Pneumonia

PNEUMONIA    Community-acquired pneumonia (CAP) is defined as an acute infection of the lung parenchyma in a patient who has acquired the infection in the community.  Hospital-acquired (or Nosocomial) pneumonia (HAP) is pneumonia that occurs 48 hours or more after admission and did not appear to be present at the time of admission.  Ventilator-associated pneumonia (VAP) is … Read more

Dark side of fluids and Fluid overload

Dark side of IV fluids? Septic patients are typically hypotensive and low blood pressure is often associated with an increased blood lactate concentration, a low urinary output, and other signs and symptoms of physiological distress. Clinicians then make an inference that there must be inadequate vital organ blood flow (typically described as poor perfusion) to … Read more

Fluid responsiveness

Fluid responsiveness and Functional hemodynamic monitoring   What is fluid responsiveness? Fluid responsiveness is an increase of stroke volume > 10-15% after the patient receives a bolus of 500 ml of crystalloid (Bolus by definition means that it has to be pressure bagged and given over 5-10 minutes). Fluid responsiveness is also known as “volume … Read more

Advanced hemodynamic monitors

Advanced hemodynamic monitors and fluid responsiveness Cardiac output is used in the ICU as a marker of oxygen delivery to tissues and to guide treatment, primarily for fluid resuscitation and the use of vasopressors, vasodilators and inotropes.   For decades, PA catheter used to be the ‘clinical reference standard’ for cardiac output monitoring, using thermodilution … Read more

Sepsis and Septic shock

Surviving Sepsis Guidelines:  In their own words of wisdom – " 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 practice and not … Read more

Contrast Nephropathy

Contrast Induced Nephropathy (CIN)   CIN is defined as a deterioration of renal function (defined as an increase in serum creatinine by more than 25%) within 3 days of intravascular administration of contrast in the absence of an alternative etiology.   CIN usually manifests as transient asymptomatic elevation of serum creatinine, which begins within 24 … Read more

Alcohol Withdrawal

Alcohol Withdrawal / Delirium tremens   Delirium tremens: The criteria for withdrawal delirium are delirium (a rapid-onset fluctuating disturbance of attention and cognition, sometimes with hallucinations) plus alcohol withdrawal.   Clinical features: Most common signs and symptoms of alcohol withdrawal are tremors, autonomic hyperreactivity ( fever, tachycardia, sweating, tachypnea, elevated blood pressure) , GI upset, nausea, … Read more

Acute Heart Failure

Heart Failure is heart’s inability to eject blood (systolic dysfunction) or fill with blood (diastolic dysfunction), causing circulatory congestion, dyspnea, fatigue and weakness. Acute HF is a sudden reduction in cardiac performance, resulting in acute pulmonary edema and hypotension with or without peripheral edema.    Classification: ACC/AHA)  task force divided CHF into the following stages: Stage … Read more

Influenza

INFLUENZA    Although most persons who become infected with influenza viruses will recover without sequelae, influenza can cause serious illness and death, particularly among persons aged ≥65 years and <2 years and those with medical conditions that confer high risk for complications from influenza.     Vaccination:  Routine annual influenza vaccination for all persons aged ≥6 … 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