Decode Medicine from Ward Rounds to ICU rounds
Acute Diarrhoea 1. Definition Acute diarrhoea = Passage of ≥3 loose/watery stools per day lasting <14 days. Persistent: 14–28 days Chronic: >4 weeks Always clarify duration, volume, blood, travel, antibiotics, immunocompromise, and systemic toxicity. Acute Diarrhoea vs Dysentery Feature Acute Watery Dysentery Stool Watery Blood + mucus Fever Mild High Pain Mild Severe cramps Cause […]
Asymptomatic Bacteriuria (ASB) Asymptomatic bacteriuria (ASB) is defined as: Presence of significant bacterial growth in urine in a patient WITHOUT signs or symptoms attributable to urinary tract infection (UTI). Symptoms that must be absent include: Dysuria Frequency Urgency Suprapubic pain Flank pain Fever attributable to UTI Costovertebral angle tenderness Diagnostic Criteria Standard Definition (IDSA 2019)
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Catheter Associated Urinary Tract Infection (CAUTI) Definition A Catheter-Associated Urinary Tract Infection (CAUTI) is a UTI occurring in a patient with: An indwelling urinary catheter in place for >2 calendar days OR Catheter removed within the previous 48 hours with: Compatible symptoms/signs of UTI AND Significant bacteriuria. Catheter-Associated Asymptomatic Bacteriuria (CA-ASB) Bacteria in urine without
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Upper UTI/Pyelonephritis Pyelonephritis is a bacterial infection of the renal pelvis and renal parenchyma causing inflammation of the kidney. It represents the upper spectrum of urinary tract infection (UTI). Acute Pyelonephritis Acute suppurative bacterial infection involving: Renal pelvis/Collecting system/Renal interstitium/Renal tubules Usually occurs due to: Ascending infection from lower urinary tract Less commonly hematogenous spread
Portopulmonary Hypertension (PoPH) Definition Portopulmonary Hypertension (PoPH) is a form of pulmonary arterial hypertension (PAH, Group 1 PH) that develops in patients with: Portal hypertension (with or without cirrhosis) Increased pulmonary vascular resistance due to pulmonary arteriopathy Normal left-sided filling pressures Diagnosis requires: 1. Portal Hypertension Evidence of: Cirrhosis Non-cirrhotic portal hypertension Portosystemic shunts AND
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Acute Cholangitis 1. Definition Acute cholangitis is a life-threatening ascending infection of the biliary tree occurring due to biliary obstruction + bacterial infection. Classic triad = Charcot’s triad Fever Jaundice Right upper quadrant pain Severe disease = Reynolds pentad Charcot triad Hypotension Altered mental status Charcot triad present in ~50–70% only → absence does NOT
Peritonitis Definition Peritonitis is inflammation of the peritoneum caused by infection, chemical irritation, ischemia, foreign material, or sterile inflammatory processes. Anatomy Relevant to Peritonitis The peritoneum is a serous membrane consisting of: Layer Description Parietal peritoneum Lines abdominal wall Visceral peritoneum Covers abdominal organs The peritoneal cavity normally contains:<50–100 mL sterile fluid Classification of Peritonitis
NON ST ELEVATION ACUTE CORONARY SYNDROME (NSTE-ACS) Definition NSTE-ACS includes: NSTEMI (Non-ST Elevation Myocardial Infarction) → myocardial necrosis + ↑ troponin Unstable Angina (UA) → ischemia(ECG CHANGES) without necrosis (normal troponin) PATHOPHYSIOLOGY Plaque rupture/erosion → platelet activation → thrombus formation Partial or intermittent occlusion (NOT complete like STEMI) Leads to subendocardial ischemia Feature NSTE-ACS STEMI
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Approach to Oliguria in the ICU Oliguria = Urine output <0.5 mL/kg/hr. KDIGO AKI Criteria (Urine Output) Stage Urine Output Criteria Stage 1 <0.5 mL/kg/hr for 6–12 hours Stage 2 <0.5 mL/kg/hr for ≥12 hours Stage 3 <0.3 mL/kg/hr for ≥24 hours OR anuria ≥12 hours Definitions Term Definition Oliguria <400–500 mL/day Severe Oliguria <100
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Amiodarone 1. CLASSIFICATION Amiodarone = Class III antiarrhythmic (Vaughan-Williams classification) 2. MECHANISM OF ACTION K⁺ channel blockade (Phase 3) ↑ repolarization time ↑ QT interval ↑ refractory period → prevents re-entry circuits Na⁺ channel blockade ↓ conduction velocity (especially in ischemic tissue) Ca²⁺ channel blockade ↓ AV node conduction Non-competitive β-blockade ↓ sympathetic drive