A 70-year-old female presented with sudden onset of left leg pain and was found to have absent pulses and decreased sensation in the left leg. Doppler ultrasound revealed a large blood clot in the left iliac artery. She was taken immediately to the operating room for emergency surgery. Acute limb ischemia requires rapid diagnosis and treatment to save threatened limbs. Options include catheter-directed thrombolysis, surgical embolectomy, or amputation if ischemia has caused irreversible damage. Prompt treatment is needed to prevent major complications like amputation or death.
ALI is most dreaded emergency presentation of peripheral arterial disease.
Definition, presentation, grading, clinical presentation, diagnostic imaging, and management of acute limb ischemia.
ALI is most dreaded emergency presentation of peripheral arterial disease.
Definition, presentation, grading, clinical presentation, diagnostic imaging, and management of acute limb ischemia.
PERIPHERAL ARTERIAL DISEASES- INTRODUCTION- Limb Ischemia
Dear Viewers,
Greetings from “Surgical Educator”
Today I am uploading an introductory video on “Peripheral Arterial Diseases”. In this video I have discussed the surgical anatomy, modes of presentation, symptoms, signs, investigations and a diagnostic algorithm of Peripheral Arterial Diseases. In the subsequent three videos I will discuss about chronic lower limb ischemia, acute lower limb ischemia and upper limb ischemia. I hope you will enjoy these series of teaching videos. You can watch these videos in the following links:
surgicaleducator.blogspot.com
youtube/c/surgicaleducator
Thank you for watching the video.
About the stabilization and care of trauma patients before leaving the emergency department for definitive care (whether to the operating room or to a higher care facility or to ICU)
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
extremity vascular injury, arterial injury, causes of arterial injury, mechanisms of arterial injury, investigations for arterial injury, treatment of arterial injury, , extremity vascular injuryfor medical students
PERIPHERAL ARTERIAL DISEASES- INTRODUCTION- Limb Ischemia
Dear Viewers,
Greetings from “Surgical Educator”
Today I am uploading an introductory video on “Peripheral Arterial Diseases”. In this video I have discussed the surgical anatomy, modes of presentation, symptoms, signs, investigations and a diagnostic algorithm of Peripheral Arterial Diseases. In the subsequent three videos I will discuss about chronic lower limb ischemia, acute lower limb ischemia and upper limb ischemia. I hope you will enjoy these series of teaching videos. You can watch these videos in the following links:
surgicaleducator.blogspot.com
youtube/c/surgicaleducator
Thank you for watching the video.
About the stabilization and care of trauma patients before leaving the emergency department for definitive care (whether to the operating room or to a higher care facility or to ICU)
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
extremity vascular injury, arterial injury, causes of arterial injury, mechanisms of arterial injury, investigations for arterial injury, treatment of arterial injury, , extremity vascular injuryfor medical students
It is very common to see patients with different Tachycardias in Emergency department. Dealing with tachycardias as a part of ACLS is a must to know for all Emergency Physicians. This presentation covers different types of Tachycardias like Sinus Tachycardia, stable tachycardia, unstable tachycardia, ventricular tachycardia, supraventricular tachycardia, svt with abberancy, AIVR, TCA Toxicity, Ventricular paced rhythm, modified vagal maneuvre, atrial fibrillation and others
Guillain - Barre syndrome after acute myocardial infarction: A rare presentat...Apollo Hospitals
The association of acute coronary syndrome with any immunological mediated polyradiculopathy like Guillain–Barré syndrome is very rare. We report such a rare association of acute myocardial infarction and Guillain–Barré syndrome. Our patient underwent primary angioplasty successfully, but developed respiratory failure while in hospital. While the difficulty in weaning off from ventilator a suspicion of neuromuscular disease was made. The further investigations, including nerve conduction study confirmed a diagnosis of Guillain–Barré syndrome. Despite treatment, the patient died secondary to multi-organ dysfunction. Our case is 4th reported in the literature without use of any thrombolytic agent for such association.
