The document outlines a curriculum for managing various acute medical conditions commonly seen in a low resource setting, including stroke, unconsciousness, seizures, paraplegia, meningitis, head injury, myocardial infarction, chest pain, shortness of breath, hypertension, abdominal issues, diarrhea, renal problems, shock, poisoning, snake bites, fractures, trauma, electrolyte imbalances, and psychiatric conditions. Guidelines are provided for determining when referral is needed for conditions that cannot be adequately managed in a low resource setting.
1. Neonatal surgical emergencies are common in developing countries due to factors like high birth rate, consanguinity, and infections during pregnancy.
2. Anesthetizing neonates requires special considerations due to their underdeveloped organ systems and immature physiology. Their cardiovascular, respiratory, renal and thermoregulatory systems are particularly vulnerable.
3. Close monitoring of vital signs, oxygenation, hydration and glucose levels is essential during anesthesia and in the post-operative period when apnea and cardiac arrest risks are high. Maintaining normal temperature is also critical for neonates.
This document discusses neonatal surgical emergencies and anesthetic management considerations. It covers the physiological differences of the neonatal system including the cardiovascular, respiratory, renal and thermal regulation systems. It emphasizes the importance of maintaining normothermia, oxygenation, hydration and glucose levels. The document provides guidance on optimization, monitoring, induction, intubation, maintenance and recovery for neonatal anesthesia. Special attention is needed in the postoperative period to prevent complications like apnea, laryngospasm and cardiac arrest.
1. Neonatal surgical emergencies are common in developing countries due to factors like high birth rate, consanguinity, and infections during pregnancy.
2. Anesthetizing neonates requires special considerations due to their underdeveloped organ systems and immature physiology. Their cardiovascular, respiratory, renal and thermoregulatory systems are particularly vulnerable.
3. Close monitoring of vital signs, oxygenation, hydration and glucose levels is essential during anesthesia and in the post-operative period when apnea and cardiac arrest risks are high. Maintaining normal temperature is also critical for neonates.
1. Neonatal surgical emergencies are common in developing countries due to factors like high birth rate, consanguinity, and infections during pregnancy.
2. Anesthetizing neonates requires special considerations due to their underdeveloped organ systems and immature physiology. Their cardiovascular, respiratory, renal and thermoregulatory systems are particularly vulnerable.
3. Close monitoring of vital signs, oxygenation, hydration and glucose levels is essential during anesthesia and in the post-operative period when apnea and cardiac arrest risks are high. Maintaining normal temperature is also critical for neonates.
This document summarizes the diagnosis and management of common cardiac emergencies in children. It presents several case studies and uses them to discuss key considerations like differentiating various causes of cyanosis, shock, or arrhythmias in infants and children. For each case, it analyzes presenting signs and test results to identify the underlying condition. It then outlines the initial emergency management principles, focusing on stabilization, organ support, and addressing specific issues like restoring blood flow or minimizing pulmonary pressures. The document emphasizes the importance of early diagnosis and intervention for high mortality cardiac conditions in children.
MANAGEMENT OF CARDIOGENIC SHOCK IN CHILDREN.pptxMANAS MAHAPATRA
- Cardiogenic shock is a state of acute circulatory failure caused by low cardiac output and signs of end organ hypoperfusion. It requires early detection and cautious fluid resuscitation in children.
- Management involves increasing oxygen delivery and decreasing demand by optimizing preload and afterload, providing inotropic support, and treating the underlying cause of myocardial dysfunction.
- For refractory cases, short term mechanical circulatory support like IABP or ECMO may be used to bridge patients to cardiac transplantation if the condition is not expected to recover.
1. The document outlines the key initial management steps for several acute medical emergencies including rapid assessment, timely management, asking for help, liaising with consultants, and avoiding harm.
2. For each condition, it provides guidance on important investigations, treatments, and management decisions. The conditions covered include acute coronary syndrome, acute heart failure, acute kidney injury, severe asthma, diabetic ketoacidosis, sepsis, headache, gastrointestinal bleed, stroke, and pulmonary embolism.
3. The overall objective is to provide concise guidance to support rapid evaluation and treatment of acute medical emergencies to optimize patient outcomes.
1. Neonatal surgical emergencies are common in developing countries due to factors like high birth rate, consanguinity, and infections during pregnancy.
2. Anesthetizing neonates requires special considerations due to their underdeveloped organ systems and immature physiology. Their cardiovascular, respiratory, renal and thermoregulatory systems are particularly vulnerable.
3. Close monitoring of vital signs, oxygenation, hydration and glucose levels is essential during anesthesia and in the post-operative period when apnea and cardiac arrest risks are high. Maintaining normal temperature is also critical for neonates.
