This document outlines the steps for analyzing arterial blood gases (ABGs) and acid-base disorders: 1) Determine if the pH is acidic or alkaline, 2) Identify the primary disorder (respiratory or metabolic), 3) Assess compensation, 4) Determine if compensation is acute or chronic, 5) Calculate the anion gap, 6) If elevated, calculate the delta gap, 7) Consider differentials based on clinical context and lab results. Examples are provided to demonstrate applying the steps to analyze specific acid-base disorders like metabolic acidosis or alkalosis.
Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent
Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent
http://yduc.net/benh-than-man.html
Bệnh Thận Mãn, suy thận mạn, bệnh học suy thận , điều trị suy thận mạn, điều trị bệnh thận mạn, chỉ định lọc thận, thay thế thận
In this presentation I have tried to cover renal disorder associated with vascular pathology of kidney. Classification, various disorder in detail with histopathology images H&E and special stains and clinical presentations. Hope it helps understanding the entity better.
http://yduc.net/benh-than-man.html
Bệnh Thận Mãn, suy thận mạn, bệnh học suy thận , điều trị suy thận mạn, điều trị bệnh thận mạn, chỉ định lọc thận, thay thế thận
In this presentation I have tried to cover renal disorder associated with vascular pathology of kidney. Classification, various disorder in detail with histopathology images H&E and special stains and clinical presentations. Hope it helps understanding the entity better.
one can learn the step by step approach of ABG interpritation and its analysis from basics with the help of different case scenarios,Ref-NEJM article regarding physiological approach to acid base disbalance
ABGs or VBGs interpretation made simple straight forward easy to remember and easy to apply. The presentation is designed to help the residents and junior ER physicians. The second part will discuss the oxygenation and the third part will review the "Stewart Approach" while fourth and last part is meant for the Experts.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Outline
1. Discuss simple steps in analyzing ABGs
2. Calculate the anion gap
3. Calculate the delta gap
4. Differentials for specific acid-base disorders
3. Steps for ABG analysis
1. What is the pH? Acidemia or Alkalemia?
2. What is the primary disorder present?
3. Is there appropriate compensation?
4. Is the compensation acute or chronic?
5. Is there an anion gap?
6. If there is a AG check the delta gap?
7. What is the differential for the clinical processes?
5. Step 1:
Look at the pH: is the blood acidemic or alkalemic?
EXAMPLE :
65yo M with CKD presenting with nausea, diarrhea and acute
respiratory distress
ABG :ABG 7.23/17/235 on 50%VM
BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5.1
ACIDMEIA OR ALKALEMIA ????
6. EXAMPLE ONE
ABG 7.23/17/235 on 50%VM
BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr
5.1
Answer PH = 7.23 , HCO3 7
Acidemia
7. Step 2: What is the primary disorder?
What disorder is
present?
pH pCO2 or HCO3
Respiratory Acidosis pH low pCO2 high
Metabolic Acidosis pH low HCO3 low
Respiratory Alkalosis pH high pCO2 low
Metabolic Alkalosis pH high HCO3 high
8. EXAMPLE
ABG 7.23/17/235 on 50%VM
BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5.
PH is low , CO2 is Low
PH and PCO2 are going in same directions then its most likely
primary metabolic will check to see if there is a mixed disoder.
9. Step 3-4: Is there appropriate
compensation? Is it chronic or acute?
Respiratory Acidosis
Acute: for every 10 increase in pCO2 -> HCO3 increases by 1 and
there is a decrease of 0.08 in pH MEMORIZE
Chronic: for every 10 increase in pCO2 -> HCO3 increases by 4
and there is a decrease of 0.03 in pH
Respiratory Alkalosis
Acute: for every 10 decrease in pCO2 -> HCO3 decreases by 2 and
there is a increase of 0.08 in PH MEMORIZE
Chronic: for every 10 decrease in pCO2 -> HCO3 decreases by 5
and there is a increase of 0.03 in PH
10. Step 3-4: Is there appropriate
compensation? Is it acute or chronic ?
