critical care topics for presentation

Internet Book of Critical Care (IBCC)

Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation

Table of Contents

March 7, 2024 by Josh Farkas

• Endocrinology
• Gastroenterology
• Hematology & Oncology

Infectious diseases

• Pulmonology
• Rheumatology
• Toxicology & Temperature

(back to contents)

• Overview: Guide to supportive care in critical illness
• Medication reconciliation in the ICU
• How to create your own IBCC smartphone app 📲
• Cardiac arrest
• 🔜 Chest pain
• Hypertensive emergency
• SCAPE (Sympathetic Crashing Acute Pulmonary Edema)
• 🔜 Syncope
• Vasopressors
• BRASH syndrome
• Atrial fibrillation & flutter
• Monomorphic VT storm
• Torsade de pointes
• Ventricular arrhythmias s/p MI

Coronary disease

• MI (type I)
• Post-MI complications
• Troponin elevation in non-cardiac critical illness

Myocardial & pericardial disease

• 🔜 Myocarditis
• Pericardial tamponade
• 🔜 Pericarditis
• Takotsubo syndrome

Shock & heart failure

• Undifferentiated shock
• Heart failure (including cardiogenic shock)
• Shock due to RV failure

Valvular disease

• Endocarditis
• LV outflow tract obstruction (LVOTO)
• 🔜 Valvular heart disease

Adrenal crisis

Glucose & insulin.

• Diabetic ketoacidosis (DKA)
• Hyperglycemic Hyperosmolar State (HHS)
• Glycemic control in the ICU
• Hypoglycemia
• ⬆️ Thyroid Storm
• ⬇️ Decompensated Hypothyroidism

Abdominal compartment syndrome

• Acalculous cholecystitis
• Community-acquired biliary sepsis (ascending cholangitis & calculus cholecystitis)

GI hemorrhage

• Nausea & antiemetics
• C. difficile
• Gastroparesis
• Colonic pseudoobstruction (Oglivie's syndrome)
• Acute Liver Failure (ALF)
• Acute on Chronic Liver Failure (ACLF)
• Alcoholic hepatitis
• Coagulopathy in liver failure
• In chronic liver failure
• In acute liver failure
• Hepatorenal syndrome (HRS-AKI)
• Spontaneous bacterial peritonitis (SBP)
• Critical care nutrition
• Refeeding syndrome

Pancreatitis

Anemia & transfusion.

• Anemia & hemoglobin transfusion targets
• Massive Transfusion Protocol (MTP)
• Sickle cell anemia – acute chest syndrome

Anticoagulation, therapeutic

• Anticoagulant reversal
• Parenteral anticoagulants (heparin, fondaparinux, argatroban, bivalirudin)

Coagulopathy

• Coagulation studies (conventional & TEG)
• Purpura fulminans
• Acute promyelocytic leukemia (APL)
• CAR-T cell recipient
• Immune-related adverse events from checkpoint inhibitors
• Tumor lysis syndrome
• Thrombocytopenia
• Catastrophic Antiphospholipid Syndrome (CAPS)
• Hemophagocytic lymphohistiocytosis (HLH)
• Thrombotic microangiopathies (including TTP and HUS)

General approach

• Allergy to beta-lactam antibiotics
• Antibiotics
• Antifungal agents
• Approach to fever in the ICU
• Septic shock

Specific infections

• Biliary sepsis (ascending cholangitis & calculus cholecystitis)
• Candidiasis
• Epiglottitis
• Line infection
• Meningitis & encephalitis
• Necrotizing fasciitis
• Aspergillosis, invasive
• Candidia pneumonia
• Community-Acquired Pneumonia (CAP)
• Pneumocystis jiroveci pneumonia (PJP)
• Ventilator-associated pneumonia (VAP)
• Spontaneous bacterial peritonitis
• Tickborne illnesses
• Toxic Shock Syndrome
• Community-acquired urosepsis
• Catheter-associated UTI (CAUTI)

Acid-base disorders

• Diagnosis: approach to pH analysis
• AGMA (Anion-Gap Metabolic Acidosis)
• NAGMA (Non-Anion-Gap Metabolic Acidosis)
• Metabolic alkalosis
• Respiratory acidosis (hypercapnia)
• Respiratory alkalosis (hypocapnia)

Acute kidney injury

• AKI & oliguria
• Hepatorenal syndrome
• Rhabdomyolysis
• Contrast nephropathy myth

Electrolytes .

• Hypernatremia
• Hyponatremia
• Hypokalemia
• Hyperkalemia
• Hypocalcemia
• Hypercalcemia
• Hypomagnesemia
• Hypermagnesemia
• Hypophosphatemia
• Hyperphosphatemia

Fluids & diuretics

• Fluid selection & pH-guided resuscitation
• Deresuscitation: Dominating the diuresis
• Stupor & Coma
• ICP elevation
• Brain death
• Neuro emergencies in pregnancy
• Neuro exam & lesion localization
• Neuroimaging
• Neuro-ultrasonography
• Analgesia and sedation
• Antiemetics

Anoxic brain injury

• Management of the post-cardiac arrest patient
• Neuroprognostication after anoxic brain injury

Effects on other organ systems

• Central (neurogenic) fever
• Takotsubo (stress) cardiomyopathy
• Neurogenic pulmonary edema
• Approach to CNS infection
• Meningitis/encephalitis
• Brain abscess
• Spinal Epidural Abscess (SEA)
• Neurological complications of COVID
• Unusual bacteria & mycobacteria
• Parasites & prions

Inflammatory

• Autoimmune encephalitis
• Acute demyelinating disorders
• Movement disorders
• Baclofen withdrawal & toxicity
• Serotonin Syndrome
• Malignant hyperthermia
• Neuroleptic Malignant Syndrome

Neuromuscular weakness

• Neuromuscular disorders & generalized weakness
• Guillain-Barre Syndrome (GBS)
• Myasthenic crisis

Neurosurgery

• External Ventricular Drain (EVD)
• Post-craniectomy management & complications

Oncological

• Neuro-oncology emergencies
• ICANS (CAR-T cell toxicity)
• Leptomeningeal carcinomatosis
• Convulsive status epilepticus
• EEG & Ictal-Interictal Continuum (IIC)
• Nonconvulsive status epilepticus (NCSE)

Spinal Cord

• Spinal cord disorders
• Traumatic Spinal Cord Injury (SCI)

