0 Introduction 0 Recently an excellent post on the Trauma Professional’s Blog pointed out that nocturnal vital signs disrupt sleep and may be unnecessary in stable patients (e.g. patients recovering from minor orthopedic surgery). I couldn’t agree more. Allowing restorative sleep is one of the best approaches to prevention of delirium. 0 What about patients […]
CT Angiogram for evaluation of severe hematochezia
Introduction 0 Gastrointestinal hemorrhage is a common reason for ICU admission. The approach to severe upper GI bleeding is relatively straightforward (figure below). A predictable approach facilitates planning ahead, and anticipating who needs to be contacted for help when. 0 0 Unfortunately, the approach to severe hematochezia is often less clear. Below is a description […]
Do CT scans cause contrast nephropathy?
Introduction 0 In April 2013 a series of articles in Radiology debated whether contrast nephropathy still exists using modern contrast dye. Two years later, the controversy remains. This is a daily conundrum when managing critically ill patients: one radiologist will urge us to use contrast, while the next radiologist will caution us against using contrast. […]
Management of severe hyperkalemia in the post-Kayexalate era
0 Introduction 0 There is increasing recognition that sodium polystyrene sulfonate (Kayexalate) is ineffective for the immediate management of severe hyperkalemia (Kamel 2012). With Kayexalate gone, there seems to be a gap in our treatment regimen. I often encounter residents who know that Kayexalate isn’t helpful, but aren’t sure exactly how to treat hyperkalemia without […]
High-flow nasal cannula for apneic oxyventilation
0 Introduction 0 Last summer I wrote a postabout preoxygenation and apneic oxygenation using high-flow nasal cannula (HFNC). At that point there was no evidence supporting it, so the post was based primarily on the physiology of HFNC. Recently two papers were published supporting the use of HFNC for preoxygenation and apneic oxygenation (Patel 2015, […]
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