This is an ARDS case study presentation done by a group of Respiratory care students in UOD:
Aziza AlAmri, Fay AlBuainain, Mashail AlRayes, Nora AlWohayeb, Salma Almakinzi .
The original case study:(http://www.researchgate.net/publication/50399037_Acute_Respiratory_Distress_SyndromeA_Case_Study)
ARDS - Diagnosis and Management
Visit www.medicalgeek.com for more
http://www.medicalgeek.com/lecture-notes/36156-ards-diagnosis-management-presentation-ppt-pdf.html#post89045
https://www.facebook.com/MedicalGeek
https://only4medical.wordpress.com/
http://www.facebook.com/group.php?gid=129413628862&ref=nf
http://groups.yahoo.com/group/only4medical/
"Best Paper Presentation Award"
Presented at 3rd Annual Critical Care Medicine Conference , Sir Gangaram Hospital, New Delhi
"A Case of H1N1 ARDS - Journey from NIV to Invasive Ventilation to recruitment to proning to ECMO & Nitric Oxide"
For PPT, Check following link
http://www.medicalgeek.com/clinical-cases/36303-h1n1-ards-case-presentation.html
FAST HUGS BID principle followed for care of critically ill patients, as checklist is a simple strategy which is used for identifying and checking the significant aspects in the general care of ICU patients.
COPD exacerbation case presentation and disease overview farah al souheil
management of a simulated case scenario: patient presenting with COPD exacerbation: what's the best next step? summary of the guideline is then described
ARDS - Diagnosis and Management
Visit www.medicalgeek.com for more
http://www.medicalgeek.com/lecture-notes/36156-ards-diagnosis-management-presentation-ppt-pdf.html#post89045
https://www.facebook.com/MedicalGeek
https://only4medical.wordpress.com/
http://www.facebook.com/group.php?gid=129413628862&ref=nf
http://groups.yahoo.com/group/only4medical/
"Best Paper Presentation Award"
Presented at 3rd Annual Critical Care Medicine Conference , Sir Gangaram Hospital, New Delhi
"A Case of H1N1 ARDS - Journey from NIV to Invasive Ventilation to recruitment to proning to ECMO & Nitric Oxide"
For PPT, Check following link
http://www.medicalgeek.com/clinical-cases/36303-h1n1-ards-case-presentation.html
FAST HUGS BID principle followed for care of critically ill patients, as checklist is a simple strategy which is used for identifying and checking the significant aspects in the general care of ICU patients.
COPD exacerbation case presentation and disease overview farah al souheil
management of a simulated case scenario: patient presenting with COPD exacerbation: what's the best next step? summary of the guideline is then described
An Approach to a Case of Severe Pneumonia with Iron Deficiency Anemia KairviRaval
Hello There,
I Kairvi Raval and my friend Mili Bulsari students of Doctor Of Pharmacy Year 3, Department of Pharmacy Practice of Shree Dhanvantary Pharmacy College- Surat, Gujarat, Affiliated to Gujarat Technological University- Ahmedabad, Gujarat.
Here we have presented a clinical case of Severe Pneumonia with Iron deficiency Anemia, in SOAP format and along with that we tried to bring light towards the disease overview and linked pathophysiology of Severe Pneumonia progressed into Iron deficiency anemia.
Furthermore, Being PharmD candidates Patient Case is our priority so for that we should Acquire accurate knowledge regarding disease epidemiology and recent advances taking place in the drug therapy. so, we've tried to bring light towards the prevalence of pneumonia in India, Emergence of S. Pneumoniae resistance worldwide and recent advances has taken place in antibiotic therapy.
Hope this finds Helpful.
Thanks and regards,
Kairvi Raval
Mili Bulsari
IPA was first described in 1953. Due to
widespread use of chemotherapy and immunosuppressive agents, its incidence has increased
over the past two decades. Of all autopsies
performed between 1978 and 1992, the rate of
invasive mycoses increased from 0.4% to 3.1%, as
documented. IPA increased
from 17% to 60% of all mycoses found on autopsy
over the course of the study. The mortality rate of
IPA exceeds 50% in neutropenic patients and
reaches 90% in haematopoietic stem-cell transplantation (HSCT) recipients
Fran Lockie, provides a useful update on paediatric drowning sequalae and outcomes. This talk was recorded at Bedside Critical Care Conference.
