Ketoacidosis Disorders: DKA, HHS, & more

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.

Thromboelastography (TEG)

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.

Ventilator Troubleshooting 1: High Pressure Alarm

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.

Approach to Pulmonary Embolism

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.

Approach to Hemorrhagic Shock

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.

Acid Base Made Easy

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.

Tracheostomy Emergencies

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.

Swans Made Simple

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.

Lobar Collapse on 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.

Understanding & Treating ARDS

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).

Weaning from Mechanical Ventilation

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.

Chest Drains Made Simple

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).