Critical Care Scenarios Episode 15: Liver failure with Elliott Tapper
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Sep 6, 2020 Join Dr. Elliott Tapper, a leading gastroenterologist and transplant hepatologist from the University of Michigan, as he dives into the complexities of liver failure. He emphasizes the importance of infection management in cirrhotic patients and unpacks the intricacies of lab result interpretation. The discussion navigates the delicate balance in treating hepatic encephalopathy and the critical role of multidisciplinary collaboration. Tune in for insights on managing spontaneous bacterial peritonitis and prognosis discussions with families in critical situations.
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Stop Chasing Ammonia Levels
- Do not routinely chase ammonia measurements; treat suspected encephalopathy clinically and address triggers like infection.
- Recognize ammonia assays are technically sensitive and can be misleading if mishandled.
INR Misleads In Cirrhosis Coagulation
- INR does not reflect the rebalanced hemostasis in cirrhosis and may underestimate thrombotic tendency.
- Tests like thrombin generation or TEG better reflect clotting risk than INR in these patients.
Paracentesis: Bedside Cultures And PMN Count
- When you tap ascites, send cell count and bedside-inoculated culture bottles and check PMN count; >250 PMNs equals SBP.
- Gram stain positive guides targeted antibiotics; bedside inoculation improves culture yield.