Rules to live by in the intensive care unit? You be the judge…

1. Coagulopathy does not cause you to bleed precipitously from a single drain; this is an indication for a re-inspection of surgical excellence.
2. A patient with a worsening metabolic acidosis after damage control laparotomy is usually still bleeding.
3. If you think that a patient who has had an abdominal aortic aneurysm repair might have dead gut then they do.
4. If you measure something and it is not normal, make it normal if it is safe to do so.
5. Penicillin, flucloxacillin, cephazolin  and vancomycin is not a good combination for antibiotic prophylaxis even if the surgeon suggests it.
6. If the surgeon says that a septic patient is too sick for an operation there are only two possibilities:
   1. the surgeon is wrong.
   2. the patient is dead.
7. Usually if you ask an Oncologist how long a patient with a metastatic cancer who has exhausted all treatment options is going to live, they will tell you ‘one year’.
   This is an ‘oncologist year’.
   In order to work out the patient’s actual life expectancy, you should begin by halving the number of days in a year (giving you a figure of approximately 182) and then you should subtract the patient’s age.  If the patient is currently admitted to the intensive care unit, you should subtract 10 for every organ system that has failed.  This figure will give you the patient’s life expectancy.  For patients outside the intensive care unit, this figure is in days. For patients in the intensive care unit, this figure is in hours.
8. If a patient who has had a bone marrow transplant is admitted to an intensive care unit they are in big trouble and when they engraft it does not mean they are getting better.
9. Neurosurgeons like doing operations. If a patient achieves flexion this is a good outcome.
10. Every patient you ever treat is going to die; if they are 85, it is likely to be sometime soon.

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