Lecture notes for medical students

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7. See notes for bibliography.

2. CRITICON2017
•

3. CRITICON2017
• CRITICON2017 was held in Raipur on 24th
and 25th of June 2017

4. Topics Covered

5. Topics Covered
1. Acute Pancreatitis.
2. Antibiotic use dos and donts
3. Ventilators
4. Sepsis update2016
5. Fluid resuscitation
6. Management of ARDS
7. ECMO
8. Hyponatremia
9. Brain trauma
10. Diabetic ketoacidosis
11. ARDS

6. Diabetic ketoacidosis

7. Diabetic ketoacidosis
Triad of
• Ketosis
• Hyperglycemia
• Acidosis
– IV Fluid Only NS
– Give Sodabicarb only if pH is <6.9
– Insulin- Plain 0.1 units/kg/hour infusion
– Potassium if <3.3 mEq/l. hold insulin first give
KCL 20-30 mEq/hour.

8. Save You Kidneys

9. Save You Kidneys
• E-Book by Dr. Sanjay Pandya

10. Acute Pancreatitis.

11. Acute Pancreatitis.
• Autodigestion of pancreas
• Presents as acute abdomen with raised
Amylase and Lipase.
• Treat with analgesics and RL/NS
• Early enteral feeding
• PPIs, octride and antibiotics are not
indicated.
• Use antibiotics only proven infection

12. Sepsis update2016

13. Sepsis update2016
• SIRS term is dropped.
• Only two terms-
– Sepsis
– Septic shock.
• SOFA (Sequential Organ Failure
Assessment)Score
• BP <100
• GCS <15
• Respiratory rate >22
2 of 3 +nt + infection – Sepsis
Need for Vasopressors/Lactate >2 – Septic Shok

14. Sepsis update2016
Management
• RL 30ml/kg. in 3hours.
• Multiple blood cultures
• 7-10 days antibiotic

15. Sepsis update2016
Management
• Vasopressors Preferred
• Nor
Ad>Vasopressin>Adrenaline>Phenylnephri
ne
• Dopamine not useful.
• No Steroids, Parenteral
nutrition,FFP,immunoglobulins

16. ARDS

17. ARDS
• Severe Hypoxemia + BL Patchy shadows
• Berlin definition
1. Timing- Within 1week
2. Imaging
3. Origin of oedema
4. Oxygenation PF ratio.

18. ARDS
• Pathophysiology damaged oedematous
alveolar membrane leads to BABY LUNG.
• Causses
1. Sepsis
2. Trauma
3. Aspiration
4. Pneumonia
5. TRALI-Transfusion Related Lung Injury

19. Management of ARDS

20. Management of ARDS
1. Treat the cause- don’t wait for ARDS to
resolve.
2. Supportive care-
1. Prone position
2. Early invasive ventilatory support.
3. Low tidal volume 4 -6 ml./Kg.
4. Pharmacological support.
sedatives and neuromuscular blockade,

21. IV Fluids in Critical Care

22. IV Fluids in Critical Care
• Use only Crystalloids ( Albumin is better in
septic shock).
• Use only RL unless contraindicated-
– Raised ICP
– Hepatic dusfunction
– Renal failure.
– Hyperklemia is not contraindication for RL

23. ECMO

24. ECMO
• Extracorporeal membrane
oxygenation (ECMO), also known
as extracorporeal life support (ECLS), is
an extracorporealtechnique of providing
both cardiac and respiratory support.
• This intervention has mostly been used on
children, but it is seeing more use in adults
with cardiac and respiratory failure.

25. ECMO: Indications

26. ECMO: Indications
• Criteria for the initiation of ECMO include
acute severe cardiac or pulmonary failure
that is potentially reversible and
unresponsive to conventional management.

27. ECMO: Results

28. ECMO: Results
• A registry of patients that have received
ECMO is maintained by the Extracorporeal
Life Support Organization (ELSO). The last
publication of ELSO registry data reported
outcomes on nearly 51,000 patients with
75% survival for neonatal respiratory
failure, 56% survival for pediatric
respiratory failure, and 55% survival for
adult respiratory failure

29. ECMO:Contraindications

30. ECMO:Contraindications
• Conditions incompatible with normal life if
the person recovers
• Preexisting conditions that affect the quality
of life (CNS status, end-stage malignancy,
risk of systemic bleeding with
anticoagulation)
• Age and size
• Futility: those who are too sick, have been
on conventional therapy too long, or have a
fatal diagnosis.

31. ECMO:Types

32. ECMO:Types
• There are several forms of ECMO,
• The two most common are-
– Veno-arterial (VA)
– Veno-venous (VV).

33. Antibiotic use dos and donts

34. Antibiotic use dos and donts
Dos
• Use in susceptible established infection.
– Fever/hypothermia
– Tachycardia
– Leukocytosis/Leukopenia
• Use higher antibiotics only if indicated by
culture & sensitivity tests.

35. Antibiotic use dos and donts
Don’ts
• Elective post operative patient
• Abscesses
• Viral fever
• Diarrhoea, dysentery
• Burns
• Ureteric colick
• Abdominal pain
• Acute and chronic pancreatitis.
• Open wounds.

36. Antibiotic use dos and donts
Don’ts
• Stitch abscess
• Breast lump
• Mastalgia
• Anal fissure
• Hemorrhoids
• Cesarean section, hysterectomy, normal
delivery, episiotomy

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