), the most common bedside technique for tracheostomy.
Current version 1.0 (originally posted 2021-08-29). Also available in 🇪🇸Spanish (PDF, PNG, PPT), 🇫🇷 French (PDF, PNG, PPT), & 🇨🇳 Chinese (JPEG)
Tracheostomy Emergencies
#criticalCare #airway #oxygenation #ventilation #hemorrhage
Tracheostomies are artificial airways that are inserted in the subglottis directly into the trachea. They are used in the setting of prolonged ventilation or as an emergency airway in the event of being unable to intubate from above. This OnePager reviews the components of a tracheostomy and an approach to managing tracheostomy emergencies, broken down into 3 categories: obstruction, decannulation, and bleeding.
Current version 1.0 (originally posted 2021-07-16). Also available in 🇪🇸Spanish (PDF, PNG, PPT)
Determining Fluid Responsiveness
#criticalCare #POCUS #resuscitation #shock #fluids #monitoring
Fluids are beneficial when needed but harmful in excess. Determining when to give fluids is a foundational critical care skill. This ICU OnePager reviews how to measure CO including invasive techniques (pulse pressure variation, pulse contour analysis, pulmonary artery catheters), ultrasound techniques (LVOT and carotid VTI, IVC distensibility) and less invasive technqiues (NICOM, End-Tidal CO2, etc). It also discusses the maneuvers that we can perform to test for fluid responsiveness: Passive Leg Raise (PLR), Mini-bolus, PEEP challenge, and End-Expiratory Occlusion (EEO). As a bonus, we talk about emerging techniques (fluid tolerance testing, VEXUS) as well as some techniques that just refuse to die (CVP, IVC size, PCWP, etc)
Current version 1.0 (originally posted 2021-03-22). Also available in 🇪🇸Spanish (PDF, PNG, PPT)
Pulmonary Renal Syndromes
#pulmonary #rheumatology #criticalCare #nephrology
Pulmonary Renal syndromes are both complex and potentially life threatening, making rapid and accurate diagnosis essential but challenging. This ICU OnePager reviews the pathogenesis and differential diagnosis, including ANCA vasculitis (GPA, MPA, EGPA), anti-basement membrane disease (anti-GBM), as well as other diseases that can present similarly (SLE & other rheum diseases), and infections. It also explains how diffuse alveolar hemorrhage (DAH) is diagnosed and how to interpret ANCA testing and renal pathology.
Current version 1.0 (originally posted 2021-06-04).
ECMO Troubleshooting
#criticalCare #oxygenation #hemodynamics #ECMO #ICUequipment #hypoxemia
In this second installment of the ECMO OnePager series, we review basic common troubleshooting for VV ECMO. Issues range from expected complications requiring monitoring (e.g. rising transmembrane pressure) to immediately life threatening emergencies that require urgent action (air embolism, oxygenator failure, etc). Understanding what can go wrong, and how emergent any of these issues are, is critical in managing people on ECMO.
Current version 1.0 (originally posted 2021-03-14). Also available in 🇪🇸Spanish (JPEG) and 🇩🇪 German (PDF, PPT, PNG)
Overview of Renal Replacement Therapy
#criticalCare #nephrology #hemodialysis #ultrafiltration #RRT #CRRT
Renal replacement therapies are commonly used in the ICU to remove excess fluid and clear the blood of endogenous and exogenous toxins. This ICU OnePager explains the physics & physiology of dialysis, discussing the key concepts (dialysis = diffusion, hemofiltration/ultrafiltration = convection) and the components of the dialysis circuit (pumps, dialyzer, dialysis solution, replacement fluid, etc). It also reviews all the confusing modes of dialysis: IHD, SLED, and CRRT including SCUF, CVVHF, CVVHD, and CVVHDF.
Current version 1.0 (originally posted 2021-02-17). Also available 🇷🇴 Romanian (PDF, PPT, PNG)
Fundamentals of ECMO
#criticalCare #oxygenation #hemodynamics #ECMO #ICUequipment
Extracorporeal Membrane Oxygenation (ECMO) is the most advanced life support modality available in the ICU, able to provide oxygenation and CO2 removal (VV ECMO) as well as support cardiac output (VA ECMO). This OnePager is the first in a series about ECMO, that orients you to the basic ECMO circuit & reviews the basics of ECMO terminology, equipment, and physiology.
