Monday December 21, 2009
2 CD VIP

In response to our yesterday pearl "WEANS NOW" we received following pearl from

MABULMAGD , MD, EDIC
Lecturer of critical care medicine, Cairo university
Consultant intensivist, Dar Alfouad Hospital


I found this mnemonics helpful for intensivist during daily clinical rounds (2 CDF VIP)

2C,2D,2F
2V,2I,2P

2C..consciousness-connections

2D…hemoDynamics-diuresis

2F..fluids-feeding

2V..ventilation-vasopressors

2I..investigations-drug Interactions

2P…dvt prophylaxis-ulcer prophylaxis

Sunday December 20, 2009
Famous "WEANS NOW" of Ventilator Weaning

W: weaning parameter - measure
E: endotracheal tube (too small ?, obstruction ? etc)
A: alkalosis (may cause apnea) or anxiety
N: nutrition
S: secretion

N: neuromuscular disease
O: obstruction, bronchospasm
W: wait !!!

Saturday December 19, 2009
The Impella - minimally invasive, catheter-based cardiac assist device

The Impella is a minimally invasive, catheter-based cardiac assist device designed to directly unload the left ventricle, reduce myocardial workload and oxygen consumption, and increase cardiac output and coronary and end-organ perfusion.

The Impella can be inserted into the left ventricle in a Cath Lab via a standard guidewire through the femoral artery, into the ascending aorta, across the valve and into the left ventricle.The tip of the catheter contains a “pigtail” that crosses the patient’s heart valve and rests in the left ventricle, generating flows up to 2.5 L/min. The Impella is hemocompatible, does no compromise to valve function. There is low hemolysis, bleeding, and stroke rates.

Friday December 18, 2009
Examination of the Neck Veins

Thursday December 17, 2009


Q: Lab call you with result that patient's pleural fluid has cholesterol level more than 45 mg/dL (1.16 mmol/L). What does it mean?


A; Pleural fluid is probably an exudate.

Using a cutoff point of 45 mg/dL for pleural cholesterol and/or LDH over 200 IU/L identified exudates with a sensitivity of 99% and a specificity of 98%.


Measurement of Pleural Fluid Cholesterol and Lactate Dehydrogenase - A Simple and Accurate Set of Indicators for Separating Exudates From Transudates - CHEST November 1995 vol. 108, no. 5 1260-1263

Wednesday December 16, 2009

Q: What is the mechanism of action of Mannitol in control of Intracranial Hypertension (Increase ICP)?


A; Immediately after bolus administration Mannitol expands circulating volume by help of osmotic forces, decreases blood viscosity, resulting in reflex vasoconstriction and lowering of intracranial pressure. Its osmotic properties take effect in 15-30 minutes when it sets up an osmotic gradient and draws water out of neurons.

Tuesday December 15, 2009

Q: Does Phenytoin (Dilantin) get cleared by hemodialysis or hemoperfusion?


A; No (clinically insignificant removal)

Clinical significance:

• In Phenytoin toxicity/overdose, Hemodialysis or hemoperfusion are ineffective for enhancing elimination.
• Hemodialysis patients do not require extra dosing post dialysis though require frequent monitoring due to lower albumin level.