This document discusses neonatal surgical emergencies and anesthetic management considerations. It covers the physiological differences of the neonatal system including the cardiovascular, respiratory, renal and thermal regulation systems. It emphasizes the importance of maintaining normothermia, oxygenation, hydration and glucose levels. The document provides guidance on optimization, monitoring, induction, intubation, maintenance and recovery for neonatal anesthesia. Special attention is needed in the postoperative period to prevent complications like apnea, laryngospasm and cardiac arrest.
1. Neonatal surgical emergencies are common in developing countries due to factors like high birth rate, consanguinity, and infections during pregnancy.
2. Anesthetizing neonates requires special considerations due to their underdeveloped organ systems and immature physiology. Their cardiovascular, respiratory, renal and thermoregulatory systems are particularly vulnerable.
3. Close monitoring of vital signs, oxygenation, hydration and glucose levels is essential during anesthesia and in the post-operative period when apnea and cardiac arrest risks are high. Maintaining normal temperature is also critical for neonates.
1. Neonatal surgical emergencies are common in developing countries due to factors like high birth rate, consanguinity, and infections during pregnancy.
2. Anesthetizing neonates requires special considerations due to their underdeveloped organ systems and immature physiology. Their cardiovascular, respiratory, renal and thermoregulatory systems are particularly vulnerable.
3. Close monitoring of vital signs, oxygenation, hydration and glucose levels is essential during anesthesia and in the post-operative period when apnea and cardiac arrest risks are high. Maintaining normal temperature is also critical for neonates.
This document summarizes the diagnosis and management of common cardiac emergencies in children. It presents several case studies and uses them to discuss key considerations like differentiating various causes of cyanosis, shock, or arrhythmias in infants and children. For each case, it analyzes presenting signs and test results to identify the underlying condition. It then outlines the initial emergency management principles, focusing on stabilization, organ support, and addressing specific issues like restoring blood flow or minimizing pulmonary pressures. The document emphasizes the importance of early diagnosis and intervention for high mortality cardiac conditions in children.
MANAGEMENT OF CARDIOGENIC SHOCK IN CHILDREN.pptxMANAS MAHAPATRA
- Cardiogenic shock is a state of acute circulatory failure caused by low cardiac output and signs of end organ hypoperfusion. It requires early detection and cautious fluid resuscitation in children.
- Management involves increasing oxygen delivery and decreasing demand by optimizing preload and afterload, providing inotropic support, and treating the underlying cause of myocardial dysfunction.
- For refractory cases, short term mechanical circulatory support like IABP or ECMO may be used to bridge patients to cardiac transplantation if the condition is not expected to recover.
1. The document outlines the key initial management steps for several acute medical emergencies including rapid assessment, timely management, asking for help, liaising with consultants, and avoiding harm.
2. For each condition, it provides guidance on important investigations, treatments, and management decisions. The conditions covered include acute coronary syndrome, acute heart failure, acute kidney injury, severe asthma, diabetic ketoacidosis, sepsis, headache, gastrointestinal bleed, stroke, and pulmonary embolism.
3. The overall objective is to provide concise guidance to support rapid evaluation and treatment of acute medical emergencies to optimize patient outcomes.
Intra cranial pressure and Anaesthesia by Prof. mridul M. PanditraoProf. Mridul Panditrao
This document discusses the management of increased intracranial pressure and its implications for anesthesia. It covers the physiology of intracranial pressure regulation, factors that can increase pressure, methods for monitoring pressure, complications of monitoring, and medical and surgical interventions to reduce pressure. It also addresses how anesthesia agents can impact intracranial pressure and the importance of preoperative optimization of patients at high risk for postoperative complications from increased intracranial pressure.
This patient presented with back pain, bilateral lower limb weakness and numbness, and bowel and bladder dysfunction. MRI revealed extensive spinal metastases resulting in malignant spinal cord compression. Emergent management was required to prevent permanent neurological injury, including high-dose steroids and consideration of radiotherapy or surgery. This case highlights the importance of promptly recognizing and treating malignant spinal cord compression.
This document discusses various types of shock and their management. It begins by defining shock as inadequate oxygen delivery to meet metabolic demands, resulting in global tissue hypoperfusion and metabolic acidosis. It then discusses the pathophysiology of different shock states including understanding the body's compensatory mechanisms in shock. It provides guidance on approaching and assessing patients in shock, as well as the goals and methods for treating different shock states, including fluid resuscitation and vasopressor use. Specific types of shock covered include hypovolemic, septic, cardiogenic, anaphylactic, neurogenic, and obstructive shock.
