Pulmonary Hypertension

PULMONARY HYPERTENSION  Pulmonary hypertension (PH) is defined simply as a mean pulmonary artery pressure of 25 mmHg or greater. The normal mean pulmonary arterial pressure is 14+-3, with upper limit being 20. Normal pulmonary arterial systolic pressure is around 10 and diastolic pressure around 5 mmHg.    Although pulmonary hypertension is primarly due to elevation of pressure … Read more

Proportional Assist Ventilation

 Proportional Assist Ventilation    PAV is a spontaneous breathing mode that offers assistance to the patient in proportion to the patient’s effort. It can be considered as adaptive pressure support. In pressure support, the support is a fixed driving pressure. In PAV, the support is adaptive to keep work of breathing constant.  In this mode, the magnitude of ventilator … Read more

APRV

Airway Pressure Release Ventilation    Airway pressure release ventilation (APRV) mode of mechanical ventilation is an elevated CPAP level with timed pressure releases. This short release for brief periods along with spontaneous breathing promotes CO2 elimination. Release time is short enough to prevent peak expiratory flow from returning to a zero baseline.  The other advantage of … Read more

Nutrition

Nutrition in ICU:    During critical illness, catabolism (breakdown of muscle protein, fat and other complex molecules) occurs faster than anabolism. The major goal of nutritional support during this period of acute illness was to ensure the body has adequate energy and nutrients available to slow down this process of fat and muscle loss. Loss of … Read more

Drug Overdose

Toxicology:    Approach to Acute Poisoning  Resuscitation  Airway  Breathing  Circulation  Seizure control  Correct hypoglycemia  Correct hyperthermia  Resuscitation antidotes  Risk assessment  Investigations  Supportive care and monitoring  Decontamination with activated charcoal. It should be given within 1 hour.  Enhanced elimination:  Multiple dose charcoal in quinine, carbamazepine, theophylline and barbiturate poisoning  Whole bowel irrigation with golytely  Urinary alkalinization: Alkaline … Read more

Neutropenic Fever

Neutropenia is usually defined as an ANC <1500 cells/microL, and severe neutropenia as an absolute neutrophil count (ANC) <500 cells/microL. Fever in neutropenic patients is defined as a single oral temperature of >38.3°C (101°F) or a temperature of >38°C (100.4°F) sustained for >1 hour.      The absolute neutrophil count (ANC) is equal to the product of the white blood cell … Read more

C Diff Colitis

Clostridium Difficile    Clostridium difficile is the causative organism of antibiotic-associated colitis. The organism is capable of elaborating exotoxins that bind to receptors on intestinal epithelial cells, leading to inflammation and diarrhea.     C difficile is highly transmissible via fomites and can be cultured readily from nearly any surface, including items in patient rooms as well … Read more

ECHO

Basic Views:    Parasternal long axis view (PLAX)  The parasternal long axis view is commonly the first view obtained in an echo examination and is useful for assessing contractility visually, assess mitral and aortic valves, calculating ejection fraction in M-mode, detecting regional wall motion abnormalities, measuring LV outflow tract diameter for cardiac output studies and identifying pericardial effusion.    … Read more

Lung Ultrasound

Lung Ultrasound:  High frequencies are useful to look at the periphery of the lung with a high resolution as in looking for 'lung sliding' and other signs of pneumothorax, as well as studying lung comets. Lower frequencies help with the imaging of deep lung tissues as in looking at consolidation and pleural effusion. Hence a … Read more