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 moreDKA and Hypoglycemia

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 moreIntracranial Bleeds

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 moreAcute Stroke

Acute pancreatitis

Acute Pancreatitis Acute pancreatitis is an inflammatory condition of the pancreas characterized clinically by abdominal pain and elevated levels of pancreatic enzymes in the blood.    Two distinct phases of AP have now been identified: early (within 1 week), characterized by the systemic inflammatory response syndrome (SIRS) and / or organ failure; and late (> … Read moreAcute pancreatitis


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 morePneumonia

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 moreGI Bleeding

Sedation, Analgesia and Paralytics

Sedation   BIS Monitor:  It is used to monitor the depth of sedation or anesthesia. BIS index is a practical processed EEG parameter that measures the direct effects of sedatives on brain.  Used mainly in paralyzed patients who can’t communicate and hence, can’t use RASS scale.    The sensor on forehead sends raw EEG information to … Read moreSedation, Analgesia and Paralytics

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 moreIntubation and Airway Management


  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 moreHemodynamics


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 moreTachyarrythmias