Decode Medicine from OPD to ICU rounds
Postoperative Fever Postoperative fever is one of the most common complications after surgery, occurring in 20–90% of patients depending on the type of surgery and the definition of fever. Definition Temperature ≥38°C (100.4°F) on two consecutive postoperative days OR single temperature ≥38.5°C (101.3°F) Fever within the first 48 hours is usually due to the inflammatory […]
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STRESS-RELATED MUCOSAL DISEASE (SRMD) / STRESS ULCERS I. DEFINITIONS 1. Stress-Related Mucosal Disease (SRMD) Acute erosive and ulcerative gastritis occurring in critically ill patients. Includes: Stress erosions (superficial) Stress ulcers (deep, bleeding lesions) 2. Stress Ulcers Multiple shallow mucosal lesions in the gastric fundus and body, caused by hypoperfusion and acid-mediated injury. II. PATHOPHYSIOLOGY 1.
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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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VExUS (Venous Excess Ultrasound Score) VExUS is a point-of-care ultrasound (POCUS)-based scoring system used to quantify systemic venous congestionand predict organ dysfunction (especially congestive nephropathy) in critically ill patients. It integrates: IVC size (macro congestion) Doppler patterns in venous systems (micro congestion transmission) Why VExUS? (Core Concept) Traditional markers (CVP, edema, weight gain) are: Late
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Preeclampsia and Eclampsia Hypertensive Disorders of Pregnancy Classification Disorder Features Chronic hypertension Hypertension before pregnancy or before 20 weeks gestation Gestational hypertension/Pregnancy-Induced Hypertension (PIH) New HTN after 20 weeks, no proteinuria/end-organ dysfunction Preeclampsia HTN after 20 weeks with proteinuria and/or end-organ dysfunction Eclampsia Preeclampsia with seizures Chronic hypertension with superimposed preeclampsia Chronic HTN plus new
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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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