Metabolic Acidosis
Winter’s formula: pCO2 = 1.5[HCO3] + 8 ± 2 MEMORIZE
If serum pCO2 > expected pCO2 -> additional respiratory
acidosis
Metabolic Alkalosis
For every 10 increase in HCO3 -> pCO2 increases by 6
11. EXAMPLE
ABG 7.23/17/235 on 50%VM
BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5.
Winter’s formula : 17= 1.5 (7) +8 = 18.5
So correct compensation so there is only one
disorder Primary metabolic
12. Step 5: Calculate the anion gap
AG = Na – Cl – HCO3 (normal 12 ± 2)
AG corrected = AG + 2.5[4 – albumin]
If there is an anion Gap then calculate the
Delta/delta gap (step 6). Only need to calculate
delta gap (excess anion gap) when there is an anion
gap to determine additional hidden metabolic
disorders (nongap metabolic acidosis or metabolic
alkalosis)
If there is no anion gap then start analyzing for
non-anion acidosis
13. EXAMPLE
Calculate Anion gap
ABG 7.23/17/235 on 50%VM
BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5/ Albumin 4.
AG = Na – Cl – HCO3 (normal 12 ± 2)
123 – 97 – 7 = 19
No need to correct for albumin as it is 4
14. Step 6: Calculate the different needed
formulas
Delta gap = (actual AG – 12) + HCO3
Adjusted HCO3 should be 24 (+_ 6) {18-30}
If delta gap > 30 -> additional metabolic alkalosis
If delta gap < 18 -> additional non-gap metabolic
acidosis
If delta gap 18 – 30 -> no additional metabolic
disorders
15. EXAMPLE : Delta Gap
ABG 7.23/17/235 on 50%VM
BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5/ Albumin 4.
Delta gap = (actual AG – 12) + HCO3
(19-12) +7 = 14
Delta gap < 18 -> additional non-gap metabolic
acidosis
So Metabolic acidosis anion and non anion gap
17. EXAMPLE: WHY ANION GAP?
65yo M with CKD presenting with nausea, diarrhea and acute
respiratory distress
ABG :ABG 7.23/17/235 on 50%VM
BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5.1
So for our patient for anion gap portion its due to BUN
of 119 UREMIA
But would still check lactic acid
18. Nongap metabolic acidosis
Causes of nongap metabolic acidosis - DURHAM
Diarrhea, ileostomy, colostomy, enteric fistulas
Ureteral diversions or pancreatic fistulas
RTA type I or IV, early renal failure
Hyperailmentation, hydrochloric acid administration
Acetazolamide, Addison’s
Miscellaneous – post-hypocapnia, toulene, sevelamer, cholestyramine ingestion
For non-gap metabolic acidosis, calculate the urine anion gap
UAG = UNA + UK – UCL
If UAG>0: renal problem
If UAG<0: nonrenal problem (most commonly GI)
