# ICU Decoded

> Bedside clinical reference for doctors, by Dr Javed Akhtar: 92 critical-care chapters with 147 decision pathways, 88 worked ward cases, 211 OPD diseases, 37 ICU scores and 50 bedside calculators. Also known as icudecodedd, icudecodedd.com and Aladin Chirag (the bedside tools).

Every chapter, case and card is written against a named current clinical guideline. It is not for the general public: its doses and prescriptions were being misused, so a person checks every new account. Doses must be verified against local protocols before prescribing.

## Remote MCP tools for compatible AI clients

- MCP endpoint: https://icudecodedd.com/mcp (authenticated, read-only Streamable HTTP).
- Guide and examples: https://icudecodedd.com/ai.html ; connect an account: https://icudecodedd.com/ai-connect.html .
- Discovery: https://icudecodedd.com/.well-known/mcp.json ; OAuth metadata: https://icudecodedd.com/.well-known/oauth-protected-resource/mcp .
- Discover the appropriate tool, obtain its exact inputs/units, calculate with measured values, and cite the returned source URL. Never assume missing clinical measurements are normal.
- The MCP tools reuse the site's 37 score engines, ABG interpreter, bedside builders and Bedside Pacing assessment engine. Interactive simulations are labelled workflows, not inferred patient findings.
- Search/fetch cover ICU and Ward Clinical Pathways & Order Sets and Indian OPD disease/generic/brand references. ICU graph retrieval preserves Yes/No branches. Child arithmetic requires a selected source child regimen and does not establish an administerable dose without maximum-dose, age, frequency and formulation review.
- Current account access is checked on every request. No patient identifiers, prescription approval, device control, account changes or offline-library export are provided through AI tools.

## How Ask AI answers

- Ask AI answers only from ICU Decoded's own pages: the ICU chapters, Ward Pathways cases, OPD cards and the Aladin Chirag tools. It does not search the internet.
- Every answer names the pages it used, so the reader can open them.
- If the site does not cover a question, Ask AI says so. It does not guess or fill the gap from other sources.

## How Auto Prescription works

- The doctor enters the patient, the diagnosis and the findings, then taps 'Pull from ICU Decoded'.
- Suggested medicines, fluids, investigations and advice come only from ICU Decoded's own guideline-cited content: ICU chapters and their treatment orders, Ward cases, OPD cards and investigation lists. Nothing comes from the internet.
- Each item shows the line it came from. Nothing is ticked automatically: the doctor reviews, edits, selects and signs.
- If the site has nothing for a diagnosis, the prescription says so and stays empty.

## How to use each part

- ICU chapters: pick a body system and a chapter, read the key points, then follow a pathway box by box (yes/no at each question). The Treatment button lists the orders with doses; the Investigations button lists the tests.
- Ward Pathways: find a case by specialty or search; each runs from presentation and first moves to decision steps, order set, admission criteria and discharge.
- OPD: search a disease, drug or Indian brand; each card gives adult and child doses, brands and an Investigations list.
- Aladin Chirag tools: choose a tool, enter the patient's weight and the numbers asked, read the result. The same numbers always give the same result.
- ICU scores: pick a score (SOFA, GCS, CURB-65 and others), fill the boxes, read the total and its meaning. Nothing entered is saved.
- Full guide: https://icudecodedd.com/how-to-use.html

## What is free

- Open to everyone: the [ICU scores](https://icudecodedd.com/icu-scores/), 8 ICU chapters, the Cardiology ward cases and the emergency drug calculators.
- Every library page shows its key points, tests and red flags free.
- Everything else opens free with a referral from a member or an approved application.
- OPD is free once you sign in; no referral is needed. Ask AI and Prescription come with a plan; a single prescription can be bought on its own.

## ICU chapters free in full

- [Septic Shock: Source, Cultures, Pressors](https://icudecodedd.com/library/icu/septic-shock-source-cultures-pressors.html): Sepsis is infection with acute organ dysfunction, operationalized as a SOFA increase of at least 2 points. Septic shock adds vasopressor need for MAP ≥65 mm Hg and lactate >2…
- [Status Epilepticus: Stop the Seizure](https://icudecodedd.com/library/icu/status-epilepticus-stop-the-seizure.html): Convulsive seizure ≥5 min, or repeated seizures without recovery: lorazepam 0.1 mg/kg IV (max 4 mg; repeat once after 5 min), or midazolam 10 mg IM if >40 kg with no IV access (5…
- [Ischemic Stroke: Reperfusion Window](https://icudecodedd.com/library/icu/ischemic-stroke-reperfusion-window.html): For disabling deficits (not NIHSS alone) give alteplase 0.9 mg/kg or tenecteplase 0.25 mg/kg (max 25 mg, co-equal Class 1, AHA/ASA 2026) within 4.5 h; IVT can extend to 4.5–9 h…
- [Subarachnoid Hemorrhage](https://icudecodedd.com/library/icu/subarachnoid-hemorrhage.html): Thunderclap headache: urgent noncontrast CT. If negative and presentation is >6 h or there is a new deficit, do an LP when safe. Within 6 h, a high-quality CT read by an expert…
- [Intracerebral Hemorrhage](https://icudecodedd.com/library/icu/intracerebral-hemorrhage.html): Immediately reverse anticoagulation: PCC + vitamin K for warfarin, idarucizumab for dabigatran, 4-factor PCC for Xa inhibitors (andexanet was withdrawn from the US market in…
- [Sodium, Potassium, Calcium & Magnesium](https://icudecodedd.com/library/icu/sodium-potassium-calcium-and-magnesium.html): Hyponatraemia: treat severe neurological symptoms promptly with monitored 3% saline boluses. Correction limits: ≤10 mmol/L in the first 24 h, then ≤8 per 24 h, and ≤18 in 48 h…
- [DKA & Hyperosmolar State](https://icudecodedd.com/library/icu/dka-and-hyperosmolar-state.html): DKA: start 0.9% NaCl or balanced crystalloid at 500–1000 mL/h for the first 2–4 h, add insulin 0.1 U/kg/h once K⁺ ≥3.5, add dextrose when glucose hits 14 mmol/L, and treat until…
- [Insulin & Glycemic Targets](https://icudecodedd.com/library/icu/insulin-and-glycemic-targets.html): Target 140–180 mg/dL (7.8–10 mmol/L); tight control (80–110) increases hypoglycemia and mortality.

