Decode Medicine from Ward Rounds to ICU rounds
TAPSE (Tricuspid Annular Plane Systolic Excursion) TAPSE is used to assess right ventricular (RV) longitudinal systolic function. In critical care, TAPSE is particularly useful because the RV contracts predominantly in the longitudinal direction, making longitudinal annular excursion an excellent surrogate of global RV systolic performance. Definition TAPSE = Distance (mm) that the lateral tricuspid annulus […]
Hypocalcemia Hypocalcemia is a reduction in serum ionized calcium, the biologically active form of calcium.calcium should not be checked daily as an “ICU routine.”Total calcium is useful for screening but is an unreliable indicator of ionized calcium, as ionized calcium is affected by factors such as pH, albumin, sodium, and phosphate concentrations. Calcium exists
Prone Ventilation (Prone Positioning) The landmark:PROSEVA Trial(2013) Demonstrated significant mortality reduction in severe ARDS when: Used early Used for prolonged periods-at least 16 hours a day for 4-5 days on average (i.e. for ~ 70-75% of the time) Combined with lung-protective ventilation Since then, prone positioning became standard care for severe ARDS. Physiological Basis Why
Ringer Lactate (RL) vs Plasma-Lyte Feature Ringer Lactate (RL / Hartmann’s) Plasma-Lyte (Plasma-Lyte A / Plasma-Lyte 148) Type Balanced crystalloid Balanced crystalloid Osmolality ~273–278 mOsm/L (slightly hypotonic) ~294–295 mOsm/L (isotonic) pH ~6.5 ~7.4 Sodium 130 mmol/L 140 mmol/L Chloride 109 mmol/L 98 mmol/L Potassium 4 mmol/L 5 mmol/L Calcium 2.7–3 mmol/L None Magnesium None 1.5
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Dextrose containing fluids Feature D25 (25% Dextrose) ½ DNS (D5 + 0.45% NaCl) DNS (D5 + 0.9% NaCl) Composition 25 g dextrose/100 mL 5% dextrose + 0.45% saline 5% dextrose + 0.9% saline Dextrose 250 g/L 50 g/L 50 g/L Sodium 0 77 mEq/L 154 mEq/L Chloride 0 77 mEq/L 154 mEq/L Osmolarity ~1260–1400 mOsm/L
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Maintenance Fluid in Critical Care (Adult ICU) In modern critical care, maintenance fluid is prescribed far less frequently than in the past because: Early enteral nutrition provides water. Many IV medications already deliver substantial fluid. Excess maintenance fluid contributes significantly to fluid overload, prolonged ventilation, AKI, and mortality. Definition Maintenance fluid replaces Insensible water loss
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Postoperative Fever Postoperative fever is one of the most common complications after surgery, occurring in 20–90% of patients depending on the type of surgery and the definition of fever. Definition Temperature ≥38°C (100.4°F) on two consecutive postoperative days OR single temperature ≥38.5°C (101.3°F) Fever within the first 48 hours is usually due to the inflammatory
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STRESS-RELATED MUCOSAL DISEASE (SRMD) / STRESS ULCERS I. DEFINITIONS 1. Stress-Related Mucosal Disease (SRMD) Acute erosive and ulcerative gastritis occurring in critically ill patients. Includes: Stress erosions (superficial) Stress ulcers (deep, bleeding lesions) 2. Stress Ulcers Multiple shallow mucosal lesions in the gastric fundus and body, caused by hypoperfusion and acid-mediated injury. II. PATHOPHYSIOLOGY 1.
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Splenic Injury (Splenic Trauma) Introduction Splenic injury is the most common solid organ injury following blunt abdominal trauma. The spleen is highly vascular and receives approximately 5% of the cardiac output, making hemorrhage the major cause of morbidity and mortality. Blunt trauma: 80–90% (motor vehicle collisions, falls, sports injuries) Penetrating trauma: Stab wounds, gunshot injuries
Posterior Reversible Encephalopathy Syndrome (PRES) Posterior Reversible Encephalopathy Syndrome (PRES) is a clinicoradiological syndrome characterized by: Acute neurological symptoms Vasogenic cerebral edema (predominantly posterior circulation territory) Reversible changes on neuroimaging It is not always posterior and not always reversible Frontal lobes may be involved Basal ganglia involvement possible Brainstem and cerebellar involvement possible Can even
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