This document provides a summary of arterial blood gas analysis. It discusses the history of arterial blood sampling dating back to 1912. Key developments include the invention of electrodes that could rapidly measure parameters like PaO2, PaCO2 and pH in the 1950s. By the mid-1960s, several university centers could provide these measurements. The first automated blood gas machine was introduced in 1973. The document reviews normal blood gas values and equations for interpreting PaCO2, PaO2, and oxygen content. It also discusses indications, contraindications, specimen collection and storage, and the physiology required to properly interpret arterial blood gas results.
This presentation discuss about acid-base-gas normal ratio and its indication in relation to varying abnormal level and how to manage it. This includes clinical analysis practice.
This presentation discuss about acid-base-gas normal ratio and its indication in relation to varying abnormal level and how to manage it. This includes clinical analysis practice.
THIS PRESENTATION WILL COVER THE FOLLOWING AREAS
Definitions
Buffer systems
Regulatory systems
Anion Gap and Osmolar gap
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
THIS PRESENTATION WILL COVER THE FOLLOWING AREAS
Definitions
Buffer systems
Regulatory systems
Anion Gap and Osmolar gap
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
Mechanical Ventilation of Patient with COPD ExacerbationDr.Mahmoud Abbas
Mechanical Ventilation of Patient with COPD Exacerbation lecture presented by Dr Andres Esteban at the Egyptian Critical care Summit 2015 held at Cairo, egypt.
The Egyptian Critical Care Summit is the leading medical event and exhibition for Intensive Care Medicine in Egypt.
Arteriovenous blood gas agreement: A research journeykellyam18
This presentation discusses the state of evidence for arteriovenous blood gas agreement for pH, pCO2, bicarbonate and base excess and how that fits into clinical decision-making. It also describes the resaerch journey of a smal clinical team to answer important clinical questions and address an issue of concern to patients.
Basic concepts of organic chemistry such as structural formulas, different kinds of representation, types of isomerism, examples, alkanes, alkenes, alkynes etc.
The presentation deals with the principles of mechanical ventilation, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
ABG is the important diagnostic tools in Pulmonary & Critical Care setting. Here how to interpret its stepwise and significance each of the components of ABG in both Blood gas and acid base abnormality
By
Dr. Anirban Saha
Pulmonary hypertension (PH) is a complex and progressive
condition characterised by high blood pressure in the lungs, leading
to significant health challenges. This book is dedicated to unravelling
the intricacies of PH, encompassing its pathophysiology, diagnosis,
management and emerging research trends. It is designed to serve
as a comprehensive guide for clinicians, researchers and students
in the field of cardiology and respiratory medicine, as well as a
valuable resource for patients and their families seeking to deepen
their understanding of this condition.
The chapters of this book are structured to provide a detailed
insight into the various facets of PH. Starting with the basic
pathophysiology and classification systems, I delve into the
clinical presentation, diagnostic criteria and the nuances of
managing this condition, including both pharmacological and
non-pharmacological approaches. Special attention is given to
the unique challenges posed by pediatric PH, PH in pregnancy
and the management of co-morbidities and complications.
Recognizing the rapid advancements in the field, this book also
dedicates a significant portion to discussing current research
trends, future therapeutic targets and evolving diagnostic
techniques. Real-world case studies and patient testimonies are
included to provide a practical perspective, highlighting the
impact of PH on patients’ lives and the importance of a patient-
centered approach to care.
The field of pulmonary hypertension is one of dynamic change
and I growing understanding. Through this book, we aim to
provide a thorough and up-to-date resource that reflects the
current state of knowledge and practice in the field of PH, while
also offering a glimpse into the future directions of research and
treatment. It is my hope that this book will not only enhance the
understanding of PH among healthcare professionals but also offer
support and information to patients and their families navigating
this challenging condition.
