Tweet

https://twitter.com/IM_Crit_/status/1640097382460272641

This Thread may be Removed Anytime!

Twitter may remove this content at anytime! Save it as PDF for later use!

More from @IM_Crit_

IMCrit

@IM_Crit_

Mar 26

From Critical Care

Fluid therapy in septic shock:

Criteria to customize the fluid strategy at different steps of septic shock:

Means for reducing the cumulative fluid balance depending on the stage of resuscitation of septic shock

Read 9 tweets

IMCrit

@IM_Crit_

Mar 5

ICU stories (a brief one): 60 yo male w lung cancer / CAD / HTN / HLD / status post chemotherapy a month ago presented to the ED w SOB/cough/weakness after failing outpatient tx w azithromycin. CT chest: no PE but positive for bilateral consolidations:

Patient came to the ICU intubated, sedated, on pressors & antibiotics for PNA. Next step: POCUS. PLAX looked "weird", so Doppler and "zoomed" views were recorded:

PSAX & subcostal views:

Read 16 tweets

IMCrit

@IM_Crit_

Feb 25

ICU stories (from the trenches): 70 yo pt w hx of A-fib/CAD/ICM w EF 25%/VT ablation s/p BiV ICD/CKD/HTN/HLD/peripheral vasc dz/COPD etc presented to outside 🏥 w SOB/weakness/falls. Labs: wbc 15k/creat 3.5 (baseline 2.0)/INR: 8.5/AST/ALT/Tbil: 180/250/3.0, lactate 3.5

RUQ US was obtained to work-up elevated LFTs:

Diagnosed w bilateral PNA/AKI/liver dysfunction. Treated for sepsis w ivf boluses, broad-spectrum antibiotics, steroids, bicarb. Continue to get worse; due to ⬆️O2 needs, transferred to our 🏥. I saw her the next am: in resp distress while on BiPAP 15/10-100%, abg 7.26/50/70/19.

Read 30 tweets

IMCrit

@IM_Crit_

Feb 24

Nice paper on cardiorenal syndrome (CJASN; 2023. doi: doi.org/10.2215/CJN.00…)

Proposed pathophysiological pathways leading to the cardiorenal syndrome and its complications

"The inciting event is usually an acute decompensation of heart failure. This may lead to either arterial underfilling or venous congestion as mediators that promote neurohormonal activity, inflammation, & endothelial dysfunction. In combination, these pathways lead to ⬇️ in GFR.

Complications include Na avidity and fluid retention, reduced kidney clearance, and endocrine function, all of which further perpetuate the pathophysiology".

Read 4 tweets

IMCrit

@IM_Crit_

Feb 4

ICU stories (a common one): It's Saturday, Jan 28, 2023. You just came on service at 7:00 am & at the same time, they were rolling in a case from the OR (Friday night case = never good...). 65 yo pt w DM2/diastolic HF/CAD/A fib/HTN/PVD. Had 10 ds' hx of abd pain; CT A/P showed

evidence of ischemic bowel. Pt came to the ICU after an exp-laparotomy w partial small bowel resection. The gut was left in discontinuity & the abdomen was left open. Pt still sedated & paralyzed, on norepi 0.18. A sleep-deprived anesth CRNA is telling you that the surgeon plans

to bring the pt back to OR for 2nd look on Monday. You feel so lucky; pt already has lines from the OR, you just have to keep him sedated for 2 days. Piece of cake! You move on to the other pts but the RN interrupts your dream rounds in 5 min. What about maintenance fluids, doc?

Read 19 tweets

IMCrit

@IM_Crit_

Jan 29

ICU stories (a brief one): One hour before the end of the am shift, u walk around in the ICU to make sure thinks look OK before u type your sign-out note. You spot the resp therapist & the nurse bagging the pt in Rm 306. From the hallway, u see the monitor: HR 160, RR/45, Sat 70%

This is a 30 yo pt w hx of a catastrophic brain bleed, s/p trach & PEG, admitted 2 wks ago w MDR Klebsiella UTI. Doing well, on trach mask 28%, until the episode of acute/unexpected desaturation

When u examine the pt, s/he is in extremis (accessory muscle use-tachycardic-tachypneic-diaphoretic). BP: 105/55. You grab the stethoscope that the resp therapist wears around his neck & you hear breath sounds in both sides (pt is skinny...)

Read 24 tweets

Share this page!

IMCrit

People who liked this thread also liked...

Try unrolling a thread yourself!

More from @IM_Crit_

IMCrit

IMCrit

IMCrit

IMCrit

IMCrit

IMCrit

Did Thread Reader help you today?

Don't want to be a Premium member but still want to support us?

Send Email!