Critical Care

Posterior Reversible Encephalopathy Syndrome

Neuro Critical Care /

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

Gastro and HepatoBilliary Critical Care​ /

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

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GASTROPARESIS 

Gastro and HepatoBilliary Critical Care​ /

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

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Nutritional Assessment in ICU

General ICU Care /

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

General ICU Care /

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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approach to shock

Cardiac Critical care /

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

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Hypertensive Crisis

Cardiac Critical care /

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 in ICU

Gastro and HepatoBilliary Critical Care​ /

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

Pulmonology Critical care /

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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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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