Sepsis is a life-threatening condition that occurs when a localized infection spreads through the bloodstream, producing an uncontrolled immune response. It is a major public health problem associated with high mortality. Early recognition, screening, and time-critical treatment are important to combat sepsis but are often lacking. The document outlines interventions for septic patients including administering oxygen, collecting blood cultures, giving IV antibiotics and fluids, monitoring lactate levels and urine output. It discusses approaches to respiratory support, fluid resuscitation, vasopressors and inotropes, appropriate antibiotic selection, source control and supportive care.
Anesthesia Pocket Guide 2020 for quick reviewDr Musadiq
This document provides guidance on managing high or total spinal anesthesia and hypotension during spinal anesthesia. Key recommendations include:
1) Call for help, start CPR and refer to ACLS protocols if cardiac arrest occurs. Support ventilation and consider intubation if necessary.
2) For significant bradycardia or hypotension, give 10mcg boluses of epinephrine and increase as needed, consider ACLS protocols and pacing pads.
3) Give IV fluid bolus and place parturient in left lateral position with legs elevated if applicable. Alert OB team and prepare for possible cesarean section.
This 2-year old child presented with signs of hypovolemic shock including a heart rate of 140 bpm, respiratory rate of 50/min, blood pressure of 60/40 mmHg, capillary refill time of 4 seconds, and oxygen saturation of 94% in room air. The child is experiencing hypovolemic shock likely due to acute gastroenteritis leading to vomiting and diarrhea causing significant fluid loss. Management should include rapid intravenous fluid resuscitation with isotonic crystalloids such as normal saline, monitoring of vitals, laboratory tests to identify cause and guide management, and treating any metabolic derangements present.
This document discusses 5 cases of acute renal failure (ARF).
Case 1 involved a diabetic man who developed ARF likely due to dehydration and receipt of a nephrotoxic antibiotic. Case 2 involved ARF from ACE inhibitor use in a patient with renal artery stenosis. Case 3 involved hyperkalemic ARF from NSAID and diuretic use in a patient with sepsis. Case 4 described rapidly progressive glomerulonephritis. Case 5 involved post-renal ARF from bilateral ureteric stones causing obstruction.
The document discusses approaches to evaluating and diagnosing different types of ARF - pre-renal, intrarenal, and post-renal. It provides
The patient is in uncompensated/hypotensive shock based on increased heart rate, cool extremities with prolonged capillary refill, and hypotension. The shock is likely hypovolemic due to fluid loss from the gunshot wounds and surgery. The initial management should be rapid fluid resuscitation with isotonic fluids to restore circulating volume and tissue perfusion.
This document describes the case of an 8-year-old girl brought to the emergency department with vomiting, breathlessness, fever, and altered mental status due to diabetic ketoacidosis (DKA). Her history of type 1 diabetes and discontinuing insulin therapy for 2 days contributed to the development of DKA. On examination, she had a low blood pressure, tachycardia, and altered mental status. Laboratory findings showed high blood glucose, low bicarbonate, and ketones in the urine, consistent with DKA. She was treated according to the Milwaukee protocol for DKA, which involves slow correction of dehydration with intravenous fluids, administration of insulin, and monitoring of electrolytes and mental status. Her
1. The document discusses the medical management of congenital heart disease, focusing on congestive heart failure, cyanotic spells, duct dependent lesions, and PDA in preterm infants.
2. Key treatments for congestive heart failure include diuretics, ACE inhibitors, ionotropes like digoxin, and newer drugs like carvedilol. For cyanotic spells, oxygen, morphine, bicarbonate, ketamine, and propranolol are used.
3. Duct dependent lesions require prostaglandin E1 infusion to maintain ductal patency. Complications of cyanosis like anemia, polycythemia, and hyperuricemia are also addressed
Hypothermia therapy is a treatment for hypoxic-ischemic encephalopathy (HIE) in newborns. It involves cooling the baby's body to 33.5°C for 72 hours using a cooling mattress. This slows the metabolic rate and allows the brain cells time to recover from damage. For hypothermia to be initiated, the baby must meet criteria for moderate to severe encephalopathy assessed using the Sarnat scale, along with indicators of perinatal asphyxia. Adjuvant treatments including fluid management, nutrition, and monitoring of vital signs are also important during hypothermia therapy and the rewarming period. The goal is to prevent neurological impairments in infants
This document describes the case of a 3-year-old boy who presented with recurrent loss of consciousness following trivial illness. Initial workup revealed hypoglycemia and hyperammonemia. Further testing found elevated 2-oxoglutaric acid and a high C0/C16-18 ratio suggestive of carnitine palmitoyltransferase I (CPT-I) deficiency. The patient was diagnosed with a fatty acid oxidation disorder and treated accordingly.