Toxic / metabolic

• Alcohol withdrawal
• Wernicke encephalopathy
• (More on toxicology 👇 below )
• Traumatic Brain Injury (TBI)
• Paroxysmal sympathetic hyperactivity (PSH)
• Spinal Cord Injury (SCI)
• Acute Ischemic Stroke (AIS)
• Cerebral Venous Thrombosis (CVT)
• Cervical artery dissection (carotid & vertebral)
• Intracranial hemorrhage
• Subarachnoid hemorrhage (SAH)
• PRES (Posterior Reversible Encephalopathy Syndrome)
• RCVS (Reversible Cerebral Vasoconstriction Syndrome)
• Index of the IBNCC
• About the IBNCC
• Cardiopulmonary disease in pregnancy
• Neurological emergencies in pregnancy
• Preeclampsia & HELLP syndrome
• Thrombotic microangiopathy in pregnancy

General 🫁

• Approach to pulmonary infection
• CO2 abnormality: Hypercapnia and Hypocapnia
• Eosinophilic lung disease
• Hemoptysis  and DAH (diffuse alveolar hemorrhage)
• ABG, VBG, and pulse oximetry
• Capnography and end-tidal CO2
• Diagnosis of acid-base disorders
• Pulmonary function tests (PFTs)
• Other diagnostics & exam signs
• Approach to thoracic imaging
• Atelectasis
• Cavitary lesions
• Consolidation
• Cystic lung disease
• Distribution of abnormalities
• GGO (ground glass opacification)
• Lymphadenopathy
• Nodular patterns
• Reticular patterns
• Immunosuppression
• Inhaled pulmonary vasodilators
• Lung transplantation
• Noninvasive respiratory support (CPAP, BiPAP, HFNC)
• Smoking cessation

Airway disorders 🫁

• Asthma: Ambulatory & ward
• Asthma in ICU
• Bronchiectasis
• Bronchiolitis
• COPD: Ambulatory & ward
• COPD in ICU
• Cystic Fibrosis exacerbation
• Vocal cord dysfunction
• Drug-induced lung disease
• EVALI (E-cigarette or vaping associated lung injury)
• Fat emboli syndrome
• Pneumoconiosis

Infectious 🫁

• CAP (community acquired pneumonia)
• HAP (hospital acquired pneumonia)
• VAP (ventilator associated pneumonia)
• Lung abscess
• Typical pneumonias
• Atypical pneumonias
• Actinomycosis
• Tuberculosis
• Non-tuberculous mycobacteria
• Pneumocystis
• Cryptococcus
• Blastomycosis
• Histoplasmosis
• Coccidioidomycosis
• Aspergillosis
• Mucormycosis
• Other viruses

Interstitial lung diseases 🫁

• Acute exacerbation of ILD
• Amyloidosis
• CT-ILD (connective tissue-related ILD)
• DAD (diffuse alveolar damage)
• DIP (desquamative interstitial pneumonitis)
• GLILD (granulomatous & lymphocytic ILD)
• HP (hypersensitivity pneumonitis)
• IgG4-related lung disease
• IPF (idiopathic pulmonary fibrosis)
• LIP (lymphocytic interstitial pneumonia)
• Lipoid pneumonia
• NSIP (nonspecific interstitial pneumonia)
• OP (organizing pneumonia)
• PAP (pulmonary alveolar proteinosis)
• PAM (pulmonary alveolar microlithiasis)
• PPFE (pleuroparenchymal fibroelastosis)
• RBILD (respiratory bronchiolitis ILD)
• Sarcoidosis

Malignant 🫁

• Lung cancer
• Lymphoproliferative disorders
• Pulmonary complications from malignancy

Neuromuscular weakness 🫁

• Neuromuscular disorders

Pleural 🫁

• Pleural effusion
• Pneumothorax & bronchopleural fistula
• Pneumomediastinum

Vascular 🫁

• Diagnosis of PE & tx of low-risk PE
• Submassive/massive PE
• Pulmonary hypertension
• Pulmonary vasculitis & Diffuse alveolar hemorrhage
• Pulmonary AVMs & other vascular abnormalities
• Sickle cell acute chest syndrome
• Superior vena cava syndrome (SVCs)

Other 🫁

• Pulmonary manifestations of systemic diseases
• Sleep-disordered breathing
• Calcification & metastatic bone formation
• Anaphylaxis
• Pulmonary vasculitis

Basic toxicology

• Approach to the poisoned patient
• Hyperthermia
• Hypothermia

Common intoxications & withdrawals

• Acetaminophen
• Alcohols, toxic (ethylene glycol & methanol)
• Anticholinergics
• Beta-blockers
• Calcium channel blockers
• Carbon monoxide
• Local Anesthetic Systemic Toxicity (LAST)
• Metformin-associated lactic acidosis (MALA)
• Methemoglobinemia
• Neuroleptic Malignant Syndrome (NMS)
• Opioid intoxication
• Opioid withdrawal & buprenorphine
• Sodium channel blockers
• Sympathomimetics
• Tricyclic antidepressants
• Valproic Acid

The Internet Book of Critical Care is an online textbook written by Josh Farkas ( @PulmCrit ), an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.

We are the EMCrit Project , a team of independent medical bloggers and podcasters joined together by our common love of cutting-edge care, iconoclastic ramblings, and FOAM.

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Critical Care Topics

• Antibiotic Resistance
• Clostridium difficile Infection
• Coronavirus (COVID-19)
• Critical Care Nursing
• Hospital Medicine
• Mechanical Ventilation
• Methicillin-Resistant Staphylococcus aureus (MRSA)
• Pain Management