I wish to express our heartfelt gratitude to the following
individuals whose unwavering support and contributions have
played a pivotal role in the creation of this book "Innovations in
Cardiology: From Fundamentals to Frontiers – Short Notes in
Cardiology," My sincere thanks go to: Professor Sufia Rahman,
Professor Abdullah Al Shafi Majumder, Professor dr. Abduz
Zaher, Professor Syed Azizul Haque, Professor Dr Nurunnahar
Fatema Begum; Professor Md. Atahar Ali, Professor Dr. Afzalur
Rahman, Professor Fazila- Tun- Nessa Malik, Professor Kh.
Qamrul Islam; Professor Dr. GM Faruque, Professor M.
Maksumul Haq,Professo Dr. Sajal Krisna Banerjee; Professor
Dr. STM Abu Azam; Professor Mir Jamal Uddin, Professor
Mohammad Abdur Rashid, Professor Dr. AKM Fazlur Rahman,
Professor Dr. Abdul Kader Akanda, Professor Dr. AQM Reza,
Professor Dr. Saiful Islam; Dr. Shams Munwar; Professor Dr.
Chaudhury Meshkat Ahmed, Professor Dr. Khaled Mohsin,
Professor Abdul Wadud Chowdhury, Professor Razia Sultana
Mahmud,Professor Dr. M Touhidul Haque; Professor Dr. Md.
Sahabuddin, Professor Prabir Kumar Das, Professor Dr. Baren
Chakraborty, Professor Dr. Amirul Khusru, Dr. Kaiser Nasrullah
Khan, Professor Ashok Dutta, Professor Md. Khalequzzaman,
Dr. Abdullah Al Jamil, Professor Dr. Amal Kumar Choudhury,
Professor Mostafa Zaman Babul, Professor Dr Dipal Krishna
Adhikary, Professor Dr. Dipankar Chandra Nag professor Dr.
Moeen Uddin Ahmed, professor Mir nesar Uddin; Brig. Gen. Dr.
Syeda Aleya Sultana,Professor Dr Syed Nasir Uddin; Professor
Dr Mohsin Hossain; Dr. Sm Shahidul Haque; Professor Dr
Tawfiq Shahriar Huq; Dr. SM Quamrul Haque; Professor Dr.
Mamunur Rashid Sizar, Professor Dr. Mohsin Ahmed, Professor
Dr. Zillur Rahman; Professor Dr. Tanjima Parveen; Professor Dr.
Harisul hoque, Dr. Reyan Anis, Dr. Ashish Dey, Dr. Mohammad
Ullah firoz, Professor Dr. Udoy Shankar Roy; Dr. Nuruddin
Tareq; Dr. Md. Towhiduzzaman, Dr. Kh. Asaduzzaman, Dr.
AKM Monwarul Islam, Dr. Abdul Momen, Dr. Md. Shafiqur
Rahman Patwary, Dr. Md, Zulfiker Ali Lenin; Dr. Mahbub
Mansur, Dr. CM Shaheen Kabir, Dr. Rumi Alam, Dr. Farah
ii
Tasneem Mowmi, Dr. Rashid Ahmed, Dr. Mohammad Anowar
Hossain, Dr. Mohammad Nasimul Gani,Professor Dr abu Tarek
Iqbal, Dr. Husnayen Nanna, Dr. Abdul Malek, Dr, Ajoy Kumar
Datta, Dr. Nur Alam; Dr. Sahela Nasrin; Dr. Haripada sarker, Dr.
Anisul Awal, Dr. Shaila Nabi; Professor Dr. Umme Salma Khan;
Dr SM Ahsan Habib; Professor Dr Solaiman Hossain; Dr. Bijoy
Dutta,Dr. Shahana Zaman; Dr. Ishrat Jahan shimu, Dr. Ibrahim
Khalil. Dr. Chayan Kumar Singha, Dr. Kazi Nazrul Islam, Dr.
Kamal pasha; professor Dr. Liakat Hossain Tapan, Professor Dr.
Mamun Iqbal, Professor Dr. MG Azam, Dr. Lima Asrin Sayami,
Dr. Smita Kanungo; Dr. Sadequl Islam Shamol; Dr. Swadesh
chakraborty; Dr. Md. Rasul Amin Shepon; Dr. Saqif shahriar;
Your collective wisdom, expertise and commitment to the field
of cardiology have enriched the content of this book. Your
mentorship and guidance have been invaluable in shapi
Definition: Cardiac arrhythmias refer to abnormal heart rhythms, where the heartbeat may be too slow (bradycardia), too fast (tachycardia), or irregular.