## All ICU chapters (92)

Each page lists the chapter's key points, its tests and its pathways: https://icudecodedd.com/library/icu/

- [Shock: Recognition & First Moves](https://icudecodedd.com/library/icu/shock-recognition-and-first-moves.html): cited to ESICM acute circulatory failure 2025 · Surviving Sepsis Campaign 2026
- [Bleeding & Volume Loss: Hypovolemic Shock](https://icudecodedd.com/library/icu/bleeding-and-volume-loss-hypovolemic-shock.html): cited to ATLS 11th (2025) · European trauma bleeding guideline 2023 · AABB 2023
- [When the Pump Fails: Cardiogenic Shock](https://icudecodedd.com/library/icu/when-the-pump-fails-cardiogenic-shock.html): cited to AHA/ACC/HFSA Heart Failure 2022 · ACC/AHA Acute Coronary Syndromes 2025
- [Anaphylaxis in the ICU](https://icudecodedd.com/library/icu/anaphylaxis-in-the-icu.html): cited to Resuscitation Council UK 2021 · WAO 2020 · AAAAI/ACAAI 2023
- [Obstructive Shock: Tamponade, Tension PTX, Massive PE](https://icudecodedd.com/library/icu/obstructive-shock-tamponade-tension-ptx-massive-pe.html): cited to AHA/ACC Acute PE 2026 · AHA CPR 2025 · SMFM AFE checklist 2026
- [Respiratory Failure: First Assessment](https://icudecodedd.com/library/icu/respiratory-failure-first-assessment.html): cited to ATS/ERS respiratory failure frameworks
- [Setting Up the Ventilator](https://icudecodedd.com/library/icu/setting-up-the-ventilator.html): cited to ARDSNet lung-protective strategy
- [Blocked Airway: Upper Obstruction](https://icudecodedd.com/library/icu/blocked-airway-upper-obstruction.html): cited to Difficult Airway Society 2025
- [ARDS: Lung-Protective Strategy](https://icudecodedd.com/library/icu/ards-lung-protective-strategy.html): cited to Berlin definition; ARDSNet; PROSEVA
- [Crash Asthma in the ICU](https://icudecodedd.com/library/icu/crash-asthma-in-the-icu.html): cited to GINA 2026
- [COPD Flare on the Vent](https://icudecodedd.com/library/icu/copd-flare-on-the-vent.html): cited to GOLD 2026
- [Sleep Apnea & the ICU Patient](https://icudecodedd.com/library/icu/sleep-apnea-and-the-icu-patient.html): cited to AASM guidelines
- [Effusion, Pneumothorax & Pleural Disease](https://icudecodedd.com/library/icu/effusion-pneumothorax-and-pleural-disease.html): cited to BTS Pleural Disease 2023
- [Liberating from the Ventilator](https://icudecodedd.com/library/icu/liberating-from-the-ventilator.html): cited to ATS/ACCP liberation guidelines
- [NIV: BiPAP, CPAP & HFNO](https://icudecodedd.com/library/icu/niv-bipap-cpap-and-hfno.html): cited to ERS/ATS NIV 2017
- [STEMI & NSTEMI in the ICU](https://icudecodedd.com/library/icu/stemi-and-nstemi-in-the-icu.html): cited to ACC/AHA STEMI; ESC ACS 2023
- [Arrhythmias & Conduction Blocks](https://icudecodedd.com/library/icu/arrhythmias-and-conduction-blocks.html): cited to AHA 2025 CPR & ECC; ESC SVT 2019
- [Aortic Dissection: Impulse Control](https://icudecodedd.com/library/icu/aortic-dissection-impulse-control.html): cited to ACC/AHA Aortic Disease 2022
- [Acute Heart Failure & Pulmonary Edema](https://icudecodedd.com/library/icu/acute-heart-failure-and-pulmonary-edema.html): cited to AHA/ACC/HFSA 2022
- [Hypertensive Crisis](https://icudecodedd.com/library/icu/hypertensive-crisis.html): cited to ACC/AHA 2025; ESC/ESH
- [RV Failure & Pulmonary Hypertension](https://icudecodedd.com/library/icu/rv-failure-and-pulmonary-hypertension.html): cited to ESC/ERS Pulmonary Hypertension 2022
- [The Comatose Patient](https://icudecodedd.com/library/icu/the-comatose-patient.html): cited to ERC/ESICM 2025 · AHA 2025
- [TBI & ICP Management](https://icudecodedd.com/library/icu/tbi-and-icp-management.html): cited to BTF 2016/2020 · NCS 2020/2024
- [Cord Compression & Cauda Equina](https://icudecodedd.com/library/icu/cord-compression-and-cauda-equina.html): cited to NICE NG234 2023 · spinal emergency guidance
- [Weakness in the ICU: GBS & MG](https://icudecodedd.com/library/icu/weakness-in-the-icu-gbs-and-mg.html): cited to EAN/PNS GBS 2023 · ABN MG 2025
- [Sedation, Pain & Delirium](https://icudecodedd.com/library/icu/sedation-pain-and-delirium.html): cited to SCCM PADIS 2018/2025
