Decode Medicine from OPD to ICU rounds
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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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
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 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
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 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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