CRITICAL CARE Medicine

Public

View Channel

1.7K

14.9K

Can't Join? @criticalcaremedicin

18k Members

Updated: May 12, 2026 at 9:49 PM

CRITICAL CARE Medicine

Know about ICU

@criticalcaremedicin is a growing community focused on about and know and related topics

Ranking

Global Ranking

#456

Language Ranking

#45

Category Ranking

#23

-1

Participant Growth (Last 12 Days)

Total: 18.0K

24h growth: +0 0%

Latest Posts

CRITICAL CARE Medicine

May 11, 2026, 09:05 AM

2⃣ Dry

🚼 Hypotensive with normal central venous pressure / cautious volume loading

🔛 saline or ringer lactate (>200 mL/15–30 min)

🟣 Afterload reduction

🔷 Warm (systolic blood [SBP] >90 mm Hg) / Vasodilators:

🔵 pressure Nitroglycerine: starting dose 10 to 20 mcg/min, increase up to 200 mcg/min

⚫️ Nitroprussate: start with 0.3 mcg/Kg/min, increase up to 5 mcg/Kg/min

🔴 Perfusion maintainment and Contractility support

⚪️ Cold (SBP <90 mm Hg) / Vasopressors and/or inotropes:

🟤 First choice norepinephrine (infusion rate 0.2–1.0 mcg/Kg/min)

🔘 If no response, add Levosimendan:

🔶 bolus 6 to 12 mcg/Kg over 10 min and then infusion rate 0.1 to 0.2 mcg/Kg/min

🔴 Phosphodiesterase III inhibitors (ie, milrinone:

🔲 bolus 25–75 mcg/Kg over 10–20 min with infusion rate of 0.374–0.75 mcg/Kg/min;

enoximone:

bolus 0.5–1.0 mg/Kg over 5–10 min
infusion rate 5–20 mcg/Kg/min)

◾️Dobutamine: infusion rate 2 to 20 mcg/Kg/min

☑️ *To avoid if beta-blockade is a contributive cause of hypotension, and in patients with severe pulmonary hypertension due to LV diseases

🔴 Adrenaline (epinephrine):

🔺 bolus 1 mg ev repeated every 3 to 5 min, infusion rate 0.05 to 0.5mcg/kg/min

⚫️ Severely impaired RV function under vasopressors and inotropes should be considered🔛 referred to mechanical circulatory support such as ECMO or life support (ECLS)

5,170

CRITICAL CARE Medicine

May 11, 2026, 09:05 AM

*Diuretic-induced edema*

A type of idiopathic edema that may be paradoxically induced by the chronic administration of diuretics.

According to this hypothesis, patients are initially begun on a diuretic for a minor degree of fluid retention.

As therapy is continued, persistent diuretic-induced hypovolemia results in the activation of sodium-retaining mechanisms, particularly the RAS system.

If the diuretic is then stopped, the patient may be unable to acutely shut off this hormonal adaptation, resulting in rapid edema formation and the mistaken assumption that chronic diuretic therapy is indicated.

If, however, the patient is maintained without diuretics for one to three weeks, a spontaneous diuresis will frequently ensue with resolution of the edema.

Uptodate

4,140

CRITICAL CARE Medicine

May 11, 2026, 09:05 AM

Pharmacologic management and dosage in acute right heart failure:

☑️ Volume Management

🔘 Wet:

🔴 Diuretics dosage diuretics-naı¨ve patients:

✔️furosemide 20 to 40 mg
✔️ or torasemide 10 to 20 mg iv

❗️❗️ Patients already on oral diuretics:

🔘 iv dose at least equivalent to the oral dose

🟤 Assessment each 24 hours of urine output and urinary sodium extraction.

✳️ If no response or diuretic resistance add 🔜another class of diuretics:

🚨 (thiazides
🚨spironolactone
🟤 Sodium - GLUcose Transporter [SGLT]- 1inhibitors)

🆘 If no response, consider continuous veno- venous hemofiltration

🆘 or ultrafiltration

1⃣ Initiation of Renal Replacement therapy if:

🔘 oliguria unresponsive to fluid resuscitation measures, 🔘 severe hyperkalemia(K1 >6.5 mmol/L)
🔘 severe acidaemia(pH < 7.2)
🔘 serum urea level greater than 25 mmol/L (150 mg/dL),

🔘 and serum creatinine greater than 300 mmol/L (>3.4 mg/dL)

4,010

CRITICAL CARE Medicine

May 11, 2026, 09:05 AM

● Prednisone 40 to 50 mg/d (or equivalent) is indicated for 5 to 7 days in asthma exacerbations and for 5 days in COPD exacerbations.

-Higher doses can be considered on a case-by-case basis; however, very high doses (ie, methylprednisolone >240 mg/d) should be avoided because of an increased risk of treatment failure,hyperglycemia, and fungal infections.

● Noninvasive ventilation (NIV) is recommended as the initial method of mechanical ventilation in COPD exacerbations and should be considered cautiously in severe asthma exacerbations.

● Among patients requiring invasive mechanical ventilation (IMV),plateau airway pressure (Pplat) and intrinsic positive end-expiratory pressure should be monitored as indicators of hyperinflation with the goal of maintaining Pplat of < 30 cmH2O.

4. Use of NIV or high-flow nasal therapy (HFNT) immediately after extubation reduces the risk of reintubation in COPD exacerbations, but these methods do not have a clear role in asthma exacerbations.

● After initiation of venovenous extracorporeal membrane oxygenation (ECMO) for a life-threatening asthma or COPD exacerbation with hypercapnic respiratory failure, partial pressure of carbon dioxide (PaCO2) should not be reduced by > 20 mm Hg or 50% of the PaCO2 before treatment (whichever is less) within the first day to avoid neurologic complications.