Current version 1.0 (originally posted 2021-01-14). Also available in 🇪🇸Spanish (JPEG) and 🇩🇪 German (PDF, PPT, PNG)
Minnesota Tubes for Upper GI Bleeds
#criticalCare #gastroenterology #hemorrhage #resuscitation
Occasionally medical and interventional therapies can’t stop an upper GI bleeds due to esophageal varices. In those rare cases, placement of a Minnesota Tube can be life-saving. This #OnePager reviews how Minnesota Tubes work & shows you how to safely place and secure them. There are also some great how-to videos that walk you through the process step by step.
Current version 1.0 (originally posted 2021-01-29).
Abdominal Compartment Syndrome
#criticalCare #shock #resuscitation #gastroenterology
Many conditions can raise intra-abdominal pressure, potentially leading a life-threatening complication: abdominal compartment syndrome (ACS). This #OnePager reviews the physiology of Abdominal Perfusion Pressure and ACS, shows you how to approximate IAP using bladder pressure measurement, and discusses an approach to diagnosis & approach to management.
Current version 1.0 (originally posted 2021-02-07). Also available in 🇪🇸Spanish (PNG, PDF, PPT)
Temporary / External Cardiac Pacing
#criticalCare #hemodynamics #ICUequipment
External cardiac pacing is a technique for temporarily treating brady- and tachydysryhthmias in the ICU. This #OnePager covers the basics, including types of pacing leads (transvenous vs epicardial, bipolar vs unipolar), pacing modes (VVI, DDD, etc), and a stepwise guide to initiating pacing.
Current version 1.1 (originally posted 2021-01-22; updated 2021-01-25).
Lactic Acidosis
#criticalCare #acidBase #shock #resuscitation
Lactate and Lactic acid are frequently used (& oft misunderstood) labs in the ICU. This OnePager reviews the physiology of why/how we produce lactic acid and breaks lactic acidosis into two categories: Impaired O2 Delivery (Type A Lactic Acidosis) and Impaired O2 clearance/utilization (Type B Lactic Acidosis). I also discuss the rare and easily missed Type D Lactic acidosis (due to bacterial production of the stereoisomer).
Current version 1.0 (originally posted 2021-01-25). Also available in 🇪🇸Spanish (JPEG), 🇩🇪 German (PNG, PDF, PPT), and 🇫🇷 French (PDF, PNG, PPT)
Massive Hemoptysis
#criticalCare #pulmonary #hemorrhage #airway #bronchoscopy
Massive hemoptysis is both terrifying and a true emergency. This ICU #OnePager reviews the d/dx (BATTLECAMP) and walks through an approach for workup, airway management, and interventions (bronchoscopic, IR, and surgical) to control hemorrhage.
Current version 1.1 (originally posted 2020-12-20; updated 2020-12-27).
Pulse Oximetry
#criticalCare #ICUequipment #oxygenation #waveforms #monitors
We use pulse oximetry on every patient every day in the ICU, but how does this machine actually work and, importantly, how does it fail? This ICU #OnePager reviews the principle of pulse oximetry and the many factors that can cause inaccurate readings: darker skin pigmentation, nail polish, low flow states (ECMO & LVADs), and abnormal hemoglobins (MetHB, COHb, etc). It introduces the important concept of pulse ox lag-time and also shows how the waveform can provide useful physiologic clues about vascular tone/compliance.
Current version 1.0 (originally posted 2020-12-17). Also available in 🇵🇹🇧🇷 Portuguese..
Cystic Lung Disease Overview
#pulmonary #radiology #ILD #cysticLungDisease
Cystic lung disease is complicated. Here’s an overview of the definitions of emphysema, cavity, and cyst as well as a deep dive into all the etiologies that can cause diffuse cystic lung disease (DCLD).
Current version 1.0 (originally posted 2020-11-15)
Achieving a Negative Fluid Balance
#criticalCare #nephrology #fluids #diuresis #RRT
Volume overload is very common in the later stages of critical illness, and achieving a negative fluid balance is key to helping patients liberate from mechanical ventilation and ultimately recover. I outline strategies for minimizing ins (avoid MIVF, use high concentration drips, switch IV to PO) and maximizing outs (stepwise diuresis with loop diuretics, thiazides, spironolactone, and acetazolamide). I also discuss special circumstances including cirrhosis, nephrotic syndrome, and hypoalbuminemia.
Current version 1.4 (originally posted 2020-10-21; updated 2020-10-23) Also available in 🇫🇷 French (PDF)
Nasal Oxygen Delivery Devices
#criticalCare #pulmonary #oxygenation #ICUEquipment
Most people breathe through the nose, and it’s a common route for administering supplementary oxygen. This OnePager reviews nasal oxygen delivery devices, including conventional nasal cannula (NC), reservoir nasal cannula, and heated high-flow nasal cannula (HFNC). It also covers apneic oxygenation.
