Decode Medicine from OPD to ICU rounds
Acute Decompensated Heart Failure (ADHF) What is ADHF? Acute Decompensated Heart Failure (ADHF) is the rapid onset or worsening of signs and symptoms of heart failure requiring urgent therapy and often hospitalization. It may occur as: De novo HF (newly diagnosed) Acute decompensation of chronic HF Progression to cardiogenic shock Major guidelines: American Heart Association […]
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Right Ventricular Failure Introduction The right ventricle is unable to provide adequate forward flow into the pulmonary circulation at normal filling pressures, leading to systemic venous congestion with or without low cardiac output.most common cause of right heart failure is left ventricular failure. In ICU practice, acute RV failure is a hemodynamic emergency — commonly
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CONSTIPATION IN ICU 1. DEFINITION (No universal consensus) Most ICU studies define constipation as: No bowel movement for ≥3 days OR need for rescue laxatives/enema OR hard stools / difficult evacuation 2. EPIDEMIOLOGY Incidence: 15–83% (very common in ICU) Higher in: Mechanically ventilated patients Sedated/paralyzed patients Opioid use Enteral feeding patients 3. WHY IT MATTERS
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HYPERPHOSPHATEMIA Hyperphosphatemia = Serum phosphate > 4.5 mg/dL (1.45 mmol/L) in adults Severity Serum Phosphate Mild 4.6–6 mg/dL Moderate 6–9 mg/dL Severe >9–10 mg/dL Life-threatening when associated with: Hypocalcemia Arrhythmias Acute kidney injury Tumor lysis syndrome Normal Phosphate Physiology Distribution 85% – bone (hydroxyapatite) 14% – intracellular <1% – extracellular (measured serum phosphate) Normal Serum
EFAST (Extended Focused Assessment with Sonography for Trauma) EFAST is an extension of FAST (Focused Assessment with Sonography for Trauma) that adds thoracic views . PROBE & SETTINGS Probe: Curvilinear (3–5 MHz) or phased array Depth: 15–20 cm (abdomen), shallow for lung Mode: B-mode (main), M-mode (for lung) 1. Pericardial View (Cardiac) A. Subxiphoid
Gastric Ultrasound Gastric point-of-care ultrasound (Gastric POCUS or Gastric USG) is a bedside ultrasound technique used to determine: Whether the stomach is empty or contains contents Nature of gastric contents (empty, clear fluid, thick fluid, solid) Estimated gastric volume Aspiration risk Suitability for anesthesia, procedural sedation, extubation, or enteral feeding The technique was pioneered by
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Subcostal (subxiphoid) view Probe: Curvilinear or phased array (2–5 MHz) 1.5–2 cm caudal to hepatic vein–IVC junction right flank approach or coronal IVC view. Right mid-axillary line or slightly anterior Level: 8th–11th intercostal space Use liver as acoustic window Parameter Value IVC diameter 1.2–2.1 cm Collapsibility >50% (spontaneous breathing) IVC Indices A. Collapsibility Index (CI)
Diaphragm ultrasound Diaphragm ultrasound has become one of the most useful bedside tools in the ICU. It provides a real-time assessment of diaphragmatic structure and function, helps predict weaning success, detects ventilator-induced diaphragmatic dysfunction (VIDD), identifies phrenic nerve injury, and follows recovery over time. Two parameters are routinely measured: Diaphragm Excursion (DE) → movement of
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Optic Nerve Sheath Diameter (ONSD) Optic Nerve Sheath Diameter (ONSD) measurement by bedside ultrasound is a rapid, non-invasive, repeatable method for estimating intracranial pressure (ICP). Although ONSD does not directly measure ICP, enlargement of the optic nerve sheath strongly correlates with raised ICP because the optic nerve sheath is anatomically continuous with the intracranial subarachnoid
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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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