Adrenaline and noradrenaline are catecholamines that act as hormones and neurotransmitters. They are synthesized from tyrosine and phenylalanine through a series of enzymatic reactions. Adrenaline acts on alpha-1, alpha-2, and beta receptors and causes effects like increased heart rate, vasoconstriction, bronchodilation and glycogenolysis. Noradrenaline predominantly acts on alpha-1 and beta-1 receptors, causing potent vasoconstriction with little bronchodilation. Both are used to treat hypotension, cardiac arrest and anaphylaxis. Their administration must be closely monitored due to risks of hypertension, arrhythmias and tissue necrosis from vasoconstrict
Pharmacology is an important part of ACLS program. In ACLS Program,we are using many essential drugs for surviving cardiac arrest cases in Emergency department. We are introducing ACLS which is locally called ARC ( Advanced Resuscitation Course) started in Square Hospitals Ltd,Dhaka,Bangladesh. Hope it will help many health care provider to know the useful medication in case of CPR.
"Navigating Neurologic and Neurosurgical Emergencies: A Guide for Nursing Students"
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Malignant hyperthermia is a potentially fatal hyperdynamic response due to pharmacogenetic abnormalities. This ppt gives a brief description of pathology and pharmacotherapy of malignant hyperthermia.
Pharmacology is an important part of ACLS program. In ACLS Program,we are using many essential drugs for surviving cardiac arrest cases in Emergency department. We are introducing ACLS which is locally called ARC ( Advanced Resuscitation Course) started in Square Hospitals Ltd,Dhaka,Bangladesh. Hope it will help many health care provider to know the useful medication in case of CPR.
"Navigating Neurologic and Neurosurgical Emergencies: A Guide for Nursing Students"
š Greetings, nursing students! Dr. Ganesh here, and today, we're embarking on a crucial journey into the realm of neurologic and neurosurgical emergencies. Whether you're on the path to becoming a registered nurse, nurse practitioner, or simply seeking foundational knowledge, this discussion is crafted to empower you in emergency care scenarios.
Malignant hyperthermia is a potentially fatal hyperdynamic response due to pharmacogenetic abnormalities. This ppt gives a brief description of pathology and pharmacotherapy of malignant hyperthermia.
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This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
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The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesarās dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empireās birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
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Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
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This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
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Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
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.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
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http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasnāt one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
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Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
ā¢ The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
ā¢ The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate āany matterā at āany timeā under House Rule X.
ā¢ The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
5. Types of ļ”-adrenergic
receptor
Receptor Sites of action Effects
ļ”1 smooth muscle,
heart, and liver
vasoconstriction,
intestinal relaxation,
uterine contraction and
pupillary dilation,
ļ”2 platelets, vascular smooth
muscle, nerve termini,
and pancreatic islets
platelet aggregation,
vasoconstriction, and
inhibition of NE release
and of insulin secretion.
8. Classification of Adrenergic Hormone
Receptors
Receptor Agonists
Second
Messenger
G protein
alpha1 (ļ”1) NE > E IP3/Ca2+; DAG Gq
alpha2 (ļ”2) E > NE ļÆ cyclic AMP Gi
beta1 (ļ¢1) E = NE ļ cyclic AMP Gs
beta2 (ļ¢2) E >> NE ļ cyclic AMP Gs
E = epinephrine; NE = norepinephrine
11. ADRENALINE PREPARATIONS
ā¢ Clear solution conc. of 1:1000 (1ml amp) or
1:10 000 (10 ml mini-jet for resuscitation).
ā¢ Along with L.A- conc. of 1:200 000, upto
1:80 000 (Lignocaine 2% for dental inj).
ā¢ Auto-injectors for use in anaphylaxis
ā¢ 0.3 mg and 0.15 mg (EpiPenĀ®) for i.m inj.
