Delirium: Acute Brain Failure and How to Reason Through It

 Delirium is not “confusion”. It is acute failure of the brain’s ability to maintain homeostasis, usually triggered by illness elsewhere in the body. When attention collapses, the cortex is signalling that its metabolic, inflammatory, or neurotransmitter environment has become unsafe.

Unlike dementia, which reflects slow structural decline, delirium develops over hours to days, fluctuates, and is usually reversible when the underlying insult is corrected.

Delirium is common, dangerous, and frequently missed — especially the quiet forms.

ECG Interpretation: A Reasoning-Based Guide 🫀

 An ECG is a simple, non-invasive test that records the electrical activity of the heart over a period of time. By placing electrodes on the skin, we can detect the tiny electrical changes that occur with each heartbeat. ⚡

Interpreting an ECG isn’t just about spotting abnormalities — it’s about understanding the heart’s electrical story in the context of the patient. This guide breaks down the process step by step. 

Dementia: When Cognitive Networks Begin to Fail

 Mrs K is a 72-year-old retired teacher who presents to her GP after becoming lost while driving home from the supermarket she has visited weekly for 20 years.

Her daughter reports that:

• she repeats questions within the same conversation
• she has stopped attending social activities
• she struggles to organise meals she previously prepared routinely

Her neurological examination is normal.

Her blood tests are normal.

Her CT scan is reported as “age-appropriate”.

So what is actually going wrong?

🫀 Ischaemic Heart Disease: From Endothelium to Infarction

Ischaemic heart disease (IHD), also referred to as coronary artery disease (CAD), describes a state in which myocardial oxygen supply is insufficient to meet myocardial metabolic demand.

At face value, that is a simple supply–demand mismatch. In reality, it reflects a complex, progressive, inflammatory disease of the coronary arteries that evolves over decades before becoming clinically apparent.

The heart extracts a very high proportion of oxygen from coronary blood at rest. Unlike skeletal muscle, it cannot simply extract much more when demand rises. When the myocardium needs more oxygen — during exercise, stress, tachycardia — the only way to meet that demand is to increase coronary blood flow.

Anything that limits the ability of coronary arteries to increase flow becomes clinically important.

To understand IHD properly, we need to follow the biology.

 

Electrophysiology of the Heart ✨🧠

The heart isn’t just a pump — it’s a beautifully coordinated electrical organ. 
Every beat begins with ions moving across membranes in a precisely coordinated sequence.

If you understand the ions, you understand the ECG.
If you understand the ECG, you understand arrhythmias.

Let’s build it from the ground up.

Understanding the Cardiovascular System: Structure, Function, and Clinical Relevance 🫀

As medical students, mastering the cardiovascular system is essential—not just for exams, but for your future clinical practice. Let’s break down the heart’s anatomy, physiology, and key concepts in a structured, detailed way to help you build a strong foundation. Ready to dive in? 

Principles of Managing Dehydration 💧

Dehydration is a common but potentially serious clinical condition that reflects a failure of the body to maintain fluid and electrolyte balance — a core example of disrupted homeostasis.

Even small fluid deficits can impair circulation, organ perfusion, and cellular function, particularly in infants, older adults, and unwell patients.

Dehydration: More Than Just Feeling Thirsty 💧

Water is essential for life, and maintaining fluid balance is a core component of homeostasis. The body works continuously to keep its internal environment stable, but illness, exertion, heat exposure, or inadequate intake can quickly disrupt this balance.

Dehydration exists on a spectrum — from mild physiological stress to life-threatening hypovolaemic shock — with progressively worsening signs and symptoms as circulating volume falls.

🩺 Anatomical terminology: the shared language of medicine🔬

No matter where you are up to in your training, anatomical terminology is the foundation of precise communication in medicine.

Instead of saying “towards the head” or “away from the body”, clinicians use standardised terms that mean the same thing to everyone — in any hospital, clinic, or country.

This shared language eliminates ambiguity and reduces the risk of miscommunication.

Understanding Vital Signs: A Clinical Perspective

 Vital signs provide immediate, objective insights into a patient’s physiological status and are often the earliest indicators of deterioration or underlying pathology. As healthcare professionals, accurate measurement and interpretation of these parameters is essential for guiding assessment and clinical decision-making.