Airway tutorial
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This document discusses endotracheal tubes, their uses, types, and properties. It covers the parts of endotracheal tubes, indications for intubation, proper insertion depth and confirmation. Several types of endotracheal tubes are described, including standard tubes, armored tubes, and laser-resistant tubes. The advantages and disadvantages of different tube types are provided. The document also discusses a specialized pediatric endotracheal tube called the Microcuff tube and its benefits over conventional tubes for sealing pediatric airways.
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Over the years various materials referred to as ‘Intra-orifice barriers’ have been sought by investigators to prevent coronal micro leakage & help produce a secondary seal for obturated canal. Thus along with time many sealing material for coronal sealing was tested. This also implies that an adequate coronal filling or restoration be placed to prevent oral bacterial microleakage. It has been shown that endodontic treatment success is dependent both on the quality of the obturation and the final restoration.1
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The ultimate goal of root canal therapy is to conquer the complex root canal system by perfect obturation. The primary objectives of operative endodontics are total debridement of the pulpal space, development of a fluid–tight seal at the apical foramen and total obturation of the root canal. Earlier, root canals have been reported to be filled with Amalgam, Asbestos, Balsam, Bamboo, Cement, Copper, Gold Foil, Iron, Lead, OxyChloride of Zinc, Paraffin, Pastes, Plaster of Paris, Resin, Rubber, Silverpoints, Tin foil etc., Among all these materials tried, none of them met the requirements of an ideal obturating material.
Even after a three dimensional obturation of the system, coronal restoration may fail to provide a perfect seal and may permit microorganism & their toxins along the canal walls to their periapical tissue, leading to the failure of the treatment. So the quality of the coronal seal should be adequate to prevent micro leakage in to the canal space.Thus the concept of double seal came . Lack of satisfactory temporary restoration during endodontic therapy ranked second amongst the contributing factors in continuing pain after commencement of treatment.
Over the years various materials referred to as ‘Intra-orifice barriers’ have been sought by investigators to prevent coronal micro leakage & help produce a secondary seal for obturated canal. Thus along with time many sealing material for coronal sealing was tested. This also implies that an adequate coronal filling or restoration be placed to prevent oral bacterial microleakage. It has been shown that endodontic treatment success is dependent both on the quality of the obturation and the final restoration.1
Definition:
A DOUBLE seal consisting of gutta percha underneath material such as temporary cement ; used to close the coronal opening in a tooth during endodontic treatment. A DOUBLE seal consisting of gutta percha underneath material such as temporary cement ; used to close the coronal opening in a tooth during endodontic treatment.
• Many materials can be used to achieve some of these goals for effective inter-
appointment temporization. It is essential to have adequate knowledge of temporization techniques and material properties in order to satisfy a wide variety of clinical requirements such as time , occlusal load and wear ,complexity of access and absence of tooth structure.
Coronal 3-4 mm should be left for the placement of this double seal.
PCI guidewires
1) Guidewire technology has advanced significantly with a wide selection for different lesion characteristics and vessel anatomies.
2) Guidewires consist of a core material, taper, tip style, coils, and various coatings which determine properties like flexibility and trackability.
3) The choice of guidewire depends on factors like vessel anatomy, lesion morphology, and the intended procedure or device. Workhorse wires are preferred for simple lesions while more complex cases require dedicated wires.
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The document discusses coronary guidewires, which are used to access and cross coronary lesions during angioplasty procedures. It provides a brief history of angioplasty and guidewire development. The key components and characteristics of guidewires are described in detail, including core material, tapering, tip design, coil placement, covers, coatings, and how these influence flexibility, torque, and other performance factors. Common guidewire classifications and specific guidewire models are also mentioned along with guidance on optimal guidewire positioning and potential complications.
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Double seal in endodontics and conservative dentistry
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This document discusses different oxygen therapy techniques including conventional oxygen therapy and high flow nasal cannula (HFNC) oxygen therapy. It provides details on:
- How HFNC works by using an air/oxygen blender to deliver high flows of humidified oxygen at variable concentrations.
- The physiologic effects of HFNC including improved oxygen delivery to the alveoli and prevention of adverse effects from lack of humidification.
- Techniques called THRIVE and STRIVE-Hi that use HFNC to provide apneic oxygenation and tubeless anesthesia, extending the time available to secure an airway without risk of hypoxemia.
