Decode Medicine from OPD to ICU rounds
LA AND RA SIZE ON POCUS The formal echo guidelines favor volumetric assessment over a single linear dimension, although POCUS usually uses qualitative/semiquantitative assessment. LEFT ATRIUM — LA For formal echocardiography, LA volume indexed to body surface area (LAVI) is preferred over a single linear dimension. The ASE/EACVI upper normal limit is approximately 34 mL/m². […]
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Esketamine (S-Ketamine) Introduction S(+) enantiomer of racemic ketamine Non-barbiturate, non-opioid dissociative anaesthetic Produces hypnosis, profound somatic analgesia, amnesia, dissociation 2 times more potent than racemic ketamine 3 times more potent than R-ketamine Available as: IV/IM injection anaesthetic use Intranasal spray for depression Trade names: Ketanest-S, Spravato Mechanism of action Anaesthetic and analgesic action Esketamine →
Remimazolam Introduction Ultra-short-acting intravenous benzodiazepine Structurally related to midazolam Rapid, predictable metabolism resembles the pharmacokinetic concept of remifentanil Available as remimazolam besylate Water-soluble formulation Trade name: Byfavo Chemistry Imidazobenzodiazepine containing a metabolically labile carboxylic ester linkage Molecular formula: C₂₁H₁₉BrN₄O₂ Molecular weight: approximately 439.3 Da The ester linkage permits rapid hydrolysis to an inactive metabolite Mechanism
Apnoeic Oxygenation Definition Apnoeic oxygenation is the continuous delivery of oxygen to the airway during apnoea, allowing ongoing alveolar oxygen uptake without spontaneous breathing or positive-pressure ventilation. It delays desaturation and prolongs safe apnoea time during airway management. Important: It maintains oxygenation but does not provide adequate ventilation. Mechanism O₂ continues to diffuse from alveoli
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NEUROPATHIC PAIN BRIEFThis guide translates Neuropatic pain: Fundamental neurophysiology and pharmacology into structured bedside diagnostic and therapeutic pathways. DEFINITION AND ETIOLOGY Neuropathic pain: Defined by the International Association for the Study of Pain (IASP) as pain caused by a lesion or disease of the somatosensory nervous system . It is critical to recognize that neuropathic
Paediatric Airway Anatomy and Assessment Introduction Paediatric airway management differs significantly from adult airway management because of unique anatomical and physiological characteristics. A relatively large tongue, cephalad larynx, compliant airway structures, and limited oxygen reserves predispose children to airway obstruction and rapid desaturation. Understanding these differences and performing a systematic airway assessment are essential for
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IRRITABLE BOWEL SYNDROME 2026 UPDATE Rome V is now available and updates IBS diagnostic criteria: recurrent abdominal pain or discomfort, on average ≥3 days/month during the previous 3 months, with symptom onset ≥6 months before diagnosis, plus ≥2 of: relationship to defecation, change in stool frequency, or change in stool form. The 2021 ACG/BSG guidance
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Acute Disseminated Encephalomyelitis (ADEM) Acute disseminated encephalomyelitis (ADEM) is a monophasic (in most cases), immune-mediated, demyelinating disorder of the CNS that classically follows a viral infection or vaccination — characterized by multifocal white and grey matter demyelination with encephalopathy, predominantly affecting children. At a Glance Domain Practical Point Definition CNS demyelinating syndrome, almost always monophasic,
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Nociceptor Classification and Molecular Transduction Clinical Pearls & Key Takeaways • Temporal Distinction: The dichotomy between ‘first’ and ‘second’ pain is purely a function of conduction velocities between fast myelinated Aδ and slow unmyelinated C fibres. • Molecular Transduction: TRPV1 acts as a non-selective gating channel responsive to heat and local acidosis, whereas mechanical noxious
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Pre-Anaesthetic Check-up (PAC) Objectives of PAC The Pre-Anaesthetic Check-up (PAC) is a systematic evaluation performed before anaesthesia to assess the patient’s current health status, identify potential preoperative risks, optimise the patient, and formulate an individualised anaesthetic plan. The main objectives are: Assess the patient’s current health status Identify existing medical conditions and their severity. Assess
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