14.02.03 ICU notes


    • 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


    • 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


    • 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


    • Erythromycin for gastric stasis

  • AmBisome = Amphotericin B

    • IV antifungal

  • Formoterol = LABA

  • Clonidine

      • Centrally acting α2 adrenergic agonist

      • For HTN. ADHA, anxiety/panic disorder, pain