Bacteria spreads into the blood from another organ such as the heart (Endocarditis). It is more likely with a Central Line, called a central line-associated bloodstream infection (CLABSI).

To identify the exact type of infection, such as a specific bacteria, samples of blood, urine, phlegm or other body fluids are sent to the microbiology lab where technicians test to see what "grows out" in microbial cultures.

"The secret to the care of the patient is caring for the patient." - Dr. Francis Peabody

"Benzos" such as midazolam and lorazepam are used for sedation, especially with mechanical ventilation. They stay in the body long after stopping and increase the risk for delirium, making them less preferred.

An anti-hypertensive (blood pressure medication) that lowers "BP", to keep pressures in a safe range, protecting against stroke. Acts on the heart and blood vessels. In the ICU, high BP is usually less concerning than low BP.

Ampules ("amps") of bicarbonate are an extremely concentrated form of baking soda used to make the blood less acidic, although usually only temporarily effective. Used in urgent situations such as a Code Blue resuscitation.

Chemical analysis of blood from an artery (ABG) or vein (VBG). Provides information about blood oxygen and carbon dioxide, which impacts the decision to initiate respiratory life support - invasive or non-invasive ventilation.

The blood bank manages the storage and release of blood products to those who need a transfusion. Blood shortages are common as the system relies on blood donors throughout the country. Blood donors save lives!

Packed Red Blood Cells (PRBCs) are "typed" (A,B,O & Rh+/-), screened & "matched" to avoid infection, rejection or reactions like blood cell destruction (hemolysis). Other blood products include platelets & plasma (FFP).

When the hospital is full and no beds are available, admitted patients wait or "board," often in the emergency department. The wait for a hospital bed can sometimes be for hours to days.

Bilevel Positive Pressure oxygenation pushes air into the lungs via large, tight masks. Used in asthma, COPD, and heart failure. This non-invasive life support won't breathe for you, unlike Mechanical Ventilation.

A slow heart rate (bradycardia) caused by a dangerous heart rhythm (arrhythmia). The slow heart is unable to pump enough blood. Often a medication side effect; usually resolves when medications are stopped (held).

Doctors are trained to deliver bad news to patients and families. It never gets easier.

A flexible tube with camera is inserted through the nose or mouth, sometimes through an endotracheal tube (ETT). The scope goes into the airways to make a diagnosis or remove blood, pus, or mucus.

Clinicians feel disconnected from their sense of self; it seems like work is meaningless and there is nothing left to give. This chronic stress is driven by the workload & the work environment and impacts patient care.

Promoting movement to build strength when immobilization due to medications & illness cause weakness (deconditioning). Everyone has a role in rehab & every step makes a difference - including passive exercise.

An Electrocardiogram measures the electrical activity of the heart (cardio) with wires and pads (leads) attached to the chest and limbs.

Dedicated ultrasound of the heart to diagnose problems such as tight (stenotic) or leaky (regurgitant) heart valves, especially mitral, tricuspid, and aortic. Often performed by a trained technician or by an ICU physician.

Extra-Corporeal Membrane Oxygenation is a form of heart and/or lung bypass beyond usual life support. Blood is drained out, oxygen added, carbon dioxide removed & pumped back in. Used only in specialized hospitals.

An Electroencephalogram measures electrical activity in the brain (encephalo) with wires and pads (leads) attached to the scalp. Often used to identify seizures.

A minimally invasive procedure that blocks blood vessels performed by Interventional Radiologists (IR). The blockage of an artery (embolization) can also occur due to illnesses (as in pulmonary embolism).

Experts at initiating critical care in the emergency department. These jack of all trades physicians perform procedures such as endotracheal intubation; some are fellowship-trained in critical care and may be the primary doctor in the ICU.

The Electronic Medical Record has largely replaced paper charts. EMRs are used for documentation and to place medical orders safely. Interruptions & glitches are common, causing delays & hampering patient care.

Emergency Medical Services include EMTs, paramedics, and critical care trained clinicians providing basic and advanced life support on the ground and by air. ICUs rely on EMS for transfers to and from other facilities.

Brain inflammation leads to confusion, speech & movement problems and may cause seizures. Caused by viral infections such as Herpes or West Nile and diagnosed with a spinal tap (lumbar puncture).

Infection of the heart valves, usually accompanied by bacteria in the blood (bacteremia). Small infected clots can break off from the valve (embolize) and deposit in other organs such as the brain and the lungs.

Flexible tube with camera (scope) inserted through the mouth to look for and treat bleeding in the food pipe (esophagus) or stomach. May require patients to have a breathing tube (intubation) prior to the procedure.