Guillain–Barré syndrome after acute myocardial infarction: A rare presentationApollo Hospitals
The association of acute coronary syndrome with any immunological mediated polyradiculopathy like Guillain–Barré syndrome is very rare. We report such a rare association of acute myocardial infarction and Guillain–Barré syndrome. Our patient underwent primary angioplasty successfully, but developed respiratory failure while in hospital. While the difficulty in weaning off from ventilator a suspicion of neuromuscular disease was made. The further investigations, including nerve conduction study confirmed a diagnosis of Guillain–Barré syndrome. Despite treatment, the patient died secondary to multi-organ dysfunction. Our case is 4th reported in the literature without use of any thrombolytic agent for such association.
Shock Case Study (15 pts)HPI. Mrs. K is a 22 yo college student, .pdfarihantgiftgallery
Shock Case Study (15 pts)
HPI. Mrs. K is a 22 y/o college student, rushed to the ED 35 minutes after sustaining multiple
stab wounds to the chest and abdomen by an unidentified assailant. A witness called 911.
Paramedics arriving at the scene found the victim to be in severe acute distress.
Vital signs were as follows: HR 128 (baseline 80), BP 80/55 (baseline 115/80), RR 37 and
labored. Chest auscultation revealed decreased breath sounds in the R lung consistent with
basilar atelectasis (ie. collapsed R lung). Pupils were equal, round, reactive to light, and
accommodation. Her LOC was reported as “awake, slightly confused, and complaining of severe
chest and abdominal pain.” Pedal pulses were absent, radial pulses were weak, and carotid pulses
were palpable. The patient was immediately started on IV Lactated Ringer’s solution at a rate of
150 mL/hr.
An ECG monitor placed at the scene of the attack revealed that the patient has developed sinus
tachycardia. She was tachypneic, became short of breath with conversation and reported her
heart was pounding out of her chest. She appeared to be very anxious and continued to c/o pain.
Her skin was cool and nail beds were pale but not cyanotic. Skin turgor was poor. Peripheral
pulses were absent with the exception of a thread, brachial pulse. Capillary refill time was 7-8
seconds. Doppler ultrasound had been required to obtain an accurate BP reading. The patient’s
skin was cool and clammy. There was a significant amount of blood on her dress and on the
pavement where she was lying.
Question 2. What is the pathophysiologic sequence of events for shock? (2pts)
Question 3. What type of shock does this patient seem to have? What is your rationale? (2 pts)
Question 4. Does this patient need a blood transfusion? Provide rationale for your answer. (2pts)
During transport to the hospital, vital signs were reassessed: HR 138, BP 75/50, RR 38 with
confusion. Patient was diagnosed with hypovolemic shock and IV fluids were doubled. Oxygen
was started at 3L/min by nasal cannula. ER physicians chose not to start a central venous line.
An indwelling foley catheter was inserted with return of 180mL of amber colored urine. Urine
output measured over the next hour was 14mL. Patient was taken to the OR for surgical
correction of lacerations to the right lung, liver and pancreas. In total, patient received 1L of
Lactated Ringers.
Table 1.
Class
Parameter
I
II
III
IV
Blood loss (ml)
<750
750–1500
1500–2000
>2000
Blood loss (%)
<15%
15–30%
30–40%
>40%
Pulse rate (beats/min)
<100
>100
>120
>140
Blood pressure
Normal
Decreased
Decreased
Decreased
Respiratory rate (breaths/min)
14–20
20–30
30–40
>35
Urine output (ml/hour)
>30
20–30
5–15
Negligible
CNS symptoms
Normal
Anxious
Confused
Lethargic
Class
Parameter
I
II
III
IV
Blood loss (ml)
<750
750–1500
1500–2000
>2000
Blood loss (%)
<15%
15–30%
30–40%
>40%
Pulse rate (beats/min)
<100
>100
>120
>140
Blood pressure
Normal
Decreased
Decreased
Decreased
Respiratory rate (breaths/min.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
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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!
2. A 70 year old female came to casuality with
c/o of sudden onset of pain in left leg from
one hour @3.30 pm on 30th july 2014
3. O/E there were absent popliteal and lower
pulsations and decreased sensations of left leg
and it was cold and pale compared to right leg.
Patient had history of Heart disease and k/c/o
Hypertension and DM type 2.
No Recent history of Trauma/Claudication/Fever/
intravascular procedures / drugs of abuse.
