euboxia and abnormality smacc gold
TRANSCRIPT
EUBOXIA and
(Ab)NORMALITY
Chris NicksonICU Fellow at The Alfred
The Itinerary
What is NORMAL?
When is NORMAL bad?
Does making it NORMAL help?
How can ABNORMAL be good?
http://lifeinthefastlane.com/education/ccc/euboxia-abnormality/OR http://bit.do/euboxia
What is
EUBOXIA?
‘A pathophysiological
state where all BOXES on a pathology print out
are in the NORMAL range’— M.C. Reade
4th Rule of Expensive Scare Medicine
IF YOU MEASURE SOMETHING
AND IT IS NOT NORMAL,
MAKE IT NORMAL…
(If it is safe to do so)
What is
NORMAL?
Just the
USUAL?
Is this
NORMAL?
HOMEOSTASIS
‘the property of a system in which
variables are regulated so that internal
conditions remain stable and relatively
constant’
ADAPTATION
Normal…
FOR WHAT?
Risk versus
DISEASE
Ambiguity is
NORMAL!
Normal can be
GOOD
Talk and tweet
#EUBOXIA
Go to
http://bit.do/euboxia2
or Twitter search: #euBOXia
When is
NORMALbad?
normal
PARAMETERSmisapplied
Panwar R, Lanyon N, Davies AR, Bailey M, Pilcher D, Bellomo R. Mean perfusion pressure deficit during the initial management of shock--an observational cohort study. J Crit Care. 2013
Oct;28(5):816-24. doi: 10.1016/j.jcrc.2013.05.009. Epub 2013 Jul 10. PubMed PMID: 23849541.
Multiple
MEASURES
Bogus
BIOLOGICAL
BASIS
(Ab)Normal
SALINE
Does making it
NORMALhelp?
Relative
RELATIVEinsufficency
Is normal
NORMAL?
Speed
KILLS
Correcting the
MEASURABLE
Unintended
CONSEQUENCES
Is seeing
BELIEVING?
The FEAST TrialAudio courtesy of
CritIQ Podcast
http://litfl.org/MZTBlv
How can
ABNORMALbe good?
The rules of
ANAESTHESIAdo not apply
It’s all just
PHYSIOLOGY
Normal
VARIATION
Not all
SURROGATESare equal
Tailor your
TARGETS
Remember
CONTEXT
Consider
ADAPTATION
Now for the
FINAL WORDS
Forget
NORMAL
Normal…
FOR WHAT?
Think
OPTIMAL
Consider the
BIG PICTURE
Know the
SCIENCE
“Evolution is
CLEVERERthan you are”
Embrace
DYSBOXIA(when it is safe to do so)
Don’t put your
PATIENT IN A BOX
THE END
http://lifeinthefastlane.com/education/ccc/euboxia-abnormality/OR http://bit.do/euboxia