These irregularities disrupt the normal electrical signaling in the heart.
In a world where hearts beat free and bold,
A silent foe creeps, its story untold,
Rheumatic whispers, in hushed refrain,
A tale of love's struggle, of heartache and pain.
A childhood song, innocent and sweet,
Takes a tragic turn, hearts skip a beat,
Rheumatic winds blow, fierce and unseen,
Leaving scars on hearts that once danced so keen.
Valves that should open, a rhythmic embrace,
Now bear the weight of this silent chase,
Rheumatic echoes, a haunting refrain,
Leaving imprints of sorrow, of loss and of pain.
But amidst the shadows, there's hope that glows,
A symphony of care, compassion bestows,
With knowledge and love, we stand side by side,
To mend these hearts, to be a healing guide.
Rheumatic battles, we'll face them anew,
A united front, a relentless crew,
For every heart deserves freedom's embrace,
And in the face of rheumatic storms, we'll find grace.
So let's raise our voices, let the world hear,
The fight against rheumatic pain, we hold dear,
With courage and faith, we'll rewrite the verse,
A tale of triumph, of hearts that converse.
"Rheumatic fever reminds us that our body is a delicate symphony, and neglecting even the slightest discord can lead to profound consequences." -
"In the battle against rheumatic fever, awareness and early intervention are our most potent allies."
"Rheumatic fever teaches us the vital lesson that the heart, both physical and emotional, must be nurtured with care and vigilance." -
"Every case of rheumatic fever avoided is a triumph of knowledge, compassion, and the will to protect our most vital instrument, the heart." -
"Rheumatic fever serves as a reminder that even the strongest fortresses need vigilant guardians to shield against the unseen enemies within." -
Case Scenario: You're presenting research findings on hypertension prevalence in
different regions. What Excel chart type would best visualize the variation in
prevalence across regions?
Options: A) Line chart B) Pie chart C) Bar chart D) Scatter plot E) Radar chart Answer:
C) Bar chart
Explanation: A bar chart effectively compares values across different categories,
making it ideal for visualizing the variation in hypertension prevalence across different
regions.
Case Scenario: You're analyzing patient demographics, and you want to find the
most common blood type among your patients. What Excel function would help
you identify the mode of the blood types?
Options: A) MEDIAN B) MODE C) COUNTIF D) AVERAGE E) SUM Answer: B)
MODE
Explanation: The MODE function in Excel helps you find the most frequently occurring
value in a range, making it suitable for identifying the most common blood type among
patients.
Case Scenario: You're conducting a study on the effects of exercise on blood
pressure. What Excel tool would you use to create a summary table showing
average blood pressure before and after exercise?
Options: A) Goal Seek B) PivotTable C) Data Validation D) Filter E) Sort Answer: B)
PivotTable
Explanation: A PivotTable in Excel can summarize data and calculate averages,
making it suitable for creating a summary table showing average blood pressure before
and after exercise.
Case Scenario: You're managing patient records and need to categorize patients
into age groups for analysis. What Excel function would you use to assign each
patient to a specific age category?
Options: A) VLOOKUP B) IF C) COUNTIF D) INDEX E) MATCH Answer: B)
IF
Explanation: The IF function in Excel allows you to apply conditional logic. It's useful
for categorizing patients into age groups based on their ages.
Case Scenario: You're analyzing the effectiveness of a new drug on reducing
cholesterol levels in patients. Which Excel function would you use to calculate
the percentage reduction in cholesterol for each patient?
Options: A) SUMIF B) AVERAGEIF C) MEDIAN D) COUNTIF E) IF Answer: E) IF
Explanation: The IF function in Excel allows you to apply conditional logic. It's useful
for calculating the percentage reduction in cholesterol levels based on the original and
post-treatment values.
