This week will be sharing some of the most popular
#ICUOnePagers
1️⃣ Overview of Ventilator Modes - covers all the common modes (VC, PC, PRVC, PS, APRV) & the pros/cons of each. Also covers the settings for each & how to adjust based on ABG/SpO2.
Continuing our
#NewPeopleInTheICU
series or
#OnePagers
:
5️⃣Interpreting Acid/Base - How do you tell the difference between a metabolic & respiratory
#acidosis
? What causes an anion gap acidosis (GOLDMARKeT), a non-anion gap acidosis (RAGES), or a metabolic
#alkalosis
(BLVD PLACE)
Understanding the devices used for mechanical circulatory support is essential if you work in an ICU.
Here are 4️⃣ ICU OnePagers, one about about each of the most common devices:
- IABP
- Impella
- vaECMO
- LVAD
Today's
#ICUOnePager
is about chest tubes. What is that bubbling box next to the bed and how does it work? What's an "air leak"? What does "water seal" mean? This
#OnePager
explains how chest drains work & even teaches you how to build one using three bottles & some tubing.
Another high-yield pair of ICU
#OnePagers
: invasive and non-invasive ventilation.
Reviews all the common ventilator modes (VC, PC, SIMV, PRVC, APRV, etc) & the non-invasive modes (CPAP, S/T, Bilevel/BiPAP, AVAPS). Also covers how to adjust settings based on ABG/VBG results.
And the 2 most popular ICU OnePagers are:
🥁🥁🥁
2️⃣Non-invasive positive pressure ventilation - when to use (& not to use!), what interface, what mode
1️⃣Mechanical ventilation modes - all your fav ventilator modes & settings
Today's
#ICUOnePager
is about
#lactic
acidosis. Why do we make
#lactate
and how do we clear it? What are the types of lactic acidosis (type A, type B, & type D) and what do they mean? This
#OnePager
has got you covered!
This month, we will be sharing a series of classic
#OnePagers
for PGY-1s joining the
#ICU
team. Welcome!
#TipsForNewDocs
#FOAMed
#FOAMcc
1️⃣Ventilator Modes. An overview of the different modes (VC, PC, PRVC, PS, SIMV, etc) of mechanical ventilation 🫁 & values to set for each🎛️.
Today's
#ICUOnePager
: hyperthermic toxidromes🥵
The 5
#toxidromes
that are most likely to cause increased body temp:
🟥Sympathomimetics
🟧Anticholinergics
🟨Seratonin syndrome
🟦Neuroleptic malignant
🟩Malignant hyperthermia
5 toxidromes that everyone in the ICU should know
Today's ICU
#OnePager
is about 5
#toxidromes
that cause hyperthermia:
🟥sympathomimetics
🟧anticholinergics
🟨serotonin syndrome
🟦neuroleptic malignant
🟩malignant hyperthermia
How to differentiate these? How to treat them? This
#ICUOnePager
has got you covered
#foamtox
#FOAMcc
Next up in the
#NewPeopleInTheICU
series of
#OnePagers
:
6️⃣Shock! What is the definition of shock (hint: it isn't any particular blood pressure!)? What are the four types of shock? And how can we use physical exam and
#POCUS
to identify the cause of shock?
5️⃣We use pulse oximeters every day in the ICU, but how do they work & when do they fail?
This
#ICUOnePager
reviews SpO2 & the factors that can affect it: skin color, nail polish, low flow/non-pulsatile states, abnormal Hb (metHb). Also the key concept of pulse ox lag time ⏱.
Another high yield pair of ICU
#OnePagers
: an approach to
#hypoxemia
& to blood gas interpretation.
Some great info including: what is the 6th cause of hypoxemia & a better mnemonic for anion gap metabolic acidosis: GOLDMARKeT.
Todays
#ICUOnePager
: chest tube drains
What is that bubbling box next to the bed? What do the different compartments do? How to assess if it's working properly?
