Shock comes in many flavors and so do vasopressors. Here’s a #OnePager summarizing my approach to pressors including when to start, which ones to use, how to administer them, and when to increase or wean. Includes my favorite pedagogical device for vasopressor: the pressor-speedometer from beta to alpha adrenergic effects..

Arterial lines are commonly used in the ICU for sampling arterial blood and for invasive hemodynamic monitoring. This ICU OnePager shows you how arterial lines work, teaches you how to troubleshoot them, and reviews some of the common (and not so common) diagnostic clues hidden in the arterial pressure waveform.

Volume overload is very common in the later stages of critical illness, and achieving a negative fluid balance is key to helping patients liberate from mechanical ventilation and ultimately recover. I outline strategies for minimizing ins (avoid MIVF, use high concentration drips, switch IV to PO) and maximizing outs (stepwise diuresis with loop diuretics, thiazides, spironolactone, and acetazolamide). I also discuss special circumstances including cirrhosis, nephrotic syndrome, and hypoalbuminemia.

Measuring exhaled carbon dioxide (End Tidal CO2, ETCO2) is an important ICU technology that can used to confirm ETT placement, to ensure safer procedural sedation, to guide ACLS/resuscitation, and to monitor cardiac and pulmonary physiology in realtime. This ICU OnePager describes the physiology, equipment, waveforms you will see with ETCO2 monitoring.

We use pulse oximetry on every patient every day in the ICU, but how does this machine actually work and, importantly, how does it fail? This ICU #OnePager reviews the principle of pulse oximetry and the many factors that can cause inaccurate readings: darker skin pigmentation, nail polish, low flow states (ECMO & LVADs), and abnormal hemoglobins (MetHB, COHb, etc). It introduces the important concept of pulse ox lag-time and also shows how the waveform can provide useful physiologic clues about vascular tone/compliance.

Non-invasive positive pressure ventilation (NIPPV) is a valuable technique to support oxygenation and ventilation in people with respiratory failure to potentially avoid intubation. This #OnePager reviews when to (and when not to) use NIPPV, as well as modes  (CPAP, BiPAP/BiLevel, & AVAPS) and interfaces (nasal, partial face, full face, & helmet).

Ventriculostomy catheters and external ventricular drains (EVDs) are a diagnostic and therapeutic intervention often used in the neuroICU. This ICU OnePager explains how EVDs work and how to interpret intracranial pressure (ICP) waveforms.

Most people breathe through the nose, and it’s a common route for administering supplementary oxygen. This OnePager reviews nasal oxygen delivery devices, including conventional nasal cannula (NC), reservoir nasal cannula, and heated high-flow nasal cannula (HFNC). It also covers apneic oxygenation.

Cystic lung disease is complicated. Here’s an overview of the definitions of emphysema, cavity, and cyst as well as a deep dive into all the etiologies that can cause diffuse cystic lung disease (DCLD).

Understanding Hypoxemia (low oxygen in the blood) & hypoxia (low oxygen in the tissues) is a fundamental part of critical care. This OnePager reviews all the key concepts (oxygen content & delivery, Aa gradient) and explains all FIVE causes of hypoxemia (low inspired O2, alveolar hypoventilation, V/Q mismatch, right to left shunt, and diffusion limitation) plus a bonus SIXTH cause which is often overlooked (low mixed venous O2).

Massive hemoptysis is both terrifying and a true emergency. This ICU #OnePager reviews the d/dx (BATTLECAMP) and walks through an approach for workup, airway management, and interventions (bronchoscopic, IR, and surgical) to control hemorrhage.

Extracorporeal Membrane Oxygenation (ECMO) is the most advanced life support modality available in the ICU, able to provide oxygenation and CO2 removal (VV ECMO) as well as support cardiac output (VA ECMO). This OnePager is the first in a series about ECMO, that orients you to the basic ECMO circuit & reviews the basics of ECMO terminology, equipment, and physiology.