Critical Care

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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Acute Respiratory Distress Syndrome

Pulmonology Critical care /

Acute Respiratory Distress Syndrome (ARDS)  ARDS (Acute Respiratory Distress Syndrome) is a diffuse inflammatory lung injury characterized by: Increased alveolar-capillary permeability Non-cardiogenic pulmonary edema Severe hypoxemia Reduced lung compliance Leading to acute respiratory failure requiring oxygen or ventilatory support. Berlin Definition (2012) — Diagnostic Criteria Criterion Requirement Timing Within 1 week of clinical insult or

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Hyperkalemia

Fluid and Electrolytes /

Hyperkalemia  Hyperkalemia is defined as:Serum potassium > 5.0 mEq/L(this value is different in different guidelines i.e >5.2mEq/L,>5.5mEq/L) Severity Classification(even this is not universal) Severity Potassium Level Mild 5.1 – 5.5 mEq/L Moderate 5.6 – 6.4 mEq/L Severe ≥ 6.5 mEq/L or ECG changes Clinical severity correlates more with rate of rise rather than absolute level.

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Tuberculoma

Neuro Critical Care /

Tuberculoma (CNS Tuberculoma) A tuberculoma is a localized granulomatous mass lesion caused by infection with Tuberculosis in the central nervous system (CNS). It represents a focal immune response to Mycobacterium tuberculosis and appears as an intracranial or spinal space-occupying lesion. Unlike tuberculous meningitis (TBM), tuberculoma is predominantly a parenchymal disease and may occur with or

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HYPOMAGNESEMIA

Fluid and Electrolytes /

HYPOMAGNESEMIA  Serum magnesium < 1.7 mg/dL/< 0.7 mmol/L/< 1.4 mEq/L Serum magnesium represents <1% of total body magnesium → normal serum levels do not exclude intracellular depletion. Severity Classification Severity Serum Mg Level Mild 1.6–1.8 mg/dL (0.66–0.74 mmol/L) Moderate 1.2–1.5 mg/dL (0.49–0.62 mmol/L) Severe <1.2 mg/dL (<0.49 mmol/L) Normal serum magnesium: 1.8–2.4 mg/dL (0.74–1.0 mmol/L)

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Diabetic Ketoacidosis

Endocrine Critical Care /

Diabetic Ketoacidosis (DKA) It results from absolute or relative insulin deficiency combined with increased counter-regulatory hormones: Glucagon Catecholamines Cortisol Growth hormone DKA occurs most commonly in:Type 1 Diabetes Mellitus but can also occur in:Type 2 Diabetes Mellitus especially during severe stress or with SGLT2 inhibitor use. Diagnostic Criteria(2024) Parameter Typical DKA Finding (Diabetes)Blood glucose >200

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Pneumothorax

Pulmonology, Pulmonology Critical care /

Pneumothorax Pneumothorax = Presence of air in the pleural space causing partial or complete collapse of the lung. Normal pleural pressure is negative relative to atmosphere. When air enters pleural space: Negative pressure is lost Lung recoils inward Chest wall expands outward Ventilation decreases Severe cases → hemodynamic compromise Classification Type Mechanism Primary Spontaneous Pneumothorax

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Upper Gastrointestinal Bleeding

Gastro and HepatoBilliary Critical Care​, Gastroenterology /

Upper Gastrointestinal Bleeding (UGIB)  Definition Upper GI bleeding refers to hemorrhage originating proximal to the ligament of Treitz (esophagus, stomach, duodenum). Anatomical Classification Site Examples Esophagus Varices, Mallory–Weiss tear, esophagitis Stomach Peptic ulcer, erosive gastritis, malignancy Duodenum Peptic ulcer, Dieulafoy lesion Etiology 1. Non-Variceal UGIB (≈ 80–85%) Peptic Ulcer Disease (most common) Duodenal ulcer >

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Refeeding Syndrome

Gastro and HepatoBilliary Critical Care​, Gastroenterology /

Refeeding Syndrome  Refeeding syndrome is a potentially fatal metabolic complication that occurs after rapid reintroduction of nutrition (especially carbohydrates) in malnourished or starved patients, characterized by acute shifts of phosphate, potassium, magnesium, fluids, and vitamins (notably thiamine) due to insulin surge. Core hallmark: Hypophosphatemia after refeeding. diagnosis of exclusion Pathophysiology  1️⃣ Starvation State ↓ Insulin,

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