Interpreting acid/base physiology can be tricky. Here's the 4 step
#ICUOnePager
approach, including some useful mnemonics for
🟠metabolic alkalosis --> BLVD PLACE
🔵non-AG metabolic acidosis --> RAGES
🟣anion gap metabolic acidosis --> GOLDMARKeT
2️⃣Fluid responsiveness & fluid tolerance - an in depth summary of all the methods of determining if a patient would benefit from an IV fluid bolus or if that bolus would be harmful.
Covers everything from CVP (👎) to PACs & IVC US (🤷♂️) to PPV, ETCO2, LVOT VTI & Bioreactance (👍)
Today's
#ICUOnePager
is about recognizing lobar collapse on CXR. Lobar collapse is common in the ICU but it's easy to miss if you can't recognize these 6 patterns. This OnePager will make you a pro at spotting a collapsed 🫁 lobe.
#FOAMrad
#FOAMed
#FOAMcc
Another ICU OnePager duo: diuresis & CRRT.
How to escalate diuretic therapy? How does CRRT work and what do all those pumps & pressures mean? This OnePager covers all the basics of fluid removal in the ICU.
Download open source versions
How do you recognize and diagnose shock?
This ICU OnePager provides a framework for classifying each etiology of shock. Including physical exam, POCUS, & physiological findings (Guyton curves):
🫀cardiogenic
🫁obstructive
🦠distributive
🏜️hypovolemic
Sharing some of the top pairs of ICU
#OnePagers
this week.
First up, two topics that go🖐in🤚:
#ECMO
fundamentals & troubleshooting. Great for learning/teaching ECMO for the first time or for brushing up on basics.
Up next in our series of
#ICUOnePager
for new members of the ICU team: an overview of the
#hypoxemia
&
#hypoxia
What is oxygen delivery? What are the 5 (actually 6!) causes of hypoxemia? What is an Aa difference & why is it used? This
#OnePager
has got your O2 questions covered!
Next up in our series of
#OnePagers
for new members of the ICU Team:
3️⃣
#Vasopressors
: what are all the choices & how are they different? What should be the goal MAP? and what are some adjuncts (methylene blue, steroids, etc)?
Today's ICU
#OnePager
is all about
#vasopressors
! When to start them (MAP 60 vs 65), which one to choose (hint: not dopamine!), & what to do when pressors aren't working (steroids, methylene blue, etc).
Download the PDF version w/ references from
Next in our series of
#OnePagers
for new ICU team members:
2️⃣Non-invasive positive pressure ventilation (NIPPV). When should you use NIPPV? (& when not?) What are the interfaces? What are the modes & settings? (CPAP, S/T, AVAPS) This
#ICUOnePager
covers all the basics of NIPPV.
Methods of non-invasive oxygen delivery in the ICU
- nasal (nasal cannula, high flow heated nasal cannula)
- masks (simple, venturi, NRB, ec)
- non-invasive positive pressure ventilation
Download them all (open-source) at
Today's ICU
#OnePager
is about a topic we should consider in every person every day:
#ICUnutrition
!
When to start feeds? Which formula? At what goal?
Also busts some persistent ICU myths: there are no magic disease specific feeds & residuals don't matter (so don't check 'em)!
More on Monitoring Equipment used frequently in the ICU:
3️⃣ Arterial lines - How do Alines work? What are the advantages (& disadvantages) of them? What do "underdamped" & "overdamped" mean? What can we learn from the subtleties of the arterial waveform?
#FOAMcc
#FOAMed
Tracheostomies are common but can be confusing if you are unfamiliar with them.
This ICU OnePager covers the basics of tracheostomies & how to troubleshoot the 3 most common emergencies: decannulation, obstruction, & bleeding.
#TipsForNewDocs
#FOAMcc
Another pair of
#ICUOnePagers
: Blood products & hemorrhagic shock.
One covers types of blood products (RBC, FFP, Cryo, Plt, etc) & the possible transfusion reactions. The second covers all the factors that determine how fast we can infuse blood/fluid
#Poiseuille
#PhysicsInTheICU
Today's
#ICUOnePager
is about a admission to the ICU: Diabetic Ketoacidosis (DKA)
What are the different etiologies of
#ketoacidosis
(DKA, HHS, AKA, etc) and how to differentiate? What's euglycemic DKA? How to treat?