Current version 1.0 (2020-10-17). Also available in 🇪🇸🇦🇷 Spanish (PDF, PNG, PPT)
Arterial lines & Waveforms
#hemodynamics #ICUEquipment #waveforms
Arterial lines are commonly used in the ICU for sampling arterial blood and for invasive hemodynamic monitoring. This ICU OnePager shows you how arterial lines work, teaches you how to troubleshoot them, and reviews some of the common (and not so common) diagnostic clues hidden in the arterial pressure waveform.
Current version 1.0 (2020-09-14). Also available in 🇪🇸Spanish (PNG, PDF, PPT)
Brain Drains Explained
#neurocrit #ICUEquipment #waveforms #ICP
Ventriculostomy catheters and external ventricular drains (EVDs) are a diagnostic and therapeutic intervention often used in the neuroICU. This ICU OnePager explains how EVDs work and how to interpret intracranial pressure (ICP) waveforms.
Current version 1.1 (originally posted 2020-08-30, updated 2021-01-25). Also available in 🇪🇸Spanish (JPEG)
Vasopressors Demystified
#criticalCare #hemodynamics #vasopressors #shock
Shock comes in many flavors and so do vasopressors. Here’s a #OnePager summarizing my approach to pressors including when to start, which ones to use, how to administer them, and when to increase or wean. Includes my favorite pedagogical device for vasopressor: the pressor-speedometer from beta to alpha adrenergic effects..
Current version 1.2 (updated 2021-02-23). Also available in 🇪🇸Spanish (JPEG) & 🇩🇪 German (PDF, PNG, PPT)
Overview of Ventilator Modes
#criticalCare #ventilators #ventilation #oxygenation
Choosing the ‘right’ ventilator mode and settings can be tricky. Here’s an ICU #OnePager with an overview of the most common modes (Volume Control Pressure Control, PRVC, SIMV, PS, etc) including pros and cons for each and an overview of the parameters you need to set. This #OnePager also defines some important concepts like Trigger, Cycle, and Limit.
Current version 1.0 (2020-04-03). Also available in 🇪🇸 Spanish and 🇫🇷 French (PDF, PNG, PPT) and 🇯🇵 Japanese (PDF)
Chest Drains Made Simple
#criticalCare #pulmonary #pneumothorax #shock #ICUEquipment
Chest tubes and drain systems can be confusing. This ICU #OnePager shows you how they work and demonstrates a 5-step tool for assessing positioning, drainage, tidaling, air leak, and suction. Also demonstrates how to build a three bottle drainage system in case you find yourself managing pnuemothoraces on a desert island (or an airplane).
Current version 1.0 (2020-07-04) Also available in 🇪🇸Spanish (PNG, PDF, PPT)
Pleural Manometry
#criticalCare #pulmonary #effusions #thoracentesis
Thoracentesis can rapidly relieve dyspnea, but not every thoracentesis goes according to plan. Pleural manometry can help identify lung pathologies like entrapped lung and trapped lung, and may even predict response to pleurodesis and likelihood of re-expansion pulmonary edema. This #OnePager explains the principles of pleural manometry and pleural elastance and shows you how to interpret the results.
Current version 1.0 (2020-08-15)
Mastering MV: Volume Assist/Control
#criticalCare #ventilators #volume #waveforms
Here’s an ICU OnePager with lots of details about how (and when) to use volume assist/control. Lots of useful details like, how to adjust flow rates and waveforms to optimize for comfort or improve I:E ratio.
Current version 1.0 (2020-04-09)
Weaning from Mechanical Ventilation
#criticalCare #ventilators #weaning #SBT
We talk a lot about how to intubate people, but we don’t say nearly enough about about how to get the tube out. Here is a #OnePager on how to optimize for success and evaluate readiness to wean from mechanical ventilation.
Current version 1.0 (2020-03-24)
Approach to Hemorrhagic Shock
#criticalCare #shock #catheters #blood #hemorrhage
Hemorrhage is truly a life-threatening emergency. Here’s an ICU OnePager summarizing how I resuscitate hemorrhagic shock, including selecting infusion catheters, hemostatic resuscitation with balanced blood products, and other considerations (coagulopathy, acidosis, hypothermia, etc). Bonus: we talk about the physics of resuscitation catheters.
