Thread by @ogi_gajic

1/ #Ogitorial No19: 49M with 2 day fever, cough & hemoptysis comes to ED at 3AM with respiratory distress & Afib RVR. History significant for HepC, smoking, methadone, warfarin post ablation. ED Rx: 2L LR, intubation (RSI), amio & phenyl bolus, ceftriaxone, azythro, steroid.

2/ Arrives to ICU at 6AM:
A ETT @ 24cm
B AC32,TV440, P9,O255%,Ppl 20
❤️HR 72 89/48, CVP7, CapRef1.5”
D avpU propofol @ 80
E unremarkable
U R>L B lines, normal LV/RV
L WBC 22, Plat 165, Cr 2.0, INR7.2, Hb11.2, ABG pH7.26, PaCO2 39, Lact 4.5

3/ At 8AM nurse concerned with hypotension (MAP59) and oliguria (40mL last hr). Resident orders 500mL LR fluid challenge that you cancelled and instead: (answer after the poll)
#FOAMed #FOAMcc @AndrewDavies66 @DrDaleNeedham @f_g_zampieri @YaseenarabiYa @iwashyna @precordialthump

4/ #Ogitorial No19 answer:
Minimizing iatrogenic effects of sedation (stopping propofol) & fluid overload (adding furosemide) are the pillars of critical care!!!
thelancet.com/journals/lance…
nejm.org/doi/pdf/10.105…

5/ The patient woke up, BP & urine improved. Extubated 9AM (after 30 min pressure support trial and strong cough without blood). In the afternoon transfereed to the floor on oral AB. Prior to hospital discharge the next they he was enrolled into our smoking cessation study...

It’s not science fiction. This is “usual care” in #zentensivist ICU. CERTAIN approach prioritizes RELEVANT from less relevant information to decrease noise/chaos in the care of our sickest patients.
#CERTAIN =Checklist for Early Recognition And Treatment of Acute Illness & iNjury