A great OnePager for July Interns!
The ICU OnePager approach to interpreting acid base including some handy mnemonics:
- metabolic acidosis: BLVD PLACE
- non-AG metabolic acidosis: RAGES
- AG metabolic acidosis: GOLDMARKeT
#TipsForNewDocs
Next up in ICU Monitoring Equipment:
2️⃣Pulse Oximetry - We use pulse
#oximetry
on every patient every day in the ICU? How does it work? What are the sources of
#SpO2
error? What's "Pulse Ox lag time" & why does it matter when intubating? Important stuff for
#PeopleNewToTheICU
The ICU OnePager approach to SHOCK:
⚡ shock is inadequate O2 delivery, NOT a specific BP
4️⃣consider 4 categories using PUMP, TANK, PIPES
💔cardiogenic
🛑obstructive
🫗hypovolemic
🤒distributive
🩺use physical exam & POCUS to differentiate
Happy July 4th!
Today's ICU
#OnePager
is non-invasive positive pressure ventilation (
#NIPPV
) - a great topic for new interns!
What are the modes of NIPPV (
#CPAP
, S/T, AVAPS, etc)? What interfaces are available? What settings will change oxygenation & ventilation?
#FOAMed
Non-invasive positive pressure ventilation (
#NIPPV
) is life-saving, in the right circumstance.
This ICU OnePager covers the basics of NIPPV:
✅indications/contra-indications
🎛️modes/settings (S/T, AVAPS, PS)
🤿interface (nasal, full/partial face, helmet)
Continuing our series of ICU
#OnePagers
for
#PeopleNewToTheICU
:
Blood
#Transfusion
- When are
#blood
products indicated?
What are the special types of products? leukocyte reduced, irradiated, washed, etc
What transfusion reactions can occur? FNHTR, AHTR, DNTR, TRALI, PTP, etc
Acid-base problems are common in the ICU, sometimes multiple at once. This
#OnePager
1⃣📟outlines an approach to pH,
#anionGap
, & a DDx for each:
#RAGES
for NAGMA,
#GOLDMARKeT
for AGMA,
#BLVDPLACE
for met alkalosis. Includes handy formulas & rules so you can🕵️♀️🔎that ABG!
#FOAMed
Next up in our series of
#ICUOnePagers
for
#PeopleNewToTheICU
: Tracheostomy Emergencies
How does a
#tracheostomy
work? What can go wrong? Why does it matter if its "a new trach" or not?
This OnePager covers the 3 big trach emergencies: Decannulation, Obstruction, & bleeding
Today's ICU
#OnePager
is transvenous & epicardial
#pacing
⚡️
Where do the leads go? What's bipolar vs unipolar? How does the pacer box work? What are the modes (e.g. VVI, DOO, etc)? How do you adjust the settings?
Learn all about these important devices:
Today's
#OnePager
: Pulmonary Renal Syndromes
What are the causes of
#PulmonaryRenal
syndrome (ANCA vasculitis, Goodpastures, etc)?
What are the🔑findings on renal biopsy?
What's🩸diffuse alveolar hemorrhage (DAH) & how do you diagnose it on bronchoscopy?
How do you treat PRS?
Today's ICU
#OnePager
is
#thromboelastography
(TEG) a rapid, useful way to assess coagulation & clotting to guide therapy in the ICU:
Prolonged R --> FFP
Decreased α angle --> cryo
Decreased MA --> Plt transfusion or enhance Plt fxn (ddAVP)
Increased LY30 --> TXA or amicar
Today's ICU OnePager is about alcohol withdrawal syndrome (AWS)
AWS is a common but often underrated ICU problem. What are the different manifestations? How do you assess and treat AWS? BZDs vs phenobarb?
Important topic for new docs joining the ICU team
Next in OnePagers for
#PeopleNewToTheICU
:
Fluid Responsiveness - Would this person benefit from a fluid bolus? An easy question to ask but sometimes hard to answer!