Plastic breathing tube used to connect a patient to the ventilator. Putting the tube in the mouth, through the throat and into the trachea is called intubation. Mechanical ventilation with the "ET tube" is used for a few weeks at most and if life support is still required, tracheostomy may be performed.

Common blood thinner (anticoagulant) injected into the skin (subcutaneous) for clotting problems. A benefit is that it does not require monitoring of PTT to measure clotting time. Dose must be adjusted for kidney disease.

These workers are trained to eliminate germs in hospitals in addition to removing trash & medical waste; they reduce the spread of infections with specialized cleaning to keep patients, staff & visitors safe.

An impartial panel with different professions and advocates that helps families and physicians resolve difficult decisions, especially about end of life. Also often called upon to discuss cases involving wards of the state.

Over 50% of medical students hold false beliefs about the biological differences between races. By verbally addressing them in the classroom and hospital, we can move towards more equitable healthcare for all.

When pagers go off, clinicians stop what they're doing to make sure there isn't an emergency. Constant "hammer" paging is overwhelming and distracts clinicians from the patient in front of them.

Damaged heart muscle is less efficient at pumping blood. In its most severe form this may require continuous intravenous medications or mechanical devices to help the heart pump better.

Vomiting blood due to a wound in the stomach or food pipe (esophagus). May require endoscopy, a scope inserted through the mouth. Considered an "upper" gastrointestinal bleed. "Lower" bleeds are in the colon.

Experts in the care of blood disorders, including bleeding and clotting (hematology) and cancer (oncology). Often in a consultant role in the ICU.

Coughing up blood from the airways or lungs. Diagnosed by a scope (bronchoscopy) through the mouth into the windpipe (trachea). Often caused by infection, cancer, or bleeding disorders.

Bleeding (hemorrhage) is often due to a trauma or from medical conditions that lead to vomiting blood (hematemesis). Treatment relies on blood transfusions and stopping the bleed, which may require medications, a procedure, or even surgery.

A form of Cerebral Vascular Accident (CVA) in which the brain suffers from bleeding (hemorrhage) due to high blood pressure or a burst bubble in the wall of a blood vessel (ruptured aneurysm).

Blood pools in the chest outside the lung. Fluid in the chest is called pleural effusion. Bloody effusions are often a result of trauma or cancer and usually require drainage with a tube or surgery.

Common IV blood thinner (anticoagulant) for clotting problems. Adjusted based on frequent "partial thromboplastin time (PTT)" blood labs; "supratherapeutic" (high) levels risk bleeding, but the drip can be stopped.

Brain damage from liver (hepatic) failure leads to progressive confusion (encephalopathy) and ultimately coma. Toxins are cleared through bowel movements, often stimulated by medications such as lactulose.

Liver failure leads to abnormal bleeding as well as clotting, abdominal swelling (ascites), confusion (hepatic encephalopathy), and impaired toxin removal. Major causes include alcohol, acetaminophen, & infections.

High Flow Nasal Cannula delivers up to 80 liters of oxygen via the nose, often humidified to keep the nose & mouth moist. This non-invasive life support doesn't push air into the lungs with positive pressure, unlike BPAP.

When hospitals are filled beyond capacity, patients may experience longer wait times and less access to the specialists or medical equipment they need.

Agitated state of confusion which may alternate with hypoactive (quiet) delirium. Caused by medications, severe illness & poor sleep in the hospital. Families can help by orienting and "redirecting" the patient.

High levels of potassium, an essential blood electrolyte, can cause fatal disturbances in the heart's rhythm (arrhythmia). Often seen with kidney failure; in extreme cases, it is treated with Dialysis.

Extremely high potassium is more likely to cause cardiac arrest than other electrolyte problems. It is usually caused by problems with the kidneys or when many cells die suddenly, such as from chemotherapy kills many cancer cells.

Healthy kidneys adjust how much water is in the blood to keep sodium (an electrolyte) in a safe range (part of homeostasis). Too little water causes high sodium levels & presents with dehydration, confusion, or coma.

Severely elevated blood pressure is termed hypertensive urgency. When organ damage is present, it is termed hypertensive emergency. The risk of ischemic and hemorrhagic stroke is increased.

Sleepy, unresponsive state that may alternate with hyperactive (agitated) delirium. Caused by medications, severe illness & poor sleep in the hospital. Families can help by orienting and "redirecting" the patient.

Extremely low blood sugar is a rare cause of cardiac arrest in adults. Easily treated if caught early enough with sugars like dextrose and possibly caused by an overdose of insulin.