This document describes the case of a 10-day-old infant presenting with signs of shock including tachycardia, poor perfusion, and decreased urine output. Examinations revealed hepatomegaly and other signs suggestive of shock. Investigations showed metabolic acidosis and low blood sugar. The infant did not respond to initial fluid resuscitation and inotropic support. Echocardiogram revealed hypoplastic left heart syndrome. Prostaglandin E1 was started and the infant responded, confirming duct-dependent systemic circulation. The case highlights the importance of early recognition and management of neonatal shock.
Approach to hypertensive emergencies in childrenAshwiniBelur2
This document discusses hypertensive emergencies in children, including definitions, etiology, management, and the updated AAP guidelines. It defines hypertensive urgency as elevated blood pressure without end organ damage, while hypertensive emergency involves acute elevation with end organ damage. Common causes in children include kidney disease, endocrine disorders, and drugs. Management involves stabilizing vital signs, confirming hypertension and end organ damage, evaluating for the underlying cause, and lowering blood pressure gradually using drugs like labetalol, sodium nitroprusside, and nicardipine. The updated AAP guidelines revised blood pressure classifications, recommended ambulatory blood pressure monitoring, and suggested screening investigations based on risk factors.
A 42-year-old female farmer presented with chest pain, breathlessness, hoarseness of voice, and double vision over the past 1 month. Imaging revealed a large cystic lesion in the left thymus. The thymus was surgically excised and found to have a multilocular thymic cyst with thymic hyperplasia. Laboratory tests confirmed myasthenia gravis. The patient was started on treatment for myasthenia gravis and the thymic cyst.
Here are the key findings on physical examination that may indicate endocarditis:
- Scars from previous episodes of endocarditis or cardiac surgery
- Deformities of heart valves from previous endocarditis
- Central cyanosis if large left-to-right shunt is present
- Malar flush (transient flush of cheeks)
- Nailfold infarctions or splinter hemorrhages of the hands
- Clubbing of the fingernails or toes
- Slowed capillary refill time of the fingernails or toes
- Osler's nodes (tender raised lesions on fingers or toes)
- Janeway lesions (non-tender hemorrhagic lesions on palms or soles
This document summarizes a seminar on childhood hypertension. It discusses the objectives of the seminar which include classification of hypertension, prevalence in children, common causes, screening candidates, measurement methods, approach to hypertensive children, and management. It then covers physiology and regulation of blood pressure, classification of hypertension in children, common etiologies like renal and endocrine diseases, conditions associated with transient hypertension, screening recommendations, measurement methods, clinical manifestations, hypertensive emergencies, and approach to evaluating a hypertensive child.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Assessment and Planning in Educational technology.pptxKavitha Krishnan
In an education system, it is understood that assessment is only for the students, but on the other hand, the Assessment of teachers is also an important aspect of the education system that ensures teachers are providing high-quality instruction to students. The assessment process can be used to provide feedback and support for professional development, to inform decisions about teacher retention or promotion, or to evaluate teacher effectiveness for accountability purposes.
Intra cranial pressure and Anaesthesia by Prof. mridul M. PanditraoProf. Mridul Panditrao
This document discusses the management of increased intracranial pressure and its implications for anesthesia. It covers the physiology of intracranial pressure regulation, factors that can increase pressure, methods for monitoring pressure, complications of monitoring, and medical and surgical interventions to reduce pressure. It also addresses how anesthesia agents can impact intracranial pressure and the importance of preoperative optimization of patients at high risk for postoperative complications from increased intracranial pressure.
This patient presented with back pain, bilateral lower limb weakness and numbness, and bowel and bladder dysfunction. MRI revealed extensive spinal metastases resulting in malignant spinal cord compression. Emergent management was required to prevent permanent neurological injury, including high-dose steroids and consideration of radiotherapy or surgery. This case highlights the importance of promptly recognizing and treating malignant spinal cord compression.
This document discusses various types of shock and their management. It begins by defining shock as inadequate oxygen delivery to meet metabolic demands, resulting in global tissue hypoperfusion and metabolic acidosis. It then discusses the pathophysiology of different shock states including understanding the body's compensatory mechanisms in shock. It provides guidance on approaching and assessing patients in shock, as well as the goals and methods for treating different shock states, including fluid resuscitation and vasopressor use. Specific types of shock covered include hypovolemic, septic, cardiogenic, anaphylactic, neurogenic, and obstructive shock.
