Public previews from the WhiteBoard Medicine medical education series. Continue each post through the Core Medical Education collection on Patreon.
Read More on PatreonWhen discussing shock, critical illness, and organ dysfunction, we often focus heavily on arterial circulation. Mean arterial pressure, cardiac output, and systemic vascular resistance dominate many bedside conversations. Yet many patients in the ICU suffer not from inadequate arterial flow, but from excessive venous pressure.
Read previewSeptic shock is often described as a distributive form of shock characterized by vasodilation and microcirculatory dysfunction. While these features are certainly important, they can distract from another common manifestation of severe sepsis: myocardial dysfunction.
Read previewFor decades, lactate has served as one of the primary markers used to guide resuscitation in septic shock. Elevated lactate levels are associated with worse outcomes and have become deeply embedded in sepsis protocols.
Read previewFew laboratory values receive as much attention in critical care as lactate. Elevated lactate levels often trigger aggressive resuscitation efforts, serial measurements, and heightened concern for impending circulatory collapse.
Read previewMost discussions regarding mechanical ventilation focus on oxygenation and carbon dioxide clearance. However, positive pressure ventilation exerts profound effects on cardiovascular physiology, particularly on the right ventricle.
Read previewSedation is one of the most frequently administered therapies in the ICU, yet it is often approached as a matter of comfort alone. In reality, sedation influences nearly every aspect of critical care.
Read previewNorepinephrine remains the first-line vasopressor for septic shock and is often highly effective at restoring arterial pressure. However, a subset of patients develop refractory vasodilatory shock despite escalating doses.
Read previewCentral venous oxygen saturation, or ScvO2, is one of the most misunderstood hemodynamic variables in critical care. Many clinicians recognize low values as concerning but are less comfortable interpreting normal or elevated measurements.
Read previewFor years, septic shock management has emphasized aggressive fluid administration early in resuscitation. However, growing evidence suggested that excessive fluid accumulation may contribute to organ dysfunction, prolonged ventilation, and worse outcomes.
Read previewMany clinicians become comfortable ordering CRRT long before they fully understand how it actually removes solutes. While modern CRRT machines automate much of the process, understanding the underlying physiology can improve prescription design and troubleshooting at the bedside.
Read previewOne of the most challenging aspects of critical care is determining when fluid resuscitation should end and fluid removal should begin.
Read previewFor decades, fluid administration has been considered a cornerstone of septic shock management. Yet increasing evidence suggested that excessive fluid accumulation may contribute to organ dysfunction, respiratory failure, and prolonged critical illness.
Read previewThe role of corticosteroids in septic shock has been debated for decades. Some studies suggested benefit, others demonstrated little effect, and clinicians remained divided regarding when steroids should be used.
Read previewVA-ECMO is often described as temporary cardiopulmonary support, but understanding how it interacts with the native circulation requires a much deeper appreciation of cardiovascular physiology.
Read previewOne of the most important physiologic concepts in mechanical circulatory support is that VA-ECMO can simultaneously save the heart and stress the heart.
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