For audio for this and similar talks, please visit www.intensivecarenetwork.com
The next BCC will be held in Cairns, 29th September - 3rd of October: http://bedsidecriticalcare.com/
Situs Inversus totalis is a genetic condition that causes the organs in the chest and abdomen to be positioned in a mirror image from their normal positions.
This gives an idea about the Signs/Symptom, Diagnosis, Treatment and Special concerns of the syndrome.
This gives a brief idea about the:
Techniques, Response To NIV, Clinical indications, Contraindications and Evidence Based Decisions on the use of noninvasive ventilation with neonates
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
VERIFICATION AND VALIDATION TOOLKIT Determining Performance Characteristics o...
ARDS (Case study)
1. Patrick Laird, DNP(C), MSN, RN, ACNP-BC, CCRN;
Susan D. Ruppert, PhD, RN, ANP-BC, NP-C, FCCM, FAANP,
2011.
Published on Wolters Kluwer Health
Case Study
2. Pathophysiology of the
disease
ECMO
Summary
First patient encounter
Day 2-4
V/S
P/E
Lab result
CXR
Plan
Outline:
3. 55 y/o male recently diagnosed with influenza A.
Presented to the emergency department (ED)
accompanied by his wife with worsening shortness of
breath, fever, productive cough ( green ) sputum, and
new onset altered mental status.
Primary assessment revealed oxygen saturation of 61% on room air.
Respirations were labored with abdominal accessory muscle use.
BIPAP was used but his respiratory status continued to deteriorate -------
( intubation ) .
Difficult intubation.
4. After intubation the patient became hypotensive.
A Levophed drip was initiated.
Once hemodynamically stable the patient was
admitted to the intensive care unit (ICU) for
continued management.
Continue
5. CHIEF COMPLAINT :
“Shortness of breath and confusion”
PAST MEDICAL AND SURGICAL HISTORY :
• Hypertension — Diagnosed in 2009.
• Hyperlipidemia — Diagnosed in 2009.
• No history of surgical procedures.
• Denied any history of smoking and drinks approximately
2 alcoholic beverages per week.
SOCIAL AND FAMILY HISTORY :
Married for 28 years , Employed with Anadarko petroleum
division. His parents both diagnosed with hypertension
treated with medication.
6. CURRENT HOSPITAL MEDICATIONS :
Levophed infusion at 0.4 μg/kg/min intravenous
(IV).
Propofol infusion at 55 μg/kg/min IV.
Protonix 40 mg IV daily.
Lovenox 40 mg subcutaneous daily.
Azithromycin 500 mg IV daily.
7. REVIEW OF SYSTEMS :
Patient orally intubated at the time of interview and
examination.
Chest :
Complains of increased dyspnea and cough with
increased green sputum production 2 days prior
to admission.
Heart:
Complains of weakness for 10 days prior to arrival.
Urinary system:
decrease in normal urinary output because of
decreased oral intake.
8. Neurological :
His wife reports change in his mental status over
last 2 days. States patient is “not making any
sense and is saying inappropriate things.
12. Overall status:
General: well nourished.
Skin: No skin rashes/lesions observed.
HEENT.
Chest: Symmetrical expansion.
Heart: (S1, S2) are noted. Regular
rhythm. No murmurs, gallops, or rubs
are appreciated.
Abdomen: Soft, nontender and
nondistended.
Day
2
13. Cont.
Extremities: Warm. No edema, clubbing, or
cyanosis was appreciated.
Capillary refill: +2 seconds. Nail beds are
pale.
Neurological: Sedated on mechanical
ventilation.
Spontaneous movement of all 4 extremities is
noted. Does not follow verbal commands.
Day
2
14. CXR:
Endotracheal tube tip located 2 cm above
the carina.
Interval worsening perihilar air space
opacity suggestive of worsening
pulmonary edema or ARDS.
