1) Shock is defined as inadequate tissue perfusion resulting from low blood pressure and abnormal cellular metabolism. The main types of shock are hypovolemic, distributive, and cardiogenic.
2) Hypovolemic shock occurs when intravascular volume is decreased, such as from blood loss, and requires fluid resuscitation. Septic shock, a form of distributive shock, involves infection and organ dysfunction and responds to antibiotics, fluids, and vasopressors.
3) Cardiogenic shock results from heart failure or damage and may be caused by myocardial infarction. It requires hemodynamic support through medications like dopamine or norepinephrine while the underlying cardiac issue is addressed.
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
Rodenticide Poisoning + Rat Killer paste poisoning managementVasif Mayan
Rodenticide paste poisoning
Case Study
Clinical features
Management
Investigations
Treatment guidelines
pathogenesis
N acetyl cysteine
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It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
Rodenticide Poisoning + Rat Killer paste poisoning managementVasif Mayan
Rodenticide paste poisoning
Case Study
Clinical features
Management
Investigations
Treatment guidelines
pathogenesis
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other rodenticides
Updated global adult sepsis guidelines, released in October 2021 by the Surviving Sepsis Campaign (SSC), place an increased emphasis on improving the care of sepsis patients after they are discharged from the intensive care unit (ICU) and represent greater geographic and gender diversity than previous versions.
The new guidelines specifically address the challenges of treating patients experiencing the long-term effects of sepsis. Patients often experience lengthy ICU stays and then face a long, complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families are often uncertain how to coordinate care that promotes recovery and matches their goals of care.
70% of RTA patients have head injury(HI).
One of the most important public health problems of today.
70% of deaths in RTA are due to HI.
At Risk population
Males 15-24
Infants
Young Children
Elderly
Updated global adult sepsis guidelines, released in October 2021 by the Surviving Sepsis Campaign (SSC), place an increased emphasis on improving the care of sepsis patients after they are discharged from the intensive care unit (ICU) and represent greater geographic and gender diversity than previous versions.
The new guidelines specifically address the challenges of treating patients experiencing the long-term effects of sepsis. Patients often experience lengthy ICU stays and then face a long, complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families are often uncertain how to coordinate care that promotes recovery and matches their goals of care.
70% of RTA patients have head injury(HI).
One of the most important public health problems of today.
70% of deaths in RTA are due to HI.
At Risk population
Males 15-24
Infants
Young Children
Elderly
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
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Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
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Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
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2. Introduction
Shock can be defined as a state of inadequate
or inappropriate tissue perfusion resulting in
abnormal cellular metabolism.
Shock is associated with anaerobic metabolism,
oxygen debt and tissue acidosis.
5. Hypovolemic shock
Hypovolemic shock is related to decreased intravascular
volume, secondary to loss of:
Blood (e.g. trauma)---- > Hemorrhagic shock
Plasma (e.g. burns)
Water and electrolytes (e.g. vomiting, diarrhoea).
10. Septic shock
Surviving sepsis campaign 2012
Sepsis is defined as the presence of infection together with systemic
manifestations of infection.
Severe sepsis is defined as sepsis plus sepsis-induced organ
dysfunction or tissue hypo perfusion.
Sepsis-induced hypotension is defined as a systolic blood pressure
(SBP) < 90 mm Hg or mean arterial pressure (MAP) < 70 mm Hg or a SBP
decrease > 40 mm Hg or less than two standard deviations below normal
for age in the absence of other causes of hypotension
11. Septic shock
Clinical feature
SBP< 90
MAP < 70
Feature of severe sepsis :
Fever Hypothermia ,tachy,Tachypnea,Altered mental
status, Leukocytosis ,Leukopenia.
With one or more organ involvement ( lung ,liver ,kidney )
12. Septic shock
Management
Goals during the first 6 hrs of resuscitation:
a) Central venous pressure 8–12 mm Hg
b) Mean arterial pressure (MAP) ≥ 65 mm Hg
c) Urine output ≥ 0.5 mL/kg/hr
d) Central venous (superior vena cava) or mixed venous
oxygen saturation 70% or 65%, respectively
14. •Fluid Therapy of Severe Sepsis:
• Crystalloids as the initial fluid of choice in the resuscitation
•Vasopressors
• Norepinephrine as the first choice vasopressor
•Inotropic Therapy
• Dobutamine infusion
• myocardial dysfunction as suggested by elevated cardiac
filling pressures and low cardiac output.
