Decode Medicine from Ward Rounds to ICU rounds
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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Ileus in the ICU Ileus is a functional, non-mechanical inhibition of intestinal propulsion resulting in impaired transit of gas, fluids, and enteral contents through the gastrointestinal tract without an anatomical obstruction. . Pathophysiology ICU ileus is multifactorial. Cause Mechanism Neurogenic mechanisms Critical illness causes ↑ sympathetic activity and ↓ parasympathetic (vagal) activity, resulting in reduced
GASTROPARESIS Delayed gastric emptying in the absence of mechanical gastric outlet obstruction. Epidemiology 40–70% mechanically ventilated patients Up to 60% septic shock patients Common after major surgery More common in: Head injury Stroke Burns Trauma Pancreatitis Multiple organ dysfunction Delayed gastric emptying contributes significantly to Underfeeding Aspiration pneumonia Ventilator-associated pneumonia (VAP) Increased ICU stay Pathophysiology
Nutritional Assessment in ICU A common pitfall in nutritional assessment is misinterpreting the effects of acute illness (e.g., albumin shifts in septic shock) as indicators of underlying malnutrition. History Acute disease effects: Conditions like sepsis, trauma, or inflammation can cause fluid shifts, hypoalbuminemia, and weight fluctuations, which may not reflect true nutritional status. Oral intake
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Enteral Nutrition in ICU Every critically ill patient staying for more than 48 h in the ICU should be considered at risk for malnutrition. Initiation of Nutrition Therapy in Critically Ill Patients (ESPEN 2023) Recommendation Practical ICU Points Start medical nutrition therapy (MNT) Consider nutrition support for all ICU patients, especially if ICU stay is
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SHOCK Definition Shock is acute circulatory failure resulting in inadequate oxygen delivery (DO₂) relative to tissue oxygen demand (VO₂), leading to cellular dysoxia, organ dysfunction, and, if untreated, death. The key concept is inadequate tissue perfusion, not simply low blood pressure. Why Shock Is Difficult to Define Historically, shock was equated with hypotension. But hypotension
Hypertensive Crisis Hypertensive crisis is a spectrum of severe blood pressure elevation associated with actual or potential acute target-organ damage. It is broadly classified into: Hypertensive Emergency Hypertensive Urgency (The 2024 AHA Scientific Statement and 2025 AHA/ACC Hypertension Guideline recommend abandoning the term “hypertensive urgency.” Instead, patients are classified as:severe asymptomatic hypertension) Hypertensive Emergency Severe
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Acute Pancreatitis Acute Pancreatitis is an acute inflammatory process of the pancreas caused by premature activation of pancreatic digestive enzymes leading to autodigestion, inflammation, edema, necrosis, and systemic inflammatory response. It ranges from: Mild self-limiting interstitial edema to Severe necrotizing pancreatitis with multiorgan failure. Diagnostic Criteria (Revised Atlanta Classification) Diagnosis requires 2 of 3 criteria:
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Ventilator Settings Trigger Trigger is the mechanism that initiates a ventilator breath. In simple words:”What tells the ventilator to start inspiration?” The trigger may be:Patient generated or Time generated Types of Trigger A. Time Trigger Ventilator starts breath according to set respiratory rate. Example:RR = 12/min so Breath every: 60/12 = 5 sec Ventilator triggers
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