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.
PH definition and determinants , how to regulate the Acid/base in our body ,ABG's normal values in atrery and vein , how to obtain an arterial blood sample, the interpretation of ABG's , steps to analuse Acid-base, respiratory acidosis and alkalosis and its causes also about metablic acidosis and alkalosis and the causes and some case studies .
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.
PH definition and determinants , how to regulate the Acid/base in our body ,ABG's normal values in atrery and vein , how to obtain an arterial blood sample, the interpretation of ABG's , steps to analuse Acid-base, respiratory acidosis and alkalosis and its causes also about metablic acidosis and alkalosis and the causes and some case studies .
Lactate has been viewed as a byproduct of anaerobic metabolism and an indicator of tissue hypoperfusion since the 1900s. This theory is still widely believed. Paul busts the myths surrounding lactic acidosis, anaerobic metabolism, tissue hypoxia and the role of lactate in sepsis.
Key take-away facts include:
- The production of lactate actually consumes hydrogen ions. Lactic acidosis is really lactic alkalosis.
- Lactate is produced physiologically and is a precursor for gluconeogenesis.
- During exercise, skeletal muscle exports lactate as the primary fuel for the heart and brain.
- At VO2max, intracellular oxygen stays the same. Anaerobic metabolism in cells only occur as a pre-terminal event. The exception is in complete arterial occlusion.
- Adrenaline promotes lactate production
- Lactate infusion has been shown to increase cardiac output in septic and cardiogenic shock
- Lactate is a survival advantage!
Lactate has been viewed as a byproduct of anaerobic metabolism and an indicator of tissue hypoperfusion since the 1900s. This theory is still widely believed. Paul busts the myths surrounding lactic acidosis, anaerobic metabolism, tissue hypoxia and the role of lactate in sepsis.
Key take-away facts include:
- The production of lactate actually consumes hydrogen ions. Lactic acidosis is really lactic alkalosis.
- Lactate is produced physiologically and is a precursor for gluconeogenesis.
- During exercise, skeletal muscle exports lactate as the primary fuel for the heart and brain.
- At VO2max, intracellular oxygen stays the same. Anaerobic metabolism in cells only occur as a pre-terminal event. The exception is in complete arterial occlusion.
- Adrenaline promotes lactate production
- Lactate infusion has been shown to increase cardiac output in septic and cardiogenic shock
- Lactate is a survival advantage!
This book explores important clinical problems in general nephrology, dialysis and transplantation, using a case-based approach. Together the 32 chapters form a comprehensive collection of clinical vignettes in renal medicine. Each chapter covers a separate clinical problem, posing multiple-choice questions and providing a detailed explanation for each. Clinical Pearls highlight the key issues. Each graded into three disctinct levels, to provide pertinent information tailored to the reader's knowledge level.
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
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
Follow us on: Pinterest
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. اﻟﺮﺣﯿﻢ اﻟﺮﺣﻤﻦ ﷲ ﺑﺴﻢ
♻ This is a summarized presentation about
acid base balance & its practical application
in the ICU.
♻ I hope this will help in simplifying this
important ICU topic.
♻ All comments are welcome & highly
appreciated.
1a
3. 1b
Dr. Sherif
Badrawy
Digitally signed by Dr.
Sherif Badrawy
DN: cn=Dr. Sherif Badrawy,
o=KKUH, ou=Critical Care,
email=sherif_badrawy@ya
hoo.com, c=SA
Date: 2015.08.25 18:40:56
+03'00'
5. Screening test for detecting abnormal
low MW solutes (e.g. ethanol, methanol
& ethylene glycol [Normal is < 10]
↑Osmolar Gap ➜ >10 ➜ indirect
evidence for the presence of an abnormal
solute in significant amounts
2b
24. Working out a Metabolic
Acidosis
◒ Calculate AG or AGc, if:
◒ High:
12a
25. ◒ Unmeasured anions likely ➜ measure osmolality.
➜ If there is no obvious cause for an elevated AGc, ➜
specific assays (glucose, renal function,
rhabdomyolysis, L-lactate, D-lactate, β-
hydroxybutyrate, salicylate)
◒ Calculate osmolar gap. If high AG and high OG
then ketones, lactate, ethanol, ethylene glycol,
methanol, mannitol.
12b
26. Working out a Metabolic
Acidosis
◒ Calculate AG or AGc, if:
◒ Normal:
13a
31. 【U S E D C A R PAR T S】
✺ U ⇨ Ureterosigmoidostomy
✺ S ⇨ saline administration (in the face of renal dysfunction)
✺ E ⇨ Endocrine〘Addisons〙
✺ D ⇨ Diarrhea
✺ C ⇨ Carbonic anhydrase inhibitors
✺ A ⇨ Ammonium chloride
✺ R ⇨ Renal tubular acidosis
✺ PAR ⇨PARathyroid Adenoma
✺ T ⇨ Triamterene, amiloride
✺ S ⇨ Spironolactone
15b
41. albumin is the major unmeasured anion
in plasma. This means that a decrease in
serum albumin will decrease the
AG,(e.g., a high AG metabolic acidosis
can present with a normal AG in the
presence of hypoalbuminemia).
