sourav dey

Foodie,Bookworm,Movie freak,Dreamer,Travelholic,MusicLover,highly ambitious Anesthesiologist ,now a budding Intensivist,Aiims,NewDelhi.Aiims,Jodhpur

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🫀 The Most Dangerous Moment in the ICU May Last Less Than 60 Seconds

We often think of tracheal intubation as an airway procedure. Physiologically, it is a profound cardiovascular intervention.

Why Do ICU Patients Crash During Intubation?

The problem begins before the laryngoscope enters the mouth.

Many critically ill patients survive on a fragile compensatory state characterized by:
🔹 Endogenous catecholamine surge
🔹 Tachycardia
🔹 Vasoconstriction
🔹 Increased myocardial oxygen demand

What appears to be "stable" hemodynamics may actually represent physiological exhaustion.

The moment induction drugs are administered, this compensatory sympathetic drive disappears.

The result? A sudden reduction in:
• Systemic vascular resistance
• Cardiac output
• Coronary perfusion pressure
• Organ blood flow

This phenomenon has been termed adrenergic collapse.

Intubation Is a Hemodynamic Timeline

The authors propose viewing intubation as a sequence of cumulative threats rather than a single procedure:
1️⃣ Pre-induction adrenergic dependence
2️⃣ Sympatholysis after induction
3️⃣ Apnea, hypoxemia, hypercapnia, and acidosis
4️⃣ Transition to positive-pressure ventilation
5️⃣ Post-intubation ventilator and sedation effects

Each phase adds physiological stress.

Together, they can culminate in cardiovascular collapse.

The Propofol Question

One of the most clinically relevant findings is the growing evidence regarding induction agent selection.

In the INTUBE cohort, propofol was associated with a higher risk of cardiovascular collapse and was the only modifiable risk factor consistently identified.

The review therefore suggests:
✅ Ketamine
✅ Etomidate
as preferred induction agents in patients at risk of hemodynamic instability, while propofol should be used cautiously in shock states.

Positive Pressure Ventilation: The Forgotten Hemodynamic Challenge

Once the tube is secured, many clinicians relax.

The physiology is only beginning.

Positive-pressure ventilation:
🔹 Reduces venous return
🔹 Increases intrathoracic pressure
🔹 Raises right ventricular afterload
🔹 May precipitate right ventricular failure

This is particularly relevant in ARDS, pulmonary hypertension, pulmonary embolism, and severe hypoxemic respiratory failure.

Reference 📚

Kotani Y, Koroki T, Hayashi Y, Russotto V. The hemodynamics of tracheal intubation in critically ill patients: a narrative review. Journal of Intensive Care. 2026;14:42. DOI: 10.1186/s40560-026-00877-4.

[sourav dey @FrodoSourav]

@Lovepettyquotes @aravind @Sonalkapa 😅😅😅

[sourav dey @FrodoSourav]

@XUnfiltere69061 @EarthlingsBoomi Not just in medical stream. In sports too!
All because of Govts policy and monopoly of Ambani & Adani’s.

[devashish sharma @astrodev15]

Brutal Astrological Laws Everyone Should Know (Undeniable)

1. Wake Up Before Sunrise (Sun) → The Sun is the King. If you sleep while the King rises, you are not a ruler; you are a subject. Early rising fixes a weak Sun and builds authority.

2. Sweat Every Day (Mars) → Mars governs muscle, blood, and war. A sedentary life kills your Mars. Lift heavy, run fast, or fight. Physical
weakness = weak will.

3. Respect Your Time (Saturn) → Saturn is the Judge of Karma. Wasting time on cheap entertainment invites Saturn's wrath (poverty and delay). Discipline is the only offering he accepts.

4. Control Your Tongue (Mercury) → Mercury is intellect and speech. Gossip, lying, and verbal diarrhea drain your intellectual power. Speak with purpose or stay silent.

5. Respect Women & Hygiene (Venus) → Venus is luxury and semen. You want wealth? Respect the feminine energy and keep yourself groomed. A dirty room and a dirty mind repel prosperity.

6. Master Your Mind (Moon) → The Moon rules emotions. If you react to every little problem, your Moon is debilitated. Meditation isn't optional; it's the anchor for a chaotic mind.

7. Honor Your Teachers & Elders (Jupiter) → Jupiter is wisdom and expansion. Mocking wisdom or disrespecting mentors blocks your luck. Arrogance shrinks your destiny.

8. Stop The Addiction Loop (Rahu) → Rahu is the smoke, the illusion, the scroll. Porn, gambling, and doom-scrolling feed the demon. Starve the distraction to find your direction.

9. Detach to Conquer (Ketu) → Ketu is liberation. If you are desperate for a result, you will never get it. Do the work and let go of the outcome.