19. EXAMPLE : NON ANION GAP ACIDOSIS
65yo M with CKD presenting with nausea, diarrhea and acute
respiratory distress
ABG :ABG 7.23/17/235 on 50%VM
BMP Na 123/ Cl 97/ HCO3 7/BUN 119/ Cr 5.1
Most likely due to the diarrhea
20. Metabolic alkalosis
Calculate the urinary chloride to differentiate saline
responsive vs saline resistant
Must be off diuretics in order to interpret urine chloride
Saline responsive UCL<10 Saline-resistant UCL >10
Vomiting If hypertensive: Cushings, Conn’s, RAS,
renal failure with alkali administartion
NG suction If not hypertensive: severe hypokalemia,
hypomagnesemia, Bartter’s, Gittelman’s,
licorice ingestion
Over-diuresis Exogenous corticosteroid administration
Post-hypercapnia
21. Respiratory Alkalosis
Causes of Respiratory Alkalosis
Anxiety, pain, fever
Hypoxia, CHF
Lung disease with or without hypoxia – pulmonary embolus, reactive
airway, pneumonia
CNS diseases
Drug use – salicylates, catecholamines, progesterone
Pregnancy
Sepsis, hypotension
Hepatic encephalopathy, liver failure
Mechanical ventilation
Hypothyroidism
High altitude
22. Respiratory Acidosis
Causes of respiratory acidosis
CNS depression – sedatives, narcotics, CVA
Neuromuscular disorders – acute or chronic
Acute airway obstruction – foreign body, tumor, reactive airway
Severe pneumonia, pulmonary edema, pleural effusion
Chest cavity problems – hemothorax, pneumothorax, flail chest
Chronic lung disease – obstructive or restrictive
Central hypoventilation, OSA
23. Steps for ABG analysis
1. What is the pH? Acidemic or Alkalemic?
2. What is the primary disorder present?
3. Is there appropriate compensation?
4. Is the compensation acute or chronic?
5. Is there an anion gap?
6. If there is a AG, what is the delta gap?
7. What is the differential for the clinical processes?
Editor's Notes
-Objective slide
Just read the steps off the slides. Quick overview . Determine if you have acidemia or alkalemia based on the PH Here we determine primary disorder is it respiratory or metabolic Check to see if there is appropriate compensation for the primary disorder in order to figure if its simple or mixed disorder Then analyze if this is an acute event or chronic Always look to see if there is an anion gap Due the other calculation depending on the underlying primary source . Such as if AG acidosis check to see if there is also a Delta gap to see if there is also non-anion gap present And lastly then come up with a DDX
Memorize these values . Just read off slides.
Just go over the table Then point out the arrows :A quick trick is to determine respiratory versus metabolic is : If PH and PCO2 are going in the opposite direction : then its respiratory, If PH and PCO2 are going in same directions then its metabolic. - Be careful with the mixed disorders using the trick.
You need to memorize these and know it by heart . Then quickly go over the changes Then summarize : The easiest one is that for acute situations for every change of 10 in the PCO2 there is should be a change of 0.08 in PH and in chronic situation there should be a change of 0.03 . - If there is a different change then know that there is most likely a mixed disorder
Metabolic acidosis is the disorder you will mostly encounter in the hospital. You must memorize Winter’s formula Winter’s formula calculates the expected pCO2 in the setting of metabolic acidosis. If the serum pCO2 > expected pCO2 then there is additional respiratory acidosis in which the etiology needs to also be determined.
Always calculate the AG . (fyi most BMP ordered calculate the gap for you but need to memorize the formula) Don’t forget to look at albumin and adjust the calculated gap. If albumin is less than 4 then add 2.5 to your gap for every decrease of 1 Delta/Delta gap needs to be calculated to see if there is other underlying acidosis/alkolosis that are present
Must memorize how to calculate the delta gap Just read off the slide
Go over the table One thing to watch out for is Toluene (initially high gap, subsequent excretion of metabolites normalizes gap) Calculate osmol gap to determine if osmotically active ingestions (methanol, paraldehyde) are the cause of the gap metabolic acidosis. Other ingestions are toluene, isopropyl alcohol.
- Go over the table - Most common cause in the hospital is IV fluids and Diarrhea
For metabolic alkalosis , check urine cholride (must be off diuretics) Urine chloride < 10 implies responsivenss to saline : extracelluar fluid volume depletion Urine chloride >10 implies resistance to sailne : severe poatssium depletion , mineralcorticoid excees syndrome Etc
Read the chart then summarize Can divide into three categories 1. systemic : (sepsis , asa , liver failure , endocrine , chf) 2. Central causes (respiratory center, ischmia , CNS tumor ) 3. Lungs (pna, asthma , PE )
Respiratory acidosis . Read the chart. Can divide into three categories 1. Chest cavity (flail chest , pneumothorax Etc.) 2. Central causes (sedation , CVA etc) 3. Lungs (pna, asthma etc)