Dr Harshit Aggarwal

Emergency Medicine in India: Why Is the Specialty Still Searching for Its Identity?

Reality of medicine / /

Emergency Medicine (EM) was officially recognized as a specialty in India in 2009. More than 15 years later, it remains one of the fastest-growing yet least understood branches of medicine. The question isn’t “Do we need Emergency Medicine?” The answer is obvious. The real question is: Why is the specialty still struggling to establish its […]

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How I Cracked NEET SS Critical Care Medicine and Secured AIR 72

NEET-SS / /

When I entered the second year of my MD residency, I was certain about one thing—I wanted to pursue Critical Care Medicine. Having a clear goal early made my preparation much more focused. I initially started with Paul Marino’s The ICU Book. It gave me a solid understanding of critical care concepts and physiology. However,

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Snake Bite

Toxicology Critical Care / /

Snake Bite (Snake Envenomation)  India accounts for one of the highest snakebite burdens globally. Important venomous snakes: “Big Four” of India Snake Scientific Name Major Toxicity Indian Cobra Naja naja Neurotoxic + Cytotoxic Common Krait Bungarus caeruleus Neurotoxic Russell’s Viper Daboia russelii Hemotoxic + Nephrotoxic Saw-scaled Viper Echis carinatus Hemotoxic Other important species: King cobra

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Subarachnoid Hemorrhage

Neuro Critical Care, Trauma Critical Care / /

Subarachnoid Hemorrhage (SAH)  Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space between the arachnoid mater and pia mater where cerebrospinal fluid (CSF) circulates. It is one of the most devastating neurological emergencies with: Mortality: 25–50% Significant disability among survivors Peak incidence: 40–60 years Approximately 80–85% of spontaneous SAH results from rupture of an intracranial

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Anaphylaxis

General ICU Care / /

Anaphylaxis  According to the World Allergy Organization (WAO): Anaphylaxis is a severe, life-threatening systemic hypersensitivity reaction characterized by rapidly developing airway, breathing and/or circulation problems, usually associated with skin and mucosal changes. Types of Anaphylaxis Feature IgE-Mediated Anaphylaxis (Classic) Non-IgE Mediated Anaphylaxis (Formerly “Anaphylactoid”) Frequency Most common type Less common Immune Mechanism IgE antibody-mediated hypersensitivity

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Cervical Spine injury

Trauma Critical Care / /

Cervical Spine injury  Etiology 1. Traumatic Causes (≈80%) Motor vehicle accidents (most common) Falls (especially in elderly) Sports injuries Violence (gunshot, stab wounds) Industrial accidents 2. Non-traumatic Causes Tumors (intramedullary/extramedullary) Infections (TB, epidural abscess) Ischemia/infarction (e.g., aortic surgery) Degenerative diseases (cervical spondylotic myelopathy) Inflammatory (transverse myelitis, MS) Anatomy  Region Vertebral Levels Function Loss  Cervical (C1–C8)

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Ventilator Asynchronies

Pulmonology Critical care / /

Ventilator Asynchronies  Ventilator asynchrony refers to a mismatch between the patient’s neural respiratory drive and the ventilator’s delivered breath (trigger, flow, cycling, or mode). It leads to: ↑ Work of breathing (WOB) Patient discomfort Sedation escalation Delirium Prolonged mechanical ventilation Increased ICU stay Possibly increased mortalityAsynchrony is present in up to 20–40% of ventilated ICU

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WEANING FROM MECHANICAL VENTILATION

Pulmonology Critical care / /

WEANING FROM MECHANICAL VENTILATION WHY WEANING IS IMPORTANT Complications of Delayed Weaning Ventilator-associated pneumonia (VAP) Diaphragmatic disuse atrophy (VIDD) ICU-acquired weakness (CIP/CIM) Increased ICU length of stay Higher mortality Increased sedation exposure Complications of Premature Weaning Reintubation Aspiration Hemodynamic instability Increased mortality (especially if reintubation within 48 hrs) CLASSIFICATION OF WEANING  1️⃣ Simple Weaning Successful

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Tracheostomy Emergencies

General ICU Care / /

Tracheostomy Emergencies Classification  Early (<7 days) Late (>7 days) Hemorrhage Tracheo-innominate fistula Tube obstruction Granulation tissue Accidental decannulation Tracheal stenosis False passage Tracheomalacia Pneumothorax Tracheoesophageal fistula Surgical emphysema Infection Tube displacement Mucus plugging Wound infection Tube fracture “DOPES Approach” Cause What to Check Management D Displacement ETT/tracheostomy tube displaced, accidental extubation, endobronchial intubation Check tube

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