10. Action Beats Prediction (Karma) → Your chart is a map, not a sentence. A strong will can override a weak placement. Sitting around waiting for a "good Dasha" is for losers.

11. Charity Without Expectation → Hoarding energy blocks flow. Giving (money, time, strength) clears karmic debt. If you are tight-fisted, the universe will be tight-fisted with you.

Fix your habits. Exalt your planets.

[sourav dey @FrodoSourav]

@TheUncertifiedX @YTKDIndia Every journalists should come foreward and make a national press conference demanding detailed probe against all these corrupt officers/leaders by a competent,independent authority.

[sourav dey @FrodoSourav]

@MoupiaNandy https://t.co/AyFOvj5yAC

এগুলো expose করেন না কেনো? Please করুন 🙏

[#YeThikKarkeDikhao @YTKDIndia]

Meet Trinamool Congress MP Kalyan Banerjee.

He is a four-time Member of Parliament, having won the 2009, 2014, 2019, and 2024 Indian General Elections from the Sreerampur Lok Sabha constituency.

Now, let’s examine the work carried out during his tenure.

A thread🧵

[sourav dey @FrodoSourav]

@SKABDULHAI9 @MoupiaNandy আর একটা উপায়- modern education.
সোচ্চার হতে হবে- যেসব political দল শুধু ভোট ব‍্যাঙ্কের জন্য ব‍্যবহার করে আসছে মুসলিমদের(আশা করি বলে দিতে হবে না- কোন দল?) তাদের against এ। ধর্মান্ধ clerics দের সরিয়ে প্রকৃত শিক্ষিত মুসলিম দের এগিয়ে আসতে হবে।

[sourav dey @FrodoSourav]

@SKABDULHAI9 @MoupiaNandy শিক্ষিত মুসলিমদের রাস্তায় নেমে এর বিরুদ্ধে সোচ্চার হতে হবে । Terrorist microenvironment না থাকলে কেউ ঐ রাস্তায় যাবে বলে মনে হয়না। দুঃখের বিষয়- কোনো মুসলিম কে এই terrorism এ মুসলিম দের involvement নিয়ে সোচ্চার হতে দেখলামনা।সবাই terrorists দের বাঁচাতে ব‍্যাস্ত!!!!!!

[sourav dey @FrodoSourav]

@MoupiaNandy পাকপ্রেমী নয় হয়তো প্রত‍্যক্ষভাবে,কিন্তু আপনি খোঁজ নিয়ে বা সমীক্ষা করে দেখুন-কেউ ভারতের “দাসত্ব” চায়না। এটার মানে কি হতে পারে,সেটা নিজেকেই নাহয় প্রশ্ন করুন ।

[sourav dey @FrodoSourav]

@obhijit4 @IamSumanDe He’s doing exactly the opposite,unfortunately.

[sourav dey @FrodoSourav]

@IamSumanDe আপনি অনুপ্রাণিত হয়ে যান। মানুষের মধ‍্যে ভয় আপনি বেশি ছরাচ্ছেন,তৃণমূলের নির্দেশে।ভাইপোকে ভয় পান?

[sourav dey @FrodoSourav]

@Shirshe50693758 @IamSumanDe এর জন‍্য যদি কেউ দায়ী হয়ে থাকে,সেটা C.M!

[sourav dey @FrodoSourav]

@IamSumanDe Tagline বাঙলা খবর,বাঙলার খবর। কিন্তু অজ্ঞাতকারণবশত সুমনবাবু বাঙলার বাইরের negative খবরগুলি দেখিয়ে অনুপ্রেরণার সরকারের নেতিবাচক দিকগুলি এড়িয়ে যেতে বদ্ধপরিকর ।

[sourav dey @FrodoSourav]

@IamSumanDe অনুপ্রাণিত সুমনবাবু যতই চেষ্টা করুণ আটকানোর,SIR হচ্ছেই।

[sourav dey @FrodoSourav]

@IamSumanDe পশ্চিমবঙ্গের ভবিষ্যৎ ভাবলে ভয় হয়।আর ৫ বছরে আর কেউ থাকবে না এখানে।

[sourav dey @FrodoSourav]

@IamSumanDe

[sourav dey @FrodoSourav]

@DrPramodPSawant That minister should apologise publicly.

[sourav dey @FrodoSourav]

@KKRiders Get rid of useless players like V.Iyer from next match and bring the likes of Russel and Rinku early in the order please.

[sourav dey @FrodoSourav]

@PeaceforGaza1 @TrumpUpdateHQ Gazans and porkis are just sides of a coin.Both are same!

[sourav dey @FrodoSourav]

@KunalGhoshAgain @MamataOfficial