4,750

CRITICAL CARE Medicine

May 11, 2026, 09:05 AM

📷 Photo

3,790

CRITICAL CARE Medicine

May 11, 2026, 09:05 AM

CO Poisoning

-Diagnosis is confirmed by measuring  carboxyhemoglobin levels (> 3% in non-smokers; >10% in smokers)

💡 A standard pulse oxymetry is unreliable and may appear normal because it cannot differentiate carboxyhemoglobin from oxyhemoglobin

- Carbon monoxide (CO) poisoning induced–myocardial infarction chest pain, ECG changes, elevated troponin, and bilateral radiographic infiltrates no acute coronary occlusion

3,480

CRITICAL CARE Medicine

May 11, 2026, 09:05 AM

📎 File

Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care, 8th Edition (2026)

ISBN: 978-­0-­323-­77922-

Total Pages numbered : 1635
Total pages in PDF file : 1873

👇👇-------
Best critical care Books
https://t.me/+YwnFX0Yv87s3NzRl

👇👇
https://t.me/critical_care_books

🏅 Board Review 2022 Video Courses
https://t.me/criticalcare_courses

https://medustudy.com/product-category/critical-care/

5,520

CRITICAL CARE Medicine

May 11, 2026, 09:05 AM

Obesity hypoventilation syndrome (OHS) is definedas daytime hypercapnia (PaCK2 >45 mm Hg) in an obese patient (BMI >30 kg/m2 , often >40 kg/m2) without another explanation for the hypercapnia.

Most patients have coexisting obstructive sleep apnea with frequent apneic events and daytime hypersomnolence.

Other features of OHS include dyspnea, polycythemia, respiratory acidosis with compensatory metabolic alkalosis, pulmonary hypertension, and cor pulmonale.

Several mechanisms likely contribute to hypoventilation and resultant hypercapnia.

Obesity reduces chest wall and lung compliance, leading to a decrease in tidal volumes and total lung capacity and an increase in airway resistance.

As a result, higher levels of ventilatory drive are required to maintain normocapnia, but there is an inability to exhale excess CO2 during the day (due to persistent restriction).

This leads to CK2 accumulation overnight, with subsequent chronic respiratory acidosis.

Renal bicarbonate excretion is decreased as a compensatory mechanism (Chloride reabsorption is decreased); this blunts the ventilatory response to the increased CK2 and contributes to hypoventilation.

In sum, patients with OHS "can't breathe" (due to excess weight and altered lung mechanics) and "won't breathe" (due to decreased chemosensitivity to hypercapnia from persistent nocturnal hypoventilation).

4,130

CRITICAL CARE Medicine

May 11, 2026, 09:05 AM

Causes of Hypernatremia

1- Excessive Sodium :-

-Improperly mixed formula
-Excess sodium bicarbonate
-Ingestion of seawater or sodium chloride
-Intentional salt poisoning (child abuse or Munchausen syndrome by proxy)
-Intravenous hypertonic saline
-Hyperaldosteronism

2- Water Deficit :-

■Nephrogenic Diabetes Insipidus
-Acquired
-X-linked
-Autosomal recessive
-Autosomal dominant
■Central Diabetes Insipidus
-Acquired
-Autosomal recessive
-Autosomal dominant
-Wolfram syndrome
■Increased Insensible Losses
-Premature infants
-Radiant warmers
-Phototherapy
-Inadequate intake:
Ineffective breastfeeding
Child neglect or abuse
Adipsia (lack of thirst)

3- Water and Sodium Deficits :-

■Gastrointestinal Losses
-Diarrhea
-Emesis/nasogastric suction
-Osmotic cathartics (lactulose)
■Cutaneous Losses
Burns
Excessive sweating

■Renal Losses
-Osmotic diuretics (mannitol)
-Diabetes mellitus
-Chronic kidney disease -(dysplasia and obstructive uropathy)
-Polyuric phase of acute tubular necrosis
-Postobstructive diuresis

3,600

CRITICAL CARE Medicine

May 11, 2026, 09:05 AM

📷 Photo

Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care, 8th Edition (2026)
(
Courtesy ----
Mohammed Abdullah
)

Total Pages numbered : 1635
Total pages in PDF file : 1873
ISBN: 978-­0-­323-­77922-­7

4,770

CRITICAL CARE Medicine

Apr 24, 2026, 06:43 PM

📎 File

👇👇-------
Best critical care Books
https://t.me/+YwnFX0Yv87s3NzRl

👇👇
https://t.me/critical_care_books

🏅 Board Review 2022 Video Courses
https://t.me/criticalcare_courses

https://medustudy.com/product-category/critical-care/

4,790

Showing 11 of 11 posts

No more posts

Loading posts...

Rating

User Reviews (0)

No reviews yet. Be the first to share your experience!

Loading reviews...

Related Telegram Channels

FEATURED

Loading recommended channels...

CRITICAL CARE Medicine

CRITICAL CARE Medicine

Ranking

Participant Growth (Last 12 Days)

Latest Posts

Rating

User Reviews (0)

Related Telegram Channels

✊🏻

.

..

$BRAINS AI

.

Alisher Qodirov

1

𝚝𝚑𝚎 𝚙𝚘𝚠𝚎𝚛 𝚘𝚏 𝚒𝚗𝚜𝚙𝚒𝚛𝚊𝚝𝚒𝚘𝚗

Related Telegram Channels

✊🏻

.

..

$BRAINS AI

.

Alisher Qodirov

1

𝚝𝚑𝚎 𝚙𝚘𝚠𝚎𝚛 𝚘𝚏 𝚒𝚗𝚜𝚙𝚒𝚛𝚊𝚝𝚒𝚘𝚗

User Reviews (0)

Latest Posts