Decode Medicine from Ward Rounds to ICU rounds
Acute Cholangitis 1. Definition Acute cholangitis is a life-threatening ascending infection of the biliary tree occurring due to biliary obstruction + bacterial infection. Classic triad = Charcot’s triad Fever Jaundice Right upper quadrant pain Severe disease = Reynolds pentad Charcot triad Hypotension Altered mental status Charcot triad present in ~50–70% only → absence does NOT […]
Peritonitis Definition Peritonitis is inflammation of the peritoneum caused by infection, chemical irritation, ischemia, foreign material, or sterile inflammatory processes. Anatomy Relevant to Peritonitis The peritoneum is a serous membrane consisting of: Layer Description Parietal peritoneum Lines abdominal wall Visceral peritoneum Covers abdominal organs The peritoneal cavity normally contains:<50–100 mL sterile fluid Classification of Peritonitis
NON ST ELEVATION ACUTE CORONARY SYNDROME (NSTE-ACS) Definition NSTE-ACS includes: NSTEMI (Non-ST Elevation Myocardial Infarction) → myocardial necrosis + ↑ troponin Unstable Angina (UA) → ischemia(ECG CHANGES) without necrosis (normal troponin) PATHOPHYSIOLOGY Plaque rupture/erosion → platelet activation → thrombus formation Partial or intermittent occlusion (NOT complete like STEMI) Leads to subendocardial ischemia Feature NSTE-ACS STEMI
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Approach to Oliguria in the ICU Oliguria = Urine output <0.5 mL/kg/hr. KDIGO AKI Criteria (Urine Output) Stage Urine Output Criteria Stage 1 <0.5 mL/kg/hr for 6–12 hours Stage 2 <0.5 mL/kg/hr for ≥12 hours Stage 3 <0.3 mL/kg/hr for ≥24 hours OR anuria ≥12 hours Definitions Term Definition Oliguria <400–500 mL/day Severe Oliguria <100
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Amiodarone 1. CLASSIFICATION Amiodarone = Class III antiarrhythmic (Vaughan-Williams classification) 2. MECHANISM OF ACTION K⁺ channel blockade (Phase 3) ↑ repolarization time ↑ QT interval ↑ refractory period → prevents re-entry circuits Na⁺ channel blockade ↓ conduction velocity (especially in ischemic tissue) Ca²⁺ channel blockade ↓ AV node conduction Non-competitive β-blockade ↓ sympathetic drive
Acute Kidney Injury (AKI) AKI is a rapid decline in kidney function (hours to days), resulting in the accumulation of nitrogenous waste, electrolyte imbalance, and dysregulation of volume and acid-base status. Category Definition / Time Course Acute Kidney Injury (AKI) Abrupt decline in kidney function occurring within ≤7 days. KDIGO AKI is identified by an
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Ventilator Associated Pneumonia (VAP) Pneumonia occurring ≥48 hours after endotracheal intubation and initiation of invasive mechanical ventilation Infection not present or incubating at the time of intubation Related Terms (CDC Surveillance) Term Definition VAP Clinical diagnosis Ventilator-Associated Event (VAE) Surveillance definition VAC Ventilator-associated condition IVAC Infection-related VAC Possible VAP IVAC + microbiology Exams focus: Clinical
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Fournier’s Gangrene Fournier’s gangrene (FG) is a rapidly progressive, life-threatening form of necrotizing fasciitis involving the perineum, genitalia, and perianal region. It is characterized by: Necrosis of superficial and deep fascial planes Microvascular thrombosis Extensive tissue destruction Polymicrobial infection Severe sepsis and septic shock Why Is It Dangerous? Mortality remains:20–40% ,Can exceed:70–80% when: Septic shock
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