- [Neuro Complications of CNS Infection](https://icudecodedd.com/library/icu/neuro-complications-of-cns-infection.html): cited to IDSA · WHO 2025 · ESCMID brain abscess 2024
- [Meningitis & Encephalitis](https://icudecodedd.com/library/icu/meningitis-and-encephalitis.html): cited to IDSA meningitis/encephalitis · WHO 2025
- [Brain Death Testing](https://icudecodedd.com/library/icu/brain-death-testing.html): cited to AAN DNC 2023 · local certification law
- [Severe Community Pneumonia](https://icudecodedd.com/library/icu/severe-community-pneumonia.html): cited to ATS/IDSA CAP 2019 · ATS CAP update 2025 · SCCM 2024 · SSC 2026
- [Hospital & Ventilator Pneumonia](https://icudecodedd.com/library/icu/hospital-and-ventilator-pneumonia.html): cited to ATS/IDSA HAP/VAP 2016 · IDSA AMR guidance 2026
- [Skin & Soft Tissue Sepsis](https://icudecodedd.com/library/icu/skin-and-soft-tissue-sepsis.html): cited to IDSA SSTI 2014 · CDC Vibrio guidance 2024
- [Bacteremia & Line Infections](https://icudecodedd.com/library/icu/bacteremia-and-line-infections.html): cited to IDSA CRBSI 2009 · IDSA/ESCMID S. aureus bacteremia 2026 Part 1
- [Invasive Fungal Disease](https://icudecodedd.com/library/icu/invasive-fungal-disease.html): cited to ECMM/ISHAM/ASM candidiasis 2025 · IDSA 2016/ATS 2025 aspergillosis · ECMM mucormycosis 2019
- [The Immunocompromised Host](https://icudecodedd.com/library/icu/the-immunocompromised-host.html): cited to IDSA FN 2010/2011 · NICE CG151 · AGIHO update published 2025
- [Infection Prevention Bundles](https://icudecodedd.com/library/icu/infection-prevention-bundles.html): cited to SHEA/IDSA/APIC HAI compendium 2022 updates
- [C. diff & ICU Diarrhea](https://icudecodedd.com/library/icu/c-diff-and-icu-diarrhea.html): cited to IDSA/SHEA CDI 2017/2021 · ACG 2021 · AGA 2024/2026
- [Pulmonary Embolism: Risk-Stratify & Treat](https://icudecodedd.com/library/icu/pulmonary-embolism-risk-stratify-and-treat.html): cited to AHA/ACC 2026 PE · ESC 2019
- [Low Platelets: HIT, TTP, DIC](https://icudecodedd.com/library/icu/low-platelets-hit-ttp-dic.html): cited to ISTH / ASH guidance
- [Coagulopathy & the Bleeding Patient](https://icudecodedd.com/library/icu/coagulopathy-and-the-bleeding-patient.html): cited to Massive transfusion protocols
- [Transfusion: When & How Much](https://icudecodedd.com/library/icu/transfusion-when-and-how-much.html): cited to AABB 2023
- [The Clotting Patient](https://icudecodedd.com/library/icu/the-clotting-patient.html): cited to ASH 2018/2020
- [Rheumatologic Crises](https://icudecodedd.com/library/icu/rheumatologic-crises.html): cited to ACR/EULAR
- [The Transplant Patient](https://icudecodedd.com/library/icu/the-transplant-patient.html): cited to AST/ISHLT guidance
- [AKI: Workup & Management](https://icudecodedd.com/library/icu/aki-workup-and-management.html): cited to KDIGO AKI 2012 · STARRT-AKI · AKIKI-2
- [Dialysis & CRRT](https://icudecodedd.com/library/icu/dialysis-and-crrt.html): cited to KDIGO AKI 2012 · CRRT dosing guidance
- [Metabolic Acidosis & Alkalosis](https://icudecodedd.com/library/icu/metabolic-acidosis-and-alkalosis.html): cited to ATS acid–base reference · BICARICU-2 2025
- [Respiratory Acid–Base Disorders](https://icudecodedd.com/library/icu/respiratory-acid-base-disorders.html): cited to ATS acid–base reference · BTS/ICS 2016
- [Upper GI Bleed](https://icudecodedd.com/library/icu/upper-gi-bleed.html): cited to ACG 2021 / ESGE 2026 UGIB · ACG 2024 H. pylori · Baveno VIII 2026
- [Lower GI Bleed](https://icudecodedd.com/library/icu/lower-gi-bleed.html): cited to ACG 2023 LGIB · ACG/SAR 2024 imaging · ASGE 2026
- [Acute Pancreatitis](https://icudecodedd.com/library/icu/acute-pancreatitis.html): cited to ACG 2024 acute pancreatitis · revised IAP 2025
- [Acute Abdomen in the ICU](https://icudecodedd.com/library/icu/acute-abdomen-in-the-icu.html): cited to WSES 2022 / CIRSE 2025 mesenteric ischemia · SIS 2024
- [Acute Liver Failure](https://icudecodedd.com/library/icu/acute-liver-failure.html): cited to AASLD 2011 / EASL 2017 ALF · ACG 2023 · SCCM 2020/2023 · ACMT 2026
- [Jaundice in the ICU](https://icudecodedd.com/library/icu/jaundice-in-the-icu.html): cited to ACG 2017 liver chemistries · Tokyo 2018 · ASGE 2021 cholangitis · CDC 2026