This
#OnePager
summarizes *all* the tests of fluid responsiveness (PPV, PLR, PCWP, ETCO2, PEEP, VTI, IVC, etc)
Today's ICU
#OnePager
is about a terrifying emergency: massive
#hemoptysis
.
This OnePager covers workup, causes (BATTLECAMP mnemonic), & what you can do to fix it: nebulized TXA, rotate bleeding side down, protect the airway, bronchial blocker/rigid bronch, etc
Next up in
#OnePagers
for
#PeopleNewToTheICU
:
Achieving a negative fluid balance:
How do
#diuretics
work? When to use a bolus vs a drip? Should I add thiazide, spironolactone, or acetazolamide?
This
#OnePager
teaches how to get fluid out! (& avoid putting too much in!)
This week will be sharing
#ICUOnePagers
about
#shock
!
First, an approach to shock. Is it cardiogenic, obstructive, hypovolemic, or distributive?
This OnePager covers
#physiology
& how to integrate
#POCUS
, 🩺exam, & 🩸hemodynamics in your assessment.
Today's ICU
#OnePager
is about
#PulmonaryEmbolism
!
PE ranges from incidental to immediate life threatening, how to differentiate them? How to support the persons hemodynamics? Who needs lytics & what are the treatment options?
Today's ICU OnePager is on nasal oxygen delivery!
How much
#oxygen
can be delivered non-invasively via the nose? What is heated high flow nasal cannula (HHFNC) & what advantages does it have? This
#OnePager
is full of O2 delivery
#TipsForNewDocs
#FOAMed
Non-invasive positive pressure ventilation (NIPPV) can support ventilation/oxygenation & potentially avoid the need for invasive ventilation.
This
#Onepager
covers the basics of NIPPV: when to use it (& when NOT to), interfaces, & modes of ventilation.
We use ETCO2 & SpO2 all the time as non-invasive surrogates to measure PaO2 & PaCO2.
How do these monitors work? What are the limitations & when can they give misleading results?
2 OnePagers 1️⃣📟about ETCO2 & SpO2 monitoring:
Identifying the etiology of shock can be challenging.
This
#ICUOnePager
illustrates how to combine physical exam, POCUS, and hemodynamics together using the framework of PUMP (CO) vs PIPES (SVR) vs TANK (preload) problems.
Spotting lobar collapse on a🩻CXR is an essential skill in the ICU.
This OnePager summarizes the 6 patterns of lobar collapse & specific clues to watch for:
🫁displacement of fissures
🫀loss of cardiac border
🌙air crescent sign (Luftsichel)
🇸golden S sign
⛵️sail sign
Capping off a week of
#OnePagers
for
#PeopleNewToTheICU
, here's two OnePagers all about
#ECMO
7️⃣ECMO Basics & Troubleshooting
Understand the equipment & physiology, what's the difference between VA & VV ECMO? How do different settings effect pCO2 & paO2? What do to in a crisis?
Today's ICU
#OnePager
is about
#ARDS
What are the diagnostic criteria? What can mimic ARDS? How to treat ARDS (hint: remember the 8 P's mnemonic!)
Also check out the new & improved website, where you can download open-source versions of every OnePager:
Today's pair of ICU
#OnePagers
concerns invasive monitoring devices used in the ICU: Arterial lines & external ventricular drains. How do these devices work? What subtle clues are present in the waveforms?
Lots of great physiology to unpack!
#FOAMed
#FOAMcc
What's ECMO and how does it work? This 📟OnePager is a gentle introduction to the basics of ECMO including:
⚙️Components & how the circuit works
🎛️Adjusting oxygenation (O2) & ventilation (CO2)
Useful
#TipsForNewDocs
here👇
Today's pair of ICU
#OnePagers
are two widely used
#cardiac
support devices: the intra-aortic balloon pump (IABP) & the external cardiac pacer.
These OnePagers explain how these machines work, what all the settings mean, & how to adjust them.