No pneumothorax or pleural effusion.
Day
2
23. Pathophysiology
Consequences of lung injury include:
Impaired gas exchange
V/Q mismatch
Increased dead space
Decreased compliance
24. PLAN
The main goal is to optimize oxygenation and prevent
further inflammation that may lead to multi-organ failure
and that may done by :
Low tidal volume
Low PEEP/high Fio2
Initial ventilator settings
made by ED physician were not compliant
with current therapy recommendations. Ventilator
settings were adjusted in the ICU immediately
following initial evaluation.
Day
2
25. Ventilator management
A/C VC
IBW = 90 Kg
VT= 8mL/Kg = 700mL
PEEP= 10 cm H2O
RR = 18 bpm
Fio2 = 100%
VT= 6mL/kg = 540mL
PEEP= 14 cm H2O
Day
2
26. Community Acquired Pneumonia ..
For the treatment of CAP for patients in the ICU
include a B-lactam, and either azithromycin or a
respiratory fluroquinolone.
Patients with a penicillin allergy should receive a
respiratory fluroquinolone and aztreonam.
27. Neuromuscular blocking agents
(NMBA) Are used :
In the ICU to facilitate and optimize mechanical ventilation.
To improve chest wall compliance, eliminate dysynchrony, and reduce
peak airway pressures.
Muscle paralysis used :
In decreasing the work of breathing and respiratory muscle blood flow
thereby reducing oxygen consumption
28. Cont.
The patient displayed mild ventilator dysynchrony and refractory
hypoxemia.
Paralytics were initiated to gain full control of ventilation and
eliminate ventilator asynchrony.
Once paralytics were initiated, the patient’s ventilator asynchrony
resolved.
30. Subjective data ..
• Remains critically ill.
• Orally intubated on mechanical ventilation.
• Oxygen saturations remain less than 86%.
Day
4
31. Objective data ..
oVital Signs:
• T = 38.4 C
• Pulse = 102 B/min
• RR = 20 B/min
• BP = 101/52
• O2 sat =84 %
Day
4
32. Physical examination ..
No murmurs, gallops, or rubs.CV
Bilateral breath sounds with course crackles; diminished in bilateral bases; no
wheezes noted.
RESP
Warm, 2+ pitting edema to bilateral lower extremities, no cyanosis or clubbing
noted.
EXT
Paralyzed on Nimbex drip at 3 μg/kg/min , Sedated on
propofol infusion at 50 μg/kg/min.
NEURO
Day
4
33. • Norepinephrine at 0.5 μg/kg/min IV
• Nimbex at 3 μg/kg/min IV
• Propofol at 50 μg/kg/min IV
• Clindamycin 600 mg IV every 8 hours
• Rocephin 2 grams IV every 24 hours
• Albuterol/Atrovent unit dose nebulized every 4 hours .
Day
4
Current medications ..
34. Chest X-ray films ..
• Bilateral infiltrates and pulmonary edema
• Endotracheal tube in adequate position above the
carina.
Day
4
36. ASSESSMENT ..
• ARDS
• Metabolic acidosis
• Septic shock
• Community acquired pneumonia
• Acute renal failure
• Recent influenza A (H1N1)
Day
4
37. PLAN ..
Despite optimal medical therapy, the patient failed conventional
treatment, and without further intervention death was eminent.
Day
4
38. Controversial ( adults )
Common indications for use of ECMO in adults include
postcardiotomy, postcardiac transplant, severe refractory
heart failure, ARDS, pneumonia, trauma, or primary graft
failure following lung transplant.
Consult cardiovascular surgeon for
placement of extracorporeal membrane
oxygenation (ECMO):
39. Use of ECMO results in 1 extra survivor for every 6 patient
treated .
40. A total of 201 adult patients received mechanical ventilation
for confirmed or suspected influenza. 68 of these patients
received ECMO and the remaining 133 received
conventional mechanical ventilation.
48 patients (71%) that received ECMO survived to ICU
discharge and 32 patients survived to hospital discharge.
Overall mortality of the ECMO group was 21%. The
researchers contributed the lower mortality to the age of the
study participants and the cause of ARDS (H1N1).
