The document discusses various aspects of medical gas cylinders and piped gas systems. It describes the parts of a cylinder including the body, valve, and pressure relief devices. It discusses safe handling practices like color coding, markings, and precautions during use. Hazards associated with cylinders are also summarized. The document then provides an overview of piped medical gas systems including the primary components, pressures, and terminal units where gases are delivered.
Anaesthesia Workstation for Residents.
With High pressure, Mid and low pressure workstation.
Explaining the Gas delivery with respect to safety features of the machine.
Oxygen concentrator-Applications and Maintenanceshashi sinha
Oxygen Concentrator is a Medical Device used to produce Oxygen from Compressed Air . An oxygen concentrator takes in air and separates the oxygen and delivers it into a person via a nasal cannula. Air is 79% nitrogen and 21% oxygen and a concentrator that works by plugging into a source of electricity delivers air that is upto 95% oxygen. The Technology is known as Pressure Swing Adsorption technology or PSA Technology.
About the newer drugs in anaesthesia. What are the problems with the existing drugs? Which all drugs failed commercially? And why? Which are the newer drugs in anaesthesia?
important points regarding ICU psychosis, role of dexmedetomidine in it's treatment, mortality associated with delirium, symptomatic and definitive management
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
- 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
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!
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
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
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
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
1. DR UNNIKRISHNAN P
SENIOR RESIDENT
NEUROANAESTHESIA
SCTIMST,TRIVANDRUM
2. Mr Cylinder
I am a supply tank containing high pressure gas or
gas mixture @ a pressure that can be in excess of
2000psig
3. We should know how we measure
pressure
Psi = pounds per square inch
Psig = pounds per square inch gauge
Difference between measured pressure and surrounding atm
pressure
Psia = pounds per square inch absolute
Based on a reference point of ‘0’ pressure=perfect vacuum
Psia = psig + local atm pressure
4. What does the cylinder contain?
[1]nonliquefied compressed gas.it doesnt liquify @
ordinary temp & pressures <2500psig
E.g. O2,N2,air,Helium
[2]liquefied compressed gas becomes liquid in
ordinary temp & pressures from 25-2500psig
E.g. nitrous oxide,CO2
5. Also note that…
100 kPa=1000mbar=760mm of Hg=1030cm of
H2O=14.7psi=1atmosphere
6. What is Critical Temperature?
It is the temperature above which a gas cant be
liquified, no matter how much pressure is applied;
O2--119 C [so it is a gas in room temp]
N2O36.5 C [so it is a gas+liquid mixture@room
temp;if temp >36.5,then it exist only as gas]
10. Valve-Port /Stem/Seat
Point of exit of gas
Take care
Im not the conical depression and I dont like the
retaining screw.
Stem closes the valve by sealing against the seat
11. Packed Valve
Stem sealed by Teflon
Turning the stem causes the seat to turn
So called Direct acting
Withstand high pressures
Opened by 2-3 full turnes
12. Diaphragm valve
Stem is separated from seat
Turning the stem moves a metal diaphragm against
the opposing force of a spring acting on seat
Can be opened by 1/2 to 3/4 turns
Less likely to leak
13. Pressure Relief Device
Vent the contents into atmosphere if pressure
inside increases to dangerous level
RUPTURE DISC: when pressure increases above
a specific level due to high temperature or
overfilling ;it rupturesrelease contents
FUSIBLE PLUG:when temperature increases
above ‘Yield temperature’ it melts
14. Pressure Relief Valve
Dont confuse with others
I am a reclosing device and prevent discharge of
contents after normal pressures have been restored
More susceptible to leakage
16. PIN INDEX SAFETY SYSTEM
Used on cylinders AE
Holes on the valve positioned in an arc below the
outlet port
Pins on the yoke or regulator are positione to fit
these holes
If both are not aligned, port wont seat
18. PRECAUTIONS
Must be tested at least every 5 years
Pressure in a filled cylinder @ 70⁰F cylinder may
not exceed the service pressure marked on the
cylinder [O2,He,He-O2,CO2-O2 are allowed
additional 10%]
19. COLOUR CODING
L
Oxygen White shoulder/Black
body
Nitrous oxide Light blue
Medical air Black and white
Suction Yellow
Nitrogen Black
Carbon dioxide Grey
Helium Brown
20. MARKINGS
DOT/TC specification number
Service pressure in psi
Serial number
Identifying symbol of the purchaser,user or
manufacturer
Initial qualifying test date
Retest date
5 pointed star after last test date=may be retested every
10 instead of 5 years
‘+’ after test date = cylinder can be charged upto 10%
in excess
23. RULES FOR SAFE USE OF
CYLINDERS
Handled only by trained staff
Keep away oils,rubber and other combustible
substances
Never expose to >52⁰C
keep all connections tight
Take care to avoid obstructions to discharge ports
24. RULES FOR SAFE USE OF
CYLINDERS
Never interchange parts of cylinder used for one
gas with other
No adapters please…
Keep the valve closed when not in use
Valve is most prone for damage
No alterations
Dont use as a roller
Avoid electric contact
25. RULES FOR SAFE USE OF
CYLINDERS
Dont drag me..
Take precautions to prevent falling
Remove wrappings before taking into OT
Storage:cool,clean room with adequate ventilation
Secure,safe place. Protect against all extreme
things!
