This document discusses several cases of respiratory distress in newborns. The key information provided includes potential causes of respiratory distress like respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), transient tachypnea of newborn (TTN), and persistent pulmonary hypertension of the newborn (PPHN). It also outlines the approach to evaluating a newborn with respiratory distress, including assessing risk factors, clinical examination findings, and initial investigations like chest x-ray and blood gas analysis. Management strategies like oxygen therapy, respiratory support, and surfactant administration are also summarized.
This presentation deals with the basic physics of human ventillation. I have made an effort to clarify most of the venti lingo , so as to make way for further discussions on ventilator use. Hope it turns out to be helpful for you. Thank you.
This presentation deals with the basic physics of human ventillation. I have made an effort to clarify most of the venti lingo , so as to make way for further discussions on ventilator use. Hope it turns out to be helpful for you. Thank you.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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.
- 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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. CASE 1
•B/O A
•1st issue
•Antenatal history -uneventful
•Term, Born by LSCS , meconium stained
liquor, CIAB ,shifted mother side
•12 hrs later developed tachypnea, so
shifted to NICU ,Required ventilation
•Spo2 rt upper limb 96, rt lower limb 89
5. CASE 2
Primi, Full term, 2.9 kg, Male child,
delivered by vaginal route
Cried immediately
Had respiratory distress & grunt
since birth
registered pregnancy
H/O poly-hydroamnios
No any drug history or any other
illness
6. On admission:
HR 168/min,RR 58/min,SPO2 92%
on room air,CRT 4sec
R/S:
shape:asymmetrical,
hyperinflsted
Air entry diminshed on Lt side,
Mediastinum shifted on Rt side
P/A: scaphoid
8. CASE 3
33 wks,2.2 kg, male child deliverd by
LSCS(ivo dimished fetal activity and
fetal bradycardia)
Cried immediately
Had respiratory distress and grunt
9. On examination……
HR 165/min
RR 60/min
CRT 3sec
spo2 85% with NPO2 2 ltr/min
PP well felt
R/S: b/L air entry diminished
Grunting +nt, subcostal
retraction +nt
CVS :normal
CNS: normal
14. CASE 4
Primi,Full term, 2.3 kg, Male
child,delivered by vaginal route in
Govt. hospital
Cried immediately
Had respiratory distress & grunt after
30 minutes of life
16. On Examination…….
HR 175/min
RR 60/min
CRT 3sec
spo2 90% with NPO2 2 ltr/min
PP low volume,+nt on all 4 limbs
Fine white froathy bubbles of mucus
present(+nt) in mouth
17. R/S:
B/L air entry diminshed
B/L crepitation +nt,grunting +nt
subcostal retraction +nt
CVS:
S1 S2 heard,no murmer
P/A:
soft,but no gastric sounds on
auscultation
19. CASE 5
•antenatal history uneventful
•Born by lscs
•Did not cry after birth
•Required suction stimulation, bag and
mask ventilation for 1.30 min, then
improved.
•Shifted to nicu
•o/e : HR- 100/min, RR-80/min, grunting
present, air entry normal
•Inv – ph-7.12, pco2- 20, Pa02-130,
hco3- 10
20. Respiratory distress
• Cause of significant morbidity and
mortality
• Incidence 4 to 6% of live births
• Many are preventable
• Early recognition, timely referral,
appropriate treatment essential
22. Pathophysiology considerations
unique to the newborn
Prolonged and unattended distress
leads to hypoxemia, hypercarbia and
acidosis. This leads to pulmonary
vasoconstriction and persistence of
fetal circulation with right to left
shunting through the ductus and
foramen ovale , thereby aggravating
hypoxemia.
