Krystal Hirayama @krystallei on GrepMed

Dizziness - Differential Diagnosis Framework Vertigo: • Peripheral: Labyrinthitis, BPPV, Meniere's disease, Alternobaric • Central: CVA/TIA - Vertebrobasilar, Vertebrobasilar artery insufficiency, Brainstem migraine, Acoustic neuroma, Complex partial Sz - Temporal Lobe Pre-syncope: • No enough blood: Acute anemia, Orthostatic hypotension, Vasovagal reaction, Arrhythmia, AS/HOCM • Not Enough Glucose: Hypoglycemia • Not Enough Oxygen: Hypoxia Dysequilibrium: • Multi-factorial: Vague story of feeling off balance, Sensory and motor deficits, Obesity, Limited vision Other: • Anxiety disorder, Panic disorder, Schizophrenia, Bipolar disorder, Substance abuse Jacobi Internal Medicine Chiefs @jmcchiefs #Dizziness #Differential #Diagnosis #dizzy #vertigo

ABC's of POCUS Forming the platform for my CCS2018 talk, ‘POCUS on ITU’! My infographic on the ABC’s of POCUS! Jonny Wilkinson @Wilkinsonjonny #Diagnosis #CriticalCare #POCUS #ABCs #ABCDEs #clinical #ultrasound

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NICE-SUGAR - Intensive versus Conventional Glucose Control in Critically Ill Patients N Engl J Med 2009; 360:1283-1297 https://www.nejm.org/doi/full/10.1056/NEJMoa0810625 Conclusion: In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter. - Visual Abstract by Usama Nasir MD https://twitter.com/usamanasirmd #NICESUGAR #Glucose #Glycemic #Control #Intense #Endocrinology #VisualAbstract #Diabetes #EBM #Trial

Sepsis - Diagnosis and Management Life-threatening organ dysfunction caused by a dysregulated host response to infection SEPTIC SHOCK is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. Patients w/ septic shock are identified with the following 3 features: 1. Clinical construct of sepsis 2. Persistent hypotension (requiring vasopressors to maintain MAP >65 mm Hg) 3. Serum lactate >2 mmol/L (despite adequate volume resuscitation) Previously, we used SIRS for screening, which was defined as positive if 2 of the following were present: 1. Temp > 38 C or < 36 C 2. HR > 90 bpm 3. RR > 20 breaths/min 4. WBC > 12 K or < 4K We now use qSOFA, defined as positive if 2 of the following are present: 1. AMS (GCS < 15) 2. SBP < 100 3. RR > 22 qSOFA > 2 indicates increased likelihood of prolonged ICU stay or in-hospital mortality Management Principles: Early recognition and treatment with: 1 Empiric broad spectrum antibiotics 2 Initial fluid resuscitation 3 Vasopressor support (if needed) 4 Source identification and control Dr. Meredith Greer @EmmGeezee #Sepsis #Criteria #Diagnosis #Management #QSOFA #SIRS #criticalcare #icu

Main types of autoimmune encephalitis in the ICU. Anti-NMDAR anti-N-methyl-d-aspartate receptor, ADEM acute disseminated encephalomyelitis, Anti-GFAP anti-glial fibrillary acidic protein, Anti-GABAAR anti-gamma aminobutyric acid A receptor, Anti-GABABR anti-gamma aminobutyric acid B receptor, Anti-LGI1 anti-leucine-rich glioma-inactivated 1, AMPA-R α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor, Anti-MOG anti-myelin oligodendrocyte protein, CSF cerebrospinal fluid, MRI magnetic resonance imaging, EEG electroencephalography, Abs antibodies, Rx prescriptions #autoimmune #encephalitis #comparison #table #neurology #diagnosis

Blood Pressure Management for Neurologic Emergencies - SAH - ICH - TBI - Ischemic Stroke (no TPA) - Ischemic Stroke + TPA By Lindsey Glaspey, DO #BloodPressure #Targets #CVA #Stroke #Neurology #Emergency #Management #Goals

National Early Warning Score (NEWS) Parameters: Originally designed to detect deteriorating patients in hospital wards, specifically those at increased risk of ICU admission, cardiac arrest, or death within 24 h 1. Respiratory rate 2. Oxygen saturations 3. Temperature 4. Systolic blood pressure 5. Heart rate 6. Level of consciousness. Calculator Here: https://www.mdcalc.com/national-early-warning-score-news #NEWS #National #Early #Warning #Score #Scale #Diagnosis #Screening #Sepsis #Risk

PocketPEM - Airway - SOAPME #Management #Peds #EM #PICU #Airway #PocketCard #SOAPME #PocketCard #PocketPEM

GHOST CAP - Neuro ICU Checklist Mnemonic G - Glycemia H - Hemoglobin O - Oxygen S - Sodium T - Temperature C - Comfort A - Arterial Pressure P - PaCO2 https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-2825-7 #GHOSTCAP #NeuroICU #neurology #Checklist #Mnemonic #management

External Ventricular Drains (EVDs) & ICP waveform interpretation An EVD is a temporary closed sterile system that both invasively measures ICP and removes excess CSF. It is typically used when ICP is increased (e.g., hemorrhage, severe head trauma, large strokes, obstructing tumors). In addition to drainage of excess CSF, ICP guided medical & surgical interventions may reduce morbiditv & mortality. ICP WAVEFORM INTERPRETATION: Examining the ICP waveform and trends can provide useful information about CNS perfusion & compliance. SHORT-TERM PATTERNS (seconds) • P1 - related to arterial pulse; to CPP • P2 - rebound of pulse; inversely to cerebral compliance (e.g. ↑P2 with ↓compliance) • P3 — related to dicrotic notch in arterial pulse • Normal - Trimodal pattern with P1 > P2, P3 is seen normally. Increased P1 may be seen with increased SBP • Increased ICP - A trimodal pattern with P2 > P1, P3 suggests abnormal CNS compliance usually due to increased ICP • Markedly Increased ICP - Loss of discreet waves is seen with markedly abnormal CNS compliance LONGER TERM PATTERNS (minutes) Periodic fluctuations in ICP over time fall into three discreet patterns, called Lundberg waves. • LUNDBERG A WAVES - Plateaus up to 50mmHg lasting 5-20 minutes; suggestive of impending brain hemiation • LUNDBERG B WAVES - Rhythmic Spikes in ICP every 30-120 seconds suggestive of cerebral vasospasm • LUNDBERG C WAVES - low amplitude oscillations in ICP every 7-15 seconds that represent normal CNS homeostasis - Dr. Nick Mark MD @nickmmark #External #Ventricular #Drains #EVDs #ICP #waveform #interpretation #neurosurgery #diagnosis