26. RULES FOR SAFE USE OF
CYLINDERS
NO SMOKING
NO OPEN FLAMES
NO OIL OR GREASE
27. RULES FOR SAFE USE OF
CYLINDERS
Small cylinders best stored upright
Dont drape with any material during storage
Should be grouped by contents or sizes
Good segregation between empty and full
Flammable gases should not be stored in an
enclosure containing oxidizing gases
28. RULES FOR SAFE USE OF
CYLINDERS
Identify contents by label; Check for DOT
Immediately before fitting, remove the protective
cover
Pressure reducing regulators always used; inspect
them for any damage before connecting
Remove dust and foreign bodies
29. RULES FOR SAFE USE OF
CYLINDERS
CRACKING—reduces possibility of flash fire
A sealing washer in good condition should be used
Valve should be opened before bringing the
apparatus to the patient. Flow control valve should
be closed before the cylinder valve is opened
While opening, stand to the side; not in front or
back
Quick opening can generate heatflame
30. RULES FOR SAFE USE OF
CYLINDERS
After opening the cylinder, check the pressure
Hissing sound= leak tightenstill leak replace
washer. Localize leak with soap water.
If leak in valve itself,tighten the packing nut by
turning it in a clockwise direction
Even if no hissing sound, check for loss of
pressure when no gas is being used
Valve should be fully open when in use
31. RULES FOR SAFE USE OF
CYLINDERS
An empty or near empty cylinder shouldnt be left
on anaesthesia machine
Valve should be closed before removing from a
regulator or yoke
Lower part of the tag removed when cylinder is
empty
Caps replaced before shipment
33. MEDICAL GAS PIPELINE
SYSTEMS
Central supply
Pipings extending to target locations
Terminal units
34. RULES FOR SAFE USE OF
CYLINDERS
The maximum amount of oxygen that can be
stored inside a health care facility is 20000 cubic ft
35. Design
2 banks of cylinders
Each have its on pressure reducing regulator
Must contain a min of two cylinders
Connected to a common manifold[header]
Check valve in between each cylinder lead &
header
37. PRIMARY/SECONDARY
SUPPLY
Primary supply [duty/running] actually is the
portion supplying the system
Secondary supply automatically becomes the
primary, when the latter fails [switch over done by
manifold change over device]
Operating supply is the portion which normally
supplies the piping system [ consists either a
primary OR primary+secondary supply ]
38. Reserve Supply
For larger systems
When operating supply fails /emergencies
/maintenance
Activating switch is there for activating reserve
supply
40. Oxygen
Stored as liquid @ low pressures & < --148⁰C[when
large amounts are required] OR
as compressed gas in G or H cylinders
41. Nitrous oxide
Be careful against leaks; its an asphyxiant
Regulator can become cold and can freeze
theft
42. Medical Air
Air that has no detectable liquid
hydrocarbons, less than 25 ppm gaseous
hydrocarbons,less than 5 mg/m3 of particulates of
1 micron size or greater @ normal atmospheric
pressure and a dew point @ 50 psig of less than
4⁰C
Low levels of nitric oxide found in ambient air may
improve oxygenation in ventilated patients
44. INTAKE
Intake location should be free of dirt/fumes
Quality checked periodically
Water content reduced with after cooler/dryer
Monitored for carbon monoxide
N.B. Other gases: CO2, Nitrogen
45. PIPED DISTRIBUTION
SYSTEM
MAIN LINES: pipes connecting the source to
risers or branch lines or both
RISERS: vertical pipes connecting the main line
with branch lines on various levels of the facility
BRANCH LINES: they service a room or group
of rooms on the same level of the facility
Flexible hoses used only in exposed areas..Why?
46. PIPED DISTRIBUTION
SYSTEM
Pressure relief valves set @50% above the normal
line pressure. Close automatically when excess
pressure relieved
Shut off valves isolate areas of the system in the
event of a problem and allows for repair.
[1]Manual @ accessible areas installed in boxes
[2]Service: only for authorized personnel
Emergency Oxygen Supply Connector: T fitting
for connecting auxiliary source of O2
47. PIPED DISTRIBUTION
SYSTEM
Master Alarm System: monitor the pressure in the
main line
When switch over from primary to secondary
supply
When reserve supply is reduced to a certain level
When reserve is below that is required to function
When pressure in main line increase or decrease
Area Alarm Systems: e.g. PACU,ICUs
48. TERMINAL UNITS
BASE BLOCK
PRIMARY VALVE: open when male probe
connected & close when detached
SECONDARY VALVE: shut off flow when
primary valve is removed
GAS SPECIFIC CONNECTION POINT /
SOCKET ASSEMBLY
49. TERMINAL UNITS
GAS SPECIFIC CONNECTION POINT /
SOCKET ASSEMBLY
Connecter may be DISS/ Quick Connector
Equipped with a backflow check valve
Quick Connector easy to use; but leak more
51. HOSES
connect anaesthesia machine to terminal units
each have a permanaent non interchangable
connector
Inlet & outlet connectors
Braid adds to strength
52. TESTING OF MEDICAL GAS
DISTRIBUTION SYSTEM -INITIAL
blow down
Initial pressure testing
Standing pressure test
Piping purge test
Test for cross connections
53. TESTING OF MEDICAL GAS
DISTRIBUTION SYSTEM-SYSTEM
VERIFICATION
Cross connection test
Test of values
Outlet flow test
Alarm testing
Piping purge test
Piping purity test
Final Tie-in test
Operational pressure test
Medical gas concentration/air purity test
Source equipment verification