Sepsis is a life-threatening condition that occurs when a localized infection spreads through the bloodstream, producing an uncontrolled immune response. It is a major public health problem associated with high mortality. Early recognition, screening, and time-critical treatment are important to combat sepsis but are often lacking. The document outlines interventions for septic patients including administering oxygen, collecting blood cultures, giving IV antibiotics and fluids, monitoring lactate levels and urine output. It discusses approaches to respiratory support, fluid resuscitation, vasopressors and inotropes, appropriate antibiotic selection, source control and supportive care.
Anesthesia Pocket Guide 2020 for quick reviewDr Musadiq
This document provides guidance on managing high or total spinal anesthesia and hypotension during spinal anesthesia. Key recommendations include:
1) Call for help, start CPR and refer to ACLS protocols if cardiac arrest occurs. Support ventilation and consider intubation if necessary.
2) For significant bradycardia or hypotension, give 10mcg boluses of epinephrine and increase as needed, consider ACLS protocols and pacing pads.
3) Give IV fluid bolus and place parturient in left lateral position with legs elevated if applicable. Alert OB team and prepare for possible cesarean section.
This 2-year old child presented with signs of hypovolemic shock including a heart rate of 140 bpm, respiratory rate of 50/min, blood pressure of 60/40 mmHg, capillary refill time of 4 seconds, and oxygen saturation of 94% in room air. The child is experiencing hypovolemic shock likely due to acute gastroenteritis leading to vomiting and diarrhea causing significant fluid loss. Management should include rapid intravenous fluid resuscitation with isotonic crystalloids such as normal saline, monitoring of vitals, laboratory tests to identify cause and guide management, and treating any metabolic derangements present.
This document discusses 5 cases of acute renal failure (ARF).
Case 1 involved a diabetic man who developed ARF likely due to dehydration and receipt of a nephrotoxic antibiotic. Case 2 involved ARF from ACE inhibitor use in a patient with renal artery stenosis. Case 3 involved hyperkalemic ARF from NSAID and diuretic use in a patient with sepsis. Case 4 described rapidly progressive glomerulonephritis. Case 5 involved post-renal ARF from bilateral ureteric stones causing obstruction.
The document discusses approaches to evaluating and diagnosing different types of ARF - pre-renal, intrarenal, and post-renal. It provides
The patient is in uncompensated/hypotensive shock based on increased heart rate, cool extremities with prolonged capillary refill, and hypotension. The shock is likely hypovolemic due to fluid loss from the gunshot wounds and surgery. The initial management should be rapid fluid resuscitation with isotonic fluids to restore circulating volume and tissue perfusion.
This document describes the case of an 8-year-old girl brought to the emergency department with vomiting, breathlessness, fever, and altered mental status due to diabetic ketoacidosis (DKA). Her history of type 1 diabetes and discontinuing insulin therapy for 2 days contributed to the development of DKA. On examination, she had a low blood pressure, tachycardia, and altered mental status. Laboratory findings showed high blood glucose, low bicarbonate, and ketones in the urine, consistent with DKA. She was treated according to the Milwaukee protocol for DKA, which involves slow correction of dehydration with intravenous fluids, administration of insulin, and monitoring of electrolytes and mental status. Her
1. The document discusses the medical management of congenital heart disease, focusing on congestive heart failure, cyanotic spells, duct dependent lesions, and PDA in preterm infants.
2. Key treatments for congestive heart failure include diuretics, ACE inhibitors, ionotropes like digoxin, and newer drugs like carvedilol. For cyanotic spells, oxygen, morphine, bicarbonate, ketamine, and propranolol are used.
3. Duct dependent lesions require prostaglandin E1 infusion to maintain ductal patency. Complications of cyanosis like anemia, polycythemia, and hyperuricemia are also addressed
Hypothermia therapy is a treatment for hypoxic-ischemic encephalopathy (HIE) in newborns. It involves cooling the baby's body to 33.5°C for 72 hours using a cooling mattress. This slows the metabolic rate and allows the brain cells time to recover from damage. For hypothermia to be initiated, the baby must meet criteria for moderate to severe encephalopathy assessed using the Sarnat scale, along with indicators of perinatal asphyxia. Adjuvant treatments including fluid management, nutrition, and monitoring of vital signs are also important during hypothermia therapy and the rewarming period. The goal is to prevent neurological impairments in infants
This document describes the case of a 3-year-old boy who presented with recurrent loss of consciousness following trivial illness. Initial workup revealed hypoglycemia and hyperammonemia. Further testing found elevated 2-oxoglutaric acid and a high C0/C16-18 ratio suggestive of carnitine palmitoyltransferase I (CPT-I) deficiency. The patient was diagnosed with a fatty acid oxidation disorder and treated accordingly.
