Acute management of ICH🩸
1⃣ET intubation for GCS < 9
2⃣NSx consult: cerebellar ICH > 3 cm2 or causing brainstem compression, IVH with obstructive HCP, hemispheric ICH with life-threatening brain compression.
3⃣Reverse anticoagulation with a specific agent. 4⃣If SBP 150-220: target is to reduce below 140 within one hour.
5⃣If SBP > 220: reduce to below 220 rapidly. Then gradually reduce over a few hours to maintain between 140-160.
6⃣Reducing SBP < 130 in the first hours has not been beneficial for reducing death or disability.

❤ HEART FAILURE💔
1⃣A clinical syndrome caused by structural or functional impairment in ventricular filling or ejection.
2⃣Associated with elevated ventricular filling pressures.
3⃣AHA staging (stage A to D), NYHA functional classification (class I to IV) 4⃣LVEF <40% is HFrEF , LVEF: 41-49% is HFmrEF & LVEF > 50% is HFpEF
5⃣Etiology: CAD, various cardiomyopathy, valvular heart disease, pericardial disease, RV dysfunction, high output HF

Cannabis (Marijuana) acute intoxication❌🆘🚷🔕
1⃣Ganja: A slang term used commonly
2⃣Cannabis sativa:MC used
3⃣world's most widely cultivated, trafficked, and abused illicit substance 🥲
5⃣Use is high in the adolescent age group😝
6⃣legalized in: Uruguay and Canada 7⃣Cannabinoid receptor: GPCR, inhibits adenylyl cyclase,stimulates potassium conductance
8⃣Delta-9 tetrahydrocannabinol (THC) is the most psychoactive form
9⃣THC is lipid soluble, highly protein bound
🔟THC metabolism: hepatic cytochrome oxidases, CYP2C9 and 3A4♻️

Mucormycosis:
1. Fatal invasive disease with high mortality
2. Genus: rhizopus, mucor, cunninghamella, lichtheimia etc
3. Risk factors: Uncontrolled DM, DKA, neutropenia, prolonged glucocorticoid use, elevated levels of free iron, SOT, HSCT, COVID-19 infection. 4. Rhino-orbital-cerebral disease: most common form, seen in diabetes, steroid use. Ethmoid sinus-->orbit-->frontal lobe/cavernous sinus, hard palate in advanced case.
5. Pulmonary disease: second most common, in organ transplant, chemotherapy receiving pt.

Iron metabolism & IDA:
1. Transferrin (iron binding protein in plasma) has two iron-binding sites & exists in 3 forms: apotransferrin (not bound to iron), monoferric & diferric forms: diferric has the highest affinity for Tf receptors. 2. Developing erythroblasts have the highest number of Tf receptors
3. Normally adult male & female need to absorb 1 mg & 1.4 mg elemental iron respectively to meet needs
4. No regulated pathway of iron excretion, lost by blood loss or loss of epithelial cells.

Aspergillosis (disease spectrum, Dx, Rx):
1. Refers collectively to all invasive and allergic disease caused by aspergillus species
2. A.fumigatus: causes most of the invasive & chronic aspergillosis & allergic disease
3. A.flavus: sinus, cutaneous infection & keratitis 4. A.niger: otitis externa
5. It's a hyaline, septate branching mold
6. Risk factors: neutropenia, glucocorticoid use, CGD, severe influenza or Covid-19, COPD, pulmonary TB, infliximab, ibrutinib use, ECMO
7. Invasiv: pulmonary, sinusitis, cutaneous, endocarditis, cerebral

Necrobiosis lipoidica:
1. Chronic granulomatous disease
2. Commonly involve lower limbs: pretibial area most common
3. A/w T1DM, T2DM but can happen in non-DM also
4. Common in young, middle aged pt 5. Red-brown, yellowish papule or plaques that enlarge, undergo atrophy & form ulcers & telangiectasia
6. Bx: granulomatous dermatitis, inflammatory infiltrates
7. Rx: avoid trauma, topical & intra-lesional corticosteroid, topical tacrolimus, PUVA photochemotherapy

Heparin induced thrombocytopenia (HIT) :
1. Risk with UFH>LMWH
2. Thrombocytopenia develops 5-10 days after exposure, may develop rapidly if prior exposure is there, rarely delayed for >2weeks
3. Incidence is around 1% in critically ill patients, overdiagnosis is common. 4. IgG antibody formed against heparin-PF4 complex-->activation of platelets-->thrombosis+thrombocytopenia
5. Venous thrombosis more common than arterial and lower limb thrombosis more common than upper limb
6. Adrenal vein, mesenteric vein thrombosis can occur.

Sarcoidosis-the great Mimicker!!! Can involve virtually all organ system