All Medscape Topics

• Acute Coronary Syndromes (ACS)
• Acute Leukemia
• Adolescent Medicine
• Aesthetic Medicine
• Affordable Care Act (ACA)
• Alzheimer's Disease
• AMD and Retinal Disease
• Antiretroviral Therapy
• Anxiety Disorders
• Arrhythmia & EP
• Arthroplasty
• Atopic Dermatitis
• Atrial Fibrillation
• Bariatric Surgery
• Barrett's Esophagus
• Bioterrorism/Disaster Medicine
• Bipolar Disorder
• Bladder Cancer
• Bone and Mineral Disorders
• Benign Prostatic Hyperplasia (BPH)
• Brain Cancer
• Breast Cancer
• C. difficile
• Cardiovascular Risk Reduction
• Cataract and Refractive Surgery
• Celiac Disease
• Child and Adolescent Psychiatry
• Chronic Kidney Disease
• Chronic Leukemia
• Colorectal Cancer
• Cornea and External Disease
• Cosmetic Dermatology
• Crohn's Disease
• CVD Prevention
• Cystic Fibrosis
• Dental and Oral Health
• Diabetic Microvascular Complications
• Eating Disorders
• Electronic Health Records
• Emerging and Reemerging Infectious Diseases
• End-Stage Renal Disease
• Erectile Dysfunction
• Exercise and Sports Medicine
• Fibromyalgia
• Gallbladder and Biliary Disease
• Genomic Medicine
• Geriatrics-Palliative Care
• GI/Colorectal Cancer
• GI/Noncolorectal Cancer
• GU/Prostate Cancer
• Head and Neck Cancer
• Health Diversity
• Healthcare Reform & the ACA
• Heart Failure
• Hepatitis B
• Hepatitis C
• HIV Transmission & Prevention
• Hodgkin's Lymphoma
• HPV and Cervical Cancer
• Hypertension
• Hypogonadism
• IBS and Chronic Constipation
• Immunization
• Infertility
• Inflammatory Bowel Disease
• Insulin Therapy
• Integrative Medicine
• Interventional Cardiology & Surgery
• Joint Disorders
• Kidney & Pancreas Transplant
• Lipids & Metabolic
• Liver & Intestine Transplant
• Lung Cancer
• Lyme Disease
• Medical Lifestyle
• Medical Malpractice and Legal Issues
• Medical Practice Management
• Mental Health and Psychiatric Nursing
• Metastatic Breast Cancer
• Minimally Invasive Gastrointestinal Surgery (MIGS)
• Moderate to Severe Asthma
• Multiple Myeloma
• Multiple Sclerosis
• Neonatal Medicine
• Neurosurgery
• Non-Hodgkin's Lymphoma
• Novel Coronavirus
• Nurse Career and Education
• Nurse Practitioners
• OB/GYN and Women's Health Nursing
• Obesity and Weight Management
• Osteoarthritis
• Osteoporosis
• Otitis Media
• Otolaryngology
• Ovarian Cancer
• Palliative Care
• Pancreatitis
• Parenteral and Enteral Nutrition
• Parkinson's Disease
• Patient Safety
• Pediatric Dermatology
• Pediatrics/Neonatal Care Nursing
• Pediatric Ophthalmology
• Peptic Ulcer Disease
• Perioperative Nursing
• Preclinical Studies
• Prostate Cancer
• Psoriatic Arthritis
• Pulmonary Arterial Hypertension
• Rare Diseases
• Reimbursement and Quality
• Renal Cell Carcinoma
• Reproductive Endocrinology
• Restless Legs Syndrome
• Rheumatoid Arthritis
• Schizophrenia
• Science and Technology
• Sjögren's Syndrome
• Skin Cancer
• Sleep Disorders
• Social Determinants of Health
• Spinal Disorders
• Stroke/Cerebrovascular Disease
• Substance Abuse and Addiction
• Systemic Lupus Erythematosus
• Thyroid Cancer
• Thyroid Disease
• Type 1 Diabetes
• Type 2 Diabetes
• Ulcerative Colitis
• Urinary Incontinence & OAB
• Women's Sexual Health
• Wound Management

Featured Topics

Critical Concepts

Meditations on critical illness

A beginner’s guide to the ICU

Newcomers to the ICU are often overwhelmed by the sheer volume of unique situations encountered among critically ill patients. Over time, they develop a basic approach and knee-jerk response to most of them — and with even more time, they acquire a more flexible and evidence-based understanding of each situation. However, particularly for residents and students rotating for only a few weeks at a time, it’s helpful to have a “cheat sheet” of basic heuristics.

Here are some simple suggestions for commonly-encountered issues. It  must be noted that these are simplifications, and each has exceptions for which it is the wrong answer. This is a starting point only; step one is learning these solutions, but step two is learning when they fail.

With that being said, there are plenty of complicated things in medicine; don’t make the simple things complicated. What follows are some simple things.

The patient is hypotensive. Should you bolus fluid?

Whole books have been written on the question of “fluid responsiveness.” If you stick with this business long enough, you’ll eventually find methods that work for you. Until then, try a small bolus, given quickly, and see if the patient responds. If not, stop doing that.

The patient is out of shock and getting better. They look like the Michelin Man. What should you do?

Diurese them. Eventually they’ll pee it off (if their kidneys work), but they’ve got stuff to do and so do you, so hasten the process. Start with 20mg of IV furosemide, increase the dose if they don’t respond within a few hours, and repeat when the effect wanes until they reach euvolemia.

Does the patient need maintenance IV fluid?

Eh. If you went nuts with their initial resuscitation, probably not. If you’ve kept them very dry, maybe a little. If they’re euvolemic and won’t be able to eat for a long time, fine.

What about albumin?

If you want to bolus but want to limit the total amount of fluid you give, fine. If you think they’re intravascularly dry but whole-body overloaded (e.g. attempts at diuresis result in hypotension, but they’re still edematous), you can try hypertonic albumin combined with diuresis. Be aware that this is all voodoo and probably doesn’t work.

Acceptable numbers

When is hypertension a problem in the routine icu patient.

Almost never. Keeping the systolic <180 is a reasonable line to draw. Of course exceptions exist, such as neuro patients and those at risk for bleeding.

When is hypotension a problem in the routine ICU patient?

Keep the MAP >65.

When is hyperglycemia a problem in the routine ICU patient?

Keep the blood glucose <180.

When is fever a problem in the routine ICU patient?

Fever may indicate infection and often warrants cultures and some thought about potential sources. The temperature itself, however, is not bad and is mostly a nuisance.

Treat it as a subjective phenomenon, like pain: if it’s bothering the patient, consider acetaminophen or external cooling. Otherwise, who cares.

When should you remove a central line?

As soon as it’s no longer needed and the odds of needing it again are low. Don’t routinely change them out, unless it was not placed in a sterile fashion (emergent lines), in which case remove them ASAP. Femoral lines in most centers are also removed within a few days.

“I can’t aspirate one of the ports on this central line, but it flushes fine.”

