Alex Yartsev, an Intensivist from Westmead ICU in Sydney, Australia.
Deranged Physiology is a very slowly growing online resource for information regarding intensive care medicine, as well as an exploration of human physiology, with frequent irrelevant digressions. It often relies on apocryphal sources, and delivers content which is occasionally more interesting than useful.
Deranged Physiology is not a medical textbook. It differs in a number of important ways. Firstly, one is typically expected to pay for a medical textbook. When one pays for it, one is rewarded not only with eight hundred grams of wood pulp, but also with the reassurance that the information contained therein is accurate, peer-reviewed, and current at least to the date of publication. There is the assurance that the writers had some expertise in their topic. There is the assurance that an editor had combed painstakingly through the text, ensuring accuracy and clarity. There is the assurance that the quality of the images and spelling will be sufficiently high to justify the price tag.
I offer no such assurances.
The documents presented here are the authors' own notes. They do not reflect what is important or what is going to be tested or what is clinically relevant. Some of these things are here only because I was transiently fascinated with them. So, in short, I politely advise you people to NOT use these notes for any real clinical applications. If you have a medical question, ask a doctor. I would also advise everybody to make their own notes for their exams; I benefited from writing these documents much more than you will benefit from reading them. There was never any intention to make the material broadly accessible. Nor was there ever any intention to deliberately make any of it obscure or to over-complicate an already complicated subject. That was accidental. If it turns out that you are having trouble making sense of something, maybe you could send me an email. Chances are, I didn't understand the topic either while writing about it, and the disorganization of my notes reflects this fact.
Deranged Physiology is available to all, at no extra cost. You will never see ads here, because the idea offends me. You will never be charged for access. You will never be asked to donate. Spontaneous donation offers will be politely rejected. If you wish to contribute, do so by offering corrections or by pointing out interesting articles for me to read.
Apart from being somebody's creative outlet, Deranged Physiology is a place where one can find concentrated information about applied physiology which is for some reason difficult to track down in any other source. It is material which has been collected in the process of self-directed learning about the basic principles behind intensive care medicine, specifically the quintessential ICU stuff like mechanical ventilation, dialysis, inotropes, hemodynamic monitoring, et cetera et cetera. All too frequently this material exists in textbooks which for many are inaccessible, or in journal articles hidden behind paywalls. Occasionally the material is scattered across multiple sources.
Certainly, much of this should probably be available from the wizened elders who control and administer intensive care units. These senior staff frequently remind me of H.G Wells' Martians: alien intellects " vast and cool and unsympathetic", gazing down dispassionately at the paramecia who do their central lines and write their ward round notes. The body of eldritch ICU lore wielded by these entities is too infrequently shared with the junior staff. Some stuff you should already know, and if you don't know it you should feel ashamed. Other stuff is too complex for a brief bedside discussion, and you should go and look it up
It is in order to address the authors own educational shortcomings that these study notes (and subsequently this website) were first compiled. I did not want all this stuff to rot quietly in my hard drive. Who knows? Perhaps someday someone might find it useful. Information wants to be known, it is nothing while it occupies an inert storage system. It needs an organic brain to be its home, an organism to apply and wield it, or even merely to delight in it.
Frequently, I forget where I got my information from. Because these notes started out as my own set of study materials for med school, without any intention of their being distributed on the internet, I had never referenced them accurately. Even now I am still very bad at it. If you read something I've published on this site and you discover that it is an unfair abuse of copyright, please write to me so I can make the necessary changes. What I don't want is intellectual property lawyers from the Oxford University Press kicking down my door one foggy morning. Suffice to say any copyright infringement here is unintentional, and I recognise that all of my content is the product of somebody else's research, imagination, labour, love, and suffering. A thousand million laboratory mice perished in the making of our health sciences, and the reference lines of scientific papers serve as their little tombstones, marking that we are grateful to them for their sacrifice.
Furthermore, the evidence and literature which does somehow end up referenced is subject to strong "el cheapo bias"; that is to say, I preferentially link articles which are available for free, which may not be the best possible articles. The rationale for this is the patent uselessness of desperately needed information which is locked inside a vault.
Anyway, rant over. Bottom line:
1) Don't use these notes to make decisions regarding patient care. How can you be sure I'm not a sociopath, deliberately misleading you with dodgy information?
2) If you kill or maim somebody with your use of these notes, I cant see how I can be responsible. Its your own fault for mistaking me for a trustworthy source. If I recommended you jump off a cliff, you would exercise your own judgement. Similarly, nebulised Yakult may not be the standard of care for cryptococcal meningitis.
3) If I used your data or images and failed to reference you, I'm sorry; it was done in the spirit of education, and if you let me know who you are and what I did wrong, I'll make the necessary changes, so that credit is directed wherever it is due.
Also: the cosmetic appearance of this site, being a rather subjective property, is controlled by the flighty whims of the author. Perhaps the layout is offensively plain, and perhaps the images fail to scale correctly on your own monitor, or the font takes too long to load. This is unfortunate for you. You should get a faster internet connection. One should not forget that the primary purpose of this entire enterprise is my amusement; anyone else's enjoyment of it is a pleasant byproduct- but by no means mandatory. Complaints and suggestions regarding the layout will be politely ignored.