Obstructive Sleep Apnea Recurrent episodes of obstructive breathing during sleep caused by collapse of the upper airways. Definitions Apnea—episodes of paused breathing lasting for at least 10 seconds Hypopnea—inadequate or shallow breathing episodes lasting for at least 10 seconds with at least 4% oxygen desaturation and at least 30% reduction in airflow; also defined as […]
Alcohol Withdrawal: Stages, Management, and Life-Threatening Complications By Dr. Paul Mirdamadi Alcohol withdrawal is a potentially life-threatening condition that occurs when individuals with chronic alcohol use abruptly reduce or stop alcohol consumption. It is especially relevant in hospitalized and postoperative patients, where access to alcohol is suddenly interrupted. Early recognition, appropriate staging, and timely treatment
Kidney Anatomy and Glomerular Structure Renal blood flow: renal artery -> segmental artery -> interlobar artery -> arcuate artery -> interlobular artery -> afferent arteriole -> glomerulus -> efferent arteriole -> vasa recta/peritubular capillaries -> venous outflow. Fluid Compartments 60-40-20 rule 60% water 40% intracellular 20% extracellular Plasma can be measured with radiolabeled albumin Extracellular
Blood volume: children (65-70 cc/kg); adult (80-100 cc/kg) Pre-load = end-diastolic ventricular pressure Cardiac tamponade: Beck’s triad of increased venous pressure, decreased arterial pressure, and muffled heart sounds Homan’s sign: calf pain with forcible dorsiflexion of the foot, associated with lower extremity deep venous thrombosis. Levine’s sign: clenched fist over the chest while describing chest
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With renal failure there is decreased glomerular filtration which results in an increased level of serum phosphate. This tends to cause serum calcium to be deposited in bone leading to a decrease serum calcium level. In response to low serum calcium the parathyroid glands are stimulated to secrete parathormone (PTH) which results in secondary hyperparathyroidism.
Nephrotic syndrome is a glomerulonephropathy causing severe proteinuria precipitating a large decrease in intravascular osmotic pressure and fluid loss to the interstitial tissue. While peripheral edema is a prominent symptom, intravascular volume depletion occurs and jugular venous distension is therefore not observed.
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Adrenal suppression occurs when a patient receives longterm exogenous steroids of >10mg/day Takes ~3 months to recover function Minor surgery – 25mg hydrocortisone; Major surgery – 100 mg hydrocortisone daily for 2-3days
Massive pulmonary embolism/ cor pulmonale are associated with right ventricular failure, arterial hypoxemia and decreasing end-tidal CO2.
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A number of factors play a role in controlling alveolar ventilation. The central areas of inspiratory and expiratory control lie in the medulla, and primarily respond to increases in hydrogen ion concentration in the cerebrospinal fluid. Although hydrogen ion concentration is the most important stimulus to the chemosensitive centers in the medulla, these ions cross
Afferent Pupillary Defect (Marcus Gunn Pupil): Definition and Clinical Significance An afferent pupillary defect (APD), also known as a Marcus Gunn pupil, is an important clinical sign that indicates damage to the optic nerve or severe retinal disease. It is most commonly identified during the swinging flashlight test and reflects an abnormal afferent (sensory) visual
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