The document discusses the management of angina pectoris, or chest pain, in dental patients. The primary goals are to decrease myocardial oxygen demand and relieve symptoms. Key steps include terminating the dental procedure, positioning the patient comfortably, administering oxygen and nitroglycerin to relieve pain, and summoning emergency help if pain is not relieved within 10 minutes or for new chest pain over 2 minutes. Additional vasodilators or calcium channel blockers may also be used to reduce oxygen demand and relieve symptoms.
Medical considerations in dental treatment of patients with liver disease. Main types of liver disease, clinical manifestations, lab tests, treatment considerations.
Medical considerations in dental treatment of patients with liver disease. Main types of liver disease, clinical manifestations, lab tests, treatment considerations.
this presentation has covered all the emergency drugs its dosage and usage from a maxillofacial surgeons point of view. very helpful for pgs especially.
Angina pectoris is a syndrome characterized by sudden severe pressing substernal chest pain or heaviness radiating to the neck, jaw, back and arms.
Those drugs used to prevent, abort or terminate angina are anti angina drugs.
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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
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
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India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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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
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
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
4. Mild to moderate discomfortMANAGEMENT.<br />Step 1 : TERMINATION OF THE PROCEDURE.<br />When the patient experiences chest pain, stop all dental procedures immediately.In many instances the precipitating may be a part of the dental treatment , such as the sight of a local anesthetic syringe, scalpel, or hand piece and simply by terminating the procedure the acute episode of the chest pain ends.<br />Step 2 (position): the angina patient is conscious and usually apprehensive. Position of the patient in the most comfortable manner. Commonly this will be sitting or standing upright. The supine position is rarely preferred by the angina patient and, infact, commonly makes the pain appear subjectively more intense.<br />Step 3 A-B-C (airway-breathing-circulation). Basic life support (BLS), as needed. The angina patients is conscious ,breathing spontaneously, and has a palpable pulse in the wrist, anticubital fossa and carotid artery. <br />Step 4 : (definitive care)<br />Step 4a :administration of vasodilator and oxygen .<br />A member of the emergency team should immediately get the emergency kit and oxygen. Oxygen may be administered at any time to the angina patient. A nasal cannula or nasal hood is preferred. As soon as possible, give nitroglycerin trans mucosally (nitroligual spray) or sublingually (tablet). The patient’s own nitro glycerin supply is preferred because the dosage will be correct for the patient. The no of sprays or tablet administered is determined by patient usually requirement (0.3-0.6 mg) is the usually dosage. One or two metered sprays are recommended initially, with no more than 3 metered dozes with a 15 minute period where as sublingual nitroglycerine tablets are recommended at one tablet at every 5 minutes as needed, with no more than 3 tablets every 15 minutes .in the dental office the use of nitro lingual sprays preferred to sublingual sprays because of the relative instability of the tablets.<br />EFFECTS AND SIDEEFEECTS OF NITROGLYCERINE.<br />Nitroglycerine normally reduces or eliminates angina discomfort dramatically within 2-4 minutes. Commonly observed side effects are a fullness or pounding in the head, flushing, tachycardia, and possible hypotension . The presence of hypotension represents a contraindication.<br /> ACTION OF NITROGLYCERINE.<br />Decreases coronary artery resistance and increases coronary blood flow. The probable mechanism is its ability to produce a decrease in systematic vascular resistance through arterial and venous dilation. Thus leads to a decrease in return of venous blood to heart and a decrease in cardiac output which results in a lessened cardiac work load. A decrease in cardiac work produces a lesser oxygen requirement of the myocardium and reversal of the oxygen in sufficiency that existed during the episode.<br />Step 4b : ADMINISTRATION OF ADDITIONAL VASODILATORS IF NECESSARY.<br />If the patients nitroglycerine tablets are ineffective in terminating angina pain within 5 minutes, give a second dose either from the patients drug supply or from the emergency kit , which will be fresher than the patients. Nitroglycerin tablets lose potency unless stored in tightly packed glass containers. Nitroglycerine spray is considerably more stable than sublingual tabs. A second possible explanation for the failure of nitroglycerine to provide relief is that the episode is not due to angina, but due to ACUTE MYOCARDIAL INFARCTION.<br />Step 4c : SUMMONING OF MEDICAL ASSISTANCE.<br />The American heart association recommends that in a patient with known angina pectoris, emergency medical care be sought if chest pain is not relieved by 3 nitroglycerine tablets or spray doses over a 10-minute period. In a person with previously unrecognized coronary disease, the persistence of chest pain for 2 minutes or longer is an indication for emergency medical assistance.<br />USE OF AMYL NITRATE.<br />Amyl nitrate is available in 0.3ml ampules, which are then crushed and inhaledthe patient should be in the supine position. It is used when the angina episode is severe and unrelieved by nitroglycerine and unless the patient has high BP .<br />EFFECTS AND SIDE EFFECTS OF CALCIUM SLOW CHANNEL BLOCKERS.<br />Patients known to have coronary artery spasm as a component of their angina episodes usually respond well to the administration of nifidipine (10-20mg) sublingually.<br />Nifedipine, verapamil & diltiazem are calcium channel blockers. Verapamil is the most important one.<br />By blocking calcium influx & supply to the myocardial contractile mechanism , verapamil exerts a direct depressant effect on the ionotropic state & therefore on the myocardial oxygen requirement. It also reduces contractile tone on in vascular smooth muscle , which results in coronary and peripheral vasodilation, which inturn reduces systemic vascular resistance.<br />Pain relieving opioids such as morphine & meperidine (Demerol) should not be used because they donot treat the cause of pain .<br />STEP 5 : MODIFICATION OF FURTHER DENTAL THERAPY .<br />Dental treatment may resume at any time(immediately if necessary) after cessation of the acute angina episode . permit the patient to rest until he/she is comfortable before resuming dental care or discharge.monitor and record vital signs before discharging the patient. The patient may be permitted to leave the office unescorted &operate a motor vehicle or do some activity. If the doubt persist about the recovery, seek medical assistance. <br />PATIENT WITH NO HISTORY OF CHEST PAIN<br />When no prior history of chest pain is present, but the patient experiences chest pain during dental treatment, the steps of angina management discussed earlier are appropriate, with the exception that medical assistance be sought immediately even before the administration of nitroglycerin & oxygen.<br />TERMINATE THE DENTAL PROCEDUREP-POSITION PATIENT COMFORTABLY A-B-C- ASSESS AND PERFORM BLS AS NEEDEDD- INITIATE DEFINITE CARE. H/O ANGINA NO H/O ANGINA (ADMINISTER ( SUMMON EMERGENCY NITROGLYCERINE) MEDICAL ASSISTANCE) ADMINISTER OXYGEN ADMINISTER OXYGEN PAIN RESOLVES ADMINISTER NITROGLYCERINE (MODIFY FUTURE DENTAL CARE) MONITOR VITAL SIGNS(IF NO RESPONE, OR IF PAIN RESOLVES,BUT RETURNS ). SUNMMON EMERGENCY MEDICAL ASSISTANCE.ADMINISTER FIBRINOLYSIS( ASPIRIN)MONITOR AND RECORD VITAL SIGNS <br />MANAGEMENT OF CHEST PAIN WITH HISTORY OF ANGINA PECTORIS<br />