ICU and You · Mnemonic No. 52

Transplantation

One word carries the ICU care of the recipient: TRANSPLANT.

T
Ischaemic timeTimes you did not control — cold and warm ischaemia shaped this graft before you met it
R
ReperfusionReperfusion syndrome — hyperkalaemia, acidosis and vasoplegia as the clamps come off
A
AnastomosesAnastomoses first — know every join, and what is lost when one of them fails
N
DenervationNerves were cut — atropine will not work, and the new lung cannot cough
S
Graft signalsSignals of function — lactate, glucose, urine output, oxygenation, hour by hour
P
PerfusionPerfusion protects the graft — no hypovolaemia, no nephrotoxins, no quiet low flow
L
ImmunosuppressionLevels daily — and again after every drug you start, stop or change
A
ProphylaxisAntimicrobial cover — valganciclovir, cotrimoxazole, antifungal; check it is actually given
N
RejectionNever one or the other — rejection and infection coexist, and biopsy decides
T
The teamTelephone the transplant unit before you change a single thing

Challenge of the week

Which one would catch you out?

Ten steps. Most of us are solid on eight of them and quietly shaky on two. Tap the one you would least want to be tested on at three in the morning, tell me why, and I'll publish the most honest answers.

TIschaemic time RReperfusion AAnastomoses NDenervation SGraft signals PPerfusion LImmunosuppression AProphylaxis NRejection TThe team

Each tap opens a reply straight to me with your chosen step filled in — just add your reasoning and send.