Only 10 days left to register for the 5th Annual McMaster Critical Care Update on Wed, Dec 11/24 @LIUNAStation. 🌟 Expand your critical care knowledge & network at this in-person CPD event. Register today 🔗 #MacCPD #CritCareCPD

Don’t miss the 5th Annual McMaster Critical Care Update on Wed, Dec 11/24 @LIUNAStation! 🌟 Learn, connect & grow your critical care network at this in-person CPD event. Register now 🔗 #MacCPD #CritCareCPD

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#CritcareCPD will be recorded, & the recordings will be accessible to all registrants for 6 months. Only registrants who attend will be eligible to receive a certificate of attendance for CME credits. View the brochure + register today!.🔗 #MacCPD

View the agenda & expert speakers for the McMaster Critical Care Update on Wed, Dec 11/24 @LIUNAStation! View the brochure + register 🔗 .#MacCPD #CritCareCPD

Register now for the 5th Annual McMaster Critical Care Update and join us on Wed, Dec. 11/24 @LIUNAStation. This in-person CPD is an opportunity to learn, connect, & expand your critical care network. Register 🔗 #MacCPD #CritCareCPD

Thank you everyone who attended the McMaster Critical Care Update Day, for those who have followed along here, and of course to our amazing speakers!. We hope to see everyone again in Hamilton next year! Stay well~. @mcmasterchse // #critcareupdate2022.

4. Goals:.A. Maintain opioid tolerance in hospitalized patients to minimize post-discharge accidental overdoses.B. Avoid unexpected discharges .C. Initiate opioid agonist therapies (OATs). If Addictions Specialist services are available at your hospital, consider a consult!.

3. Consider adjuncts in PWUD (persons who use drugs). - Nicotine replacement therapy. - THC replacement (nabilone) anecdotally may be helpful. - Keep Narcan at bedside (2/3rd of pts willing to accept a Narcan kit offered in ER). - Make patients aware of Needle & Syringe programs.

Dr. Suzanne Turner's pearls from "Managing chronic opioid dependency in the ICU". 1. Fentanyl analogues do not come up on urine drug screens.2. Patients who use high doses of fentanyl, especially injection, go into withdrawal VERY quickly (within a couple hours).

3. Check out the DOREMI study (Mathew et al., 2021, NEJM; : Among patients with cardiogenic shock, there were no significant differences in cardiovascular or renal outcomes between milrinone and dobutamine.

2. Two common options (in Canada): Dobutamine & milrinone. Dobutamine is "on-fast, off-fast," but is arrhythmogenic. Milrinone causes fewer arrhythmias, but has a slower onset and can drop BP (especially as a bolus, so keep a vasopressor [i.e. NorE] handy).

Dr. Belley-Côté's (@ebelleycote) pearls from "When should we be starting inotropes?". 1. Two situations to consider: Cardiogenic shock (pump failure) and mixed shock ('relative' pump failure). Necessary in the "cold & wet" patient.

Misc extracts; weak recommendations: Steroids in refractory shock, stress-ulcer prophylaxis in at-risk patients, initiation of enteric nutrition by 72h.

Selected key updates:. - Capillary refill time may be used as adjunct to guide resuscitation [ANDROMEDA-SHOCK; Hernández et al., 2019, JAMA]. - Balanced crystalloids as initial fluids; although debate remains in literature on true impact on balanced crystalloid vs. normal saline.

Dr. Roman Jaeschke's (@jaeschke3) pearls from "Surviving Sepsis 2021 Update":. 2021 Sepsis guidelines available here: Table 1 provides an at-a-glance summary of recommendations.

4. Multi-specialist approach: Legal, policy, ethics, and clinical experts are necessary to minimize the harms of triage, while protecting patients/families. "Despite preparation, we will never be 'ready' for triage.".

2. Lack of consensus on best triage criteria: Short-term survival? Long-term survival? Limited number of validated prognostication tools. 3. Triaging for a disease with an unknown prognosis?: Changing epidemiology, new treatments, and learning curve.

Dr. Simon Oczkowski's (@Simon_Ocz) pearls from "Triage in the ICU". 1. Triage preparation (+ target) requires: Broad community awareness (pts + families), creation of a "triage team" & necessary training (clinicians), and have a central oversight / monitoring committee (hospital).

3. Antivirals: Best if given within 5 days of symptom onset, and recommended only in those with >10% risk of hospitalization. Paxlovid showing most promise currently.

2. Severe COVID: Corticosteroids for hospitalized pts (ward or ICU) [RECOVERY]; + EITHER IL-6 inhibitors (Tocilizumab, sarlumab) or JAKi2 inhibitors (baricitinib) when patients deteriorating. Combination of IL-6 and JAK-2 not recommended (?over-immunosuppression).