A fibrin sheath or small clot is probably creating a one-way valve at the tip. Don’t worry about it. In terribly rare cases the catheter tip could be somewhere bad (extravascular); take an xray if in doubt.

“I can’t aspirate blood from this arterial line, and the tracing is really damped.”

Same problem, a common occurrence in radial lines. Pull it out, and if still needed, replace it. Rewiring it rarely works.

“One of the ports in this line won’t flush.”

It’s clotted. Instill tPA (packaged for this purpose and called “Cathflo”), let it dwell, and then aspirate it back out. Nursing knows how to do this.

Ventilators

Ventilator is “losing volume,” i.e. exhaling substantially less air with each breath than was inhaled..

AKA a “cuff leak.”

Involve respiratory therapy. If minor, add a bit of air to the cuff, and take a chest xray: the tube may be high. If major and the patient is destabilizing, treat as an emergency: pull the tube and reintubate.

The patient occasionally has a paroxysm of movement, and the ventilator’s “high peak pressure” alarm sounds.

They’re coughing. Suction their tube.

The patient is tachypneic, restless, and repeatedly bucking and sounding high pressure alarms.

They are “dyssynchronous.” In order:

• Ask if they are in pain.
• See if there is anything else making them uncomfortable.
• Collaborate with respiratory therapy to adjust the vent to improve their comfort.
• Sedate them.

The patient is precipitously desaturating or having other sudden respiratory deterioriation on the vent.

With the help of respiratory therapy, disconnect the vent and bag the patient. Call everyone.

A tracheostomy came out.

If >1 week old, consider carefully replacing it. If <1 week old, don’t  stick it back in; get help. (It probably won’t go where you want.) If the patient is doing poorly, just reintubate from above.

The most common reason to intubate someone?

They look terrible.

What should you do immediately after intubation?

Order a chest xray, a blood gas, and an analgesia/sedation package. Remember they may still be paralyzed, yet your RSI sedative may be wearing off, and awake paralysis is never acceptable for even a short time.

What should you do immediately after extubation?

Order pulmonary toilet stuff, discontinue continuous IV sedatives (fentanyl, propofol, benzos, etc), and consider ordering either a diet or a swallow study.

What exactly is “pulmonary toilet”?

The process of clearing secretions from the lungs. Often a problem in weak patients with a poor cough reflex, in trauma patients with chest wall injury (hurts to cough), and in anyone who is bedbound. Manage pain aggressively in trauma patients, such as with PCAs and lidocaine patches. Other than that, in order of aggressiveness, use:

• Incentive spirometry, mobilizing out of bed
• Flutter valve
• Chest physiotherapy (thumping on their chest)
• Positive pressure and oscillatory therapies [where available]
• Nasotracheal suctioning
• Bronchoscopy

Give high-risk admissions and recently-extubated patients the “pulmonary toilet” speech:

Your job now is going to be to use your lungs: take deep breaths, cough out any junk you have in there, and do breathing exercises. Healthy lungs are filled with air and nothing else, but they only stay healthy if you use them. If you take small breaths and don’t cough stuff out, you’re going to get complications like pneumonia. We’ll manage your pain and try to help you out, but using your lungs is your job.

Daily workflow

What should you order every day.

Depends on your unit culture and policy. Common daily labs may include a chemistry, CBC, serum magnesium, and serum phosphorous. Vented patients may have a daily blood gas and xray. When in doubt, order away, but don’t order something you don’t need.

Should you order that CT scan, MRI, or other study requiring travel outside the unit?

Only if it’s going to change your care and is worth the risk. Bad things happen and people can die in Radiology. Especially in MRI. When in doubt, personally go with them.

What are the most common things you’re looking for on routine xrays?

ET tube position, volume status, and focal infiltrates.

Less often: pleural effusions, pneumothorax, other hardware.

How should you organize presentations, notes, and general plans of care?

By system .

What should you ask every day when rounding on a patient no longer being actively resuscitated ?

What meds, labs, and other orders can you discontinue? What devices can you remove? Can the patient mobilize? Can they be downgraded from the ICU?

A nurse needs something you find frivolous. Can you act annoyed?

Absolutely not. The next time they may not tell you when a patient is crashing.

A nurse calls because a patient is hypotensive, desaturating, or their airway is causing trouble. You should…

Go there. Now. Physically.

When should you involve someone senior to you in a decision?

• When you’re unsure (this depends on you).
• When they would expect it (this depends on them).

When should you arrive for your shift?

Early enough that you’ll know each of your patients sufficiently well to understand what’s happening if they code one minute after your shift begins.

When should you leave?

Once you finish all the tasks that would suffer or be delayed from being handed off.

What’s the most important message to convey when you arrive at a code, rapid response, or other emergency?

You’re here. The emergency is over.

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• Clinical Topics

Critical Care

Critical care educational resources.

SHM strives not only to create and deliver top quality content, but also to help hospitalist find and access existing resources. The content below is a listing of existing resources from other societies and organizations.*

SHM Resources

Critical care for the hospitalist series.

This educational series covers common or high-risk clinical scenarios that hospitalists encounter in and out of the intensive care unit, covered over seven modules on SHM’s Learning Portal.

COVID-19: What's Next - Preparing for the Second Wave

SHM has partnered with the Society of Critical Care Medicine (SCCM), along with several sponsoring societies to bring this online conference to you, September 11-12, 2020. Ensure that you are equipped with the latest information and clinical knowledge as the disease continues to spread.

Reference Sites

Airway world.

Written content and videos covering all things related to airway management. They also run several hands-on airway management courses .

American Thoracic Society

Extensive library of critical care videos, lectures and other educational resources.

Website dedicated to ARDS research and education. They publish a concise and very useful ventilator management protocol for patients with ARDS.

The Bottom Line

Concise synopses of important critical care trials, categorized by subject.

Critical Care Reviews

Comprehensive weekly synopsis of top critical care publications and guidelines. Subscribers get a weekly email.

Difficult Airway Society

British airway website dedicated to (you guessed it), management of the difficult airway.

Deranged Physiology

Excellent reviews of critical care physiology and pathophysiology.  Great resource for re-learning basic concepts as they apply to the ICU.

Emcrit/Pulmcrit

One of the oldest and best critical care websites.  Videos, podcasts and written content covering many topics and controversies in acute resuscitation and critical care.  Excellent procedure guidelines and videos.