• ongoing signs of hypoperfusion, despite achieving adequate
intravascular volume and adequate MAP
•Blood Product Administration
• Red blood cell transfusion if Hb <7.0 g/dL
• Platelets prophylactically when counts are <10,000/mm3 in the
absence of apparent bleeding
15. Diagnosis :
• Cultures as clinically appropriate before antimicrobial therapy
• imaging
•Antimicrobial Therapy
• Administration of effective broad spectrum intravenous
antimicrobials within the first hour of recognition of septic shock.
• Not more than 5 days, De-escalate antibiotic therapy.
• Duration of therapy typically 7–10 days
•Source Control
• eg: abscess drainage
•Mechanical Ventilation of Sepsis-Induced ARDS
16. Anaphylactic shock
Anaphylaxis :
life threating clinical manifestation
IgE mediated hypersensitivity
Mast cell and basophil degranulation
Anphylactoid rxn:
Not IgE mediated
19. Anaphylactic shock
Suspected impending respiratory collapse ---->
intubate
IM epinephrine 0.3-0.5 mg to ant/ lat thigh
For severe symptoms poor response
Iv bolus epinephrine 0.1-0.2 mg
If hypotensive start fliud therapy
if no response to above
start iv epi infusion
Aggressive fluid therapy
Pt on beta blocker ----> Glucagon
20. Treat all patients with Histamine 1,2 blocker
Diphenhydramine (H1)
Ranitidine (H2)
21. Cardiogenic shock
Cardiogenic shock is related to ‘pump’
failure from many possible causes
myocardial infarct ( common)
valve dysfunction
papillae rupture
arrhythmias
tamponade
pulmonary embolus
23. Cardiogenic shock
Initial evaluation & rapid stabilization
Immediate ECG:
Look for evidence of AMI (ST ele , LBBB)
Supplemental O2/mech vent
BP support
Dopamine
Nor epi
Need CVP,Intra arterial blood pressure monitoring
24. Cardiogenic shock
Patient with positive ECG finding :
Immediate reperfusion therapy :
Thrombolytic therapy
Cardiac catheterization
Negative ECG finding :
Rule out mechanical cause of CS ( ECHO)
Cardiac monitoring ( confirm cardiac etiology )
Continued medical support (vasopressure, inotropic)
25. Cardiogenic shock
In case of refractory cardiac shock
Left venticular assist device
Transplant
Cradiac temponade :
Beck’s triad ( raised jvp,muffled hreart sound,hypotension)
Presence of pulsus paradox( insp fall in SBP>10)
Echo finding
Consider Subxiphoid Pericardiocentesis
Shock can be defined as a state of inadequate cellular sustenance associated
with inadequate or inappropriate tissue perfusion resulting in abnormal cellular
metabolism. This can occur as a result of inadequate DO2, maldistribution of
blood flow, a low perfusion pressure, or, as usually is the case, a combination of
all three. Shock is associated with anaerobic metabolism, oxygen debt and tissue
acidosis
There are many classifications of shock, some based on clinical entities and some on pathophysiology.
This is somewhat unreal, as there is a large overlap between some of the groups, especially in their more severe forms and one or more processes
may be involved simultaneously (Table 8.1).
All forms of shock can eventually result in profound cellular dysfunction and death – so-called irreversible shock.
Irreversibility is difficult to define and may depend on inappropriate management as much as on the clinical state.
The following is a clinically useful initial approach to shock in association with the classical causes of shock (Table 8.1).
The patient’s history is very important in determining the cause.
Hypotension is often the first sign of shock.
BP = cardiac output × systemic vascular resistance (SVR).
Firstly, determine whether the problem is mainly one of decreased SVR or decreased cardiac output.
Sepsis :
Fever (&gt; 38.3°C)
Hypothermia (core temperature &lt; 36°C)
Heart rate &gt; 90/min–1 or more than two sd above the normal value for age
Tachypnea
Altered mental status
Leukocytosis (WBC count &gt; 12,000 μL–1)
Leukopenia
severe sepsis :
Organ dysfunction variables
Arterial hypoxemia (Pao2/Fio2 &lt; 300)
Acute oliguria (urine output &lt; 0.5 mL/kg/hr for at least 2 hrs despite adequate fluid resuscitation)
Creatinine increase &gt; 0.5 mg/dL or 44.2 μmol/L
Coagulation abnormalities (INR &gt; 1.5 or aPTT &gt; 60 s)
Ileus (absent bowel sounds)
Thrombocytopenia (platelet count &lt; 100,000 μL–1)
Hyperbilirubinemia (plasma total bilirubin &gt; 4 mg/dL or 70 μmol/L)
Tell about ephinephine prepartion
Inadeqaute circulation and comprimised organ perfusion due to cardiac dysfunction