23. Causes of respiratory distress -
Medical
• Respiratory distress syndrome (RDS)
• Meconium aspiration syndrome (MAS)
• Transient tachypnoea of newborn (TTNB)
• Asphyxial lung disease
• Pneumonia- Congenital, aspiration, nosocomial
• Persistent pulmonary hypertension (PPHN)
• Cardiac: Congenital heart disease, Ductus dependant
lesions, PDA of prematurity,
• Metabolic: Acidosis, hypoglycemia, polycythemia, anemia
• Shock due to any cause
25. Approach to respiratory distress
History
• Onset of distress
• Gestation
• Predisposing factors- PROM, fever
• Meconium stained amniotic fluid
• Asphyxia
26. Approach to respiratory distress
Examination
• Severity of respiratory
distress
• Neurological status
• Blood pressure, CFT
• Hepatomegaly
• Cyanosis
• Features of sepsis
• Look for malformations
28. Suspect surgical cause
• Obvious malformation
• Scaphoid abdomen
• Frothing
• History of aspiration
29. Were there any risk factors in the antepartum
period or evidence of foetal distress prior to
delivery? (Birth asphyxia or PPHN)
Did the mother receive antenatal steroids if it
was a preterm delivery? (Antenatal steroids
decrease the incidence of HMD by 50%)
Was there a history of premature rupture of
membranes and fever? (congenital pneumonia
or sepsis)
Was there meconium stained amniotic fluid?
(MAS is a possibility)
30. A look at the antenatal ultrasonography (USG) for
the amount of amniotic fluid would tell us the status
of the foetal lung. (congenital anomalies of lung)
Was resuscitation required at birth? (resuscitation
trauma/PPHN/ acidosis)
Did the distress appear immediately or a few hours
after birth? (HMD appears earlier than pneumonia)
Was it related to feeding or frothing at the mouth?
(tracheo-esophageal fistula or aspiration)
Does the distress decrease with crying? (choanal
atresia).
31. For babies presenting later with distress we
have to ask a few other questions :-
Is the distress associated with feed refusal
and lethargy? (sepsis, pneumonia)
Did the distress appear slowly after starting
feeds? (IEM).
Is there a family history of early neonatal
deaths? (CHD, IEM).
32. Clinical Examination
A preterm baby weighing <1500 gms with retractions and
grunt is likely to have HMD.
A term baby born through meconium stained amniotic fluid
with an increase in the anterior- posterior diameter of the
chest (full chest) is likely to be suffering from MAS.
A depressed baby with poor circulation is likely to have
neonatal sepsis with or without congenital pneumonia.
A near term baby with no risk factors and mild distress may
have TTNB
33. An asphyxiated baby may have PPHN.
A growth retarded baby with a plethoric look may have
polycythaemia.
A baby with respiratory distress should be checked for
an air leak by placing a cold light source over the chest
wall in a darkened room.
A baby presenting with tachypnoea and a cardiac
murmur - congenital heart disease.
Inability to pass an 5F catheter through the nostril --
choanal atresia.
39. Pulse oximetry
• Effective non invasive monitoring of
oxygen therapy
• Ideally must for all sick neonates and
those requiring oxygen therapy
• Maintain SaO2 between 90 – 95 %
40. Shake test
• Take a test tube
• Mix 0.5 ml gastric aspirate +
0.5 ml absolute alcohol
• Shake for 15 seconds
• Allow to stand 15 minutes for
interpretation of result
41. Arterial blood gas (ABG) analysis:
Blood gas is essential because with clinical
assessment and pulse oximetry alone, one
would not be able to assess PaO2, PCO2
and pH.
Normal & abnormal values:
PaO2: Pre-ductal PaO2 50–70 mmHg with an
O2 saturation of 87-93%. A PaO2 up to 80
mmHg is acceptable in term infants
42. PaO2:
Hypoxemia: PaO2<50 mmHg
Low normal oxygenation: PaO2 - 50-
60mmHg
Hyperoxemia: >80 mmHg in preterm
and >90 in term.
Hyperoxia is associated with adverse
effects like ROP and BPD due to
increase in the reactive oxygen
species (ROS).
43. PaCO2:
Normal PaCO2 is 35-45 mmHg
Acceptable upper limit: 45-50mmHg,
There is increasing evidence that the strategy of
permissive hypercapnia reduces the duration of
ventilation and decreases the severity of
bronchopulmonary dysplasia (BPD) .
Hypocarbia: <35 mmHg.
