The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
A nasopharyngeal airway, also known as an NPA, nasal trumpet (because of its flared end), or nose hose, is a type of airway adjunct, a tube that is designed to be inserted into the nasal passageway to secure an open airway
a complete slide of endotracheal intubation for mbbs students and students of other medical background. the refrence is from uptodate.com and short text book of anaesthesia by Ajay yadav, 5th edition.
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
A nasopharyngeal airway, also known as an NPA, nasal trumpet (because of its flared end), or nose hose, is a type of airway adjunct, a tube that is designed to be inserted into the nasal passageway to secure an open airway
a complete slide of endotracheal intubation for mbbs students and students of other medical background. the refrence is from uptodate.com and short text book of anaesthesia by Ajay yadav, 5th edition.
The insertion of a cannula or a tube into a hollow organ such as intestines or trachea, to maintain an opening or passageway is known as intubation.
The insertion of a long breathing tube or artificial airway (endotracheal tube - ETT) into the trachea (windpipe) via the mouth is called endotracheal intubation
A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide.
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
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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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
- 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
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
4. Cylinders
• Constructed from Molybdenum
• Colour coded according to gas supplied
• Safety – Pin index system
– Oxygen
– Nitrous oxide
– Pipe line gas supply
6. Oxygen
• In the form of gas – 130 bars
• Pressure gauge is there
• Outlet valve can only connect the O 2
cylinder to the machine
• Alarm – when O2 is depleting
7. Nitrous oxide
• Liquid form – pressure 51 bars until the
liquid vaporizes
• Heat vaporization
• Pressure gauge – doesn’t indicate the
measure of contents
• Blue color cylinder
8. Pipe line gas supply
• All gases in liquid form – economical
• Pressure 4 bars
• Identification – gas name, color code,
shape
• Convenient
10. Flow meters
• Tapered glass tubes contains Spinning bobbins
• Calibrated for a specific gas
Vaporizers
• Vaporizes inhalational anesthetics in liquid form
at room T
• Calibrated for a specific inhalational agent
11. Breathing systems
• Delivers anaesthetic gases & oxygen to
the patient & removes CO2
– Magill circuit
– T-piece (Paediatric circuit)
– Bain circuit
– Circle circuit – commonly used
12. Mapleson classification
• Mapleson system A
•
•
– Magill system – most
satisfactory with
spontaneous respiration
Mapleson system B – not
common
Mapleson system C – not
common
– Water’s system
• Mapleson system D
– Bain co-axial system
• Mapleson system E
– Ayre’s T piece – paediatric
use
• Efficiency of systems with
spontaneous respiration
A > D, E > C > B
• Efficiency of systems with
IPPV
D, E > B > C > A
• Most important closed
circle or low flow system
– Rebreathing system
Refer more on Circle system
13. Ventilator circuit – circle circuit
Re breathing system
Sodalime is needed to
absorb CO2 from exhaled
gas
Low fresh gas flows
Economical
Less theater pollution
Humidification is better
Valves – not ideal for
pediatric use
Heavy
14. Bain circuit
Coaxial system –
inspiratory limb inside
& outer expiratory limb
Used both in
spontaneous &
controlled ventilation
Scavenging gases is
easy
Reservoir bag – 2 L
15. Pediatric – T-Piece
No valves no resistance
to respiration
Fresh gas flow should be
twice the minute volume
Reservoir bag fixed on
the open end – for
controlled ventilation
See different breathing circuits identify according to MAPLESON classification
16. Sodalime
• Used with circle circuit – re-breathing systems
• Calcium hydroxide(94%)Na(5%) & K(1%)
hydroxides
• Absorbs CO2 – color change when it becomes
inactive
Facemasks
• Rubber or plastic
• Transparent ones show vomitus &
secretions
18. Setting up a simple ventilator
• Connect the gas supply – usually N2O(66%)
O2(33%) air…
• Connect the outlet to the breathing circuit
• Select the,
– Tidal volume – 7-10ml/kg
– Respiratory rate -12-16/min
– Inspiration : expiration ratio (usually 1:2)
• Keep upper airway pressure 10-20 cmH2O
• Negative upper airway pressure means patient
is voluntarily breathing
19. Oxygen mask
Look how this is connected to gas supply & to
ambu bag
What happens if
connection to ambu
bag is lost?