Extremely low potassium is often due to diarrhea, medications that make you urinate like Furosemide, and kidney problems. Low potassium leads to dangerous heart rhythms (arrhythmias) and cardiac arrest. Treated with IV potassium.

Healthy kidneys adjust how much water is in the blood to keep sodium (an electrolyte) in a safe range (part of homeostasis). Too much water causes low sodium levels & may lead to confusion, seizures, or coma.

Low blood pressure is always concerning in the hospital and warrants evaluation to look for the cause, especially when it is unexpected. Causes may include infections, heart disease, lung disease, blood clots and bleeding.

Extremely low body temperatures can lead to cardiac arrest. Unfortunately, this often happens to patients living on the streets in the deep of winter. Treated with re-warming and supportive care...and prevented with housing.

Severe lack of oxygen can cause the heart to stop beating (cardiac arrest). Often caused by an obstruction in the airway, like choking (aspiration) or severe infections like pneumonia.

Forum to discuss medical errors and complications resulting in further suffering (Morbidity) or death (Mortality). Each case - medical history, diagnosis, hospital course, outcome - is analyzed to learn and prevent future harm.

A large blood clot in the blood vessels in the lungs blocks blood flow (thrombosis), making it harder to get oxygen into the blood and harder for the heart to pump blood through the lungs. Treated with TPA or invasive procedures (thrombectomy).

This form of life support performs the work of breathing when a patient cannot. The "Vent" connects to the lungs via breathing tube in the mouth (endotracheal tube, ETT) or by surgical incision in the neck (tracheostomy).

All medications (including supplments) are reviewed for dose, route (IV, oral, etc), & frequency. Medication reconciliation is the key to figuring out what needs to be stopped ("held"), continued, or substituted.

Despite protocols, systems and constant surveillance, things can still go wrong. Errors don't necessarily result in harm, but always highlight opportunities for improvement.

Physicians in their 1st year of clinical training who have just graduated medical school. Working up to 80 hours/week, they provide direct patient care and somehow still find time to learn evidence based medicine!

Students in the ICU are often in their final year of medical school, just months away from being physicians in training (Interns & Residents). Students may take on significant patient care responsibilities.

Occasionally, essential first line drugs are unavailable due to a variety of supply chain or purchasing issues, requiring less optimal medication alternatives.

Inflammation of the lining surrounding the brain (meninges). Patients present with headache, fever, nausea, vomiting & confusion. Often caused by an infection and diagnosed with a spinal tap (lumbar puncture).

Pain medications like fentanyl or hydromorphone; opioids cause drowsiness, nausea, confusion, & low blood pressure. Often used with mechanical ventilation; prolonged use risks addiction. Reversed with naloxone.

Magnetic Resonance Imaging uses energy from powerful magnets to view organs and soft tissue. Can be used with or without contrast. Is not safe for individuals with certain kinds of metal implants in the body.

Airways are blocked or "plugged" by mucus (phlegm) often from Asthma or COPD, impairing breathing. Chest physiotherapy (pulmonary hygiene) brings up the plugs, which may be suctioned out by Bronchoscopy.

Playing music at the bedside is a simple intervention that may help decrease the anxiety of patients in the ICU. It is often used in palliative care to help treat the psychological needs of patients and families during end of life care.

"MI" is a heart attack. Blood vessels feeding the heart (coronary arteries) are blocked, depriving it of oxygen & causing Acute Coronary Syndrome (ACS). May cause the heart to stop beating (cardiac arrest).

A sudden blockage (thrombosis) in the blood vessels that feed the heart (coronary arteries) is the most frequent cause of out-of-hospital cardiac arrest. Often treated with a 'stent' (percutaneous coronary intervention or "PCI") to open up blood vessels.

Critical illness myopathy is severe muscle weakness resulting from prolonged immobilization, especially medically induced paralysis. Physical therapy is necessary to regain function.

Pulmonary Artery AKA "the Swan" are long central lines. The catheter is inserted near the neck to obtain blood samples & special blood pressure measurements only possible from within and near the heart.

Using electric charges to maintain or "pace" an abnormally slow heart rate. This life support is delivered by pads on the chest or via a wire inserted through the neck to the heart. Used until a long-term device is implanted.

Experts in the care of patients & families dealing with serious conditions, especially with comfort and symptom management. Leads discussions around what types of care may or may not make sense given a patient's goals of care and provides family support.

Painful abdominal inflammation in the pancreas, an organ that makes hormones such as insulin & enzymes that help break down food. Often triggered by alcohol or gallstones. Severe cases may be life-threatening.

