Topics in Critical Care Medicine and Applied Physiology

Causes of acidosis in hyperlactataemia

Though the term "lactic acidosis" is imbibed together with mother's milk in one's medical training, the very concept of lactate causing acidosis is mired in sordid controversy. The question of whether or not lactate actually causes acidosis is itself debated; highly respected members of the intensive care community disagree on this rather important point. Less respected members are even more conflicted. Capture a senior intensivist, and corner them with the question: can infusion of Hartmanns cause lactic acidosis in an anhepatic patient? Why or why not? How can there be severe hyperlactataemia with a normal base excess? One may be disappointed with the results of this experiment.

Interpreting the shape of the flow-volume loop

Typically, when one thinks of flow-volume loops, one refers to the classical loops of forced expiratory spirometry. Most of what is written about flow-volume loops refers to these. Indeed, both the LITFL entry on flow-volume loops and the AnaesthesiaUK revision article use the formal pulmonary function test standard of flow-volume loop interpretation. The shape of the curves is quite similar, but the fundamental difference is in the fact that in the ventilator loop is by convention upside-down.

Multi-organ system failure: the "Final Common Pathway"

Definition

Multi-organ-system-failure is a constellation of several horrible problems, each of which would be life-threatening all on its own. This entity is a luxury of our enlightened age. In the olden days people never survived long enough to develop this syndrome.

As per Oh's Manual, The Definition is: "in an acutely ill patient, the function in two or more organ systems altered such that homeostasis cannot be maintained without intervention"

Tricuspid stenosis

Keep the heart rate slow, give them milrinone if you absolutely have to, and avoid AF like the plague.

Physiological consequences of tricuspid stenosis

The limitation of right heart preload by a stenotic mitral valve manifests as right heart failure. Hepatomegaly and portal venous congestion with ascites tend to complicate the picture.

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