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Promote education in critical care (ICU), acute& emergency medicine and improve ICU treatment. Teach concepts, updated database ,answer q CRITICAL CARE WEBINAR 4PM IST EVERY SUNDAY .Pot pourri of didactic lectures by leading national &international faculty; ICU BASICS and PROCEDURES (esp for younger students) Webinar live streamed on channel and zoom ,then uploaded. MEET THE EXPERT sessions soon. 30 UNIQUE ICU CASE PRESENTATIONS (STARTED Ist ON YT BY ME) covering all important cases are available on the channel. IMP POSTS.WELCOME TO JOIN OUR CHANNEL IF U WANT TO LEARN ICU 🏥😷🩺Evolving now into a digital intensive care journal for young intensivists)👨⚕️💻 🏥🌏- ahead folks THERE IS GREAT BEAUTY IN SCIENCE - M CURIE💥 tapeshbansal1@gmail.com *Donations may be made by buying SUPERTHANK 💰 GOD BLESS ALL🤲
Sir , Colistin is prodrug which activates in renal parenchyma so preferred choice of urosepsis and poly B is active molecule preferred for bacteremia In CNS infection due to carbapenem resistant GNB , intrathecal colistin preferred over poly B? And what is funda of nebulized colistin if it is a prodrug It's need to be activated in kidney then why don't we use poly B in place of colistin for local effect?
@shruti ,, thank you for your contribution , it will help us in our daily expenses and improve content. if u need any academic help pl let me know ❤🧡💙💯💰🙏
1cycle means 1set of 30:2 , in 2min we should perform 5 cycle ( 5 turns/ sets of 30:2) right sir...if person received 10 min CPR means he received 25 cycles... hope my understanding is right?
@pallavi ..5 cycles of 30 compressions and 2 breaths typically take around 2 minutes when performed continuously at the recommended rate. of 100 compressions/min .This timing guideline helps ensure that rescuers switch after every 2 minutes to avoid fatigue, keeping the quality of compressions U r right in calculations
@AhmadRaza-ye9qg , there is no indication as per literature to give in divided doses in CF though there is controversy , in fact nebulized AMG are used in CF along with systemic appropriate ab,. Toxicity of AMG is less in CF for unknown reasons Divided doses of genta are used in IE and when used in synergy for gram pos organisms
@youngintensivist, dr tapesh sir what is the cause of increased crp like more than 250 but procal level remains normal?? Sir Post trauma patient sp craniectomy with multiple febrile episodes with crp -400 , procal - 0.5 sir What could be the cause sir?
@ranjith..crp can be high for sometime like 2-3 days after polytrauma since this is SIRS similarly after surgery/craniectomy it can be high for 3 days . Fever can be bcz of central fever or post OP fever If all this does not explain then u hv to investigate and obviously infn has to be ruled out Procal may not rise despite hi crp and infection bcz of genetic variation and response
@@youngindiaintensivist7709 in last week alone I have seen 3 patients all with high degree fever like 104-106F with only raised crp sir can cns infection manifest like with only high CRP ? Sir?