- [Cirrhosis Complications](https://icudecodedd.com/library/icu/cirrhosis-complications.html): cited to AASLD 2021 ascites/SBP · ADQI–ICA 2024 HRS · Baveno VIII / ACG HE 2026
- [Thyroid Storm & Myxedema](https://icudecodedd.com/library/icu/thyroid-storm-and-myxedema.html): cited to ATA 2016; Burch–Wartofsky score
- [Adrenal Crisis in Critical Illness](https://icudecodedd.com/library/icu/adrenal-crisis-in-critical-illness.html): cited to SCCM/ESICM 2017
- [Cancer Emergencies: TLS, SVC, Hypercalcemia](https://icudecodedd.com/library/icu/cancer-emergencies-tls-svc-hypercalcemia.html): cited to ESMO/NCCN frameworks
- [Too Cold, Too Hot: Temperature Emergencies](https://icudecodedd.com/library/icu/too-cold-too-hot-temperature-emergencies.html): cited to ERC/AHA temperature guidelines
- [Overdose & Poisoning](https://icudecodedd.com/library/icu/overdose-and-poisoning.html): cited to AACT/EAPCCT position papers
- [Trauma: Primary Survey (xABCDE)](https://icudecodedd.com/library/icu/trauma-primary-survey-xabcde.html): cited to ATLS 11th edition (2025)
- [The Pregnant ICU Patient](https://icudecodedd.com/library/icu/the-pregnant-icu-patient.html): cited to SMFM / ACOG guidance
- [Preeclampsia & Eclampsia](https://icudecodedd.com/library/icu/preeclampsia-and-eclampsia.html): cited to ACOG 2020
- [Organ Donor Management](https://icudecodedd.com/library/icu/organ-donor-management.html): cited to Donor management guidelines
- [Arterial Line Placement](https://icudecodedd.com/library/icu/arterial-line-placement.html): cited to Standard procedural guidance
- [Central Line Placement](https://icudecodedd.com/library/icu/central-line-placement.html): cited to CDC/SHEA line guidelines
- [Intubation: Preparation & Technique](https://icudecodedd.com/library/icu/intubation-preparation-and-technique.html): cited to Difficult Airway Society 2025
- [Tracheostomy](https://icudecodedd.com/library/icu/tracheostomy.html): cited to Society guidelines
- [Chest Drain Placement](https://icudecodedd.com/library/icu/chest-drain-placement.html): cited to BTS guidelines
- [Paracentesis](https://icudecodedd.com/library/icu/paracentesis.html): cited to AASLD ascites guidance
- [Lumbar Puncture](https://icudecodedd.com/library/icu/lumbar-puncture.html): cited to IDSA meningitis LP guidance
- [Thoracentesis](https://icudecodedd.com/library/icu/thoracentesis.html): cited to BTS pleural guidance
- [Swan-Ganz Catheter](https://icudecodedd.com/library/icu/swan-ganz-catheter.html): cited to Hemodynamic society guidance
- [Hemodynamic Monitors Compared](https://icudecodedd.com/library/icu/hemodynamic-monitors-compared.html): cited to ESICM hemodynamic guidance
- [Fluid Responsiveness Testing](https://icudecodedd.com/library/icu/fluid-responsiveness-testing.html): cited to Fluid responsiveness consensus
- [Pericardiocentesis](https://icudecodedd.com/library/icu/pericardiocentesis.html): cited to ESC pericardial guidance
- [ECMO & ECLS](https://icudecodedd.com/library/icu/ecmo-and-ecls.html): cited to ELSO guidelines
- [Point-of-Care Ultrasound](https://icudecodedd.com/library/icu/point-of-care-ultrasound.html): cited to ACCP/SRLM ultrasound guidance
- [Feeding the ICU Patient](https://icudecodedd.com/library/icu/feeding-the-icu-patient.html): cited to ASPEN/SCCM 2016; ESPEN 2019
- [Family Communication at End of Life](https://icudecodedd.com/library/icu/family-communication-at-end-of-life.html): cited to SCCM family-centered care 2017
- [ICU Equations Cheat Sheet](https://icudecodedd.com/library/icu/icu-equations-cheat-sheet.html): cited to Reference
- [Key Drug Interactions](https://icudecodedd.com/library/icu/key-drug-interactions.html): cited to Reference
- [ICU Drug Dosing Reference](https://icudecodedd.com/library/icu/icu-drug-dosing-reference.html): cited to Reference
- [Tropical & Vector-Borne Critical Illness](https://icudecodedd.com/library/icu/tropical-and-vector-borne-critical-illness.html): cited to WHO malaria Sep 2026 · WHO arboviral management 2025 · WHO/India snakebite 2016 · WHO TB 2025 · CDC/ICMR tropical guidance

