play_arrow ICU Primary Snippet – iNO & Prostacyclins Dr Swapnil Pawar   Notes by Dr Madhuri Anupindi   Nitric oxide: Mechanism of action: Rapidly absorbed into pulmonary circulation  Activates guanylate cyclase (soluble enzyme in cytosol version – natural version is membrane found protein)  converts GTP into cGMP  activates protein kinase G  inhibits IP3-mediated release of calcium, phosphorylates voltage gated ca channels (inactivates), phosphorylates phospholamban (regulates ca pump) which increases ca uptake in sarcoplasmic reticulum  smooth muscle relaxation  pulm ..read more

play_arrow ICU Primary Snippet 2 – Serum Creatinine and Creatinine Clearance Dr Swapnil Pawar Primary Snippet 2The post ICU Primary Snippet 2 – Serum Creatinine and Creatinine Clearance first appeared on Critical Care Education ..read more

play_arrow ICU Fellowship Vivas – Type 1 Respiratory failure, Determination of Brain death and Failed intubation Dr Swapnil Pawar   Blog written by – Dr Madhuri Anupindi   You are asked to review a 56F in recovery who became hypoxic post bronchoscopy. The bronchoscopy was done to investigate a 2 week history of increasing shortness of breath and bilateral infiltrates on CXR. She is intubated and ventilated with sats of 88% on an fio2 of 1. Her respiratory function tests from one week prior to admission show an FVC of 40% predicted and an FEV1 of 43% predicted with minimal bronc ..read more

play_arrow Double Sequential External Defibrillation – A game-changer Dr Swapnil Pawar   Alternate defibrillation strategies for refractory ventricular fibrillation Cheskes S, Verbeek PR, Drennan IR, et al.  N Engl J Med. 2022 Nov 24;387(21):1947-1956. doi: 10.1056/NEJMoa2207304. Epub 2022 Nov 6. PMID: 36342151.   Blog Written by Dr Jose Chacko Background Double sequential (DSED) and vector change (VC) defibrillation have been in use for many years. Observational studies and case reports have switched to these strategies mainly as a last resort in refractory ventricular fib ..read more

play_arrow TEAM Trial – Early Mobilisation in Intensive Care Dr Swapnil Pawar   Early Active Mobilization during Mechanical Ventilation in the ICU The TEAM Study Investigators and the ANZICS Clinical Trials Group Blog Written by – Dr Jose Chacko  Population and setting The study was held from February 27, 2018, to November 19, 2021, across 49 hospitals in 6 countries, including Australia, New Zealand, Ireland, the UK, Germany, and Brazil. Patients were on mechanical ventilation. Ventilation was expected to continue beyond the calendar day after randomization. Patients were jud ..read more

play_arrow Spinal Cord Compression Dr Swapnil Pawar   Spinal Cord Compression Written by – Ashly Liu Spinal Cord Compression Shownotes Spinal cord compression is when arterial, venous and cerebrospinal fluid spaces or the cord are compressed or displaced.  Differentials include Trauma including MVA, falls, and osteoporotic fractures. Intervertebral disc herniation Malignancy, including metastases Spinal epidural abscess Common Presentation Patients can present in a variety of ways depending on the level of the spine that is affected.  The typical clinical findings of pain ..read more

play_arrow SETPOINT 2 Trial – Early Vs Late Tracheostomy in Stroke patients Dr Swapnil Pawar   Blog Written by – Dr Jose Chacko Effect of Early vs Standard Approach to Tracheostomy on Functional Outcome at 6 Months Among Patients With Severe Stroke Receiving Mechanical Ventilation The SETPOINT2 Randomized Clinical Trial Background In the SETPOINT pilot study, 60 patients with stroke on mechanical ventilation were randomized to tracheostomy within 3 days of intubation or between days 7 and 14 if they remained intubated. The ICU length of stay, the primary endpoint, was similar. Howeve ..read more

play_arrow Fellowship Vivas – Thrombocytopenia, TAVI and TBI Dr Swapnil Pawar FELLOWSHIP PODCAST  Written by Dr Madhuri Anupindi   75M has been in ICU for 4 days following MVR + CABGs, he is ventilated and shocked, requiring ongoing cardiovascular support. Over this time, his platelet count has dropped (386 pre-op  109 post bypass  151 day 1  61 on day 5). What are the likely causes of thrombocytopenia in this situation? The likely causes of thrombocytopenia in this gentleman are via increased destruction or consumption, decreased production, dilution, sequestration or fact ..read more

play_arrow Lithium Toxicity Dr Swapnil Pawar Lithium Toxicity Written by Dr Andrew Lam Interpretation of Lithium Levels Therapeutic level – 0.8 – 1.2mmol/L Mild Toxicity – 1.5 – 2.5mmol/L Moderate to Severe Toxicity from – 2.5 – 3.5mmol/L  Severe toxicity – >3.5mmol/L Symptoms of Toxicity  Gastrointestinal – nausea, vomiting and diarrhea. (More common in acute toxicity) Neurological –  ataxia, sluggishness, slurred speech, agitation and tremors. In more severe toxicity, can result in seizures and encephalopathy (More common in chronic toxicity) Cardiovascular – dysrhythm ..read more

play_arrow Ectopic Pregnancy Dr Swapnil Pawar Ectopic Pregnancy  Written by Dr Ashley Liu Ectopic Pregnancy Ectopic pregnancies should always be considered in any patient of reproductive age with vaginal bleeding +/- abdominal pain. Clinical Manifestation The most common presentation of ectopic pregnancy is usually first-trimester vaginal bleeding and/or abdominal pain. This may be associated with normal pregnancy discomforts (breast tenderness, frequent urination, nausea). Vaginal bleeding: varied but usually preceded by a period of amenorrhoea. Abdominal pain: varied but may be dif ..read more