@@ranjithkumar-rm8zw evening fever has no meaning. Normal body temperature is more in the eve. But in ICU circadian rhythm is lost. Evaluate and progress as per the reasoning I provided
@srirupadaspalit5057 thanks so much💕💯👍 for buying superthanks and suppoting your channel financially, this will help in meeting running expenses and further improve our channel🌟🙏💥 if i can be of any academic pl let me know
@ahmad ... ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE--aqWpeeJ6GU.htmlsi=k8glsPthKrorUofO pl see @ 00:12:45 specific test requires testing to cefoxitin if not done in the c/s
@divaanshu.. currently agenda is full, busy organzing virtual conference on fluids with IFA for 27th OCT amongst other things , wiil try to organize after all this is sorted out, thanks for liking the video👍❤
@avinabd....leuk estrase comes from PC so it means there are pc, nitrites from gram neg bacteria ..however the sensitivity and specificity is not good thereby wbc(pc) and culture are better indicators
So concise and great lecture by my beloved teacher and guru Dalim sir . Recent data suggest that prone positioning does not significantly alter perfusion. Carbon dioxide (CO₂) removal may be a more reliable predictor of patient outcomes than oxygenation, as a decrease in CO₂ reflects improved lung mechanics, better ventilation, reduced hyperinflation, and fewer areas of collapse. In the supine position, two factors-shape mismatch and gravity-work in the same direction, contributing to uneven ventilation. During prone positioning, these vectors oppose each other, resulting in more even distribution of ventilation. This leads to greater lung homogenization, as shown by an increase in the "decay distance"-the point from the top (ventral) to the bottom (dorsal) where lung aeration is reduced to 37%. In the prone position, this distance is extended, indicating a more uniform distribution of air across the lungs. Interestingly, some studies have shown that the total lung aeration does not significantly change with prone positioning. The overall average aeration and homogeneity factor (HF) remain roughly the same. However, it is the redistribution of ventilation with proning that plays the critical role, ensuring more homogenized aeration. This redistribution optimizes lung mechanics by reducing regional overdistension and collapse, thereby decreasing ventilator-induced lung injury (VILI). As a result, prone positioning makes the lungs more responsive to other interventions like PEEP, reduces the need for high FiO₂ and PEEP levels, and eventually decreases the risk of biotrauma. This cumulative effect is why proning is a powerful tool in managing acute respiratory failure and improving patient outcomes. The effect of recreation drainage cross contamination of healthy lung are also there . In ARDS with severe, resistant hypoxemia, achieving progress requires a combination of precise interventions. While proning is crucial, it must be integrated with lung protective ventilation, optimal PEEP, and careful fluid management. If proning is done without optimizing PEEP or adjusting the duration and timing of the maneuver, its effect will be limited. Additionally, identifying and addressing the underlying cause of ARDS is essential. The success of proning relies on the synergistic use of co-interventions, as no single maneuver will suffice on its own. When a patient is placed in the prone position, the compliance dynamics of the chest wall shift significantly. The ventral chest wall, which is more deformable in the supine position, becomes dependent, leading to a decrease in chest wall compliance. Meanwhile, the dorsal chest wall, now non-dependent, is naturally less deformable, preventing hyperinflation of non-dependent lung areas. This promotes more uniform ventilation distribution and improves lung homogenization, which is crucial for managing acute respiratory failure. While net effect on respiratory system compliance ie chest wall vs lung parenchyma will reflect in plateau pressures . Additionally, unpublished data suggest that placing a weight of 2 to 3 kg on the ventral chest wall in the supine position may further optimize lung mechanics. The added weight likely reduces the deformability of the ventral chest wall even more, limiting hyperinflation of the underlying lung tissue. This has been observed to increase tidal volumes and decrease plateau pressures, further enhancing the benefits of proning by ensuring better ventilation-perfusion matching and more efficient oxygenation.