Current version 1.1 (2020-04-20); updated 2022-07-08. Also available in 🇪🇸Spanish (JPG, PDF, PPT)
Understanding & Treating ARDS
#criticalCare #ventilators #ARDS #proning
Acute Respiratory Distress Syndrome (ARDS) is one of the most serious and challenging conditions we encounter in the ICU. It’s also one of the life threatening complications of COVID-19. Here’s a #onePager that will help you understand ARDS, including its definition, pathophysiology, and the approach I use for treatment. Hint: just remember the Eight P’s: PEEP (lung protective ventilation), Prone positioning, Paralysis (neuromuscular blockade), Prostacyclins (inhaled vasodilators), Peeing (diuresis), Pleural evacuation (thoracentesis), Peripheral oxygenation (ECMO), and Prednisone (corticosteroids).
Current version 1.1 (originally posted 2020-03-30; last updated 2020-10-01) Also available in Spanish 🇪🇸 (JPEG).
Approach to Pulmonary Embolism
#criticalCare #hemodynamics #shock #anticoagulation #thrombosis
Pulmonary Embolism is a complex and challenging clinical problem that varies from incidental to immediately life threatening. This OnePager summarizes my approach to PE including diagnosis, prognostication, and how I manage anticoagulation, hemodynamics, and thrombolysis or other therapies.
Current version 1.0 (2020-05-03)
Lobar Collapse on CXR
#criticalCare #pulmonary #radiology #CXR
Lobar collapse is common in intubated ICU patients. Here is a an ICU One Pager on identifying which lobe is collapsed using just a CXR. Bonus: Teaches you how to get the most out of the PA and lateral too.
Current version v1.0 (2020-03-19)
Flow Volume Loops on PFTs
#pulmonary #obstruction #PFTs
Flow volume loops are an under-utilized aspect of pulmonary function tests. This OnePager teaches you how to identify intra-thoracic, extra-thoracic and fixed obstructions as well as obstructive and restrictive ventilatory impairments.
Current version v1.0 (2020-07-17)
Pain, Anxiety, and Delirium
#criticalCare #neurology #pain #anxiety #delirium
One of the most important things we do in critical care is manage pain and anxiety while avoiding delirium. Here’s a #OnePager summary of how I assess, prevent, and treat each of these issues. Handy cheat-sheet for RASS & CAM-ICU scoring too.
Current version v1.1 (2020-03-30)
Ventilator Troubleshooting 1: High Pressure Alarm
#criticalCare #ventilators #waveforms
Ventilators can be scary, especially when they alarm. One of the most common alarms is the High Pressure Alarm. This #OnePager explains how you can rapidly determine if High Pressures are due to a Resistance Problem, a Compliance Problem, or a PEEP problem.
Current version v1.2 (originally posted 2020-03-20, updated 2022-01-28)
Swans Made Simple
#criticalCare #cardiology #monitoring #hemodynamics #waveforms #ICUequipment
As Physiology Nerds we love Pulmonary Artery Catheters, but there are lots of tricky details. How can we tell what chamber it is in? How do we accurately measure PAOP? I made this #OnePager to demystify the Swan and show the expected pressures and waveforms encountered sequentially during placement/wedging.
Current version v1.1 (updated 2018-03-24)
Thromboelastography (TEG)
#criticalCare #coagulation #resuscitation #hematology
Coagulation, clotting, and thrombolysis are complicated. Did you ever wish there was one test that could evaluate all three holistically? Turns out there is: Thromboelastography (TEG). Here’s a #OnePager that reviews the principles and interpretation of TEG and shows you how you can use it in resuscitation.
Current version v1.2 (originally posted 2020-04-01 updated on 2020-10-26)
Procedure Checklists
ICU Intubation
#criticalCare #airway #procedures #checklists
I use checklists every day to do important stuff, like making sure I closed the garage or buckled my kids in. I use checklists in the ICU too. This is the checklist I refer to every time I intubate. It’s intended to be printed 4 to a page and folded up (it fits in your scrub pockets this way). You can laminate if you’re fancy or just print a new one when it wears out.
Also available in 🇵🇹🇧🇷 Portuguese. ads.txt
Chest Tubes
#criticalCare #pulmonary #procedures #checklists
With all the COVID patients being ventilated on high PEEP its good to have a guide for chest tube placement. Here’s my two page checklist. (front/back)
Also available in 🇵🇹🇧🇷 Portuguese.
Other ICU Resources
Mobility Flipbook
#criticalCare #mobility
There are numerous benefits to early mobility in the ICU, such as improved functional status after discharge, reduced incidence of delirium, earlier liberation from mechanical ventilation, and lower risk of VAP, CLABSI & CAUTI.
This flipbook adopts the Johns Hopkins Mobility scale into a format that is easy to hang on doorways and encourages a shared mental model about patient mobility. Print onto 8 sheets of paper, laminate, and place on rings outside the patient’s room. Now everyone can understand the level of mobility achieved by that day.