This is a chat about the ICU patient with problems with their swallow or dysphagia, I had with Martin Brodsky (@MBBrodskyPhD), who is an Assistant Professor of Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine. He is a clinician, researcher and educator with interests in swallowing and swallowing disorders, head and neck cancer, neurologic communication disorders, and ethics. Jackie McRae (@Daisy_project) also joined us and she is a speech and language therapist and an NIHR research fellow undertaking a PhD to investigate intensive care practice in identifying and managing swallowing problems in cervical spinal cord injury (The Daisy Project).
Lots of food for thought and perhaps raises many questions for us to ponder.
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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