Critical care clinicians can change physiology with a number of tools. They can repeatedly, often and mercilessly change physiological variables. They can increase the blood pressure (or decrease it); they can increase cardiac output (or decrease it), they can increase cardiac filling pressures (or decrease them), they can increase glucose levels (or decrease them), they can increase positive fluid balance (or decrease it) and so on. This kind of “numerology” is attractive because the outcomes are tautological and clinicians feel powerful and effective. However, outside the obvious situations where physiology is so dangerously abnormal as to threaten life, such physiological manipulations have an unproven relationship with outcome. Importantly, patients do not care whether their cardiac output has been increased from 5L/min to 6 L/min. They only care whether they live or die, get out of hospital intact and return to their previous life. Thus, physiological gain is not patient centred. Moreover, all research focusing of the physiology of a specific intervention always and inevitably deals with the effect on a specific set of variables. For example and fluid bolus may or may not increase cardiac output for a while. Thus studies focus on identifying fluid responders for such purposes. However, no one studies the effect of such fluid bolus on anything other than hemodynamics. No one measures what the effect is on the immune system, cerebral edema, the glycocalyx, interstitial oxygen gradient, pulmonary congestion, body temperature, haemoglobin and white cell function etc. etc. Thus, all physiological studies are “blind” to the effects that their protagonists cannot or will not measure. In other words, the measurable is made important but the important may not be measured. Clinicians need to reflect on this before they become seduced by physiological manipulation.
The Problem with Physiology
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‘Everything’ at the End of Life
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The meaning of ‘everything’ from the perspective of the patient, their family, their doctor and their health economist. We...
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Helping Without Harming
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You’ve been resuscitating the patient for hours and finally caught up with volume. You come back on your next...
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Prehospital Care: The Future is Now
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Trauma is an epidemic. It is globally the biggest killer in young people.This talk will outline the current deficits...
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Neuroimaging Nibble Subtle SAH
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Neuro Imaging Nibble: Subtle Subarachnoid haemorrhage on CT by Jordan Bonomo
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Voices in my Head
Phoebe Adams, , 2017, The Talks DASsmacc, Failure, medicine, mindfulness, performance, Resuscitation, Self-compassion, 0
We are all imperfect, this is the human condition. Pursuing a career in resuscitation means that some of our...
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Four Tragic Dog Deaths: Lessons in Program Design and Development
Phoebe Adams, , The Talks DASsmacc, Administration, emergency medicine, innovation, medical education, Point-of-care Ultrasound, Program Design, Research, 0
Academic programs are built on four main pillars: clinical excellence, research, education, and administration. These apply whether you build...
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Diagnosing Meningitis – CSF lactate, procalcitonin and fungitell, when to pull the trigger on steroids/abx?
Phoebe Adams, , 2017, The Talks DASsmacc, antibiotics, bacteria, brain, CSF, CT, emergency department, fungitell, lactate, LP, Meningitis, Neuro EM, procalcitonin, steroids, 0
The golden hour of meningitis involves rapid identification, workup, and treatment. In most cases, the diagnosis of meningitis is...
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SonoBYTE: Ultrasound in Extreme Environments
Phoebe Adams, , 2017, The Talks DASsmacc, adventure, Altitude, Antarctica, Cold, extreme, HAPE, ICE, Mountains, Ultrasound, wilderness, 0
South pole…North pole, hot…cold, on earth…in space, below the sea…on Mount Everest, alone and far, far away. Ultrasound will...