## Ward pathways by specialty

### Cardiology (12 cases) — free in full

- [Acute Pulmonary Oedema](https://icudecodedd.com/library/ward/acute-pulmonary-oedema.html): Casualty: breathless, orthopnoea, rales, JVD, S3 gallop, bilateral pitting oedema; prior MI/HTN
- [Congestive Heart Failure (chronic, systolic)](https://icudecodedd.com/library/ward/congestive-heart-failure-chronic-systolic.html): Ambulatory: exertional dyspnoea, orthopnoea, PND, S4, apical murmur→axilla, oedema; long-standing HTN
- [Acute Coronary Syndrome](https://icudecodedd.com/library/ward/acute-coronary-syndrome.html): Casualty: crushing substernal chest pain; risk factors (HTN, smoking, dyslipidaemia)
- [Aortic Stenosis](https://icudecodedd.com/library/ward/aortic-stenosis.html): Elderly: exertional dyspnoea, syncope, angina; crescendo-decrescendo systolic murmur 2nd R ICS → carotids; louder on squatting, softer with…
- [Mitral Stenosis](https://icudecodedd.com/library/ward/mitral-stenosis.html): Rheumatic fever in childhood (common in India): dyspnoea, haemoptysis, AF; diastolic rumble + opening snap, loud S1 at apex
- [Atrial Fibrillation](https://icudecodedd.com/library/ward/atrial-fibrillation.html): Irregularly irregular pulse, no P waves, rapid rate
- [SVT / VT / WPW](https://icudecodedd.com/library/ward/svt-vt-wpw.html): SVT: narrow, regular, fast. VT: wide. WPW: delta wave, short PR
- [Pericardial Tamponade](https://icudecodedd.com/library/ward/pericardial-tamponade.html): Hypotension + ↑JVP + muffled sounds (Beck); pulsus paradoxus >10 mmHg; electrical alternans; effusion/post-MI
- [Complete Heart Block](https://icudecodedd.com/library/ward/complete-heart-block.html): AV dissociation, bradycardia, syncope, cannon a-waves
- [Mitral Regurgitation](https://icudecodedd.com/library/ward/mitral-regurgitation.html): Holosystolic murmur at apex → axilla, soft S1
- [Peripheral Arterial Disease](https://icudecodedd.com/library/ward/peripheral-arterial-disease.html): Claudication, ↓ pulses, shiny hairless skin; smoker
- [Syncope](https://icudecodedd.com/library/ward/syncope.html): Transient LOC with spontaneous recovery

### Hematology (8 cases)

- [Sickle Cell Crisis](https://icudecodedd.com/library/ward/sickle-cell-crisis.html): Casualty: known sickle cell disease (HbSS); severe bone, back or chest pain for 1 day, fever 38.6 °C; stopped hydroxyurea
- [Autoimmune Hemolysis](https://icudecodedd.com/library/ward/autoimmune-hemolysis.html): Fatigue, jaundice, dark urine; Hb 62 g/L falling; ↑reticulocytes, ↑LDH, ↑indirect bilirubin, ↓haptoglobin; spherocytes on the film
- [G6PD Deficiency](https://icudecodedd.com/library/ward/g6pd-deficiency.html): Young man with cola-coloured urine, jaundice, pallor and back pain 2 days after starting primaquine (or dapsone, nitrofurantoin, fava…
- [Paroxysmal Nocturnal Hemoglobinuria](https://icudecodedd.com/library/ward/paroxysmal-nocturnal-hemoglobinuria.html): Young adult with dark morning urine, fatigue and abdominal pain; DAT-negative haemolysis, low counts; new hepatic vein thrombosis on…
- [HUS / TTP](https://icudecodedd.com/library/ward/hus-ttp.html): Fever, confusion and headache; purpura; platelets 12×10⁹/L, Hb 72 g/L; schistocytes; normal PT/aPTT. Bloody diarrhoea before kidney failure…
- [Immune Thrombocytopenic Purpura](https://icudecodedd.com/library/ward/immune-thrombocytopenic-purpura.html): Petechiae, bruising, gum bleeding; platelets 8×10⁹/L with normal Hb and WBC; otherwise well
- [Clotting Factor Deficiency (Hemophilia)](https://icudecodedd.com/library/ward/clotting-factor-deficiency-hemophilia.html): Known severe haemophilia A; painful swollen right knee after minor trauma (or groin pain with the hip held flexed, or a head knock); aPTT…
- [Thrombophilia / DVT / HIT](https://icudecodedd.com/library/ward/thrombophilia-dvt-hit.html): Swollen, painful left leg for 3 days after surgery; or platelets fallen >50% on day 5–10 of heparin with a new clot

### Endocrinology (4 cases)

- [Diabetic Ketoacidosis](https://icudecodedd.com/library/ward/diabetic-ketoacidosis.html): Type 1 diabetes, stopped insulin 2 days ago; vomiting, abdominal pain, Kussmaul breathing; glucose 420 mg/dL, pH 7.12, HCO₃ 9, BOHB 5.8…
- [Hyperosmolar Hyperglycaemic State (HHS)](https://icudecodedd.com/library/ward/hyperosmolar-hyperglycaemic-state-hhs.html): Elderly type 2 diabetes, 1 week of polyuria then confusion; very dry; glucose 980 mg/dL, Na⁺ 148, effective osmolality 345 mOsm/kg, pH…
- [Hypoglycaemia (Severe, Inpatient)](https://icudecodedd.com/library/ward/hypoglycaemia-severe-inpatient.html): Type 2 diabetes on gliclazide and insulin, eGFR 35; found sweaty and confused at 4 am; capillary glucose 42 mg/dL
- [Adrenal Crisis](https://icudecodedd.com/library/ward/adrenal-crisis.html): On prednisolone 10 mg for 2 years, stopped it 1 week ago; vomiting, abdominal pain, confusion; BP 78/46, Na⁺ 126, K⁺ 5.6, glucose 60 mg/dL

### Neurology (6 cases)

- [Stroke (Ischaemic)](https://icudecodedd.com/library/ward/stroke-ischaemic.html): Sudden right weakness and slurred speech 90 min ago; BP 196/104; glucose 132 mg/dL; NIHSS 12
- [Myasthenia Gravis](https://icudecodedd.com/library/ward/myasthenia-gravis.html): Known myasthenia gravis, chest infection; worsening ptosis, nasal speech, choking on liquids, breathless lying flat; single-breath count 14
- [Subarachnoid Haemorrhage](https://icudecodedd.com/library/ward/subarachnoid-haemorrhage.html): Sudden "worst headache of my life" at peak intensity within a minute, vomiting, neck stiffness; GCS 14; BP 180/100
- [Guillain-Barré Syndrome](https://icudecodedd.com/library/ward/guillain-barr-syndrome.html): Ascending leg weakness over 5 days after diarrhoea; now cannot walk; areflexia; tingling hands; FVC 22 mL/kg
- [Meningitis (Bacterial)](https://icudecodedd.com/library/ward/meningitis-bacterial.html): Fever, severe headache, neck stiffness, confusion (GCS 13) for 1 day; petechial rash on the legs
- [Head Trauma — Subdural Hematoma](https://icudecodedd.com/library/ward/head-trauma-subdural-hematoma.html): 78-year-old on apixaban for AF; fall 3 weeks ago; now increasing confusion, headache and right-hand clumsiness; CT: left crescentic…

