Intensive Care & Critical Care Medicine (ICCM) – Key ConceptsIntensive Care and Critical Care Medicine (ICCM) focuses on the management of life-threatening conditions in critically ill patients, often in an ICU setting. Below is a structured breakdown of core topics in ICCM.1. Core Principles of Critical CareA. Hemodynamic Monitoring & Shock ManagementTypes of Shock:Hypovolemic (hemorrhage, dehydration) → Fluids, blood transfusion.Cardiogenic (MI, HF) → Inotropes (dobutamine), vasopressors (norepinephrine).Distributive (septic, anaphylactic) → Fluids, norepinephrine, epinephrine.Obstructive (PE, tamponade) → Thrombolysis, pericardiocentesis.Monitoring Tools:Invasive BP (arterial line), CVP, PAC (pulmonary artery catheter).Echocardiography (assess cardiac function).B. Respiratory Critical CareAcute Respiratory Failure:ARDS (low tidal volume ventilation, prone positioning).COPD exacerbation (NIV, steroids, bronchodilators).Mechanical Ventilation:Modes:ACV (Assist-Control Ventilation).PSV (Pressure Support Ventilation).PCV (Pressure Control Ventilation).Weaning: Spontaneous breathing trials (SBT).C. Neurological Critical CareComa & Altered Mental Status:Glasgow Coma Scale (GCS).Causes: Stroke, seizures, metabolic (hypoglycemia, hepatic encephalopathy).Status Epilepticus:Benzodiazepines (1st-line) → Lorazepam IV.Second-line: Levetiracetam, valproate, propofol.Increased ICP:Mannitol, hypertonic saline, sedation, decompressive craniectomy.D. Renal & Metabolic Critical CareAcute Kidney Injury (AKI):RRT (CRRT vs. intermittent HD).Electrolyte Emergencies:Hyperkalemia (calcium gluconate, insulin/glucose, dialysis).Hyponatremia (slow correction to avoid osmotic demyelination).2. ICU-Specific SyndromesA. Sepsis & Septic ShockManagement:Fluids (30 mL/kg crystalloid).Vasopressors (norepinephrine).Antibiotics within 1 hour.Source control (drainage, debridement).B. Multiorgan Dysfunction Syndrome (MODS)Progressive failure of ≥2 organ systems (e.g., lungs, kidneys, liver).Treatment: Supportive care, treat underlying cause.C. Delirium in ICUCAM-ICU (diagnostic tool).Management:Non-pharmacologic (reorientation, sleep hygiene).Pharmacologic (haloperidol, dexmedetomidine).3. Advanced ICU InterventionsA. Extracorporeal Membrane Oxygenation (ECMO)Types:VV-ECMO (respiratory failure).VA-ECMO (cardiac + respiratory failure).Indications:Severe ARDS (PaO₂/FiO₂ <80 despite optimal care).Refractory cardiogenic shock.B. Therapeutic Hypothermia (TTM)Post-cardiac arrest (target 32–36°C for 24 hrs).C. Tracheostomy in ICUIndications: Prolonged mechanical ventilation (>7–10 days).

Acute Respiratory Distress Syndrome (ARDS) – ManagementARDS is a life-threatening form of respiratory failure characterized by diffuse alveolar damage, non-cardiogenic pulmonary edema, and severe hypoxemia. It is classified by the Berlin Definition based on severity.

epsis and Septic Shock ManagementSepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, while septic shock is sepsis with persistent hypotension requiring vasopressors and a lactate >2 mmol/L despite adequate fluid resuscitation.1. Immediate Management (First Hour – 'Golden Hour')A. Initial Resuscitation (Sepsis-6 Bundle)Oxygen – High-flow O₂ if hypoxic (target SpO₂ ≥94%).Blood cultures – Before antibiotics (but do not delay treatment).Broad-spectrum antibiotics – Within 1 hour of recognition (see below).IV fluid bolus – 30 mL/kg crystalloid (e.g., normal saline or balanced solutions like Ringer’s lactate).Lactate measurement – If >2 mmol/L, indicates tissue hypoperfusion.Vasopressors if refractory hypotension – Norepinephrine (1st-line) if MAP <65 mmHg after fluids.B. Hemodynamic SupportFluids:Crystalloids (avoid hydroxyethyl starch).Monitor for fluid overload (e.g., crackles, JVP↑).Vasopressors:1st-line: Norepinephrine (α-agonist → vasoconstriction).2nd-line: Vasopressin (if refractory shock).Epinephrine (if extremely unstable).Inotropes (if low cardiac output):Dobutamine (if poor ejection fraction).3. Adjunctive TherapiesA. CorticosteroidsHydrocortisone 50 mg IV q6h (if refractory shock despite fluids + vasopressors).Consider ACTH stimulation test (but do not delay steroids if shock is severe).B. Blood Glucose ControlTarget: 140–180 mg/dL (avoid severe hypoglycemia).C. Venous Thromboembolism (VTE) ProphylaxisLMWH (e.g., enoxaparin) or heparin SC.D. Stress Ulcer ProphylaxisPPI (e.g., pantoprazole) or H2 blocker (if high bleeding risk).4. Monitoring & Supportive CareA. Hemodynamic MonitoringArterial line (for continuous BP monitoring).Central venous catheter (for vasopressors, CVP monitoring).Echocardiography (assess cardiac function).B. Respiratory SupportMechanical ventilation if ARDS develops (use low tidal volume ~6 mL/kg).C. Renal SupportCRRT (Continuous RRT) if AKI with fluid overload/refractory acidosis.5. Prognostic Markers & ComplicationsPoor prognosis:Lactate >4 mmol/L, persistent hypotension, multiorgan failure.Complications:ARDS, DIC, AKI, adrenal insufficiency, critical illness neuropathy.