Hemolytic transfusion reaction
Hemolytic transfusion reactions (HTR) are adverse reactions to blood transfusions that can range from subclinical to lethal. They occur when a patient receives incompatible red blood cells and their immune system mounts an immune response that destroys the transfused red blood cells. The summary discusses preventive strategies like electronic verification systems and protocols to avoid incompatible transfusions, as well as treatments for different types of reactions like acute HTR, delayed HTR, and passenger lymphocyte syndrome in transplant recipients. Effective prevention and management requires understanding the pathophysiology and risk factors for different transfusion reactions.
Difficult airway guidelines paeds
1) The document provides guidelines for managing difficult airways in pediatrics, outlining a 3-step approach including laryngoscopy and intubation, use of a supraglottic airway device, and emergency surgical access if ventilation fails.
2) It discusses the anatomical and physiological differences between children and adults that increase airway management challenges in pediatrics.
3) Adjuvants like video laryngoscopy, passive oxygenation, and ultrasound guidance are reviewed as tools that can help extend the safe apnea time and improve visualization or placement of airway devices in children.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
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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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Dehradun #ℂall #gIRLS Oyo Hotel 8107221448 #ℂall #gIRL in Dehradun
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Cell Therapy Expansion and Challenges in Autoimmune Disease
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
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- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeProf. Marcus Renato de Carvalho
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
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Airway tutorial
- 2. • • • • •
- 4. IDENTIFY PARTS RELEVANT HISTORY TYPES/CLASSIFICATION USES SOAP ME CONFIRMATION CUFFS ENDOTRACHEAL SUCTION PROTOCOL FORMULA FOR SIZE & DEPTH
- 7. PRESSURE MANOMETER MURPHYS EYE / BEVEL
- 8. ET TUBE TIP / CUFF INDUCATIONS OF INTUBATION
- 9. Contraindications to intubaton Depth of insertion
- 10. • • • • •
- 12. • • • • •
- 15. In contrast to ‘standard’ ET tubes, the tube connector of armored tubes is firmly fixed to the tube shaft and not detachable. The fact that armored tubes are 'bendier' and therefore not as well pre-formed as standard tubes means they are more likely to require a stylet for successful intubation since they don't keep their curved shape quite as well The metal wire coil does not make armored/ reinforced ET tubes laser-proof!
- 17. Laser Hazards 1. Atmospheric Contamination 2. Perforation of Vessel or structure 3. Embolism 4. Inappropriate energy transfer
- 18. Types: 1. Norton tube 2. Mallinckrodt laser tube 3. Xomed laser shield II Tube 4. Bivona Fome Cuff laser Tube 5. Metal Tubes 6. Wrapped standard tubes Advantages: 1. Metal components are noninflammable. 2. The tube maintains its shape during intubation and is kink resistant. 3. The proximal cuff serves as a shield for the distal tracheal cuff. Disadvantages: 1. Although metal may reflect the laser onto non- targeted tissues and result in damage, the matte finish and convexity of this product reduce this potential. 2. The cuffed model contains materials which are flammable and requires that the cuff be inflated with saline to decrease the risk of ignition. 3. Metal tubes are thick walled. 4. The double cuff takes more time to inflate and deflate than a single cuff. 5. Metal may transfer heat to adjacent tissue and other materials.
- 20. MICROCUFF Pediatric Endotracheal Tubes • Reducing tracheal trauma and providing a sealed airway that allows minimal and low flow anesthesia use. • Its short and cylindrical cuff membrane compensates for different sized and shaped pediatric airways, reducing the need for replacing oversized tracheal tubes, and resulting in lower re-intubation rates. • Designed for ideal anatomical cuff placement • Advanced micro thin polyurethane material (10 microns) permits a true high volume, low pressure (HVLP) cuff, effectively sealing at an average of 11 cm H20 about half the pressure of conventional tubes • Anatomically-based intubation depth mark results in correct placement and a cuff-free subglottic zone2 • Precision bands facilitate and confirm optimal tube placement • Seal with a cuff membrane in the trachea, instead of rigid tube shaft in the cricoid • Reduced risk of aspiration of blood and secretions due to improved seal • Sealing with a cuff compensates for different sized and shaped airways
- 25. • • • •
- 29. •
- 30. •