### Gastroenterology (4 cases)

- [Gastrointestinal Bleeding](https://icudecodedd.com/library/ward/gastrointestinal-bleeding.html): Two episodes of haematemesis and melaena since morning; HR 118, BP 92/60; on aspirin and ibuprofen (or known cirrhosis)
- [Inflammatory Bowel Disease](https://icudecodedd.com/library/ward/inflammatory-bowel-disease.html): Known ulcerative colitis; 9 bloody stools a day, cramps, fever 38.1 °C, HR 104; Hb 98 g/L, CRP 68 — acute severe UC (Truelove & Witts)
- [Acute Pancreatitis](https://icudecodedd.com/library/ward/acute-pancreatitis.html): Severe epigastric pain radiating to the back, vomiting; gallstones on USS; lipase 12× ULN; HR 112, RR 24
- [Decompensated Cirrhosis (Ascites, SBP, Encephalopathy)](https://icudecodedd.com/library/ward/decompensated-cirrhosis-ascites-sbp-encephalopathy.html): Alcohol-related cirrhosis; tense ascites, fever 38.2 °C, drowsy with asterixis; creatinine 1.9 mg/dL (baseline 0.9), Na⁺ 128

### Nephrology (7 cases)

- [Acute Kidney Injury — Prerenal](https://icudecodedd.com/library/ward/acute-kidney-injury-prerenal.html): Three days of diarrhoea and vomiting on ramipril, furosemide and diclofenac; dizzy on standing; creatinine 2.8 mg/dL (baseline 1.0), urine…
- [Acute Tubular Necrosis (incl. Rhabdomyolysis)](https://icudecodedd.com/library/ward/acute-tubular-necrosis-incl-rhabdomyolysis.html): Found on the floor for 18 hours; tea-coloured urine; CK 48,000 U/L; creatinine 3.4 mg/dL; K⁺ 6.2; muddy-brown casts (or ATN after…
- [Nephrotic Syndrome (Membranous)](https://icudecodedd.com/library/ward/nephrotic-syndrome-membranous.html): 45-year-old with 3 weeks of swelling from face to legs, frothy urine; albumin 1.8 g/dL, urine PCR 9 g/g, cholesterol 380 mg/dL; now painful…
- [End-Stage Renal Failure / Dialysis](https://icudecodedd.com/library/ward/end-stage-renal-failure-dialysis.html): CKD stage 5 (eGFR 8), not yet on dialysis; 1 week of vomiting, itching and breathlessness; K⁺ 6.8, HCO₃ 12, urea 260 mg/dL; pericardial rub
- [SIADH](https://icudecodedd.com/library/ward/siadh.html): 68-year-old on sertraline with pneumonia; confusion, vomiting, one seizure; Na⁺ 116, serum osmolality 245, urine osmolality 480, urine Na…
- [Central Diabetes Insipidus](https://icudecodedd.com/library/ward/central-diabetes-insipidus.html): 3 days after pituitary surgery: urine 300 mL/h, thirsty; Na⁺ 154, serum osmolality 318, urine osmolality 120 (or an elderly, bed-bound…
- [Hyperkalaemia / Tumour Lysis](https://icudecodedd.com/library/ward/hyperkalaemia-tumour-lysis.html): CKD 4 on ramipril and spironolactone; weak and nauseated; K⁺ 7.1; ECG: peaked T waves, wide QRS

### Pulmonary (6 cases)

- [Asthma](https://icudecodedd.com/library/ward/asthma.html): Known asthma, 2 days of worsening wheeze; can speak only in phrases; RR 30, HR 120, SpO₂ 91%, PEF 35% of best
- [COPD](https://icudecodedd.com/library/ward/copd.html): Ex-smoker with COPD, 3 days of more breathlessness and purulent sputum; SpO₂ 84% on air; ABG pH 7.30, PaCO₂ 62 mmHg, PaO₂ 50
- [Pneumonia (CAP)](https://icudecodedd.com/library/ward/pneumonia-cap.html): Diabetic 60-year-old, 3 days of fever, cough with rusty sputum, right pleuritic pain; RR 28, BP 100/60, urea 50 mg/dL, confused — CURB-65 =…
- [Pneumocystis (PCP) Pneumonia](https://icudecodedd.com/library/ward/pneumocystis-pcp-pneumonia.html): Newly diagnosed HIV (CD4 60), 3 weeks of dry cough, fever, breathless on walking; SpO₂ 90% on air falling to 82% on exertion; LDH 480…
- [Tuberculosis](https://icudecodedd.com/library/ward/tuberculosis.html): 32-year-old, 2 months of cough, evening fever, 8 kg weight loss, streaky haemoptysis; right upper lobe cavity; sputum GeneXpert MTB…
- [Pulmonary Embolus](https://icudecodedd.com/library/ward/pulmonary-embolus.html): Day 6 after knee replacement: sudden pleuritic chest pain and breathlessness; HR 118, BP 104/70, SpO₂ 90%; right calf swollen