This document describes the case of a 10-day-old infant presenting with signs of shock including tachycardia, poor perfusion, and decreased urine output. Examinations revealed hepatomegaly and other signs suggestive of shock. Investigations showed metabolic acidosis and low blood sugar. The infant did not respond to initial fluid resuscitation and inotropic support. Echocardiogram revealed hypoplastic left heart syndrome. Prostaglandin E1 was started and the infant responded, confirming duct-dependent systemic circulation. The case highlights the importance of early recognition and management of neonatal shock.
Approach to hypertensive emergencies in childrenAshwiniBelur2
This document discusses hypertensive emergencies in children, including definitions, etiology, management, and the updated AAP guidelines. It defines hypertensive urgency as elevated blood pressure without end organ damage, while hypertensive emergency involves acute elevation with end organ damage. Common causes in children include kidney disease, endocrine disorders, and drugs. Management involves stabilizing vital signs, confirming hypertension and end organ damage, evaluating for the underlying cause, and lowering blood pressure gradually using drugs like labetalol, sodium nitroprusside, and nicardipine. The updated AAP guidelines revised blood pressure classifications, recommended ambulatory blood pressure monitoring, and suggested screening investigations based on risk factors.
A 42-year-old female farmer presented with chest pain, breathlessness, hoarseness of voice, and double vision over the past 1 month. Imaging revealed a large cystic lesion in the left thymus. The thymus was surgically excised and found to have a multilocular thymic cyst with thymic hyperplasia. Laboratory tests confirmed myasthenia gravis. The patient was started on treatment for myasthenia gravis and the thymic cyst.
Here are the key findings on physical examination that may indicate endocarditis:
- Scars from previous episodes of endocarditis or cardiac surgery
- Deformities of heart valves from previous endocarditis
- Central cyanosis if large left-to-right shunt is present
- Malar flush (transient flush of cheeks)
- Nailfold infarctions or splinter hemorrhages of the hands
- Clubbing of the fingernails or toes
- Slowed capillary refill time of the fingernails or toes
- Osler's nodes (tender raised lesions on fingers or toes)
- Janeway lesions (non-tender hemorrhagic lesions on palms or soles
This document summarizes a seminar on childhood hypertension. It discusses the objectives of the seminar which include classification of hypertension, prevalence in children, common causes, screening candidates, measurement methods, approach to hypertensive children, and management. It then covers physiology and regulation of blood pressure, classification of hypertension in children, common etiologies like renal and endocrine diseases, conditions associated with transient hypertension, screening recommendations, measurement methods, clinical manifestations, hypertensive emergencies, and approach to evaluating a hypertensive child.
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How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Assessment and Planning in Educational technology.pptxKavitha Krishnan
In an education system, it is understood that assessment is only for the students, but on the other hand, the Assessment of teachers is also an important aspect of the education system that ensures teachers are providing high-quality instruction to students. The assessment process can be used to provide feedback and support for professional development, to inform decisions about teacher retention or promotion, or to evaluate teacher effectiveness for accountability purposes.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
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আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
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Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
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it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Physiology and chemistry of skin and pigmentation, hairs, scalp, lips and nail, Cleansing cream, Lotions, Face powders, Face packs, Lipsticks, Bath products, soaps and baby product,
Preparation and standardization of the following : Tonic, Bleaches, Dentifrices and Mouth washes & Tooth Pastes, Cosmetics for Nails.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
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1. Curriculum
1. Stroke Mx in Low Resource Setting
2. Acute Unconsciousness Mx in Low
Resource Setting
3. Status Epilepticus Mx in Low
Resource Setting
4. Acute Paraparesis Mx in Low
Resource Setting
5. Acute Meningo-Encephalitis Mx in
Low Resource Setting
6. Head Injury Mx in Low Resource
Setting
7. MI & UA Mx in Low Resource
Setting
8. Acute Severe Chest Pain Mx in
Low Resource Setting
9. Acute SOB Mx in Low Resource
Setting
10. Hypertensive Emergency Mx in
Low Resource Setting
11. Acute Abdomen Mx in Low
Resource Setting
12. Acute GI Bleeding Mx in Low
Resource Setting
13. Acute Diarrhoea, Vomiting Mx in
Low Resource Setting
14. Acute Anuria/Urinary Retention
Mx in Low Resource Setting
15. Shock Mx in Low Resource Setting
16. Acute Poisoning Mx in Low
Resource Setting
17. Snake bite Mx in Low Resource
Setting
18. Fracture Mx in Low Resource
Setting
19. RTA Mx in Low Resource Setting
20. Na & K Mx in Low Resource Setting
21. Acute Hyper & Hypoglycaemia Mx
in Low Resource Setting
22. Acute Psychosis Mx in Low
Resource Setting
23. Antibiotic Choice in Low Resource
Setting
24. Handling Arrogant Attendant
25. Handling VIP & Politically Powerful
Pt./Attendant
2.