41. Use of ECMO has a multitude of potential complications
including life-threatening bleeding, coagulopathy, air
embolism, thromboembolism, intracerebral hemorrhage
(in neonates), and limb ischemia.
risks must carefully be weighed against benefit prior to
initiation
42. Despite optimal medical therapy, the patient failed
conventional treatment, and with- out further intervention
death was eminent. After consulting cardiovascular
surgery, available therapy options were discussed with the
patient’s spouse and the decision was made to place the
patient on ECMO as salvage therapy.
In this scenario
45. day 4 : taken to OR , ECMO was
initiated.
ECMO for 6 days
day 10 ,returned to the OR for removal of
ECMO and insertion of a percutaneous
tracheostomy , and percutaneous
endoscopic gastrostomy (PEG) tube
placement
46. continued to make marked
improvements following removal of
ECMO .
Day 18 :was weaned from the ventilator.
Physical therapy, occupational therapy,
and speech therapy were consulted.
Day 21, the patient was discharged from
the ICU.
day 25 transferred to a long-term acute
care (LTAC) facility for continued
physical and occupational therapy
47. On day 25 transferred to a long-term acute care facility for
continued physical and occupational therapy( 2 weeks ).
The patient was discharged to his home with no physical or
cognitive deficits noted.
Since his discharge from LTAC, the patient has returned to
work and has no limitations .
49. 55 y/o male recently diagnosed with influenza A.
Presented to the emergency department (ED)
accompanied by his wife with worsening shortness
of breath, fever, productive cough ( green ) sputum,
and new onset altered mental status.
This case study explores the management of an
unusually complicated case of (ARDS) extending
over 52 days of hospitalization. Despite the
utilization of conventional medical treatments and
optimum respiratory support modalities, the patient’s
condition worsened and death was imminent without
salvage therapy. After cardiovascular surgery
consultation, (ECMO) therapy was initiated for 6
days. The patient recovered and was able to return
to regular employment.
50. Conclusion
Acute respiratory distress syndrome (ARDS) is a life-
threatening medical condition where the lungs can't provide
enough oxygen for the rest of the body.
ARDS can affect people of any age and usually develops as a
complication of a serious existing health condition.
(ARDS) has a mortality rate of 34% to 58% .
Editor's Notes
Flu (influenza) viruses are divided into three broad categories: influenza A, B or C. Influenza A is the most common type. H1N1 flu is a variety of influenza A.
Influenza A viruses are divided into subtypes based on two proteins on the surface of the virus: the hemagglutinin (H) and the neuraminidase
first Intubation ------- without success.
A Combi-tube was placed then replace it with a traditional endotracheal tube.
to keep the mean arterial pressure greater than 70 mm Hg.
Levophed :Treating low blood pressure
Prpofol : sedative
Sodium chloride inhalation can remove certain bacteria in body secretions. / n catheter flush injections or intravenous infusions
Protonix :is a proton pump inhibitor that decreases the amount of acid produced in the stomach.
Levonex :Anticoagulant
Azithromycin : antibiotic.
Information was gath- ered from the spouse and from the patient’s chart.
Interpretation.
Go through each more in details.
Go through each more in details.
Brain-natriuretic peptide: -18 < refer to the lecture for more info.
Indirect – acute systemic inflammation response
Direct or indirect injury to the alveolus causes alveolar macrophages to release pro-inflammatory cytokines
Cytokines attract neutrophils into the alveolus and interstitum, where they damage the alveolar-capillary membrane (ACM).
ACM integrity is lost, interstitial and alveolus fills with proteinaceous fluid, surfactant can no longer support alveolus
V/Q mismatch = shunt
VD = Results in high minute ventilation
Dec.C = Fluid filled lung becomes stiff
height—72 inches
CAP originates outside of the hospital may becaused by Streptococcus pneumoniae, Mycoplasma
pneumoniae, Haemophilus influenzae, and Chlamydophila pneumoniae
Use of ECMO in adults remains controversial. Two early randomized controlled trials utilizing ECMO in adults failed to identify any benefit of therapy.