CONTENTS Rapid Reference 🚀 Physiology Hydrocephalus Different types of edema Focal versus global ICP elevation Causes of ICP elevation Diagnosis Clinical manifestations Ultrasound evaluation for ICP elevation Neuroimaging Single measurement of ICP with lumbar puncture ICP monitoring Indications for continuous ICP monitoring Techniques for continuous ICP monitoring ICP value interpretation CPP value interpretation ICP waveform […]
Search Results for: procedural sedation
Submassive & Massive PE
CONTENTS Most useful material: Crashing patient: Massive PE resuscitation guide 🚀 General approach to (sub)massive PE: (#1) Investigation package (#2) Risk stratification (#3) Thrombolytic contraindications (#4) Treatment approach Resuscitation of massive PE Avoid procedures if possible Fluid management Inotropes & vasopressors Inhaled pulmonary vasodilator(s) Hematologic management: Anticoagulation (heparin) Thrombolysis Regimens: Full dose Half dose Quarter […]
PulmCrit- Neurocritical care of the comatose meningitis patient
Early in my training I had a few comatose meningitis patients. They were admitted, given antibiotics, and supported on a ventilator. They died. For a while, I believed that this condition was fairly hopeless. Then I encountered a comatose young man with meningitis due to adjacent mastoiditis. His lumbar puncture opening pressure was ~50cm. Following mastoidectomy and temporary placement of a lumbar drain, he recovered. Since then, I have been increasingly aggressive about managing this. Some patients have responded surprisingly well.
Traumatic Brain Injury (TBI)
CONTENTS Rapid Reference 🚀 Epidemiology Primary vs. secondary injury Glasgow Coma Scale (GCS) Initial evaluation Specific types of injury Diffuse axonal injury (DAI) Contusions & intraparenchymal hematomas Epidural hematoma Subdural hematoma Subarachnoid hemorrhage Intraventricular hemorrhage Cerebral venous sinus thrombosis Fat embolism Management Coagulation management Hemodynamic management ICP management Ventilator management Seizure prophylaxis & management DVT […]
Neurological complications of COVID
CONTENTS Limitations of this chapter Brief word on pathogenesis General clinical principles Encephalopathy Diffuse leukoencephalopathy with diffusion restriction Acute necrotizing encephalopathy (ANE) Mild encephalopathy with reversible splenial lesion (MERS) Acute disseminated encephalomyelitis (ADEM) & Acute hemorrhagic leukoencephalitis (AHLE) Myelitis Autoimmune encephalitis Posterior reversible encephalopathy syndrome (PRES) Stroke Acute ischemic stroke Intracranial hemorrhage & microbleeds Cerebral […]
Right Ventricular failure
CONTENTS Rapid Reference: Approach to RV failure 🚀 Preamble: Don’t forget the right ventricle! Pathophysiology of RV failure RV death spiral RV myocardial perfusion Falling off the Starling curve Occult systemic hypoperfusion Diagnosis of RV failure Defining RV failure Physical exam findings Lab findings Radiology EKG Echocardiography Causes of right ventricular failure Chronic pulmonary hypertension […]
Approach to Stupor & Coma
CONTENTS Front matter: Most clinically relevant: Rapid Reference – Clinical approach 🚀 Causes of stupor & coma Definitions Distinctive states that mimic coma: Locked-in syndrome Abulia and akinetic mutism Hypokinetic catatonia Functional unresponsiveness Malingering Management – some additional comments Airway management Related Coma syndromes (section of Exam chapter) Podcast Questions & discussion Pitfalls diagnostic approach […]
Pulmonary & cardiac complications of pregnancy
CONTENTS GENERAL APPROACH History & symptoms Dyspnea Chest pain Cough Hemoptysis ➡️ Palpitations Peripheral edema Physical examination Laboratory tests Common laboratory tests ABG interpretation Radiology Pharmacologic issues in pregnancy Antibiotic ➡️ Anticoagulation & antiplatelets Cardiac medications Steroid Uterotonic medications SPECIFIC DISEASE STATES Airway Asthma Cardiac Acute coronary syndrome (ACS) Aortic dissection Arrhythmias SVT (supraventricular tachycardia) […]
Atelectasis
CONTENTS Basics Clinical presentation Types and causes of atelectasis Radiology Right upper lobe Right middle lobe Right middle lobe syndrome Left upper lobe Lower lobe atelectasis Bronchoscopy Management Additional/related topics Round atelectasis Drowned lung Questions & discussion abbreviations used in the pulmonary section: 6 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 […]
Management of COVID-19 patients admitted to stepdown or ICU
CONTENTS Rapid Reference 🚀 Initial tests to guide management Chest CT findings Organ support Cardiovascular Respiratory Noninvasive respiratory support Invasive mechanical ventilation Infectious disease – antibiotics Renal Hematology Neurology Immunomodulation Steroid Tocilizumab Baricitinib Tofacitinib Things that don’t work Remdesivir Convalescent plasma Questions & Discussion References checklist for COVID admission to ICU/stepdown ✅ Review medication list […]
Ventilator Associated Pneumonia (VAP)
CONTENTS Rapid Reference 🚀 Preamble: The riddle of VAP Stepwise approach to VAP Step #1 – Does the patient have probable VAP? Step #2 – Pulling the trigger on antibiotics & cultures Step #3 – Management of suspected VAP #3a) Cultures & repeat imaging #3b) Antibiotics for probable VAP Step #4 – Data review & […]
Septic Shock
CONTENTS Rapid Reference 🚀 Definitions of septic shock Diagnosis & evaluation Clinical Presentations Biomarkers: NLR Procalcitonin & CRP ➡️ Evaluation for the source Sepsis mimics Treatment Vasopressors Source control Fluid Steroid DVT prophylaxis with heparin REFRACTORY SHOCK Methylene blue Resuscitative endpoints MAP Heart rate Urine output Fluid balance Lactate Skin perfusion Interventions of no real […]
CAR-T cell therapy recipient in the ICU
CONTENTS Initial approach to CAR-T recipient in ICU CRS (cytokine release syndrome) Epidemiology Clinical manifestations Laboratory findings Differential diagnosis Staging Management Combined CRS & ICANS HLH (hemophagocytic lymphohistiocytosis) DIC (disseminated intravascular coagulation) ICANS (immune effector cell-associated neurotoxicity syndrome) Epidemiology Clinical manifestations Radiology Laboratory findings CSF EEG Diagnosis & differential diagnosis Staging Management Podcast Questions & […]
Neuromuscular Disorders
CONTENTS Initial approach to acute, diffuse weakness History & physical examination Causes of acute, diffuse weakness Brain Spinal cord Anterior horn cells Neuropathy NMJ (neuromuscular junction) Myopathy Laboratory evaluation Evaluation of respiratory muscle strength: Bedside pulmonary function tests Single breath count test Blood gas measurement Specific neuromuscular disorders Myasthenia gravis ➡️ Guillain-Barre syndrome ➡️ Botulism […]
Subarachnoid Hemorrhage (SAH)
CONTENTS Rapid Reference: Initial management 🚀 Epidemiology, causes, & location Epidemiology Causes of SAH based on blood distribution Diffuse or basal SAH Convexity SAH Perimesencephalic SAH Presentation Thunderclap headache – causes & approach Grading scales Diagnostic approach Diagnosis of SAH Noncontrast CT CT angiography Lumbar puncture MRI & MRA Invasive angiography Overall diagnostic algorithm Diagnosis […]
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