20b
45. In the presence of a high AG metabolic
acidosis, it is possible to detect another
metabolic acid-base disorder (a
normal AG metabolic acidosis or a
metabolic alkalosis)
by comparing the AG excess to the HC03
deficit
22b
49. ☼ Mixed Metabolic Acidoses
↑AG metabolic acidosis the ↓in serum HC03 = the ↑in
AG, and the AG excess/HC03 deficit ratio is unity
(=1) when a hyperchloremic acidosis appears, the↓in
HCO3 is > ↑in the AG, and the ratio (AG
excess/HCO3 deficit) falls below unity (<1),( as 24-
HCO3 ➜ will be a bigger number dt ↓in HCO3).
∴Gap-Gap <1 indicates the coexistence of a ↑AG
metabolic acidosis + normal AG metabolic acidosis
24b
51. ☼ Metabolic Acidosis and Alkalosis
When alkali is added in the presence of a ↑AG
metabolic acidosis, the ↓in HCO3 is < the ↑in
AG, and the gap-gap (AG excess /HCO3
deficit) is greater than unity (>1).
∴Gap-Gap > 1 indicates the coexistence of a
↑AG metabolic acidosis + normal AG
metabolic Alkalosis
25b
57. - when levels are greater than 5 mmols/l
- As levels rise above 5mmols/l, the associated mortality
rate can become very high.
- The brief and often very high lactate levels that occur
with severe exercise or generalised convulsions (eg up to
30 mmol/l) are associated with an extremely low
mortality rate so the absolute lactate level (alone) is not a
good predictor of outcome unless the cause of the high
level is also considered.
28b
61. - Lactate is produced from pyruvate in a
reaction catalysed by lactate
dehydrogenase
This reaction considered to be always in
an
equilibrium situation. Normally the ratio
of lactate to pyruvate in the cell is 10 to 1.
30b
65. - If hypoxaemia is the only factor present, it
needs to be severe (eg paO2 < 35mmHg) to
ppt lactic acidosis dt protection afforded by
the body's compensatory
mechanisms which ↑tissue blood flow.
Similarly anaemia needs to be severe (eg
[Hb] <5g/dl) if present alone because tissue
blood flow is increased in compensation.
32b
73. Assoc with inborn errors of
metabolism (eg congenital forms of
lactic acidosis with various enzyme
defects eg pyruvate dehydrogenase
deficiency)
36b
75. D-lactate generated by bacterial fermentation in the
bowel can enter the systemic circulation and produce
a metabolic acidosis, often combined with a
metabolic encephalopathy, 【after extensive small
bowel resection or after jejunoileal bypass】 for
morbid obesity, can ↑anion gap, but the standard lab
assay for lactate measures only l-lactate. If d-lactic
acidosis is suspected, you must request a specific d-
lactate assay.
37b
76. The principles of management
of patients with lactic acidosis
are:
38a
77. (i) Diagnose and correct the underlying
condition (if possible)
(ii) Restore adequate tissue oxygen
delivery (esp restore adequate perfusion)
(iii) Ensure appropriate compensatory
hyperventilation where possible
38b
78. patients with severe acidosis (pH
<7.1), HD unstable, a trial infusion
of HCO3 can be attempted by
administering 1/2 of the estimated
bicarbonate deficit
39a
83. (i) acute hypercapnia
(ii) ionised hypocalcaemia
(iii) intracellular acidosis due to CO2 crossing cell
membranes rapidly
(iv) acute intravascular overload
(v) bicarbonate ↑lactate production by ↑activity of
the rate limiting enzyme phosphofructokinase, ➜
shifts Hb-O2 dissociation curve, ↑O2 affinity of Hb
➜ ↓DO2 to tissue
41b
87. ☼ Lactate is a question not any
answer: exclude occult sepsis,
inadequate resuscitation, localised
ischaemia or CVS failure
☼ Stop NRTIs in HIV
43b
99. ✪ Activation of (RAAS) is a key factor
✪ Aldosterone ➜ reabsorption of Na+ in exchange
for H+ in the DCT
✪ ECF depletion (vomiting, diuretics) ➜ Na+ and
Cl- loss activation of RAAS➜ ↑ aldosterone levels
✪ In Hypokalemia, K+ shift from cells ➜ ECF.
Alkalosis is caused by shift of H+ into cells to
maintain neutrality
49b