20. Ambu bag
Ideal valve should have
No foreward leak
No backward leak
Low resistance
Minimal dead space
Self inflating bag
Light weight
Reservoir bag – 100% O2
Minimal opening pressure without
sticking
Valves –
Transparency
1.Prevent forward leak
Reliability & durability
2.Prevent backward leak
3.Expiratory
4.Inspiratory
5. Pressure releasing >40mmHg
21. Face mask
Triple manure
1. Head tilt
2. Extended to straiten the airway &
prevent tongue falling back
3. Jaw thrust
Why DENITRATION is important?
To increase the % of O2 in alveoli before
intubation
This enables enough time to intubate
22. Face Masks
NOTE : How face mask is
held preventing air leak
Practice Triple Maneuver
23. Air ways
• Air way maintenance by displacing the
tongue from posterior pharynx
• Oro-pharygeal airway
• Nasal airway – when unable to open the
mouth & in oral surgeries
• Paediatric & adult types
Dotted
Color coding
25. Nasal airway
What are the contraindications for nasal intubation?
What are the complications of nasal intubation?
Note : Why gauze
pack is put into the
oral cavity in nasal
intubation?
26. Laryngeal mask airways
• Short tube with a elliptical cuff
• Placed in the laryngopharynx behind the inlet
• Can avoid muscle relaxants no haemodynamic
response like in ET tube
• Relieves hypoxia in failed intubation
• Blind intubation through mask is possible
• Risk of regurgitation is there
• Alternative to face mask
• Needs minimum skills
Learn the procedure of putting
laryngeal mask
27. Laryngoscope
Curved blade – Macintosh
Straight blade – Magill (for children)
Battery in the handle – check
whether the bulb is working before
use
Use with the left hand
Put it in from the right side
Groove in the left side of the blade is
for to keep the tongue apart & lifted
What are the uses of
laryngoscope?
Macintosh laryngoscope – curved blade
28. Endotracheal tube - cuffed
How to describe a
endotracheal tube?
Cuffed or not
Internal diameter
Main parts – from above
downwards
1.Universal airway
connector
2.Tube
3. Radio opaque line
7.Murfy’s eye
8. Black lines 2
Use of each part &
there importance
4. Pilot tube
5.Pilot inflator bag
6.Cuff type – high P/ low
V or low P / high V
What are the uses of flexible &
reinforced tubes?
What is RAE tube?
29. Importance
• Universal airway
connector
– external diameter is same
in every tube (15mm)
• Tube- internal diameter
– female – 7.0 to 8.0 mm
– male 8.0 to 10.0 mm
• Radio opaque line
– identify it radiologically
• Pilot tube
– to inflate the cuff
• Inflating bag – 5ml
• Cuff
– High pressure / low volume
– high risk of aspiration &
pressure necrosis
– Low pressure / high volume
– vise versa
• Two black lines
– vocal cords should be in
between – risk of damage
is reduced
• Murfy’s eye
– to keep patancy when
secretions block the tube
– To keep the patancy of the
upper right bronchus
30. Endotracheal tube – plain/non
cuffed
Indications for ET tubes
1.When muscle relaxants given
2.In patients with risk of aspiration
3.To provide controlled ventilation
4.For prolong operations
Why non-cuffed is preferred in children?
Their narrowest place is at cricoid. tube fits nicely.
31. Endotracheal tubes
•
What is I.T. on tube?
– Implantation test for allergies has been done.
•
What is the importance of reinforced tube?
– It is not liable to kink – in oral surgeries
•
What are the indications of Proper Intubation?