Contralateral leg pulses are felt
9. Clinical Evaluation of Acute Ischemia (Clinical Picture)
Signs of acute ischemia
5Ps
Pain: symptom
+
Pulseless
Pale
Parasthesia
Paralysis
Inspection
COLOR:
Early: pale
Later: cyanosed mottling fixed
mottling & cyanosis
Pallor
Reversible
mottling
An area of fixed
cyanosis surrounded
by reversible
mottling
Fixed
mottling &
cyanosis
10. Clinical Evaluation of Acute Ischemia (Clinical Picture)
Signs of acute ischemia
5Ps
Pain: symptom
+
Pulseless
Pale
Parasthesia
Paralysis
Palpation
Femoral Popliteal
Posterior tibial Dorsalis pedis
Palpate peripheral pulses, compare with the other
side & write it down on a sketch
Slow capillary refilling of the skin after finger pressure
11. Clinical Evaluation of Acute Ischemia (Clinical Picture)
Signs of acute ischemia
5Ps
Pain: symptom
+
Pulseless
Pale
Parasthesia
Paralysis
Palpation
Loss of sensory function
Numbness will progress to anesthesia
Progress of Sensory loss
Light touch
Vibration sense
Proprioreception
Deep pain
Pressure sense
Late
12. Clinical Evaluation of Acute Ischemia (Clinical Picture)
Signs of acute ischemia
5Ps
Pain: symptom
+
Pulseless
Pale
Parasthesia
Paralysis
Palpation
Loss of motor function:
Indicates advanced limb threatening
ischemia
Late irreversible ischemia: Muscle turgidity
Intrinsic foot muscles are affected first,
followed by the leg muscles
Detecting early muscle weakness is
difficult because toes movements are
produced mainly by leg muscles
15. • What are we
• looking for?
• NORMAL
• • Multiphasic
• • Pulsatile
• • Regular amplitude
• An audible Doppler signal assures some blood flow. No Doppler
signals, then a vascular surgeon should be immediately consult
16. If a pulse is detected, then the ankle-brachial index (ABI)
and segmental leg pressures should be checked..
17. 0.7 to 0.9 is mild disease,
0.5 to 0.69 is moderate disease,
< 0.5 is severe disease.
18. Management of Acute Limb Ischemia
The severity and duration
of ischemia at the time of
presentation provides a
narrow margin of time for
investigations and
treatment.
19. Rutherford Classification
Category Description Cap. refill Paralysis Sensory
loss
A V
I Viable Not immediately
threatened
Intact - - Aud Aud
IIa Marginally
Threatened
Salvagable if
treated
Intact/slow - Partial _ Aud
IIb Immediately
Threatened
Salvagable if
treated
emergently
Slow/absent Partial Partial _ Aud
III Irreversible Primary
amputation req.
Absent Complete Complete _ _
Doppler
22. B Catheter directed thrombolysis
Agents used: Streptokinase,
Urokinase, tissue plasminogen
activator
Indications:
1. Viable or marginally threatened limb (class I, IIa)
2. Recent acute thrombosis (not suitable for embolism or old thrombi)
3. Avoid patients with contraindications
23. Contraindications:
Absolute:
1. Cerebro-vascular stroke within previous 2 months
2. Active bleeding or recent GI bleeding within previous 10 days
3. Intracranial trauma or neurosurgery within previous 3 months
Relative:
1. Cardio-pulmonary resuscitation within previous 10 days
2. Major surgery or trauma within previous 10 days
3. Uncontrolled hypertension
27. Clinical Outcomes
• Mortality -15–20%.
• Major morbidities include:
1. Due to major bleeding 10–15% of patients
require transfusion/and or operative
intervention
2. Amputation (25–30% of patients)
3. Fasciotomy (5–25% of patients)
4. Renal insufficiency (up to 20% of patients)
28.
29. Conclusions and Recommendations
• Heparin should be administered as soon as
possible.
• In Patient with viable and marginally threatened
limb imaging studies can be obtained to guide
therapeutic decision.
• In patient with Immediate threatened limb
Emergency angiography followed by catheter
based thrombolysis or thrombectomy or open
surgical vascularization is indicated to restore or
preserve limb viability.