Archive for category: Critical Care

Approach to the Critically Ill Child: Shock

15 Oct
October 15, 2018

If you mainly treat adults or both adults and children like me, then you have probably heard the (very annoying) quote, “kids are not just small adults”, and so I won’t say it again. Well, I guess I just did, but at least I wont stop at this quote, but attempt to explain how kids […]

Accidental Hypothermia

08 Oct
October 8, 2018

Definition: Accidental hypothermia is an unintentional core body temperature of < 35°C when heat loss to surroundings is greater than heat generation Most frequent cause is environmental exposure Patient with impaired thermoregulation can develop hypothermia in relatively warm environments Elderly, underlying illness, trauma, intoxication, or malnutrition (Brown 2012)

Pediatric Push Dose Epinephrine: Getting the Epi Dose Right During Pediatric Resuscitation

13 Sep
September 13, 2018

Warning: Limited Published Evidence on this Topic You have just intubated a 4 year old with sepsis from a bad pneumonia. Post intubation BP is 70 systolic, while waiting for the epinephrine (adrenaline) infusion to come up from pharmacy you watch the BP decline into the 60 systolic range and start to use fluids to […]

BICAR-ICU: How Should this Study Affect Care in the ED?

10 Sep
September 10, 2018

During a busy resuscitation it behooves the ED resuscitationist to avoid ordering therapies that have no clear benefit to their patients. Our nurses are overburdened, and adding interventions ‘just to be safe’ or ‘because we always do it’ is a great way to overwhelm our nursing colleagues. Bicarb administration is a contentious issue and many […]

Simplifying Mechanical Ventilation – Part 6 – Choosing Your Initial Settings

27 Aug
August 27, 2018

Choosing Your Initial Settings: I hope you now see what physiologies to consider when setting up the ventilator and your goals for each. If your patient doesn’t fit into one of these three categories, then I set up my ventilator as if I was managing a patient who has refractory hypoxemia to maintain a lung protective […]