Life in the Fast Lane (LITFL)

Rapid reference for almost any topic in critical care medicine.  Content is presented in succinct, outline format.  Excellent resource when time is short and you need answers.

Neurocritical Care Society

Guidelines, toolkits and publications covering all aspects of neuro-critical care.

Social Media and Critical Care (SMACC)

The gathering place for many of the people who sponsor open access critical care education.  Hosts many lecture videos from the annual SMACC conference. 

Surviving Sepsis Campaign

Published by SCCM and ESICM.  Excellent resource for sepsis guidelines, care bundles and quality improvement tools.

Needs no introduction.  Regularly updated content in critical care medicine.

5 Minute Sono

Excellent short videos on all aspects of point of care ultrasound.

Introduction to Radiology

Comprehensive tutorial for every imaging modality and everybody part.

Stanford University Focused Echo and Ultrasound Course

Free, self-paced, comprehensive on-line critical care ultrasound course.  Good discussions of basic ultrasound physics and imaging.

Ultrasound podcast

Comprehensive and often irreverent ultrasound resource focused on emergency medicine and critical care sonography.

Formal Courses and Curricula

Accp and sccm board review courses.

Multi-day Critical Care Board Review Courses.  Designed for intensivists, but could easily apply to hospitalists looking for a comprehensive refresher in critical care medicine.

Airway Management

The airway site.

Emergency Neurological Life Support (ENLS)   

Structured curriculum teaching the approach the first few hours of many neurological emergencies.

Fundamentals of Critical Care Support (FCCS)

Approach to initial identification and management of the critically ill patient.  Curriculum can be completed at a traditional live course or on line at one’s own pace.

ACCP Mechanical Ventilation Course

Self-paced at home curriculum followed by a 3-day hands on training course and a final exam. 

Principles of Critical Care Medicine for Non-Intensivists

Annual 3-day course sponsored by Harvard and Beth Israel Deaconess.  Covers many topics in critical care.

ICU Ultrasound

There are many regional and national courses for point of care ultrasound.  Here’s a very partial list:  ACP , ACCP , SCCM ,  The Emergency Ultrasound Course .

Procedure Videos

Nejm videos in clinical medicine series.

High quality videos covering most common ICU procedures. Requires a NEJM subscription, although some videos are available on YouTube.  

*SHM does not endorse any of these particular resources in any way.

Critical Care Compendium

The LITFL Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care. Currently there are over 1,500 entries with more in the works, and all the pages are being constantly revised and improved.

The CCC was created, and is maintained, by Chris Nickson and originated from the FCICM exam study notes created by Jeremy Fernando in 2011. All of these pages have been updated, modified and added to since by a number of contributors (see below). As such will be particularly useful to those studying for the CICM Fellowship exam (though there are topics outside the scope of the exam as well). Increasingly, entries relevant to the FACEM exam are also being added.

NOTE : Pages are continually added under these topic headings, to find a current list of pages for each topic just search for the topic heading in the searchable index table.

We have defined “critical care medicine” as the triad of 1) resuscitation, 2) emergency care for life-threatening conditions, and 3) intensive care; including all components of the emergency and critical care medicine delivery system, prehospital and hospital. Peter Safar, 1974

• CCC Update 014
• CCC Update 013
• CCC Update 012
• CCC Update 011
• CCC Update 010
• CCC Update 009
• CCC Update 008
• CCC Update 007
• CCC Update 006
• CCC Update 005
• CCC Update 004
• CCC Update 003
• CCC Update 002
• CCC Update 001

References and resources

Numerous resources and references, in addition to those listed at the end of each page, were particularly useful in creating the compendium.

• ICU Mind Maps by Paul Young, litfl.com
• ECG Library by Buttner R, Burns E, Larkin J, Nickson C, Cadogan M
• CICM Fellowship Overview

FOAM and web-based resources

• CriticalCareReviews.com  (curated articles from the critical care literature, including an annual free-to-access book critically appraising major trials)
• Medsafe (New Zealand Medicines and Medical Devices Safety Authority)
• The Bottom Line  (compendium of critical appraisals of the ICU research literature)
• David Tripp’s magnum opus of Intensive Care Medicine FCICM study notes  (pdf last updated December 2014; David Tripp’s website is here )
• Acute Pain Management: Scientific Evidence (3e) PDF Macintyre PE, Schug SA, Scott DA, Visser EJ, Walker SM; Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. Melbourne, 2010.
• Atlas of Emergency Radiology Block, Jordanov, Stack. 2013
• Australian animal toxins: the creatures, their toxins and care of the poisoned patient (2e) Sutherland SK, Tibballs J. Oxford University Press 2001.
• Clinical Examination: A Systematic Guide to Physical Diagnosis (7e) Talley NJ, O’Connor S. 2013.
• Clinical Procedures in Emergency Medicine (6e) Roberts JR, Hedges JR. Saunders 2013.
• Data Interpretation in Critical Care Medicine (5e) Venkatesh B, Morgan TJ, Joyce C, Townsend S. Butterworth-Heinemann, 2012.
• Diagnostic Imaging in Critical Care – A problem based approach Joyce, C, Saad, N, Kruger, P, Foot, C, Blackwell, N. Elsevier, Churchill Livingstone, Australia, 2010
• ECG in Emergency Medicine and Acute Care . Chan T, Brady W, Harrigan R, Ornato J, Rosen P. Mosby, 2004.
• Emergency Radiology Schwartz DT, Reisdorff EJ. McGraw-Hill 2000.
• Examination Intensive Care Medicine (2e), Foote C, Steel L, Vidhani K, Lister B, MacPartlin M, Blackwell N. Elsevier 2011.
• Eye Emergency Manual 2e PDF NSW Statewide Opthalmology Service.
• Goldfrank’s Toxicologic Emergencies (9e) Flomenbaum N, et al. McGraw-Hill 2010.
• MD Consult online resource
• Neurological differential diagnosis: a prioritized approach Bhidayasiri R, Waters MF, Giza CC. Blackwell Publishing 2005.
• Neurological differential diagnosis (2e) Patten J. Springer-Verlag 2004.
• Oh’s Intensive Care Manual (7e) Bersten AD, Soni N. 2013.
• Paediatric Handbook (8th edition) Royal Children’s Hospital Melbourne 2010
• Patient Safety in Emergency Medicine . Croskerry P, Cosby KS, Schenkel SM, Wears RL. Lippincott Williams & Wilkins, 2009.
• Plum and Posner’s Diagnosis of Stupor and Coma (4e) Posner JB, et al. Oxford university Press 2007.
• Poisoning and Drug Overdose (6e) Olsen, K. Lange/ McGraw-Hill 2006.
• Principles and Practice of Mechanical Ventilation (3e) Tobin M. McGraw-Hill, 2012
• RCH Clinical Practice Guidelines Royal Children’s Hospital Melbourne
• Rosen’s Emergency Medicine: Concepts and Clinical Practice (8e) Marx JA, Hockberger R, Walls RM. Mosby 2013.
• Textbook of Critical Care (6e). Vincent J-L, Abraham E, Kchanek P, Moor FA, Fink MA.Elsevier, 2013.
• The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease Ehlers JP, Shah CP, Fenton GL, and Hoskins EN. Lippincott Williams & Wilkins 2012.
• Therapeutic Guidelines (Australia) [subscription required]
• Toxicology Handbook (2e) Murray L, Daly FFS, Little M, and Cadogan M. Elsevier Australia 2011.
• Trauma: A Comprehensive Emergency Medicine Approach Legome E, Shockley LW. Cambridge University Press, 2011.
• Wilderness Medicine (6e) Auerbach P, Mosby Elsevier 2011
• Wounds and Lacerations: Emergency Care and Closure (4e) Trott AT. Mosby, 2012.
• Alex Psirides FCICM
• Cameron Knott FCICM
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• Esti Blazquez FANZCA FCICM
• James Hayes FACEM
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Critical Care

