Seizures

Approach to Seizures    Definition  A seizure is a paroxysmal event due to abnormal, excessive, hypersynchronous discharges from an aggregate of central nervous system (CNS) neurons.  Epilepsy describes a condition in which a person has recurrent seizures due to a chronic, underlying process. i.e. 2 or more episodes of seizures.  Partial (or focal) seizures  Simple-partial seizures … Read more

Capnography

Capnography:    Capnogram is a plot of PCO2 vs. time or volume.     Physiology:  In expired respiratory gases, capnography directly reflects the elimination of CO2 by the lungs to the anesthesia device. Indirectly, it reflects the production of CO2 by tissues and the circulatory transport of CO2 from tissues to the lungs. Thus capnography is an important non-invasive technique that provides information … Read more

BLS and ACLS

Basic Life Support (BLS)      Immediate recognition and activation, early CPR, and rapid defibrillation (when appropriate) are the first three BLS links in the adult Chain of Survival. Patient survival depends primarily upon immediate initiation of excellent CPR and early defibrillation. AHA Guidelines 2015   Chest compressions  Chest compressions are the most important element of cardiopulmonary resuscitation (CPR). The recommended … Read more

Anticoagulation

ANTICOAGULATION IN ICU    Clotting cascade:      Warfarin:  For patients sufficiently healthy to be treated as outpatients, we suggest initiating VKA therapy with warfarin 10 mg daily for the first 2 days followed by dosing based on INR measurements rather than starting with the estimated maintenance dose  For patients taking VKA therapy with consistently … Read more

DIC and TTP

Disseminated Intravascular Coagulation  DIC, also called consumption coagulopathy, is a systemic process producing both thrombosis and hemorrhage. It consists of the following components:    Exposure of blood to procoagulants such as tissue factor and cancer procoagulant   Formation of fibrin within the circulation   Fibrinolysis   Depletion of clotting factors   End-organ damage  Purpura fulminans is a severe form of DIC resulting from thrombosis … Read more

Variceal Bleeding

Variceal Bleeding:      Pathogenesis : The most important predictor of hemorrhage is the size of varices. There are two distinct phases in the course of variceal hemorrhage: an acute phase and a later phase in which there is a high risk of recurrent bleeding.   The acute phase starts with the onset of active hemorrhage. Patients … Read more

Cardiac Tamponade

Cardiac Tamponade:  Cardiac tamponade – Characterized by the accumulation of pericardial fluid under pressure.   Constrictive pericarditis – Scarring of pericardium with resultant loss of elasticity of the pericardial sac.   An important pathophysiologic feature of both cardiac tamponade and constrictive pericarditis is greatly enhanced ventricular interaction or interdependence, in which the hemodynamics of the left and right … Read more

Sodium and Water disorders

Sodium and water balance    TBW (Males) = 60% of bodyweight    TBW (Females) = 50% of bodyweight    TBW = ECF (1/3rd) + ICF (2/3rd)    ECF = Intravascular (1/4th) + Extra vascular (3/4th)    Plasma Osmolarity = = 2[Na+] + [Glucose]/18 + [BUN]/2.8 + [Ethanol]/4.5                            Loss … Read more

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