Acute Stroke

Definition  Stroke is defined as sudden onset of a neurologic deficit from a vascular mechanism. 85% of strokes are ischemic  and 15% are primary hemorrhages (Subarachnoid and Intraparenchymal).  Transient ischemic attacks (TIAs) are episodes of stroke symptoms that resolve rapidly, lasting fewer than 24 hours.   However, infarcts of the brain do occur in 15–50% of TIAs even though neurologic signs and … Read more

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

GI Bleeding

Upper GI Bleeding:  Patients with acute upper gastrointestinal (GI) bleeding commonly present with hematemesis (vomiting of blood or coffee-ground like material) and/or melena (black, tarry stools). The initial evaluation of patients with acute upper GI bleeding involves an assessment of hemodynamic stability and resuscitation if necessary.     Etiology:  The most common causes of upper gastrointestinal bleeding include … Read more

Intubation and Airway Management

Airway Management:  Emergency airway management is associated with a high complication rate. Evaluating the patient prior to airway management is important to identify patients with increased risk of failed airways. Induction agents are often required, but most induction agents are associated with hypotension during emergency intubation. Use of muscle relaxants is controversial for emergency intubation, … Read more

Hemodynamics

  Static hemodynamic monitoring variables  The utility of each variable as a single absolute value is questionable. Some individual hemodynamic values are useful primarily as threshold monitors. For example, because a primary determinate of organ perfusion is perfusion pressure, systemic hypotension to below a certain threshold is clinically relevant. Furthermore, elevation in central venous pressure … Read more

Tachyarrythmias

Tachycardia  Tachycardia is defined as a heart rate above 100 beats per minute, but symptomatic tachycardia generally involves rates over 150 beats per minute, unless underlying ventricular dysfunction exists. Management of tachyarrhythmias is determined by the presence of clinical symptoms and signs caused by the rapid heart rate.    The fundamental approach is as follows: … Read more

Cardiac Arrest

Cardiac Arrest Sudden cardiac arrest and sudden cardiac death refer to the sudden cessation of cardiac activity with hemodynamic collapse, typically due to sustained ventricular tachycardia/ventricular fibrillation.    Etiology: Coronary artery disease – 70% of sudden cardiac arrests are due to CAD. Other structural heart disease:  Heart failure and cardiomyopathy Left ventricular hypertrophy due to hypertension or other causes. … Read more