#FOAMed
#FOAMcc
2️⃣ ICU OnePagers about common causes of metabolic acidosis:
KETOSIS
- DKA vs HHS, AKA, euglycemic DKA, etc
- including the 3 pillars of treating DKA (fluid, insulin, electrolytes)
-
LACTIC ACIDOSIS
- Type🅰️ vs🅱️ (& type D)
-
ICU OnePager approach to understanding the causes of hypoxia & hypoxemia. Know the SIX causes of hypoxemic hypoxia & how to differentiate:
🏔️Low inspired O2
😴Alveolar hypoventilation
🚬V/Q mismatch
🦠Shunt
🦜Impaired diffusion
💔Low SvO2
Non-invasive monitoring is a crucial aspect of critical care. This pair of ICU
#OnePagers
explains how pulse oximetry (
#SpO2
) & end tidal CO2 (
#ETCO2
) monitoring work and what factors can cause them to read incorrectly.
#FOAMed
#FOAMcc
For those taking pulmonary boards tomorrow, good luck! You're gonna ace 'em!
Here's some high yield pulmonary 🫁 OnePagers to help you snag a few extra points: pulmonary renal syndromes (in collab w/
@MithuRheum
), cystic lung disease, lobar collapse on CXR, & flow volume loops!
Today's ICUOnePager is hemorrhagic shock resuscitation
What factors determine how fast product can be transfused? What lines have the fastest flow rates? How can you optimize resuscitation?
This OnePager covers the
#PhysicInTheICU
& teaches you all about resuscitation.
Finishing up a week long series on
#shock
: here are three OnePagers about types of mechanical circulatory support: IABP, LVAD, and vaECMO
What are the hemodynamic effects & advantages/disadvatages of each?
Tracheostomy emergencies are terrifying! (especially if you are less familiar with em)
This ICU OnePager has you covered, breaking them into a few useful categories:
🌬️Decannulation
🩸Bleeding
⛔ Obstruction
⏳ Early (<7 days) vs ⌛ late (>7 days)
Today's Shock
#ICUOnePager
is about
#vasopressors
!
This covers:
What is the goal MAP?
When to give "push dose pressors"?
When is a central line required?
What can you do when pressors aren't enough? (hydroxycobalamin, methylene blue, steroids, etc)
This week the
#OnePagers
for
#PeopleNewToTheICU
will be about monitoring equipment:
1️⃣End Tidal CO2 /
#capnography
What is ETCO2? How does it work? What are the different types (waveform vs quantitative vs semi-quant) & when are they useful? Includes
#ETCO2
waveforms to know!
Overview of continuous renal replacement therapy:
⬛ Modes: CVVH, CVVHDF, etc?
🟥Qb
🟦Qd
🟨dialysate
🟩replacement
🟧anticoagulant
⬜ dialyzer
This OnePager is great intro for people learning about how CRRT works & what the settings mean.
#FOAM
Continuing the daily duo of ICU OnePagers:
Today, a high yield pair of
#toxicology
themed ICU
#OnePagers
: hyperthermic toxidromes (5HT syndrome, NMS, sympathomimetic, and MH) & alcohol withdrawal. Two OnePagers that summarize the important but easy-to-miss toxicities in the ICU.
There are *many* tests of fluid responsiveness but they aren't all the same, and some are truly bad. (ahem CVP)
This ICU OnePager compares *ALL* the methods available for determining fluid responsiveness & fluid tolerance.
#FOAMed
#FOAMcc
Today, here are two pulmonary OnePagers: Pulmonary renal syndromes & cystic lung disease.
Know how to recognize & treat important rare causes of respiratory failure, including life-threatening emergencies DAH, ANCA-vasculitis, and Goodpasture's syndrome.
#FOAMed
#FOAMcc
Ketoacidosis is a common admission to the ICU, but misdiagnosis or mismanagement is dangerous.
This ICU OnePager covers:
D/dx of ketoacidosis: DKA, HHS, AKA, etc
5 I's mnemonic for finding the etiology
3 pillars approach w/ insulin, fluids, electrolytes