A needle drains abdominal fluid (ascites), often built up from liver failure. Fluid may be bloody (hemoperitoneum), infected (bacterial peritonitis), cancerous (malignant), or it may be a straw-colored uncomplicated fluid.

Medications such as "roc" or "cis" temporarily stop voluntary movement to maximize ventilator efficiency. Always used with deep sedation. "Fighting the vent" impairs the ventilator's ability to provide life support.

A virus, bacteria, fungus or parasite that has the ability to infect people and cause illness. Certain medical conditions and medications may weaken the immune system, putting patients at a higher risk of developing infections.

Prothrombin Complex includes components of the blood that promote clotting - these are taken from donated blood and given intravenously to treat bleeding, especially when using blood thinners (anticoagulants).

A tube to deliver nutrition or drain stomach contents, including blood. These flexible tubes are inserted through the belly & often paired with tracheostomy for patients with long-term breathing problems.

A needle inserted through the chest into the envelope surrounding the heart (pericardial sac) drains fluid that shouldn't be there, relieving compression and irritation.

Through looking, listening (auscultation), and touching (palpation), an skilled clinician may detect small changes & diagnostic clues that technology and lab results may not capture. Expertise is honed through experience.

A variety of soft restraints including wrist, ankle, safety vests and mittens help prevent patient and staff harm. Physical restraints are avoided unless absolutely necessary for severe agitation.

PTs know everything about movement and strength. Their care decreases time on the ventilator & reduces complications like delirium. They help send people straight home instead of needing to go to a rehab facility after the hospital!

Swelling in the ankles & shins caused by excess water in the body, often due to heart or kidney problems. Pushing on the skin leaves an indentation. Treated with diuretics like Furosemide which increase urination.

Removing the liquid part of the blood along with any antibodies in it can help treat a variety of inflammatory conditions.

These small blood cells are critical for helping the healthy clotting process. They are transfused for severe thrombocytopenia (low platelet counts). Other blood products include blood cells (PRBCs) and plasma (FFP).

Fluid in the chest-- can be watery (serous), blood (Hemothorax), or infected pus (empyema). Too much fluid collapses the lung. May require a procedure to drain the fluid with a needle & catheter (Thoracentesis).

Hospitalization increases the risk of lung infections. Hospital Acquired Pneumonias (HAP) are caused by antibiotic-resistant germs. Mechanical ventilation increases risk of Ventilator Associated Pneumonia (VAP).

Trapped air accumulated in the space of the chest cavity around the lung may cause the lung to collapse. Often seen with underlying lung damage from COPD or ARDS. May require a Chest Tube for drainage.

Point of Care Ultrasound, performed at the bedside, shows organs & structures inside the body non-invasively. Useful to evaluate the heart, lungs, abdomen, & some blood vessels. Used for diagnosis & procedures.

The Point of Care Ultrasound (POCUS) is out of commission - especially if left unplugged - leading to frustration, often for the medical intern or student.

More than half of patients who survive the ICU will have at least one symptom of "PICS" - cognitive, psychiatric, or physical impairment. Risk is increased with longer and more severe illness as well as delirium, medications, and prolonged bedrest.

Healthcare workers frequently experience everything from microaggressions to overt verbal & even physical assaults driven by racism and sexism. Hospital policies & support from allies - especially leadership - is critical.

New medications are added to treat the side effects of other medications, causing their own problems, which may lead to even more medications!

To place face down (prone) in the bed with the aim of improving oxygen delivery. Especially used for severe respiratory failure (such as ARDS) on the ventilator. Requires many skilled hands to perform safely.

Used for anesthesia (for surgery) and sedation (for mechanical ventilation), lowers consciousness and can cause deep sleep, but does not treat pain. Fast-acting; has an "on-off" effect to quickly wake patients up.

Used for anesthesia (for surgery) and sedation (for mechanical ventilation), lowers consciousness and can cause deep sleep, but does not treat pain. Characteristically milky white, it can sometimes turn your urine green!

Experts in mental health and substance use disorders. In the ICU, they often help distinguish general medical and psychiatric causes of confusion and agitation, assist with withdrawal from substances like alcohol, and manage psychiatric medications.

Post Traumatic Stress Disorder may be caused by severe illness or injury, invasive treatments, delirium & nightmares. Suffer may persist long after ICU discharge, but care from a mental health professional can help.

The lungs fill up with fluid in a matter of minutes, making it suddenly hard to breathe. Often related to heart failure. When this is sudden (acute) it is called flash pulmonary edema.