### Rheumatology (2 cases)

- [Systemic Lupus Erythematosus](https://icudecodedd.com/library/ward/systemic-lupus-erythematosus.html): 26-year-old woman with SLE, stopped hydroxychloroquine; 2 weeks of facial swelling, frothy urine, joint pain; BP 160/100, creatinine 1.8…
- [Septic Arthritis (Acute Hot Joint)](https://icudecodedd.com/library/ward/septic-arthritis-acute-hot-joint.html): Diabetic 58-year-old; 2 days of a hot, swollen, very painful right knee, cannot bear weight or move it; T 38.4 °C; WBC 16,000, CRP 180 mg/L

### Oncology (4 cases)

- [Multiple Myeloma](https://icudecodedd.com/library/ward/multiple-myeloma.html): 65-year-old with 3 months of back pain and fatigue; Hb 82 g/L, creatinine 3.1 mg/dL, corrected calcium 12.8 mg/dL, total protein 9.2 g/dL…
- [Tumour Lysis Syndrome](https://icudecodedd.com/library/ward/tumour-lysis-syndrome.html): Day 2 after first chemo for Burkitt lymphoma — K⁺ 6.4, phosphate 2.8, creatinine doubling. Cell death is flooding the blood: fluids…
- [Febrile Neutropenia](https://icudecodedd.com/library/ward/febrile-neutropenia.html): Chemo 8 days ago, now T 38.6 °C, ANC 0.2 — treat as sepsis with an hour on the clock: cultures then piperacillin-tazobactam immediately.
- [Hypercalcaemia of Malignancy](https://icudecodedd.com/library/ward/hypercalcaemia-of-malignancy.html): Known myeloma, now confused and constipated — corrected Ca²⁺ 3.6. Volume first, calcitonin for speed, zoledronate for durability.

### Infectious Disease (8 cases)

- [Osteomyelitis](https://icudecodedd.com/library/ward/osteomyelitis.html): Diabetic with a foul plantar ulcer over the 1st metatarsal head for 6 weeks; probe touches bone; swollen red forefoot; T 37.9 °C (or back…
- [Endocarditis](https://icudecodedd.com/library/ward/endocarditis.html): Rheumatic heart disease with mitral regurgitation; 3 weeks of fever, weight loss, new breathlessness; splinter haemorrhages, splenomegaly…
- [Pyelonephritis](https://icudecodedd.com/library/ward/pyelonephritis.html): Diabetic woman, 2 days of fever with rigors, right flank pain, vomiting; renal angle tender; BP 96/60; urine nitrite + leucocytes
- [Cellulitis](https://icudecodedd.com/library/ward/cellulitis.html): Diabetic with filarial lymphoedema; 2 days of a hot, red, swollen, painful left leg with fever 38.8 °C; tinea between the toes
- [Infectious Diarrhea](https://icudecodedd.com/library/ward/infectious-diarrhea.html): 45-year-old, 1 day of profuse watery diarrhoea ("rice-water"), vomiting, leg cramps; very dry, BP 86/50, not passing urine (or bloody…
- [Malaria](https://icudecodedd.com/library/ward/malaria.html): Fever with rigors for 5 days, now drowsy and jaundiced; creatinine 3.4, Hb 68 g/L, glucose 52 mg/dL; P. falciparum 8% parasitaemia (P.…
- [Dengue with Warning Signs](https://icudecodedd.com/library/ward/dengue-with-warning-signs.html): Day 5 of fever (now settling); abdominal pain, repeated vomiting, gum bleeding, restless; liver 3 cm; haematocrit 48% (baseline 38%)…
- [Typhoid (Enteric Fever)](https://icudecodedd.com/library/ward/typhoid-enteric-fever.html): 24-year-old, 10 days of rising fever, headache, abdominal pain and loose stools; now vomiting and unable to keep tablets down. HR 88 with…

### Emergency / Toxicology (10 cases)

- [Tricyclic Antidepressant Overdose](https://icudecodedd.com/library/ward/tricyclic-antidepressant-overdose.html): Took 30 tablets of amitriptyline 2 h ago; drowsy, dry, flushed, pupils dilated; HR 128, BP 88/50; QRS 128 ms
- [Paracetamol Overdose](https://icudecodedd.com/library/ward/paracetamol-overdose.html): Took 40 tablets of paracetamol 500 mg (20 g) 5 h ago; 60 kg; nausea only; 4-hour level pending
- [Aspirin / Salicylate Overdose](https://icudecodedd.com/library/ward/aspirin-salicylate-overdose.html): Took 60 tablets of aspirin 325 mg; tinnitus, vomiting, RR 32; VBG pH 7.36, PaCO₂ 22, HCO₃ 12 (mixed respiratory alkalosis + anion-gap…
- [Carbon Monoxide Poisoning](https://icudecodedd.com/library/ward/carbon-monoxide-poisoning.html): Family found drowsy in a closed room with a coal brazier (angithi) overnight; headache, vomiting; GCS 13; SpO₂ reads 99%; COHb 32%
- [Ethylene Glycol / Methanol](https://icudecodedd.com/library/ward/ethylene-glycol-methanol.html): Several labourers after drinking illicit liquor 24 h ago; one has blurred "snowfield" vision, vomiting, RR 30; pH 7.08, anion gap 28…
- [Organophosphate Poisoning](https://icudecodedd.com/library/ward/organophosphate-poisoning.html): Farmer drank an organophosphate insecticide 1 h ago; vomiting, drooling, pinpoint pupils, fasciculations, wheeze with bronchorrhoea; HR 48…
- [Snakebite Envenomation](https://icudecodedd.com/library/ward/snakebite-envenomation.html): Farmer bitten on the foot while harvesting at night 3 h ago; swelling to the knee, bleeding gums; 20-minute whole-blood clotting test…
- [Digoxin Toxicity](https://icudecodedd.com/library/ward/digoxin-toxicity.html): Elderly on digoxin for AF with CKD; 3 days of nausea, vomiting, yellow-tinged vision, confusion; HR 38 with regularised AF; K⁺ 5.9; digoxin…
- [Drowning / Hypothermia](https://icudecodedd.com/library/ward/drowning-hypothermia.html): Pulled from a river after 5 minutes; now breathing, GCS 12, SpO₂ 86%, crackles; core temperature 32 °C (or found cold outdoors with…
- [Neuroleptic Malignant Syndrome](https://icudecodedd.com/library/ward/neuroleptic-malignant-syndrome.html): Started haloperidol injections 5 days ago; now T 40.2 °C, lead-pipe rigidity, confusion, sweating, labile BP; CK 18,000 U/L

