Approach To Intensive care Unit Patient...Dr. Sajid Mumtaz Sodhar

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Allah has created humans & jins to worship Him only but unfortunately we are::

Allah has created humans & jins to worship Him only but unfortunately we are: Doing business ( intrest/riba is in our business) Doing shirk in our daily activities. Allah is greater only at the time of salat (praying), after that family members & money is greater than,,,,,,, ( striving for it until see the grave)

Approach To Intensive Care Unit Patient:

Approach To Intensive Care Unit Patient Sajid Mumtaz Sodhar “ Sodhar Courtesy ” “ Sodhar Courtesy ”

Medical Intensive Care Unit :

Medical Intensive Care Unit The management of patients in the intensive care unit is complex. Many times decisions regarding the best option for the diagnosis of an entity or management need to be made in a short period of time. “ Sodhar Courtesy ”

“This approach can reduce mistakes in those hectic moments when decisions are made. ”:

“ This approach can reduce mistakes in those hectic moments when decisions are made . ” “ Sodhar Courtesy ”

ICU Care: A Check List Approach :

ICU Care: A Check List Approach

Slide 6:

“ Sodhar Courtesy ”

Common problems facing in our ICU :

Common problems facing in our ICU FEVER IN THE ICU PATIENT HYPOTENSION AND SHOCK GI BLEED DVT PROPHYLAXIS TUBE FEEDING GUIDELINES HYPONATREMIA (NA < 135 meq/L) HYPERNATREMIA IN ICU HYPOKALEMIA K < 3.5 HYPERKALEMIA K > 5.0 MEQ/L AGITATION IN THE NON-INTUBATED PATIENT ACUTE RENAL FAILURE IN ICU HYPOMAGNESEMIA DIABETIC KETOACIDOSIS DIAGNOSTIC APPROACH TO DVT INITIAL MANAGEMENT OF VENOUS THROMBOEMBOLISM ACUTE RESPIRATORY DISTRESS DURING MECHANICAL VENTILATION HYPOXIA: DIAGNOSTIC APPROACH DIAGNOSTIC APPROACH TO ACID-BASE DISORDERS METABOLIC ACIDOSIS IN ICU PATIENT AGITATION IN THE NON-INTUBATED PATIENT AGITATION IN INTUBATED PATIENTS APPROACH TO HYPERCALCEMIA HYPOPHOSPHATEMIA

Common problems facing in our ICU:

Common problems facing in our ICU Hemodynamic Monitoring INITIATION OF MECHANICAL VENTILATION MICU NEUROMUSCULAR BLOCKER GUIDELINES MICU SEDATION GUIDELINES WEANING AN APPROACH TO PATIENTS WITH VENOUS THROMBOEMBOLISM AND HEPARIN INDUCED THROMBOCYTOPENIA POISIONING IN THE ICU PATIENT DIARRHEA IN THE ICU

Fever in the ICU Patient:

Fever in the ICU Patient “ Sodhar Courtesy ”

Hypotension and Shock :

Hypotension and Shock “ Sodhar Courtesy ”

GI Bleed:

GI Bleed “ Sodhar Courtesy ”

DVT Prophylaxis :

DVT Prophylaxis

Tube Feeding Guidelines:

Tube Feeding Guidelines “ Sodhar Courtesy ”

Hemodynamic Monitoring :

Hemodynamic Monitoring “ Sodhar Courtesy ”

Hyponatremia (Na < 135 meq/L):

Hyponatremia (Na < 135 meq/L) “ Sodhar Courtesy ”

Hypernatremia in ICU:

Hypernatremia in ICU “ Sodhar Courtesy ”

Hypokalemia K <3.5:

Hypokalemia K <3.5

Hyperkalemia K > 5.0 MEQ/L:

Hyperkalemia K > 5.0 MEQ/L “ Sodhar Courtesy ”

Agitation in Intubated Patients:

Agitation in Intubated Patients “ Sodhar Courtesy ”

Agitation in the Non-intubated Patient:

Agitation in the Non-intubated Patient “ Sodhar Courtesy ”

Acute Renal Failure in ICU :

Acute Renal Failure in ICU

Hypomagnesemia:

Hypomagnesemia

Diabetic Ketoacidosis:

Diabetic Ketoacidosis

Diagnostic Approach to DVT:

Diagnostic Approach to DVT

Diagnostic Approach to Pulmonary Embolism:

Diagnostic Approach to Pulmonary Embolism

Acute Respiratory Distress During Mechanical Ventilation :