13. Effects of adrenaline on organs and
tissues in the body
ORGAN EFFECT RECEPTOR TYPE
Heart Increase heart rate
Increased contractility
Ī²1
Ī²1
Blood vessels Vasoconstriction
Vasodilation
Ī±1
Ī²2
Lungs Bronchodilation Ī²2
Uterus Relaxation Ī²2
14. ORGAN EFFECT RECEPTOR
Metabolism Inhibits pancreatic insulin secretion Ī±2Ī²2
Glycogenolysis in liver and muscle Ī±1Ī²2
Glycolysis in muscle Ī±1Ī²2
Gluconeogenesis Ī±1Ī²2
Glucagon secretion in pancreas Ī±2
ACTH secretion by pituitary Ī²
Lipolysis in adipose tissue Ī²2Ī²3
Renin secretion from kidney Ī²1Ī²2
15. RESUSCITATION
ā¢ Adrenaline - DOC -cardiac arrest.
ā¢ Main action - ā vascular resistance via Ī±1
vasoconstriction ā improves perfusion
pressure to the myocardium and brain.
ā¢ Adrenaline -greatest effect when given i.v
intraosseous route if i.v route not patent.
16. ADR IN ACLS
ā¢ VF/VT cardiac arrest -1mg ,in the third cycle
after 2 shocks and then every 3-5 minutes
(alternate CPR cycles).
ā¢ PEA arrest -1 mg, and then every 3-5
minutes (alternate cycles).
ā¢ Children-10 micrograms ( 0.1 mL of the
1:10,000 solution) per kg i.v ,repeated every
3-5 minutes.
17. ADR IN ACLS
ā¢ Bradycardia: 1mg ADR with 500ml of NS or
D5W. Infusion @ 2-10 Āµg/min (titrated to
effect).
ā¢ ROSC hypotension: 0.1-0.5 mcg/kg/min
ā¢ Endotracheal Tube: 2-2.5mg ADR is diluted
in 10cc NS and given directly into ET tube.
18. ANAPHYLAXIS
ā¢ Adrenaline is the drug of choice.
ā¢ Ī±1-agonist, reverses -peripheral vasodilation
by inflammatory mediator release,ā oedema.
ā¢ Ī² activity dilates bronchial airways,
āmyocardial contractility, ā histamine and
LT release and ā severity of IgE-mediated
allergic reactions.
19. Management of acute anaphylaxis
AGE IM DOSE (micrograms)
(ml of 1:1000 solution)
IV DOSE (micrograms)
(ml of 1:10 000 solution)
Adult 500 micrograms (0.5 ml) 50 micrograms (0.5 ml)
titrated to effect
Child > 12
years
500 micrograms (0.5 ml) 50 micrograms (0.5 ml)
titrated to effect
Child 6-12
years
300 micrograms (0.3 ml) 1 microgram/kg titrated
to effect
Child < 6 years 150 micrograms (0.15 ml) 1 microgram/kg titrated
to effect
20. ANAPHYLAXIS DOSES
ā¢ Adults-initial dose is 100 to 500 microgram
(0.1 to 0.5 mL of the 1:1,000 sol) SC or IM.
ā¢ repeated at 20 minute to 4 hour intervals
ā¢ severe anaphylactic shock, slow and
cautious IV administration-100 to 250
microgram
ā¢ Children-10 microgram per kg SC repeated
at intervals of 20 min to 4 hrs
21. INOTROPIC SUPPORT
ā¢ Continuous infusion in ICU- via CVP line,
with invasive blood pressure monitoring.
ā¢ Indications :
ā¢ profoundly low blood pressure,
ā¢ shock,
ā¢ low cardiac output states and
ā¢ status asthmaticus.
22. ā¢ There is no single appropriate
concentration.
ā¢ 4 mg Adrenaline diluted to 50 ml in saline or
5% dextrose, infused by means of a syringe
driver.
ā¢ Rate of infusion -titrated to effect, to achieve
target blood pressure.
23. AIRWAY OBSTRUCTION
ā¢ Severe croup-m/c airway indication for Adr.
ā¢ angio-oedema- life threatening obstruction.
ā¢ racemic adrenaline -nebulized route.
ā¢ MOA-reduce the local inflammatory process
and to provide local vasoconstriction-
reducing obstruction caused by oedema.