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Table of contents.

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Introduction

• Core teaching topics

Respiratory

Cardiovascular, gastrointestinal, renal, fluids, and electrolytes, endocrine and metabolic, infectious diseases, hematological, central nervous system and neuromuscular disorders, transplantation, environmental, trauma, burns, ethical, legal, and psychosocial issues, transport of the critically ill.

• ICU administration

Procedural skills

Miscellaneous.

• Medical Student's Guide to the ICU - from the Society of Critical Care Medicine
• Critical Care Medicine Tutorials - A collection of tutorials from the Gasworks Group

Core topics

• Airway objectives P Melanson, MD
• Acute respiratory failure P Melanson, MD
• Introduction to Mechanical Ventilation Erin Monaghan, RRT
• Management of Post-op Cardiac Surgery Patients
• Continuous Renal Replacement Therapy (CVVH, CVVHD) D Payen, MD
• Invasive Procedures On-line Training Modules from EMEDU.org
• Pulmonary Artery Catheter Education Project - hemodynamic monitoring/Swan-Ganz

Airway series - Pat Melanson, MD

• Airway teaching objectives
• Basic emergency airway management slides
• Bag-mask-ventilation slides
• Emergency airway management
• Rapid sequence intubation slides
• Difficult airway management slides
• The Difficult Airway Kit - Devices and techniques
• Advanced airway management
• Acute Respiratory Failure Pat Melanson, MD
• CPAP BiPAP Pat Melanson, MD
• Preventing intubation in acute respiratory failure Pat Melanson, MD
• Massive Hemoptysis D Laporta, MD
• Pericardial tamponade Pat Melanson, MD
• Hypertensive Emergencies Pat Melanson, MD
• Hemodynamic Monitoring N Christou, MD
• Shock D Laporta
• GI Bleed N Christou, MD
• Acute Pancreatitis A M. Albert, MD
• Acute Pancreatitis B M. Albert, MD
• Fulminate hepatic failure Pat Melanson, MD
• Renal Replacement Therapy in the ICU - A link to Medical Education Rounds, St Paul's Hospital, Vancouver, BC
• Acute Renal Failure Pat Melanson, MD

No information available at this time.

• Soft Tissue Infections N Christou, MD
• Antibiotic Therapy for Intra-Abdominal Infections N Christou, MD
• SIRS - Diffuse severe peritonitis study, phase 1 N Christou, MD
• Blood component therapy Pat Melanson, MD
• Stroke Therapy in the Age of Thrombolysis Mark Angle, MD
• Guidelines for the ED Management of Acute CVA Pat Melanson, MD
• Blood Pressure Management in Acute CVA Pat Melanson, MD
• Cerebral vasospasm in SAH Mark Angle MD
• Obstetrics in Critical Care D Laporta, MD
• Heat Illness Pat Melanson, MD
• Burns N Christou, MD

Toxicology series - Pat Melanson, MDe

• Toxicology: General management principles
• Toxicology references
• Tricyclic antidepressants
• Acetaminophen
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• Theophylline
• Drug-induced hyperthermia
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• Bioethics for clinicians (Canadian Medical Association)
• Ethics Curriculum - Royal College of Physicians and Surgeons of Canada
• Guidelines for Transfer of the Critically Ill - SCCM

ICU Administration

• ICU Triage and Admission Criteria
• ICU Scoring Systems N Christou, MD
• Use of Corticosteroids in the ICU D Laporta, MD

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• Overview Connect with SCCM Members
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Critical Care Ultrasound

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• Overview Accredited Education and Subject Matter Expert Resources
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• Overview Critical Care Innovation Incubator
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• Overview Research Grants
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• Overview Quality Improvement
• ICU Centers of Excellence Program
• Overview Global Health
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• Overview LearnICU

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Supporting humanitarian efforts worldwide, the latest from sccm, leaning forward, sccm journals transition to fully online.

Explore why SCCM is shifting its journal strategy to online-only models starting in January 2025 and what that means for readers and authors.

Crisis and Chaos: Pandemic Perspectives

Critical Care Congress 2024 Thought Leader Jerome Adams, MD, MPH, FASA, discusses the urgent need for health equity initiatives and innovative solutions to systemic healthcare challenges.

Achieving Sustainable Healthcare in Africa

Learn how the Africa Infrastructure Relief and Support (AIRS) project is ensuring the availability of medical oxygen to patients in the Gambia, Liberia, and Sierra Leone.

Membership Benefits

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Subscription to Critical Care Medicine , the #1 critical care subspecialty journal, as well as full online access to the archives.

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Access to a fully searchable collection of more than 1500 critical care presentations, book chapters, podcasts, webcasts, articles, and more in LearnICU.

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Join world-renowned experts and your colleagues February 23-25, 2025, in Orlando, Florida, for an immersive educational experience.

Fundamental Critical Care Support

Provide critical care knowledge and training for healthcare professionals of all levels.

