Intra-abdominal Pressure and Renal Function

"An' it ain't no use in turnin' on your light, babe, I'm on the dark side of the road ..." -Bob Dylan A 44 year old man with cryptogenic cirrhosis is admitted with large ascites and acute kidney injury.  A 50 mL, diagnostic paracentesis reveals 12 PMNs and he is admitted from the emergency department for further [... read more]

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A Free & Open-Access Hemodynamic Physiology Curriculum

“A rising tide lifts all boats.” -John F. Kennedy Two years ago, heart-lung.org went live – a project borne out of my deep interest of the inter-connectedness of the cardiovascular and respiratory pumps.  I have been truly amazed and deeply appreciative of the kind words which I have received from around the world; indeed, I [... read more]

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The Revised Starling Principle: Implications for Rational Fluid Therapy

“Doctrine once sown strikes deep its root, and respect for antiquity influences all men.” -William Harvey [1628] The use of hyperoncotic albumin to draw fluid from the interstitial space permeates dark corners of the critical care community.  The ‘pull and push’ of 25% albumin followed by furosemide remains somewhat of a cryptic lore – its [... read more]

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Blood Pressure Goals in Intracerebral Hemorrhage – ATACH II

“… it is a tale.  Told by an idiot, full of sound and fury, signifying nothing.” Macbeth: Act V, Scene V The results of the ATACH II trial are out; we have even more guidance when managing the blood pressure of hypertensive patients with supratentorial, intra-cerebral hemorrhage of less than 60 cm3 in volume.  The question: [... read more]

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ICU Physiology in 1,000 Words: ARDS – Part 3

Jon-Emile S. Kenny [@heart_lung] While parts 1 and 2 of this trilogy considered the mechanical power applied to the lung skeleton and the effects of lung inhomogeneity [i.e. ‘stress raisers’], respectively; this final installment will draw the reader towards the pulmonary vasculature as a key mediator of ventilator induced lung injury [VILI].  That the pulmonary [... read more]

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