Decode Medicine from OPD to ICU rounds
INFLUENZA Definition Influenza is an acute respiratory infection caused by influenza viruses, characterized by abrupt onset of fever, headache, myalgia, malaise, cough, sore throat and respiratory symptoms. It is important in critical care because influenza can cause: Viral pneumonia Primary influenza viral pneumonia Secondary bacterial pneumonia Acute hypoxemic respiratory failure ARDS Sepsis/septic shock Myocarditis Encephalitis/encephalopathy […]
MYOCARDITIS DEFINITION Myocarditis = inflammatory disease of the myocardium, diagnosed clinically and/or histologically, with myocardial injury that may produce: myocardial necrosis ventricular dysfunction heart failure arrhythmias conduction abnormalities cardiogenic shock sudden cardiac death. MYOCARDITIS vs MYOPERICARDITIS vs PERIMYOCARDITIS Term Predominant disease LV function Pericarditis Pericardium Usually preserved Myocarditis Myocardium May be impaired Myopericarditis Predominantly pericarditis
DIRECT ORAL ANTICOAGULANTS (DOACs) 1. CLASSIFICATION Two classes Class Drug Target Direct thrombin inhibitor Dabigatran Factor IIa (thrombin) Direct factor Xa inhibitors Rivaroxaban Xa Apixaban Xa Edoxaban Xa NOAC = Non-vitamin K antagonist oral anticoagulant.(Older terminology for DOAC) Dabigatran = highly renal dependent → avoid in AKI Apixaban = safest in renal dysfunction 2. Major
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Supraclavicular brachial plexus block History First introduced by Kulemkempff and Percy in 1911 for mid humerus level to hand surgeries. Relevant anatomy Targets the trunks of brachial plexus formed by C5 -T1 when they form divisions at the level of clavicle. Subclavian artery lies on top of fist rib along with brachial plexus lying
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DIFFICULT PEDIATRIC AIRWAY Definition A difficult paediatric airway is a clinical situation in which a conventionally trained anaesthesiologist experiences difficulty with one or more of the following: Face mask ventilation Supraglottic airway placement Tracheal intubation Extubation Front-of-neck access (FONA) Children desaturate much faster than adults because of: Higher oxygen consumption (6–8 mL/kg/min) Lower functional residual
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PEDIATRIC AIRWAY MANAGEMENT Introduction Paediatric airway management is one of the most important and challenging aspects of paediatric anaesthesia. Children are not small adults; they possess unique anatomical and physiological characteristics that predispose them to airway obstruction, difficult ventilation, rapid desaturation, and airway-related complications. The primary goals of paediatric airway management are: • Maintain airway
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Preoperative Cardiac Risk Assessment Introduction The aim of preoperative cardiac risk assessment is to identify patients at increased risk of perioperative cardiovascular complications. To detect any active or unstable cardiovascular disease requiring evaluation or treatment prior to surgery. Used to estimate the risk of major adverse cardiovascular events (MACE). Used to assess the functional capacity.
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Preoperative Investigations Guidelines Preoperative investigations should not be ordered as a routine battery of tests for every patient. The decision should be based on the patient’s clinical condition, comorbidities, medications, age, and the type and extent of surgery. Two commonly referenced guidelines are: Indian Society of Anaesthesiologists (ISA) Practice Guidelines for Preoperative Investigations — Indian
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AIRWAY ASSESMENT Objectives of airway assessment Identify a potentially difficult airway. Anticipate the type of difficulty likely to occur. Prepare appropriate equipment and personnel. Develop a primary and alternative airway plan. Maintain oxygenation throughout airway management. Reduce airway trauma and complications. Anticipate difficulty with extubation and reintubation. No single airway examination test can reliably predict
APPROACH TO CHEST PAIN 1. What makes chest pain suspicious for ACS? Typical ischemic pain Typical ischemic pain • Central / retrosternal • Pressure, squeezing, gripping, heaviness, tightness • Exertional / stress-related • May radiate to left/right/both arms, jaw, neck, shoulders, epigastrium • Usually relieved by rest / nitroglycerin Angina equivalents Angina equivalents • Dyspnea,
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