Gain the realistic training needed to perform and interpret ultrasound imaging.

Multiprofessional Critical Care Review

Receive the most comprehensive review and update in the diagnosis, monitoring, and management of critically ill patients.

Host a Course at Your Institution

Contact the SCCM Hosted Training Team to get more information about bringing training to your institution.

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A central component of the Society's mission is the support of quality-based improvement initiatives and resources to support the multiprofessional critical care team.

ICU Liberation

Liberate patients from the harmful effects of an ICU stay and improve their long-term outcomes.  

Surviving Sepsis Campaign

Be part of the international effort to reduce mortality and morbidity from sepsis and septic shock.

Help expand research to improve outcomes for critically ill and injured patients.  

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Explore resources for patients and families and information about post-intensive care syndrome.  

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Access resources on COVID-19 vaccines, best practices for treatment, clinician well-being, and more.  

CLINICAL 

SCCM and IDSA Guidelines for Evaluating New Fever in Adult Patients in the ICU

Guidelines for rapid sequence intubation in the critically ill adult patient, guidelines for the management of adult acute and acute-on-chronic liver failure in the icu (part ii), sccm journals.

SCCM’s premier peer-reviewed journals provide articles to help readers stay ahead of the latest advances in critical care technology and research as new and innovative findings continually improve the practice of critical care. SCCM’s Professional and Select members receive  Critical Care Medicine  as part of their benefits, and members of the Pediatrics Section receive  Pediatric Critical Care Medicine . SCCM also publishes the open access journal  Critical Care Explorations . 

Critical Care Medicine

Critical Care Medicine  covers all aspects of acute and emergency care for the critically ill or injured patient, including the latest news on clinical breakthroughs and promising research.

Pediatric Critical Care Medicine

As the official pediatric publication of SCCM and WFPICCS, Pediatric Critical Care Medicine  is devoted to pediatric and neonatal intensive care medicine.  

Critical Care Explorations

Critical Care Explorations  is a rapid-publication, open-access journal that publishes exploratory and timely studies.  

Powerpoints and Presentations

Atrial Fibrillation

Pulmonary Embolism  

EKG at a glance

Hype rtensive c risis

Management of COPD

Invasive Fungal infections in ICU

Viral Encephalitis

Perioperative Anticoagulation

Human Granulocytic Anaplasmosis

Targeted Temperature Management

ECMO in ARDS

Management of ICH

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Critical Care

Contribute to the state of the science— submit a topic proposal for a CHEST guideline on critical care or one of eight other topic areas. Proposals are due Monday, April 15. START YOUR SUBMISSION »

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Must-reads and more in CHEST ® journal portfolio

Barriers and Facilitators of Surrogates Providing Consent for Critically Ill Patients in Clinical Trials

Clinician- and Patient-Identified Solutions to Reduce the Fragmentation of Post-ICU Care in Australia

Barriers, Facilitators, and Trends in Prone Positioning for ARDS

Physician Perspectives on Challenges in Understanding Patient Preferences for Emergency Intubation

Integrating Social Determinants of Health in Critical Care

Post-COVID-19 Clinic Utilization Among Survivors of Critical Illness in Two Waves of SARS-CoV-2 Infection

Use of Intravenous Albumin: A Guideline From the International Collaboration for Transfusion Medicine Guidelines

Achieving Goals of Care Decisions in Chronic Critical Illness Sarah K. Andersen, MD, and Gretchen Winter, MD (moderator)

Is automatic ventilation feasible and comparable with manual ventilation during cardiopulmonary resuscitation?

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CHEST JOURNAL PORTFOLIO | Access even more critical care research. READ THE JOURNALS »

On this page

Clinician education resources

Patient education resources

News and notes

Critical care resources to enhance patient care

Clinician education and in-person training.

Algorithm for Initiation of Noninvasive Ventilation

This flowchart is based on the Respiratory Management of Patients With Neuromuscular Weakness guideline from CHEST.

Antithrombotic Therapy in COVID-19

This guideline provides recommendations for managing four arterial (pro)thrombotic medical conditions in patients with COVID-19.

Reviewing RSV in Immunocompromised Adults

Dr. Ryan Maves speaks with Dr. Kelly Pennington about how clinicians can help patients with respiratory syncytial virus (RSV) achieve their best outcomes.

CHEST Annual Meeting

Get the latest updates in clinical chest medicine, engage in interactive and experiential learning, and connect with like-minded clinicians.

Ultrasonography: Essentials in Critical Care

Grow your competence in point-of-care ultrasonography with an emphasis on image acquisition and interpretation, September 12 to 13.

Advanced Airway Management

Enhance your airway management skills through cadaver-based, interactive sessions for managing challenging airway scenarios, November 22.

Respiratory Syncytial Virus (RSV): Measuring the Impact and Vaccine Prevention

Review this interactive infographic to learn how to identify RSV pathophysiology; describe risk factors, impact, and potential complications of RSV in older adults; relate the importance of protecting older adults at risk for serious complications as a result of respiratory comorbidities; and implement new and emerging vaccines.

Supported by an independent medical educational grant from GSK.

VIEW THE INTERACTIVE INFOGRAPHIC »

Join the Critical Care Network

CHEST Networks are specialty-focused communities that provide forums for leadership, education, and advocacy. The Critical Care Network enhances the scientific knowledge, evidence-based medicine, and clinical practices that further our understanding of the mechanism and management of acute and life-threatening critical illness, nonrespiratory critical care, palliative and end-of-life care, and sepsis/shock.

LEARN MORE »

Critical care news and notes

Follow the latest critical care news.

Addressing Physician Burnout in Pulmonology and Critical Care Explore infographics on reported rates of burnout, common manifestations of burnout, and how to combat it among health care workers.

Use of albumin in critically ill patients This article highlights albumin, a human-derived blood product studied widely in a variety of patient populations, with a focus on when it should be administered.

On thoughtful selection of medications This article discusses the use of opioids for sedation management in the acute critical care setting.

Complexity of hemodynamic assessment in patients with cirrhosis and septic shock In patients with decompensated cirrhosis, there are multiple intrahepatic and extrahepatic factors contributing to hemodynamic alterations at baseline.

APPs and POCUS: Overcoming credentialing challenges Given their increased role within critical care, APPs need to not only become familiar with POCUS but also demonstrate proficiency in practice.

