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).

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 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).

Shock comes in many flavors and so do vasopressors. Here’s a #OnePager summarizing my approach to pressors including when to start, which ones to use, how to administer them, and when to increase or wean. Includes my favorite pedagogical device for vasopressor: the pressor-speedometer from beta to alpha adrenergic effects..

Arterial lines are commonly used in the ICU for sampling arterial blood and for invasive hemodynamic monitoring. This ICU OnePager shows you how arterial lines work, teaches you how to troubleshoot them, and reviews some of the common (and not so common) diagnostic clues hidden in the arterial pressure waveform.

Volume overload is very common in the later stages of critical illness, and achieving a negative fluid balance is key to helping patients liberate from mechanical ventilation and ultimately recover. I outline strategies for minimizing ins (avoid MIVF, use high concentration drips, switch IV to PO) and maximizing outs (stepwise diuresis with loop diuretics, thiazides, spironolactone, and acetazolamide). I also discuss special circumstances including cirrhosis, nephrotic syndrome, and hypoalbuminemia.

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 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.

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.

Ventriculostomy catheters and external ventricular drains (EVDs) are a diagnostic and therapeutic intervention often used in the neuroICU. This ICU OnePager explains how EVDs work and how to interpret intracranial pressure (ICP) waveforms.

Most people breathe through the nose, and it’s a common route for administering supplementary oxygen. This OnePager reviews nasal oxygen delivery devices, including conventional nasal cannula (NC), reservoir nasal cannula, and heated high-flow nasal cannula (HFNC). It also covers apneic oxygenation.

Cystic lung disease is complicated. Here’s an overview of the definitions of emphysema, cavity, and cyst as well as a deep dive into all the etiologies that can cause diffuse cystic lung disease (DCLD).