Adrian Wong, a consultant and clinical lead at King’s College Hospital in London, explores rational fluid therapy's complexities in critical care. He emphasizes evidence-based practices for better patient outcomes. Wong discusses the 'four Ds' framework and the significance of fluid stewardship. He addresses recent IV fluid shortages and the implications for hospitals. The conversation also highlights the 'ROSE' framework for managing critically ill patients and examines ethical considerations in treatment choices, urging a focus on quality of life.
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volunteer_activism ADVICE
Fluids in Intensive Care
Consider fluid management as core intensive care practice.
Recognize the variability in fluid administration approaches.
insights INSIGHT
Fluids as Medications
Think of fluids as medications with indications and contraindications.
Utilize the "4 Ds" framework: drug, dosing, duration, and de-escalation.
volunteer_activism ADVICE
Applying the 4 Ds
Diagnose the underlying issue before administering fluids.
Consider fluid type, dose, duration, and de-escalation strategy.
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In 'Start with Why', Simon Sinek introduces the concept of 'The Golden Circle', which consists of 'Why', 'How', and 'What'. He argues that successful leaders and organizations start with their purpose or 'Why', which inspires loyalty and trust. Sinek uses examples such as Apple, Martin Luther King Jr., and the Wright Brothers to illustrate how this approach can lead to significant influence and success. The book emphasizes the importance of leadership and purpose in inspiring others and achieving long-term success.
Thinking, Fast and Slow
Daniel Kahneman
In this book, Daniel Kahneman takes readers on a tour of the mind, explaining how the two systems of thought shape our judgments and decisions. System 1 is fast, automatic, and emotional, while System 2 is slower, effortful, and logical. Kahneman discusses the impact of cognitive biases, the difficulties of predicting future happiness, and the effects of overconfidence on corporate strategies. He offers practical insights into how to guard against mental glitches and how to benefit from slow thinking in both personal and business life. The book also explores the distinction between the 'experiencing self' and the 'remembering self' and their roles in our perception of happiness.
In this episode, Dr. Sergio Zanotti discusses rational fluid therapy. He is joined by Dr. Adrian Wong, a practicing intensive care medicine and anesthesia physician. Dr. Wong is a consultant and clinical lead at King’s College Hospital, London. He also serves as a committee member for the Intensive Care Society FUSIC, examiner for the European Diploma of Intensive Care Medicine, on the executive committee of the International Fluid Academy.
Additional resources:
Intravenous fluid therapy in the perioperative and critical care setting” Executive summary of the International Fluid Academy (IFA). Malbrain ML, et al. Ann. Intensive Care 2020: https://pubmed.ncbi.nlm.nih.gov/32449147/
Multidisciplinary expert panel report on fluid stewardship: perspectives and practice. Malbrain ML, et al. Annals of Intensive Care 2023: https://pubmed.ncbi.nlm.nih.gov/37747558/
The emerging concept of fluid tolerance: A position paper. Kattan E, et al. Journal of Critical Care 2022: https://pubmed.ncbi.nlm.nih.gov/35660844/
Everything you need to know about derescuscitation. Malbrain ML, et al. Intensive Care Med 2022: https://pubmed.ncbi.nlm.nih.gov/35932335/
Start with Why. TED Talk presented by Simon Sinek: https://simonsinek.com/videos/ted-talks/
Books mentioned in this episode:
Thinking Fast and Slow. By Daniel Kahneman: https://amzn.to/4hicUoj
Start with Why: How Great Leaders Inspire Everybody to Take Action. By Simon Sinek: https://bit.ly/42hzt8n