Critical Care

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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Subarachnoid Hemorrhage

Neuro Critical Care, Trauma Critical Care /

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

General ICU Care /

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

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Cervical Spine injury

Trauma Critical Care /

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

Pulmonology Critical care /

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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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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