Acute Respiratory Distress During Mechanical Ventilation

Hypoxia: Diagnostic Approach :

Hypoxia: Diagnostic Approach

Hypoxia: Management :

Hypoxia: Management “ Sodhar Courtesy ”

Diagnostic Approach to Acid Base Disorders - 1 :

Diagnostic Approach to Acid Base Disorders - 1

Diagnostic Approach to Acid Base Disorders 2 :

Diagnostic Approach to Acid Base Disorders 2 “ Sodhar Courtesy ”

Diagnostic Approach to Acid Base Disorders 3 :

Diagnostic Approach to Acid Base Disorders 3 “ Sodhar Courtesy ”

Metabolic Acidosis in ICU Patient :

Metabolic Acidosis in ICU Patient “ Sodhar Courtesy ”

Hypercalcemia:

Hypercalcemia

Hypophosphatemia:

Hypophosphatemia

Initiation of Mechanical Ventilation:

Initiation of Mechanical Ventilation “ Sodhar Courtesy ”

Weaning:

Weaning

MICU Sedation Guidelines :

MICU Sedation Guidelines “ Sodhar Courtesy ”

MICU Neuromuscular Blocker Guidelines :

MICU Neuromuscular Blocker Guidelines

Poisoning in the ICU Patient:

Poisoning in the ICU Patient

Diarrhea in the ICU:

Diarrhea in the ICU

Initial Management of Venous Thromboembolism :

Initial Management of Venous Thromboembolism

An Approach to Patients with Venous Thromboembolism and Heparin Induced Thrombocytopenia :

An Approach to Patients with Venous Thromboembolism and Heparin Induced Thrombocytopenia

R u ready 4r Quizzzzzzz……:

R u ready 4r Quizzzzzzz ……

Slide 44:

A 64-year-old man presents to the emergency room after awaking with an acute change in sensory perception. Specifically he complains of the loss of all feeling along his left side. Past medical history is significant for poorly controlled hypertension. Social history confirms cigarette smoking

Slide 45:

75-year-old male in consultation for fevers and mental status changes. This patient originally presented 10 days prior with an acute dissection of the abdominal aorta. His management at that time included emergent surgery and multiple blood transfusions. Following this the patient has been managed in the intensive care unit. 4 days ago he had been successfully weaned from the ventilator and off all pressors. 3 days ago the patient developed low grade fevers, headaches, gastrointestinal complaints, and myalgias. Blood cultures and chest X-ray were negative. Over the past 48 hours the patient has developed confusion and weakness; he became agitated and combative and was re-intubated for airway protection. The patient continued to exhibit deterioration in mental status as well as progressive and demonstrable weakness; he was noted to have evidence suggestive of an axonal polyneuropathy on electromyogram testing. Past medical history is most significant for vasculitis. The patient has been maintained on corticosteroids for the same. Physical examination reveals a male patient, intubated, on mechanical ventilatory support. Temperature is 38.5. Heart rate 90 bpm. Blood pressure 100/60 without pressor agents. The examination is difficult due to the patient's condition, however the neurologic examination is suggestive of a diffuse flaccid paralysis. The remainder of the examination is nonspecific.

Slide 46:

An MRI of the head and spine are performed; significant findings are shown above .

Slide 47:

Acute hemorrhagic stroke Toxic shock syndrome Cushing's Syndrome Meningoencephalitis Central pontine myelinolysis

Slide 48:

The MRI data presented reveal enhancement at the lepomeningeal and cauda equina areas, findings which are seen in about one-third of patients with West Nile Virus meningoencephalitis, the diagnosis in this case. You have correctly identified this week's Image of the Week.

Slide 49:

A 45-year-old man complains of persistent abdominal pain located in the midline of his abdomen, occasionally radiating to the back. No fever, chills, chest pain, or urinary symptoms are reported. Medical history is most significant for alcohol and tobacco abuse, two episodes of pancreatitis within the past year, and chronic diarrhea. Physical exam reveals a man in no distress. Vital signs are normal. Abdominal tenderness without overt guarding is confirmed. Toxic megacolon Urinary bladder distension Hepatocellular carcinoma Pancreatic pseudocyst Abdominal aortic aneurysm

Slide 50:

An 80 year-old-female presents with the new onset of seizure activity. She was living independently until recently, when she began staying with family members after they had noticed she was having difficulty caring for herself. Earlier that day she had a witnessed tonic-clonic seizure. The patient's family states the patient had been previously well until approximately 3 months ago when she began to complain of moderate to severe headaches which were unresponsive to over-the-counter pain relievers. This was followed by the subtle, gradual development of memory loss, personality changes, and eventually confusion. Her past medical history is significant for osteoarthritis and benign hypertension. She denied any drug or alcohol use

Slide 51:

Normal pressure hydrocephalus Hemorrhagic stroke Glioblastoma multiforme Multiple sclerosis with unidentified bright objects Cysticercosis

Slide 52:

70-year-old female presents as a new patient with a complaint of painful joints, specifically in her shoulders and knees. These symptoms have been present for several years and she has self-medicated with NSAIDS prior to this evaluation. She also reports frequent headaches, fatigue, deteriorating vision, and numbness in her hands.

Slide 53:

A 47-year-old male presents for follow-up. Six months ago the patient suffered from an acute apical transmural myocardial infarction complicated by a gastrointestinal bleed. The patient did not receive thrombolytics due to the GI bleeding. Cardiac catheterization after the infarction did not suggest other areas of critical narrowing. Subsequently the patient underwent medical treatment and was released. Over the past week he has noticed increasing dyspnea and orthopnea. The patient reports a past history of hypertension, and diabetes. Medications now include insulin, aspirin, a B-blocker, and a statin. He does not smoke or drink alcohol.

Slide 55:

A 60-year-old female presents for evaluation of exercise related dyspnea and chronic dry cough. The symptoms have been present and progressive for several months. There have been no associated fevers or chills. The patient reports a previous history of smoking. There is no history of environmental exposure, cardiac disease, connective tissue disease, or exposure to medications or drugs with these adverse effects. A recent evaluation found no infectious or cardiac explanation for these symptoms.

Slide 56:

Physical examination reveals a patient in no distress. Vital signs are normal. The exam is notable for dry rales at the bases of the lung fields as well as clubbing. Pericardial effusion Emphysema Tuberculosis Pneumonia, community acquired Idiopathic pulmonary fibrosis

Slide 57:

A 35-year-old man has been detained by the police for suspected participation in the distribution of biologic weapons. During his detainment the man has become ill with the development of a rash on the face, initially described as a non-painful red macule which has subsequently progressed and is now more severe. There are no associated constitutional signs, and the remainder of the exam is normal except for mild tachycardia. There are no cultures available and the man refuses to cooperate with the authorities The skin lesion is ……… .

Slide 58:

Smallpox Anthrax Plague Botulism Tularemia

Slide 59:

A 16-year-old teenager presents for routine school-related physical exam. He has just moved to the area from Connecticut. He denies any past medical history. He is a non-smoker and does not consume alcohol. He is an avid outdoorsman and spent most of the spring and summer camping. He does report a brief febrile illness with diarrhea, which occurred about 3 weeks ago and has since resolved. He otherwise denies any current symptoms. Physical examination is most remarkable for a diffuse eruption occurring at the face, chest and back. The eruption consists of superficial papules and pustular lesions along with deeper cystic nodules. The surrounding skin has an "oily" consistency. There appear to be some scars with hyperpigmentation as well. Individual lesions are tender to palpation. There is no associated pruritus.

Slide 60:

Infectious exanthem Dermatitis herpetiformis Erythema multiforme Sweet's syndrome (acute febrile neutrophilic dermatosis) Acne vulgaris

Slide 61:

28-year-old female presents with a complaint of persistent fevers at night for the past 3 weeks. Over the same time period she has experienced 5 pounds of weight loss in spite of little or no change in appetite. Two days prior to the visit she noticed a new painful skin rash. Past medical history is most signficant for stage 3 chronic kidney disease thought secondary to longstanding intravenous drug abuse. Physical examination reveals a thin female patient in no distress. Temperature is 37.8. Heart rate is 96 bpm. Blood pressure is 126/80. The cardiac examination reveals a single mid-systolic click best heard medial to the apex, followed by a soft late systolic murmur. The pulmonary examination is normal. The abdominal examination is normal. The skin and extremity examination reveals 1 + edema at the dorsum of the feet. There are several small hematomas in various stages of resolution located along the superficial veins of the upper arms. In addition there is a raised, red, somewhat tender skin lesion located on the left palm.

Slide 62:

Gottron's papule: dermatomyositis Burrow and vesicle: scabies Bone cyst: sarcoidosis Erythema migrans: Lyme disease Osler's node: bacterial endocarditis

Slide 63:

Jasakumallah khair