Yorkshire ICM

Perhaps because most of our Intensivists are part time Anaesthetists the UK  discussion of critical care airway management is eclipsed by the vociferous new world considerations of this topic, with many examples of what we/I would consider extreme such as the routine preparation for “emergency cric’s” in emergency patients. On that note, this month’s questions: 1. … More ICU Airway Management

This month’s question: What factors should influence the decision to proceed to surgical fixation of rib fractures? Does anyone have any experience/anecdotes of rib fixation improving the clinical position of a patient? What regional analgesic strategies have people employed and have these been successful? This month’s very recent paper comes out of SJUH’s Thoracic team on … More Rib fractures – Sira Debate

This month’s questions: When is it appropriate to use CVVHDF solely as a means of maintaining a neutral fluid balance or should we just minimise fluids and give diuretics? How is this best done? Are there any advantages to 0.9% saline vs balanced crystalloids as our resuscitative fluid of choice on ICU? This month’s paper is a … More Fluids and fluid balance

This month’s questions: In patients with pulmonary embolism and evidence of right ventricular failure as a result of acute pulmonary artery hypertension: 1. How is the decision made as to whether to thrombolysis is appropriate? 2. When should surgical or mechanical thrombectomy be considered? 3. Is there a role for inotropes and if so, what is … More Pulmonary Embolism

This month’s questions: 1. What determines whether we anticoagulate our patients with line related thromboses? And when is the optimum time for line removal? 2. Should we be placing midlines instead of peripheral cannulas when the need arises for non-cvc related access in our ICU patients ? This month’s paper: Essential reading in the  form of https://www.nejm.org/doi/full/10.1056/NEJMoa1714919 , or is … More Line management