### Critical Care / ICU (10 cases)

- [Sepsis & Septic Shock](https://icudecodedd.com/library/ward/sepsis-and-septic-shock.html): Fever + confusion + lactate 4.2; BP 84/50 after 2 L — suspected pneumonia. Move fast: every hour of antibiotic delay costs lives.
- [Undifferentiated Shock & Vasopressor Guide](https://icudecodedd.com/library/ward/undifferentiated-shock-and-vasopressor-guide.html): MAP 58 with cold mottled legs and a lactate of 5 — cold & wet, warm & dry, or obstructed? Pick the right pressor for the physiology.
- [Anaphylaxis](https://icudecodedd.com/library/ward/anaphylaxis.html): Urticaria + stridor + BP 78/40 minutes after IV antibiotic — this is adrenaline IM now, not antihistamines first.
- [Acute Respiratory Failure — Initial Ventilator Setup](https://icudecodedd.com/library/ward/acute-respiratory-failure-initial-ventilator-setup.html): Exhausted, SpO₂ 82% on 15 L, PaCO₂ 68 mmHg and climbing — type I vs type II failure, NIV or tube, and the first safe ventilator settings.
- [ARDS](https://icudecodedd.com/library/ward/ards.html): Bilateral infiltrates, PaO₂/FiO₂ 110 on PEEP 5, 3 days into pneumonia — this is ARDS; the ventilator itself can injure, so set it like a…
- [Status Epilepticus](https://icudecodedd.com/library/ward/status-epilepticus.html): Generalised tonic-clonic seizure ongoing at 7 minutes — treat the clock: benzodiazepine at 5 min, second-line loaded by 20 min, airway by…
- [Aortic Dissection](https://icudecodedd.com/library/ward/aortic-dissection.html): Tearing interscapular pain, BP 210/120, right arm pulse weaker than left — kill the shear forces: β-block FIRST, then vasodilate, then CTA.
- [Hypertensive Emergency](https://icudecodedd.com/library/ward/hypertensive-emergency.html): BP 240/130 with blurred vision, pulmonary oedema and creatinine climbing — the DAMAGE defines the emergency, not the number. Lower SBP by…
- [Cardiac Arrest & Post-ROSC Care](https://icudecodedd.com/library/ward/cardiac-arrest-and-post-rosc-care.html): Collapse, pulseless — start the clockwork: quality CPR, adrenaline every 3–5 min, shock the shockable, hunt Hs & Ts, then protect the brain…
- [Acute Liver Failure](https://icudecodedd.com/library/ward/acute-liver-failure.html): Paracetamol overdose 2 days ago, now INR 3.8, confused, glucose 2.1 — INR ≥1.5 + encephalopathy = acute liver failure. NAC for everyone…

### Miscellaneous (7 cases)

- [Invasive Fungal Infection in the ICU](https://icudecodedd.com/library/ward/invasive-fungal-infection-in-the-icu.html): ICU day 8, persistent fever on broad-spectrum antibiotics; central line, TPN, recent abdominal surgery
- [Clostridioides difficile and ICU Diarrhoea](https://icudecodedd.com/library/ward/clostridioides-difficile-and-icu-diarrhoea.html): Day 6 of piperacillin-tazobactam; 8 loose stools/day, cramping, WCC 22 × 10⁹/L, albumin falling
- [Coagulopathy in the Bleeding Patient](https://icudecodedd.com/library/ward/coagulopathy-in-the-bleeding-patient.html): Post-operative patient oozing from every puncture site; INR 2.1, platelets 68 × 10⁹/L, fibrinogen 1.1 g/L, temperature 34.8 °C
- [Rheumatological Emergencies](https://icudecodedd.com/library/ward/rheumatological-emergencies.html): Known vasculitis, now breathless with haemoptysis, creatinine risen from 1.0 to 3.6 mg/dL, urine dipstick blood +++ and protein ++
- [The Transplant Patient with Fever](https://icudecodedd.com/library/ward/the-transplant-patient-with-fever.html): Renal transplant 4 months ago on tacrolimus, mycophenolate and prednisolone; fever 38.8 °C, dry cough, creatinine up 40%
- [Thyroid Storm and Myxoedema Coma](https://icudecodedd.com/library/ward/thyroid-storm-and-myxoedema-coma.html): Agitated, temperature 40 °C, AF at 160/min, vomiting, jaundice — two weeks after stopping carbimazole
- [Device-Associated Infection Prevention Bundles](https://icudecodedd.com/library/ward/device-associated-infection-prevention-bundles.html): Daily ward round on a ventilated patient with a central line, an arterial line and a urinary catheter on day 5

## OPD

- [OPD](https://icudecodedd.com/library/opd/): 211 outpatient and casualty diseases in 15 chapters. Each page lists the drugs, the investigations and when to refer. Doses and Indian brand names open in the OPD app.

## Contact

- Site: https://icudecodedd.com/
- Library index: https://icudecodedd.com/library/
- How to use: https://icudecodedd.com/how-to-use.html
- About the author: https://icudecodedd.com/about.html
- Android app: Google Play, 'ICU Decoded'