Sepsis and Septic shock

Surviving Sepsis Guidelines:  In their own words of wisdon – " The recommendations in this document are intended to provide guidance for the clinician caring for adult patients with sepsis or septic shock. Recommendations from these guidelines cannot replace the clinician’s decision-making capability when presented with a patient’s unique set of clinical variables. These guidelines are intended to be best … Read more

Vasopressors and Shock

Shock is a physiologic state characterized by a significant reduction of systemic tissue perfusion, resulting in decreased oxygen delivery to the tissues. This creates an imbalance between oxygen delivery and oxygen consumption.    Mechanism: Systemic tissue perfusion is determined by the cardiac output (CO) and systemic vascular resistance (SVR):  CO is the product of heart rate and … Read more

Basics of Mechanical Ventilation

Mechanical Ventilation:  Respiratory failure is caused by failure to oxygenate (Type I respiratory failure), with resultant decreae in PO2 or failure to ventilate (Type II respiratory failure), with a resultant increase in PCO2.     Breathing Pattern consists of a Control variable, Breath sequence and a targeting scheme.    Ventilator can control only one variable at a time.     Equation of Motion: … Read more

Acute Coronary syndrome

Acute Coronary Syndrome Unstable angina (UA),  non–ST-segment elevation myocardial infarction (NSTEMI) and STEMI are among the acute coronary syndromes (ACS).  Stable angina pectoris is characterized by chest or arm discomfort that is reproducibly associated with physical exertion or stress and relieved within 5–10 minutes by rest and/or sublingual nitroglycerin.  Unstable angina describes the occurrence of angina pectoris or equivalent ischemic discomfort … Read more

Pulmonary embolism

Pulmonary Embolism Acute PE can be classified as massive or submassive: Massive PE causes hypotension, defined as a systolic blood pressure <90 mmHg or a drop in systolic blood pressure of ≥40 mmHg from baseline for a period >15 minutes. It should be suspected anytime there is hypotension accompanied by an elevated central venous pressure … Read more

COPD Exacerbation

Chronic Obstructive Lung Disease  A disease state characterized by airflow limitation that is not fully reversible.  It is characterized by airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.  Emphysema: anatomically defined as abnormal and permanent enlargement of the airspaces distal to the … Read more

Asthma

Asthma  A chronic inflammatory disease of airways, characterized by increased responsiveness of the tracheobronchial tree to various stimuli  Bronchospasm is a secondary phenomenon caused by the underlying inflammatory process.  Manifested physiologically by widespread narrowing of the air passages, and clinically by paroxysms of dyspnea, cough, chest tightness and wheezing    Etiology  Airway hyperresponsiveness to both specific … Read more

DKA and Hypoglycemia

DKA  Diagnostic criteria Elevated sugars of >250 Ketonemia or ketonuria (  In early DKA, acetoacetate concentration is low and could be falsely negative. Conversely, β-OHB is an early and abundant ketoacid, which may first signal the development of DKA )  Acidosis​ with Ph<7.3 or Biacarb <18 Elevated anion gap   Pathophysiology: There are two major hyperglycemic crises associated with … Read more

Intracranial Bleeds

Sub-Arachnoid Hemorrhage    Aneurysms occur most frequently at the bifurcations of the basal cerebral arteries, implying a hemodynamic effect to the vessel wall. Almost all of the SAH is due to ruptured berry aneurysms. Other important causes include trauma, cocaine abuse, AV malformations and vasculitis. HTN, smoking and HLP are strongly associated with development of aneurysms.    Cause … Read more