24. DOSAGE
ā¢ L-Adrenaline-0.5 ml/kg of a 1:1000 solution
(maximum of 5 ml) placed undiluted into
the chamber of the nebulizer for children.
ā¢ Racemic -0.05 ml/kg (max 1.5 ml) of 2.25%
sol diluted to 4 ml NS.
25. Topical or local vasoconstriction
ā¢ Local vasoconstricting action- adrenaline
used as a topical application or combined
with local anaesthetic to be infiltrated.
ā¢ Prolongs its action, reduces bleeding at the
site of injection or topically (nasal mucosa
as part of Moffatās solution)
26. CONTRA-INDICATIONS
ā¢ Known hypersensitivity
ā¢ Shock (other than anaphylactic shock)
ā¢ Cardiac dilatation and insufficiency
ā¢ Hypertension
ā¢ Ischaemic heart disease
ā¢ Arrhythmias
ā¢ Cerebral arteriosclerosis
27. ā¢ Diabetes mellitusĀ·
ā¢ Hyperthyroidism
ā¢ Narrow angle (congestive) glaucoma
ā¢ Organic brain damage
ā¢ Phaeochromocytoma / thyrotoxicosis
ā¢ halogenated hydrocarbons or cyclopropane
ā¢ L.A in fingers, toes, ears, nose or genitalia
ā¢ Labour
32. VESICULAR TRANSPORT
ā¢ Between the decarboxylation and final Ī²-
oxidation, norepinephrine is transported
into synaptic vesicles.
ā¢ Accomplished by vesicular monoamine
transporter (VMAT) in the lipid bilayer.
ā¢ This transporter has equal affinity for
norepinephrine, epinephrine and
isoprenaline
34. PHARMACOKINETICS
Onset- 1-2 min
Duration- 1-2 min
Metabolism- by COMT and MAO
Distribution
ā¢ Sympathetic nervous tissue.
ā¢ Crosses the placenta not blood-brain barrier.
Excretion- mainly urine (84-96%)
35. HYPOTENSIVE STATES
ā¢ First-line therapy for maintenance of B.P
and tissue perfusion in septic shock.
ā¢ adjunct to correct hemodynamic imbalances
ā¢ Start:8-12 Āµg/min IV infusion; titrate to
effect
ā¢ Maintenance: 2-4 mcg/min IV infusion
ā¢ Septic shock: 0.01-3 mcg/kg/min IV infusion
36. Cardiac Arrest
ā¢ Adjunctive Treatment in Cardiac Arrest
ā¢ Infusions of noradrenaline given during
cardiac arrest to restore and maintain an
adequate blood pressure after an effective
heartbeat and ventilation have been
established by other means.
ā¢ Initial: 8-12 mcg/min IV infusion; titrate to
effect
ā¢ Maintenance: 2-4 mcg/min IV infusion
37. DOSAGE
ā¢ The usual dose range is 0.01-0.1 m/kg/min
ā¢ Avg. adult maintenance dosage: 2ā4 Āµg/min
ā¢ May require 8ā30 mcg/minute in cases of
refractory shock
ā¢ Drug is diluted with 5% dextrose or
dextrose normal saline
38. ā¢ administered through central venous line to
minimize the risk of extravasation and
subsequent tissue necrosis
ā¢ control rate and strict monitoring
ā¢ must not be stopped suddenly, gradually
withdrawn to avoid disastrous falls in blood
pressure
Noradrenaline infusion
39. Noradrenaline infusion
ā¢ 4mg = 4mL of 1:1000
ā¢ Add 4mL of 1:1000 Noradrenaline to 46mL
5% Glucose to make 50mL
ā¢ Starting dose- 0.025microgram/kg/minute
ā¢ the rate in mL/hour
42. Extravasation
ā¢ Infusion site-checked frequently for free flow.
ā¢ Avoid extravasation of noradrenaline
ā¢ Local necrosis -vasoconstrictive action
ā¢ Blanching- change infusion site
ā¢ Extravasation-infiltrate area ā 10 ml-15 ml
of saline solution containing 5 mg to 10 mg of
phentolamine.
