Decode Medicine from Ward Rounds to ICU rounds
Arterial Blood Gas (ABG) Analysis What Does an ABG Measure? Parameter Normal arterial value significance pH 7.35–7.45 Overall acid–base status PaCO₂ 35–45 mmHg Respiratory component / alveolar ventilation PaO₂ 80–100 mmHg in young adult on room air Oxygenation SaO₂ ~95–100% Arterial Hb oxygen saturation HCO₃⁻ 22–26 mEq/L HCO₃⁻(actual) → bicarbonate at the patient’s actual PaCO₂ […]
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Uremic Encephalopathy Definition Uremic encephalopathy is an organic brain syndrome caused by accumulation of uremic toxins and associated metabolic abnormalities in renal failure. It may occur with: Severe AKI Advanced CKD/kidney failure Acute deterioration of CKD Inadequate dialysis Missed dialysis sessions Dialysis-access dysfunction causing inadequate clearance It is generally associated with severe reduction in renal
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Acute Liver Failure (ALF) Acute liver failure (ALF) is one of the few true medical emergencies in critical care. It is characterized by rapid loss of hepatic function, resulting in coagulopathy and hepatic encephalopathy in a patient without pre-existing cirrhosis, leading to profound metabolic, hemodynamic, neurologic, immunologic, and multiorgan derangements. For the intensivist, management revolves
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Cardiac Output in Critical Care Echocardiography It represents the volume of blood pumped by the heart each minute and reflects the adequacy of systemic perfusion. Unlike pulmonary artery catheter measurements, echocardiography estimates CO non-invasively by measuring LVOT diameter and LVOT Velocity Time Integral (VTI). Introduction Cardiac Output = Amount of blood ejected by the
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Ejection Fraction in Critical Care Echocardiography Ejection Fraction (EF) is the percentage of blood ejected by the left ventricle (LV) during systole. It is the most commonly reported index of LV systolic function but should never be interpreted in isolation, especially in critically ill patients where preload, afterload, inotropes, vasopressors, and mechanical ventilation significantly influence
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RV and LV Size Assessment in Critical Care Echocardiography Chamber size immediately narrows the differential diagnosis of shock and guides fluid, vasopressor, thrombolysis, or mechanical support decisions. Current CCE competency statements recommend that every intensivist be able to assess global LV size and global RV size, initially by visual estimation and, when necessary, by quantitative
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Mitral Annular Plane Systolic Excursion (MAPSE) MAPSE (Mitral Annular Plane Systolic Excursion) measures the distance the mitral annulus moves toward the LV apex during systole. Unlike LVEF, which mainly reflects radial shortening, MAPSE reflects longitudinal myocardial fiber contraction i.e (LV) longitudinal systolic function, making it particularly sensitive for detecting early LV systolic dysfunction. It is
L.V Dysfunction Diastolic Dysfunction Grades(Pulse Wave Doppler) Grade Filling Pattern LAP Typical Findings Normal Normal relaxation Normal Normal E/A ≥0.8 Grade I Impaired relaxation Normal E/A <0.8 Grade II Pseudonormal Elevated E/A 0.8–2 Grade III Restrictive Markedly elevated E/A ≥2 Diastolic Dysfunction Grades(Tissue Doppler) Average E/e′ Interpretation LV Filling Pressure <8 Normal Normal LAP/LVEDP 8–14
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RVSP / PASP Definitions Parameter Definition RVSP Peak systolic pressure generated by the RV during systole PASP Peak systolic pressure within the pulmonary artery during systole Normal physiology RV systolic pressure ≈ PASP because there is almost no pressure gradient across a normal pulmonary valve Therefore,RVSP ≈ PASP (if pulmonary valve is normal). If pulmonary
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