Final year‎ > ‎

14.02.03 ICU notes

Kawasaki
  • Fever of ≥5 days' duration plus 4 of:
    • Bilateral nonsuppurative conjunctivitis
    • One or more changes of the mucous membranes of the upper respiratory tract
      • Pharyngeal injection, dry fissured lips, injected lips, "strawberry" tongue
    • One or more changes of the extremities
      • Peripheral erythema, peripheral edema, periungual desquamation, generalized desquamation
    • Polymorphous rash
      • Pimarily truncal
    • Cervical lymphadenopathy
      • >1.5 cm in diameter
  • Need echocardiogram to exclude coronary artery aneurysm

Maculopapular
  • Macules are small, flat discolored spots
  • Papules are small, raised bumps


Mefenamic acid overdose

  • Convulsions, nausea, emesis, haematemesis, bradypnea, coma
  • Renal failure
  • Onset of symptoms is usually between 30 minutes and 4 hours, but signs of renal failure may appear several days after an overdose
  • Lethal dose can be as low as 2.5 g
  • Conservative management; Can manage acidosis with bicarb


Sylvian fissure

  • AKA lateral sulcus
  • Divides the frontal lobe and parietal lobe above from the temporal lobe below
  • Longer in the left hemisphere in most people
  • Dot sign = MCA embolus


Methemoglobinemia

  • PathPhys
    • Higher than normal level of methemoglobin (metHb, i.e., ferric [Fe3+] rather than ferrous [Fe2+] haemoglobin) in the blood
    • Methemoglobin has a decreased ability to bind oxygen, but allosterically raises affinity for the other 3 ferrous haemoglobins
      • => Shifts dissociation curve to left => Tissue hypoxia
    • Elevated levels of methemoglobin in the blood are caused when the mechanisms that defend against oxidative stress within the red blood cell are overwhelmed
      • => Oxidation of ferrous iron
    • Can give the blood a bluish or chocolate-brown color
  • Causes
    • Congenital methemoglobinemia
      • Autosomal recessive - due to a deficiency of the enzyme diaphorase I (NADH methemoglobin reductase)
      • May also be seen in patients with abnormal hemoglobin variants such as hemoglobin M (HbM), or hemoglobin H (HbH)
        • Not amenable to reduction despite intact enzyme systems
      • Can also arise in patients with pyruvate kinase deficiency due to impaired production of NADH
      • Patients with Glucose-6-phosphate dehydrogenase (G6PD) deficiency may have impaired production of NADPH
    • Acquired
      • Exposure to exogenous oxidizing drugs and their metabolites (benzocaine, dapsone, nitrates)
        • e.g. Nitrates from farms in drinking water
      • Other classical drug causes:
        • Antibiotics (trimethoprim, sulfonamides, dapsone)
        • Local anesthetics (especially articaine and prilocaine)
        • Aniline dyes, metoclopramide, chlorates, bromates
  • Management
    • Supplemental oxygen and methylene blue 1% solution (10 mg/ml) 1 to 2 mg/kg slow IV
      • Restores the iron in hemoglobin to its normal (reduced) oxygen-carrying state


Notes

  • Erythromycin for gastric stasis
  • AmBisome = Amphotericin B
    • IV antifungal
  • Formoterol = LABA
  • Clonidine
    • Centrally acting α2 adrenergic agonist
    • For HTN. ADHA, anxiety/panic disorder, pain

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