I made contact with Dr Segun Olunsanya via Twitter to discuss some of the issues around the fluid management of the sick patient. He in turn persuaded a couple of others involved in ITU. This has led to this fascinating discussion around this issue and it is one of the podcasts I am most pleased with. I have tried to include a lot of the links to the papers and sites we discuss below.
A great conversation and very useful. I am hoping to be able to repeat this type of discussion again.
This weeks
a physician who found a link between cancer and X Rays. This is also about discovering the truth and acting upon it. Well worth listening to.
Margaret has also written a book called
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Tom, one of my colleagues from the Critical Care Outreach Team and I discuss this paper and its findings reaching our own conclusions. Deferring Arterial Catheterisation in Patients with Septic Shock.
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We return to our 48-year-old patient: jaundiced, hypotensive, drowsy, and bleeding. In decompensated cirrhosis, every treatment targets a disrupted system — splanchnic vasodilation, portal hypertension, toxin accumulation, and renal hypoperfusion.Although these patients look fluid overloaded, they are effectively hypovolaemic. Start with small aliquots of balanced crystalloid, avoiding 0.9% saline. In hepatorenal syndrome or tense ascites, 20% albumin is
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In this episode, I walk through the real-world critical care management of acute decompensated alcohol-related liver disease, using a high-risk ICU case to anchor the discussion. The focus is on understanding the underlying physiology—portal hypertension, rebalanced haemostasis, hepatic encephalopathy, infection, and hepatorenal syndrome—and translating that physiology into clear first-hour priorities at the bedside. Listeners are
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