1. Feels expired air touching the dorsal surface of hand
when it is neared to the airway connector
2. See vapor in the tube
3. Hold a piece of thread near the opening – it will
move
4. Positive capnogram on monitor
32. Tracheostomy tube
Sized according to the internal
diameter
Cuffed or uncuffed
Introducer is available
Winged flange to secured to
skin
Indications
1.In ICU patients who needs
prolong intubation
2.Vocal cord palsy
3.OP poisoning
4.Oropharyngeal laryngeal
carcinomas
5. Chemical burns
6. Gillian Bare syndrome .. etc
33. Complications of tracheostomy
1. Early :
•
•
•
•
•
•
•
•
2. Late :
Haemorrhage
• Infection
Displacement or
• Tracheal ulceration
obstruction
• Tracheal dilatation
Injury to trachea
• Tracheal stenosis
Tracheitis
• Cardiovascular
Crust formation
collapse
Surgical emphysema
Difficult insertion
pneumothorax
34. After care of tracheostomy
•
Position the patient
– Adults – propped up
– Children – chin should not occlude
•
Suction – clean catheter used
– Deep suction + physiotherapy or ventilation – in unconcious
•
Humidification
– Prevent drying & formation of crusts
– Wet guaze in the opening
•
Tube changing
–
–
–
–
•
•
2-3 days
Silver tubes – remove inner tube & clean
Cuffed tubes – regular deflation to prevent pressure necrosis
Air – minimum to prevent air leak
Pain management
Management of hemorrhage
35. Intravenous fluid set
Priming an IV line
1.Take out from the pack – mark
to scratch in the packet
2.Clamp it
3.Never touch the connector
4.Open the cap of fluid bottle &
connect the line
5.Open the line till half of the
syringe fills
6.Open fully & allow fluid to come
out – to assure no air bubbles
inside
Risks
7.Connect to the cannula
Septicemia
Air embolism
36. I.V.Cannula
Gauges – color code
Orange 14G
Ash 16G
White 17G
Green 18G
Pink 20G
Blue 22G
Yellow 24G
(Spinal needle – 25Gfrench grading)
Demonstrate how IV cannulation is done discuss importance of each step
38. Syringe pumps
• Electrically driven – battery back-up is there
• Alerts provided for
– Power failure
– Empty syringe
– Occlusion of delivery pipe
• Applications
–
–
–
–
–
–
Pain relief
Total IV anaesthesia
Sedation in intensive care
CVS support
Relaxants
Control of diabetes
39. Dose calculation for syringe pump
•
•
•
•
Dobutamine solution – 200mg in 500ml
Dose – eg: 2.0μg / kg / min
Body weight of the patient – eg: 50kg
So, amount of mg per hour
= 2.0 μg × 50kg × 60 = 6mg
1000
• Amount of solution needed per hour
= 500ml × 6mg = 15ml / hour
200mg
• So the infusion rate = 3.8 per minute
40. Magill’s forceps
Guide the ET tube into larynx –
in nasal intubation
Guide the nasogastric tube into
oesophagus
See how this is held?
41. Blood transfusion set
Normal blood amount
Adult male – 70ml / kg
Adult female – 60ml / kg
Child – 80ml / kg
Discuss how blood loss is
assessed in theatre?
Discuss management of
hemorrhagic shock?
Learn the appropriate use of three way tap
44. CVP Manometer
Measure,
Adequacy of blood or fluid
replacement
Easy & rapid transfusion of blood
Normal – 3 to 10 cmH2O
Low CVP
1.Hypovolemia
2.Septic shock
High CVP
1.Heart failure
2.Increased intra thoracic pressure
– IPPV, PEEP pneumothorax
3.Ovetransfusion
4.Constrictive pericarditis
5.Pulmonary vasoconstriction
45. Central Venous Pressure
• >50% of the total blood volume is in venous
system – alteration in venous tone play a large
part in regulation of hemodynamics
• Zero at mid axillary line
• Normal – 3 to 10 cmH2O
• Complications
–
–
–
–
–
–
–
–
Thromboplebitis, infection, septicemia
Pneumothorax, haemothorax, hydrothorax
Bracheal plexus injury
Air embolus
Pericardial effusion
Lymphatic leakage
Arrhythmias
Catheter breaking
50. Spinal needle
Whitacre spinal needle - 25G
Commonly used
Subarachnoid anaesthesia
1. Take the consent
2. Look for contraindications
1. CNS lesions – ideally full CNS examination
should be done
2. Sepsis around the area of pricking
3. Any coagulopathies
3. Sterile procedure
55. Nasogastric tube
Indications
1. Aspiration of gastric juices for
the diagnostic & therapeutic
purposes
2. Confirmation of gastroduodenal
hemorrhage
3. Feeding
Confirmation of it’s presence in
the stomach
1.Syringing the air down the tube
while listening over epigastrium
2.Suck the tube to see juices are
coming
3.Vapour inside in accidental
tracheal intubation
59. I.V.Cannula
Why do you tap to find
appropriate vein for
canulation?
Why veins in the periphery
are selected first?
What should be done if
peripheral veins are not
visible?
When do you use low
grade cannulae for adults?
What are the
complications?
Why anti-cubital fossa is
not selected as a good site
for cannulation?