Critical Medicine and Intensive Care

📄🫁 Corticosteroids in adults with acute respiratory distress syndrome and severe pneumonia (by Dilip Jayasimhan) 🫁📄 1️⃣ Corticosteroids may ⬇️ mortality in patients with acute respiratory distress syndrome (ARDS) through an anti-inflammatory effect. 2️⃣ The efficacy of corticosteroids in ARDS is dependent on the ⏱️ and duration of treatment, along with the underlying aetiology of ARDS. 3️⃣ A 📈 body of evidence supports the use of corticosteroids in certain subtypes of severe pneumonia, a leading cause of ARDS. 4️⃣ Corticosteroids are associated with ☣️ effects which may limit the effectiveness of treatment, including delirium, hyperglycaemia and neuromuscular weakness. 5️⃣ Ongoing research on the sub-phenotypes of ARDS may 🆔 patients who would most benefit from treatment with corticosteroids.

Left ventricular assist device #LVAD HeartMate II™ #HMII Due to the continuous flow #physiology, almost half of #LVAD patients do not have a palpable pulse and measuring BP and #oxygen saturation may be difficult. Use #Doppler #techniques for measuring #MAP, optimally between 70–90 mmHg. #Leftventricularassistdevice #LVAD #HeartMateII™ #HMII #ICU #CriticalCare #IntensiveCare #IntensiveCarecommunity #FOAM #JCardenas_MD #MICU #CICU @jcardenas_md

Left ventricular assist device #LVAD HeartMate II™ #HMII Pump ⁃ The body of the #LVAD located at the apex of the left #ventricle, houses the impeller (magnetically levitated frictionless rotor), connected to the ascending #aorta via the outflow graft Inflow cannula ⁃ stationed inside the left #ventricle connects the left #ventricular cavity to the pump and directs blood into the #pump Outflow cannnula ⁃ Flexible conduit that directs blood from the #pump to the ascending #aorta Driveline ⁃ The #pump is connected by the #driveline, a cable subcutaneously tunnelled from the pump exiting the body at the lower abdominal wall, to the external controller and the energy supply. #Leftventricularassistdevice #LVAD #HeartMateII™ #HMII #ICU #CriticalCare #IntensiveCare #IntensiveCarecommunity #FOAM #JCardenas_MD #MICU #CICU @jcardenas_md

🚨Mechanical Complications of Acute Myocardial Infarction🚨 🫀Ventricular septal defect🫀 💀Mortality rate 30–40 %💀 #MechanicalComplications #MyocardialInfarction #ICU #CriticalCare #IntensiveCare #IntensiveCarecommunity #FOAM #JCardenas_MD #MICU #CICU @jcardenas_md

🫁 Physics of lung US 🫁 1️⃣(Left) Ultrasound waves reflected at the pleural line creating A-line reverberation artifacts.🫁 2️⃣(Center) As the interstitium thickens, the artifact pattern changes, with B-line artifacts obliterating A-lines. B-lines are hyperechoic vertical artifacts arising from the pleural line extending to the bottom of the field of view. 🫁 3️⃣(Right) Consolidation is directly penetrated by US, resulting in visualization without artifact if the consolidation is touching the pleural line.🫁 #lungultrasound #ICU #CriticalCare #IntensiveCare #IntensiveCarecommunity #FOAM #JCardenas_MD #MICU #CICU @jcardenas_md

. 👉🏼🫁Sensitivity and Specificity of Lung US versus Chest Radiography🫁👈🏽 📝Meta-analyses suggest that compared with chest radiography, lung US may have higher sensitivity and similar specificity for detection of #pleuraleffusion #pneumonia #pneumothorax #pulmonaryedema📝 👨🏻‍⚕️Studies have shown that the rudimentary skills of the modality can be learned with relative ease👨🏻‍⚕️ 👉🏼Chest radiography and lung US function as complementary modalities that can be used in conjunction to benefit patient care👈🏽 #chestradiography #lungultrasound #ICU #CriticalCare #IntensiveCare #IntensiveCarecommunity #FOAM #JCardenas_MD #MICU #CICU @jcardenas_md

👉🏽Recirculation is a phenomenon, exclusive to venovenous #ECMO 🫁🫀🩸 👉🏽Reinfused oxygenated blood is withdrawn through the drainage cannula without passing through the systemic circulation 🫀🫁🩸 👉🏽 Its presence decreases the efficiency with which #ECMO provides oxygenation 🫁🫀🩸 #ECMO #venovenousECMO #SDRA #networking #socialmediamedicaldoctor #ICU #CriticalCare #IntensiveCare #IntensiveCarecommunity #FOAM #JCardenas_MD #MICU #CICU @jcardenas_md

Flow chart for the initial management of an acute aortic dissection.

🤔🤔🤔Cual es el efecto de la elevación pasiva de la piernas ⬆️🦵 realizada durante la reanimación cardiopulmonar 🫀 en la perfusión cerebral 🩸🧠?? 🤔🤔🤔 La elevación pasiva de las piernas ⬆️🦵 #EPP durante la reanimación cardiopulmonar 🫀#RCP es una maniobra simple y no invasiva, que potencialmente puede mejorar los resultados relacionados con el paciente, conduce a un aumento del flujo sanguíneo cerebral 📈🩸🧠 y potencialmente puede atenuar la disminución esperada en el flujo sanguíneo cerebral 📉🩸🧠 a lo largo del tiempo durante la 🫀#RCP 💡💡💡 👉🏽👉🏽👉🏽La importancia clínica de estos hallazgos requiere más investigaciones👈🏽👈🏽👈🏽💡💡💡 #ICU #CriticalCare #IntensiveCare #IntensiveCarecommunity #FOAM #JCardenas_MD #MICU #CICU @JCardenas_MD