3. mRS Score: CMS Customization
ক োন ধরণের করো করোগী উপণেলোয় ম্যোণনে
রণেন?
• 0 – No Symptoms
• 1 – Can do all ADL
• 2 – Can’t do all ADL
• 3 – Can’t do selfcare
• 4 – Can’t walk
• 5 – Bed bound
• 6 – Dead
• NB: ADL = Activities of Daily Life
• MRS 0 – 3 can be managed @ Low Resource Setting after CT Scan & Cause Evaluation
4.
5. High vs Low Risk NSTE ACS (TIMI Score)
ক োন ধরণের MI করোগী উপণেলোয় ম্যোণনে
রণেন?
Mnemonic: ABC (Score 1 for each point)
• A = Age > 65
• A = Aspirin (Receiving Aspirin – Criteria of Aspirin fulfilled previously)
• A = Angina – two episode in last 24 hr
• B = Biomarker – Raised Trop I (NSTEMI, not UA)
• C = CAD (Known case of CAD)
• C = CAD Risk (3 out of 5 – HTN, DM, Dyslipidaemia, Smoking F/H of CAD)
• E = ECG Changes
• High Risk: 4 or above, should get LMWH, Score < 4 can be managed in Low Resource
Setting as no injectable drugs needed
• Condition: Repeat ECG in every 3-6 hr should be non deteriorating.
6. Acute SOB: Metabolic or Non Metabolic
CMS Differentiation
Metabolic Breathing
• Rate – Low
• Depth – High
• SpO2 – Normal
• Chest – Normal
• Check dehydration, RBS (DKA),
Vision (MP), BP (CKD, DKA), Lactate
• Prepare for HD
Non Metabolic Breathing
• Rate – High
• Depth – Low
• SpO2 – Low
• Chest – Normal/Abnormal
• Auscultate Chest, if normal Check
GCS, Deep Tendon Reflex, Plantar
Reflexes
10/8/2022 6
7. Acute SOB: Metabolic or Non Metabolic
ক োন ধরণের SOB করোগী উপণেলোয় ম্যোণনে
রণেন?
• SOB due to cardio-respiratory cause – Hemodynamic should be
stable, O2 req. < 10 L/min
• SOB due to Neurological Cause (Medulla, Cervical Cord, Phrenic
Nerve, Diaphragm) – All pt. must be referred
• SOB due to metabolic cause – Pt. not needing Haemodialysis (HCO3 >
17
8. Convulsion Mx in Low Resource Setting
নভোলশন করোগী উপণেলোয় ীভোণে ম্যোণনে
রণেন?
• Step 1: PR Diazepam (Easium Suppository), wait 10 min
• Step 2: Repeat PR Diazepam (Easium Suppository), wait 20 min
• Step 3: 9 Phenytoin/6 Phos-phenytoin/6 Barbiturate tablets in NG/PO stat.
Wait 60 min
• Step 4: Midazolam 5 mg IV stat, repeat 2 more doses (5 mg in each dose)
• Step 5: Refer to HIGHER Center with PRIMARY Mx of Underlying Cause
9. Unconsciousness without & with shock
Without Shock
• Brain – Vascular, Infection, Trauma
• Lungs – Type I or II Failure
• Liver – Hepatic Encephalopathy
• Kidney – Uremic Encephalopathy
• Thyroid, Heat Stroke
• Parathyroid
• Environmental
With Shock
• Heart – Cardiac Arrest, Cardiogenic
Shock – Modified MONAS Therapy
2
• Pituitary Apoplexy
• Thyroid – Myxoedema Coma
• Adrenal Crisis
• Blood – Endotoxin (Sepsis)
• Blood – Na Vomiting/Diarrhoea
11. When to Refer Acute Myelopathy/ATM Pt. from LRS
কখন উপজেলা থেজক থেফাে কেজেন? CMS
Guideline
• Every pt. of Acute Myelopathy need to refer (Except those with normal X ray &
Normal MRI, but MRI is not available at LRS) from Low Resource Setting.
Besides
• Spinal Instability in X ray.
• Suspected Malignancy, Pott’s, Metastasis
• Mx before referral: 3 – 5 g IV Methylprednisolone, 1 g/day for 3 – 5 days.
12. Counselling before referral
Evaluation process is very expensive.