Hospital-onset sepsis: Why the brouhaha? Authors highlight the importance of prompt identification and treatment of HOS within the first few hours of onset and regular reevaluation of the patient’s response.

EIT: Visualization and integration of the impact of mechanical ventilation Integrating EIT into invasive mechanical ventilation can provide a personalized approach to determining the optimum ventilatory settings based on individual patient conditions.

The pendulum swings in favor of corticosteroids This article provide an update on trials and guidelines that consider how low-dose corticosteriods impact mortality in adults with septic shock.

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NEW | Test your knowledge with 150 newly added critical care questions, including multiple case-based questions on acid-base disorders, cerebrovascular disease, and mechanical ventilation.

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• Upcoming Journal Club - September 23rd: Health-Related Quality of Life Among Survivors of Pediatric Sepsis
• Webinar - Integrating Age-Friendly Care in Pulmonary Clinic: What Every Clinician Should Know
• Podcast: At The Bedside: Episode 3 – Approach to Thrombocytopenia in the ICU
• Podcast: ATSRxPodcast: Emerging Trends and Treatments for Asthma
• Joint Webinar - The Landscape of Undergraduate Medical Critical Care Education, the Now and Future Directions
• Journal Club - Identification of Persistent and Resolving Subphenotypes of Acute Hypoxemic Respiratory Failure in Two Independent Cohorts
• Podcast: Elevator Pitch: Antibiotic Delays - New Insights into an Old Problem
• Journal Club - September 8, 2021: Multisystem Inflammatory Syndrome in Children – Initial Therapy and Outcomes
• Podcast: Critical Perspective: Administration of IL-6 Antagonists and Mortality Among Patients Hospitalized for COVID-19, A Meta-analysis
• Podcast: Critical Perspective: Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure
• Podcast: Critical Perspective: Multicenter Adaptive Platform Trials in Adults with COVID-19
• Podcast: Critical Perspective: Protocolized Post-Extubation Respiratory Support to Prevent Re-intubation
• Journal Club - June 10, 2021: Effect of Phenylephrine Push before Continuous Infusion Norepinephrine in Patients with Septic Shock
• Joint Journal Club RSF-AII-CC-SRN - June 4, 2021: Remote Ischemic Conditioning for Acute Respiratory Distress Syndrome in COVID-19
• Joint Webinar - COVID-19 and chronic lung diseases: pathobiological and clinical considerations. Insights into the savage Italian outbreak
• Finding Your Niche in Medical Education
• Health-Related Quality of Life Among Survivors of Pediatric Sepsis
• Journal Club:  Effect of a Low vs Intermediate Tidal Volume Strategy on Ventilator-Free Days in Intensive Care Unit Patients Without ARDS
• Clinical Education: Applied Physiology video lectures
• New Podcast: Eddy Fan talks about ECMO and EOLIA

Welcome to the ATS Critical Care website. We hope that this site will be a resource for clinical tools and educational material that enhance your work at the bedside, on rounds, and in the laboratory.

Critical care medicine makes up about half of the clinical activities of the American Thoracic Society membership.  Intensivists and other specialists who practice in the intensive care unit are drawn to our society because of its leadership in critical care practice, education, and scholarship.

The site harnesses that expertise and contains materials and programs developed by members of the ATS Critical Care assembly.  We invite new proposals and submissions to publish here. Interactive educational materials such as critical care case presentations, medical imaging, and reviews of recent critical care journal articles are particularly well-suited for this site. All submitted work will undergo peer review and be posted as enduring educational material.

Web Director: Sarina Sahetya, MD, MHS

The American Thoracic Society improves global health by advancing research, patient care, and public health in pulmonary disease, critical illness, and sleep disorders. Founded in 1905 to combat TB, the ATS has grown to tackle asthma, COPD, lung cancer, sepsis, acute respiratory distress, and sleep apnea, among other diseases.

AMERICAN THORACIC SOCIETY 25 Broadway New York, NY 10004 United States of America Phone: +1 (212) 315-8600 Fax: +1 (212) 315-6498 Email: [email protected]

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Mayo Clinic Resources

Mayo clinic libraries services.

Please let us know if you have any suggestions , questions, or find broken links. Contact us at:

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Surgicalcriticalcare.net

Evidence based-medicine guidelines.

The following is a collection of best practice guidelines currently in use by the Surgical Critical Care service at Orlando Regional Medical Center (ORMC). They are based upon the most recent medical literature and are reviewed and updated on a regular basis. Please note that certain aspects of these guidelines, such as antibiotic sensitivities and recommendations, are specific to the adult ICU's at ORMC and may not be applicable to other patient populations. These guidelines may be downloaded and adapted for use in your own intensive care unit. Please contact the Webmaster if you have questions or suggestions regarding these guidelines.

The Evidence-Based Medicine Guidelines Committee is pleased to share these guidelines for clinical use in your intensive care unit. If you choose to do so, the Committee requests that the time and effort involved in developing these guidelines be appropriately recognized. All guidelines contained on this site are copyrighted by Surgicalcriticalcare.net unless otherwise indicated. Guidelines should be referenced in the following manner: Rojas K, Birrer K, Cheatham M, Smith C. Seizure Prophylaxis following Traumatic Brain Injury. http://www.surgicalcriticalcare.net/Guidelines/Seizure prophylaxis in TBI 2017.pdf. Updated July 26, 2017. Accessed January 13, 2021.

Cardiovascular

Fluids, Electrolytes, Nutrition

Gastrointestinal, hematologic, infectious disease, miscellaneous.

Critical Care Northampton

Reviewing Critical Care, Journals and FOAMed

General ICU Topics

ABG Analysis

Continuous Veno Venous Haemofiltration

IV Fluid Therapy

Basic Maintenance

O2 Delivery

Shock – A General Definition

Shock – A Guide on How to Distinguish Types

Shock – Anaphylactic

Shock – Cardiogenic

Shock – Compensatory Mechanisms

Shock – Diagnosis

Shock – Diagnosis & Treatment

Shock – Dissociative

Shock – Haemodynamics

Shock – Hypovolaemic

Shock – Neurogenic

Shock – O2 Delivery

Shock – Septic

Shock – Obstructive

  Focus on Sepsis

Sepsis in 5 minutes!

Sepsis – Consensus definitions

Sepsis – Endothelial Barrier Dysfunction 3D

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