Hypocarbia with PaCO2<30 mmHg increases the
risk of periventricular leucomalacia (PVL) in
preterm neonates
44. Assessment of gas exchange
1)Alveolar-arterial Oxygen
gradient (A-aDO2)
2)a/A ratio
3)Oxygenation Index (OI)
45. A-aDO2 (alveolar arterial oxygen diffusion
gradient):
This is to be calculated as shown below.
A-a DO2 =PAO2 – PaO2
= [(PB-PW) × FiO2 – PaCO2/RQ] – PaO2
= [(760-47) × FiO2 – PaCO2/.8] – PaO2
Normally it ranges between 5-15, if breathing room
air.
A-aDO2 is considered to be abnormal if more than
40.
46. 2) a /A ratio:
Ratio of PaO2 to PAO2.
It is considered to be a better indicator of gas
exchange as the ratio is usually not affected by
changes in FiO2
Interpretation:
a) Greater than 0.8: Normal
b) Less than 0.6: indicates need for O2 therapy
c) Less than 0.15: severe hypoxemia
47. 3)Oxygenation Index (OI):
Recommended in babies
who are mechanically ventilated as this index
includes mean airway pressure (MAP).
OI = (MAP × FiO2 ×100) / PaO2
Interpretation:
a) OI 25 – 40: severe respiratory failure;
mortality risk is 50 – 60%
b) OI > 40: Mortality risk is >80%
48. A comparison of indices of respiratory failure in ventilated
preterm infants
N V Subhedar, A T Tan, E M Sweeney, N J Shaw
There was no evidence of a Significant
difference between the performance of the a/A
ratio, A-aDO2, and OI in predicting adverse
respiratory outcomes.
use of the OI is recommended because of its
ease of calculation.
49. Respiratory distress -
Management
• Monitoring
• Supportive
- IV fluid
- Maintain vital signs
- Oxygen therapy
- Respiratory support
• Specific
50. Oxygen therapy*
Indications
• All babies with distress
• Cyanosis
• Pulse oximetry SaO2 <90%
Method
• Flow rate 2-5 L/ min
• Humidified oxygen by hood or nasal prongs
* Cautious administration in pre-term
51.
52.
53. [*Failure of CPAP (): Even on a CPAP of
7cmH2O and 70% FiO2if the neonate has
excessive work of breathing (or)
PCO2>60mmHg with pH <7.2 (or)
recurrent apnea or hypoxemia (PaO2 <50
mmHg), this should be considered as
failure of CPAP].
58. Antenatal corticosteroid
- Simple therapy that saves neonatal lives
• Preterm labor 24-34 weeks of gestation
irrespective of PROM, hypertension and
diabetes
• Dose:
Inj Betamethasone 12mg IM every 24 hrs X
2 doses; or Inj Dexamethasone 6 mg IM
every 12 hrs X 4 doses
• Multiple doses not beneficial
59. Surfactant therapy - Issues
• Should be used only if facilities for
ventilation available
• Cost
• Prophylactic Vs rescue
60. Surfactant therapy - Issues
Prophylactic therapy
Extremely preterm <28 wks
<1000 gm
Not routine in India
Rescue therapy
Any neonate diagnosed to have RDS
Dose 100mg/kg phospholipid Intra tracheal
64. MAS - Prevention
• Oropharyngeal suction before delivery of
shoulder for all neonates born through
MSAF
• Endotracheal suction for non vigorous*
neonates born through MSAF
*Avoid bag & mask ventilation till trachea
is cleared
65. Transient tachypnoea of newborn
(TTNB)
• Cesarean born, term baby
• Delayed clearance of lung fluid
• Diagnosis by exclusion
• Management: supportive
• Prognosis - good
Assessment of gas exchange
Though the blood gas parameters indicate oxygenation and ventilation at a single point of time, these parameters alone would not be sufficient to evaluate gas exchange. Interpretation of PaO2 without FiO2 is misleading. Hence
the gas exchange should be assessed using various parameters like
It is measure of oxigenation. Normal -2.5+.21*age in year
Determines severity of hypoxia and guide to timing of intervention