ICU Airway Management

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

Rib fractures – Sira Debate

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

Pulmonary Embolism

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

Line management

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

Status epilepticus

1. What are the essential investigations for a patient presenting with refractory status epilepticus? 2. Once traditional treatments (propofol, benzodiazepine infusion, and barbiturates) have been exhausted what should be our next line therapies? 2. Where should these patient’s be managed and what is the minimum monitoring standard?   This month’s paper is a fantastic article from the NEJM from this year, … More Status epilepticus

QOTM – BP management in sepsis

This month’s questions: 1. In patients on escalating doses of vasopressors (and/or inotropes) should we routinely be inserting a femoral arterial line to correlate with radial arterial pressures, and if so and they differ which pressure do we target? Is anyone doing this already 2. Is there ever any benefit in using inotropes as part of the management of septic shock? Do they do more harm … More QOTM – BP management in sepsis