Critical care medicine illustrations by Nick Mark from ICU One Pager based on an understanding of physiology and evidence-based medicine.
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.
Jul 16, 2021
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.
Mar 24, 2019
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).
Oct 1, 2020
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).
Apr 4, 2020
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.
Oct 26, 2020
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.
Jan 28, 2022
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.
Apr 3, 2020
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.
Apr 20, 2020
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.
Oct 7, 2020
Overview of Ventilator Modes
Choosing the ‘right’ ventilator mode and settings can be tricky. Here’s an ICU #OnePager with an overview of the most common modes (Volume Control Pressure Control, PRVC, SIMV, PS, etc) including pros and cons for each and an overview of the parameters you need to set. This #OnePager also defines some important concepts like Trigger, Cycle, and Limit.
Apr 3, 2020