"PE" often starts as a blood clot in the veins of the legs (Deep Venous Thrombosis or DVT) which travels to the lungs, where it blocks blood vessels and strains the heart, making it harder to pump.

Experts in the care of the lungs and breathing. The primary doctor in the Medical ICU (MICU) is often trained in both pulmonary and critical care medicine. Serve as consultants for lung problems in other ICUs.

Playing tabletop games may help improve memory, increase release of hormones in the brain that stimulate happiness and increase motivation. It is a simple way to keep busy and have fun during long hospital stays!

A rapid heart rate (tachycardia) caused by a dangerous heart rhythm (arrhythmia) cannot pump blood effectively. Often treated with medication or electric shocks (cardioversion).

An elevated heart rate that can have a normal (sinus) or abnormal (arrhythmia) rhythm. Often, the heart rate is elevated as a reaction due to underlying illness, but can be one of the first signs of trouble when it occurs.

Broken Heart Syndrome (stress cardiomyopathy) is caused by severe stress, temporarily deforming the heart to a shape like the Japanese octopus trap or "Takotsubo," impairing its ability to pump blood.

Heart rate and rhythm are continuously monitored with electrode stickers (leads) and displayed at the bedside and the nursing station. "Tele" catches abnormal heart rhythms (arrhythmia) but also causes many false alarms.

Air is inhaled into the lungs and exhaled back out through the windpipe (trachea). If the lung is punctured, air can escape and collect in the chest, increasing pressure & collapsing the lung & preventing the heart from beating, leading to a cardiac arrest.

Gratitude is never expected but always appreciated.

Therapy dogs are trained to provide comfort, support, and joy to patients, visitors... and staff!

A procedure that removes blood clots from the brain (from ischemic stroke) or lungs (from pulmonary embolism). Performed by mechanical removal by an Interventional Radiologist or Neurologist.

Thyroid hormone controls the body's metabolism. Excess hormone (hyperthyroidism) drives up the heart rate & temperature. This may lead to dangerous heart rhythms (arrhythmia), heart failure, and seizures.

Inadequte blood flow to the brain leads to facial drooping, sudden weakness, difficulty speaking, or vision loss which resolve rapidly, indicating a Transient Ischemic Attack (ministroke). TIAs signal risk for a major stroke.

A bacterial infection (usually staph or strep) releases a large amount of harmful toxins into the blood, triggering an overactive response from the body's immune system and causes multi-system organ failure.

Many toxins and poisons alter the electrical activity of the heart, leading to dangerous electric rhythms (arrhythmias) which can cause cardiac arrest.

Clot-busting medication ideally used soon after a blood clot develops, especially in the brain (ischemic strokes) or lungs (pulmonary embolism) or delivered through chest tubes to break up infections around the lung.

Total Parenteral Nutrition bypasses the gut entirely and delivers nutrition via IV (parenteral). Prolonged use may result in complications, and artificial nutrition is a form of life support.

A surgical incision is made in the throat to insert a "trach," a specialized breathing tube necessary for long-term life support with mechanical ventilation. Allows patients to continue recovery in a rehab facility or home,

Ultrasound on the skull used to evaluate blood vessels that may be narrowed (stenotic), to monitor for swelling (cerebral edema), spasm after bleeding (subarachnoid hemorrhage), and for diagnosing brain death.

Allergic reaction to transfused blood causing red blood cell destruction or "hemolysis." To limit this, blood is screened to ensure compatability - also known as a "type & screen."

In the Surgical ICU (SICU), these surgeons are often trained in both trauma & critical care. They are the primary doctors for critically ill patients who have had or may need an operation.

Triage sorts out illness or injury severity and care needs. Patients can be sent to the wrong type of unit, requiring prompt re-evaluation and transfer.

Syndrome in which many cancer cells break open (called "lysis"), dying (naturally or by treatment) & flooding the bloodstream with chemicals. May result in kidney failure, abnormal heart rhythm (arrhythmia), & seizures.

Specially trained in the care of the skin & wounds as well as ostomies - surgically created openings into organs. For example, a colostomy is an opening for the bowels out of the skin, usually into a plastic bag.

A holistic and compassionate approach to the art of caring for the critically ill that is minimally invasive but maximally attentive.

The Emergency Department (ED, aka ER) & hospital floors (aka medical-surgical wards) consult intensivists around the clock to evaluate patients who may require ICU admission due to the severity of their condition.

An urgent call to the family in the middle of the night rarely brings good news and usually means a patient has gotten much sicker or "decompensated."