ICU OnePager

This week will be sharing some of the most popular #ICUOnePagers onepagericu.com 1️⃣ Overview of Ventilator Modes - covers all the common modes (VC, PC, PRVC, PS, APRV) & the pros/cons of each. Also covers the settings for each & how to adjust based on ABG/SpO2.

Every day 215,000 people “donate”plasma, except unlike blood donors they get paid for it. Increasingly plasma donation is a side hustle people depend on to pay the bills. People can “donate” plasma up to twice a week earning an extra $500-$1000/month. Because paid plasma donation is banned in most countries, the US provides 70% of global supply, exporting over $35 billion dollars worth of plasma every year. Next time you order FFP think about the for-profit strip malls donation centers that supply it.

A lot of people are worried about gas prices. I'm worried about the shortage of methanol & other solvents and the implications for availability of generic meds. Some background: India makes ~20% of the world's generic drugs and supplies ~40% of US generics. Synthesis of active pharmaceutical ingredients (API) depends on a steady flow of organic solvents: the so-called solvent chain. Those solvents mostly start as natural gas. And a lot of that gas comes from the Middle East. The closure of the straight of Hormuz threatens the global supply of these solvents. Prices are already spiking. Within weeks the supply will become constrained. Generic meds will get much more expensive, then severe shortages will begin. The most vulnerable drug classes: antibiotics, antiretrovirals, cardiovascular generics, diabetes medications, all high-volume, India-dominant, NMP/DMF-dependent synthesis.

“We’re not going to teach an essential skill because we don’t know it” - academic medicine

I like the Wayne chest tube kit but I don’t understood why it has this little prison shiv of a scalpel. Was it too expensive to put an actual 11 blade in a $500 tray?

🌍 New ICUOnePager on ICU Sustainability: How can we reduce the massive carbon footprint of critical care? A concise guide to reducing the carbon footprint of critical care: from MDIs, anesthetic gases to reusables, best practices, & smarter energy use. onepagericu.com/icu-sustainabi…

Anyone who has read history has wondered what it was like to live during the rise of fascism. What was it like? What would I have done? Today we have the opportunity to find out. Regardless of whom you voted for, will you now speak out? Take action? Or will you continue to look the other way? Being scared to act is ok but if you don’t register visceral disgust at the events in Minneapolis, consider that you might simply be a terrible person.

People in the custody of law enforcement officers (LEO) have a right to medical care, including in the ICU. As clinicians we we need to know: - LEO is not a surrogate decision maker - LEO have no right to medical info - we can demand LEOs leave the room and remove restraints More here:

It's that wonderful time of the year when CME funds are use 'em or lose 'em. To help ya'll make the best of it, I made a list of my favorite critical care books. It's broken down by topic (physiology, POCUS, CCM, CV, neuro, surgery, ID, nephro, etc) & each is assigned a "trail rating" 🟢 for beginners (e.g. people new to the ICU) 🟦 for intermediates ◆ for more advanced learners onepagericu.com/blog/icu-readi… 🧵

🚀 Get excited for a special year end episode talking about SPACE MEDICINE with guest astronaut Dr @shawnapandya! 🍏 podcasts.apple.com/us/podcast/cri… ✳️ open.spotify.com/episode/2magAb… 📽️ youtu.be/f0ZaOhEhYdw?si… 📑 criticalcaretime.com/episodes/40-sp…

Improved version now shows the maximum flow for a given pressure drop.

I got tired of flipping through a dozen PDFs to find the ECMO pressure/flow curve I needed. So I made an app! Choose a cannula/size & see the flow for a given pressure drop or compare multiple cannula at once. Lmk what y’all think. More cannula? onepagericu.com/ecmo-calculator

Want to learn how to: 🤖 use LLMs in medical education 🖼️ make infographics 🎧 record podcasts 📡 disseminate MedEd using social media 💰 & get paid for you MedEd work Get excited for the upcoming Digital Education & Artificial Intelligence conference! cmecatalog.hms.harvard.edu/digital-educat…

Hope you found this 🧵 useful. Let me know if you have any more suggestions for how to minimize the harms of the the #IVFluidShortage! 25/25

1️⃣6️⃣Address climate change! Ultimately we can expect more shortages & we will need far more IV fluids if we fail to address the root cause of medical supply chain disruptions: Anthropogenic climate change! I'll leave it here as this isn't my expertise... 24/

1️⃣5️⃣ Eliminate shipments to med spas providing unnecessary fluid infusions Med-spas are a poorly regulated $15b industry. Increasingly they charge $100s to provide IV fluid. This is not just medically dubious, it wastes a scarce resource. Let's stop the sale of IVF to spas! 23/

1️⃣4️⃣Allow imports from Europe To ensure quality, the FDA generally bans the import of meds manufactured outside the US. This makes sense. It would be beneficial to have a streamlined process to approve imports from trusted manufacturers in Europe. It worked with babyfood! 22/

Expanding the Strategic National Stockpile would enable it to function more like the much larger strategic petroleum reserve (SPS), not just used in crises but also acting as a "buffer" to prevent shortages of essential meds. 21/

1️⃣3️⃣ Expand the CDC's strategic national stockpile (SNS) As we saw with national shortages early in COVID, we need a larger investment in the SNS. In addition to PPE, vaccines, antibiotics, this should also include other essential meds & IV fluids. aspr.hhs.gov/SNS/Pages/Stoc… 20/

1️⃣3️⃣Get pharma to DECENTRALIZE 60% of IVF were made in ONE factory; centralized production is a big weakness. We should use incentives (tax credits, infrastructure investment, streamlined approval, etc) to encourage manufacturers to build multiple factories in different regions.