Description

Intensive Care & Critical Care Medicine (ICCM) – Key Concepts Intensive 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 Care A. Hemodynamic Monitoring & Shock Management Types 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 Care Acute 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 Care Coma & 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 Care Acute 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 Syndromes A. Sepsis & Septic Shock Management: 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 ICU CAM-ICU (diagnostic tool). Management: Non-pharmacologic (reorientation, sleep hygiene). Pharmacologic (haloperidol, dexmedetomidine). 3. Advanced ICU Interventions A. 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 ICU Indications: Prolonged mechanical ventilation (>7–10 days).

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