Nice Dr Zahid However Co2 may increase - due to decrease in MV /CO and thus perfusion or decrease due to dead space decrease At times there is a variable change due to mix of factors Below is a nice article by prof guerin who did the proseva trial doi.org/10.1007%2Fs00134-020-06306-w
@@youngindiaintensivist7709 yes sir co2 can go in any direction depends upon the net difference in non dependent recruitment and dependant derecriutment… since better oxygenation isn’t translated into better survival necessarily while better pco2 after proning has better outcomes . Your dynamicity and great depth and understanding is a great treasure for all of us . Thank you sir will go through it …
pubmed.ncbi.nlm.nih.gov/31060091/ This is a masterpiece for basics and physiology Alongwith chapter from tobins book . pubmed.ncbi.nlm.nih.gov/24134414/ pubmed.ncbi.nlm.nih.gov/34825929/ www.ncbi.nlm.nih.gov/pmc/articles/PMC9995262/ Overall integrated and good one Will read one posted by you sir Thank you again
@oshadaviduranga2638 hi,nice to hear from SriLanka In Airway Pressure Release Ventilation (APRV) mode, the respiratory rate is not directly set in the traditional sense as it is in other ventilator modes like Volume-Controlled or Pressure-Controlled Ventilation. APRV primarily focuses on two time settings-T-high (time at high pressure, or the inspiratory phase) and T-low (time at low pressure, or the expiratory phase). How Respiratory Rate is Managed in APRV: T-high (Time at high pressure, P-high): Represents the duration the airway is held at a higher pressure to facilitate alveolar recruitment and oxygenation. It usually lasts longer than the expiratory phase. Typical range: 4-6 seconds, but can be adjusted based on the patient's needs. T-low (Time at low pressure, P-low): Represents the brief time allowed for exhalation, releasing pressure from the lungs. This setting influences CO₂ elimination and provides a brief period for exhalation before quickly returning to the high pressure. Typical range: 0.2-0.8 seconds (this is usually short to avoid full lung collapse and maintain alveolar recruitment). Calculating Respiratory Rate in APRV: The "effective" respiratory rate (RR) in APRV is determined by the combination of T-high and T-low settings. The equation for the respiratory rate is: 𝑅𝑅=60/ 𝑇ℎ𝑖𝑔ℎ+𝑇𝑙𝑜w For example: If T-high = 5 seconds and T-low = 0.5 seconds, the cycle time is 5.5 seconds. so 60/5.5 This results in an approximate respiratory rate of 10.9 breaths per minute. by varying Thigh and T low u can control the rate BILEVEL refers to portable non invasive vents , here we set IPAP and EPAP the pt breathes spontaneously and we cannot set a RR , only a backup RR can be set which comes into play if pt"s respiration fails , sometimes BILEVEL also refers to PSV in intubated pts on vent , here again we cannot set RR hope this answers your q
Thanks Sir ... This clears how & why of S.Creat & Blood Urea analysis. Please also make a video on PCT & CRP. Very often need to analyse their results in conjunction & it will be helpful... Thanks 😊😊😊
Plz make more video on case presentation rather than specific topic ( teaching 1 way is quite boring ) .. that helps to understand the scenario and better understanding of approach
@@krishmahat1343 I think u hv joined channel recently We have done 30 actual case presentations from ICU s , unfiltered discussions In fact our channel is the 1st one to do so We hv stopped currently as interest was dwindling Please go thru the playlists and find case presentations U can find all impt cases Pl give feedback then
@@youngindiaintensivist7709 already see those case presentation videos ., that was amazing .. missing this type of videos .. can you make those type in future ?? .. Dr tapas question was really amazing and the way he highlights important things is really difficult to get in books ..
glad you liked the case discussions, as for now we are not doing cases as audience interest has decreased and all-important cases are put up, yes definitely after sometime we shall do more cases
@drshashanksrivastava - thanks so much💕💯👍 for buying superthanks and suppoting your channel financially, this will help in meeting running expenses and further improve our channel🌟🙏💥 if i can be of any academic pl let me know
@drshashanksrivastava..thanks so much 😍👍💯for buying superthanks and providing financial support this helps in meeting running expenses and will help to improve our channel❤🙏❤
@pallavi To locate the lung point, you typically follow these steps: Start with the anterior chest wall: In a supine patient, begin by placing the ultrasound probe (linear or curvilinear) on the anterior chest wall, as this is where air typically collects in a pneumothorax. The probe is usually placed between the 2nd and 5th intercostal spaces along the midclavicular to anterior axillary line. Scan laterally: Gradually move the probe laterally (towards the axilla) and sometimes inferiorly while continuing to scan each intercostal space. The lung point is often found along the anterior axillary to mid-axillary line, though its exact location can vary depending on the extent of the pneumothorax. Identifying the lung point: As you scan, you will observe the absence of lung sliding (suggesting pneumothorax) over the pneumothorax region. The lung point is where the lung sliding reappears, marking the boundary between the pneumothorax and normal lung. In M-mode, this transition is characterized by a shift from the "barcode sign" (pneumothorax) to the "seashore sign" (normal lung).