Needs at least 20,000/- tk investigations
• MRI of Dorsal spine with contrast with whole spine screening
• Compressive: TTT – TB, Tumour (Primary – BM, Metastasis), Trauma –
Blunt Trauma/Pathological Fracture – BMD, Vit D)
• Non compressive – MS/ADEM-CSF for OCB, IgG Index, Aquaporin 4,
Anti MAG Ab
13. When to Refer GBS Pt. from LRS
কখন উপজেলা থেজক থেফাে কেজেন? CMS
Guideline
1. RR > 24
2. SpO2 < 94%
3. Counting < 15 digit
4. Breath Holding < 10 sec
5. Unable to Blow from 6” distance
6. Absence of Upper Limb Jerks (Biceps, Triceps, Supinator)
NB: Biceps & Supinator Root C6, Triceps C7, Phrenic nerve root value C 3, 4. So
absence of UL jerks indicates the disease is ascending.
14. When to Refer Meningo-Encephalitis Pt. from LRS
কখন উপজেলা থেজক থেফাে কেজেন? CMS
Guideline
• Non responsive/static to Rx (After 120 hr of Antibiotic, Anti-viral, CS, phenytoin)
• Newly appearance/deterioration of focal signs
• Gradual deterioration of GCS/LOC (> 2 from baseline)
• Newly appearance/deterioration of Raised ICP: Systolic HTN, Brady, Papilloedema
Purpose of Referral
• CSF Study
• Neuro-imaging
• Exclusion of Chr. Meningitis – TBM
15. When to Refer Brain Abscess Pt. from LRS
কখন উপজেলা থেজক থেফাে কেজেন? CMS
Guideline
• Non responsive/static to Rx – 2 weeks
• Gradual deterioration of GCS/LOC
• Newly appearance/deterioration of focal signs
• Newly appearance/deterioration of Raised ICP: Full blown Raised ICP: Systolic
HTN, Brady, Papilloedema
Purpose of Referral
• Neuro-imaging
• Surgical Intervention
16. When to Refer Head Injury Pt. from LRS
কখন উপজেলা থেজক থেফাে কেজেন? CMS
Guideline
• Convulsion
• Vomiting
• Blurring of vision
• Focal Deficit
Examination
• Focal Sign – e.g. plantar extensor
• Systolic HTN, Pulse < 60, Papilloedema
• Mx during referral – 1st Dose Mannitol
17. Acute Diarrhoea Mx Approach in Low Resource
কখন উপজেলা থেজক থেফাে কেজেন? CMS
Guideline
• Assess Dehydration Status – 3%, 6%, 9% or > 10%
• Exclude oedematous state – Face, Chest, Abdomen, Led Oedema
• If no oedema – 2 L fluid in 15 min, If oedema – 1L in 30 min > gradual
increase with cautious evaluation of chest base/lung base
• Maintenance – After bolus, remaining fluid to be given in 24 hr
• Monitoring – Continue Fluid & measure Urine Output
• Diuresis - Add diuretics if fluid overload/5L +ve balance to achieve target
U/O 0.5 ml/kg/hr
• Maintenance Fluid to be added/NOT? Maintenance Fluid given if pt. NPO
• Refer – If Target OUTPUT not fill up in 6 hr, refer the pt. for dialysis.
18. Managing acute vigorous Vomiting Pt.
কখন উপজেলা থেজক থেফাে কেজেন? CMS
Guideline
Acute Projectile Vomiting
• Acute Projectile Vomiting with NORMAL ABDOMEN – must be referred
• ACUTE ABDOMEN – Start Initial Conservative Mx (নোণ নল, শশরোয় েল,
প্রস্রোণের ল), AXR, USG, then refer if immediate surgical intervention needed.
Acute Non Projectile Vomiting
• Check Abdomen, RBS, Urine Strip. If acute abdomen, refer after conservative mx
• If DKA/HONC – Refer if worsening of pt. even after a) 6 L fluid a day, (according
to dehydration), b) 6 U/hr Insulin (Till Sugar > 16.67, If lower, 3 U/hr), c) 60 – 100
mmol K after ECG recording d) LPT
• Weapon you must need for DKA Mx – Glucometer, ECG Machine, Urine Strip
19. CMS AKI Protocol: Summary of six steps
কখন উপজেলা থেজক থেফাে কেজেন?
CMS Guideline
1: Establish the diagnosis (as AKI by AKIN or RIFLE criteria)
2: Exclude post renal cause (obstructive uropathy by abdomen palpation, DRE & USG
of KUB)
3: StartFluid Resuscitation, stop unnecessary medication & send investigation
4: Monitor the Parameters of fluid overload (Pulse, Pulse oximetry, Pressure, CVP,
Bi-basal Creps & U/O)
5: StartIV Frusemide if no output with 5L +ve balance or evidence of fluid overload
6: If stillurineoutputsub optimal, acidosis increased, refer the patient for dialysis
Mx during/before Transfer: K Mx, Acidosis Mx