Case Scenario: You're preparing a presentation on global prevalence rates of
different heart diseases. What Excel chart type would best display the proportion
of each disease in relation to the whole?
Options: A) Line chart B) Scatter plot C) Bar chart D) Pie chart E) Area chart Answer:
D) Pie chart
Explanation: A pie chart effectively displays proportions and percentages, making it
ideal for showcasing the proportion of each heart disease in relation to the total.
Case Scenario: You're managing a database of medical research papers, including
titles, authors, and publication years. What Excel tool can you use to quickly find
papers published between cert
5. A 5 years old boy presents with fever & swelling of knee and ankle joint for 3 weeks. Write down 3 important D/D. Discuss the treatment of acute rheumatic fever with carditis. (DU-09Ju)
Three important differential diagnoses of a 5-year-old boy presenting with fever and joint swelling for 3 weeks include:
Septic arthritis: This is an acute bacterial infection of a joint that causes similar symptoms to rheumatic fever but is usually monoarticular and associated with more severe pain, redness, and tenderness of the affected joint. Septic arthritis requires urgent drainage and antibiotics.
Juvenile idiopathic arthritis: This is a group of chronic autoimmune disorders that can present with fever, joint swelling, and stiffness. The diagnosis is based on clinical features, laboratory tests, and imaging studies. The treatment may include nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, and biologic agents.
Reactive arthritis: This is an inflammatory joint disease that can occur after an infection, especially with certain bacteria such as Chlamydia, Salmonella, or Shigella. Reactive arthritis usually affects the lower limb joints, such as knees, ankles, and feet, and may be associated with skin rash, eye inflammation, or urethritis. The treatment may include antibiotics, nonsteroidal anti-inflammatory drugs, and corticosteroids.
Assuming the diagnosis of acute rheumatic fever with carditis, the treatment usually involves a combination of antibiotics and anti-inflammatory drugs. The antibiotics aim to eradicate the streptococcal infection and prevent further rheumatic fever recurrences, while the anti-inflammatory drugs aim to reduce the inflammation and symptoms of carditis. The specific regimen may vary depending on the severity of carditis, the presence of other complications, and the patient's age and weight. In general, the following principles apply:
Antibiotics: A 10-day course of oral or intramuscular penicillin is the first-line antibiotic for acute rheumatic fever, as it is effective against most strains of streptococci and has low toxicity. Alternative antibiotics may be used for patients who are allergic to penicillin or have recurrent rheumatic fever despite adequate penicillin therapy. Long-term prophylaxis with penicillin is recommended to prevent recurrences, usually until the age of 21 years or for 10 years after the last episode of rheumatic fever, whichever is longer.
Anti-inflammatory drugs: High-dose aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are usually given for the first 2-3 weeks of acute rheumatic fever to control fever, pain, and inflammation. Corticosteroids such as prednisone or methylprednisolone may be used in severe cases of carditis or when other therapies are not effective or contraindicated. The duration and dose of anti-inflammatory drugs should be tailored to the patient's response and adverse effects, such as gastric
The Cardiovascular System: Life's Vital Transport System
The cardiovascular system, comprising the heart, blood vessels, and blood, is a fundamental physiological network in the body.
It facilitates the circulation of oxygen, nutrients, hormones, and immune cells while eliminating waste products.
Essential for maintaining tissue function, energy production, and overall homeostasis.
Defining the Cardiovascular System
The cardiovascular system, also known as the circulatory system, is a complex network responsible for circulating vital substances throughout the body.
Components of the Cardiovascular System
Heart: A muscular organ that pumps blood, generating the force required to propel blood through the blood vessels.
Blood Vessels: A network of tubes that carry blood to and from various body tissues.
Blood: A specialized fluid containing red and white blood cells, platelets, and plasma, essential for nutrient and gas exchange.
Exploring Applied Physiology of the Cardiovascular System
The cardiovascular system is a cornerstone of human health, regulating the circulation of vital nutrients, oxygen, and waste products throughout the body.
Understanding the applied physiology of this system is essential for healthcare professionals to provide effective medical care and interventions.
Importance of Applied Cardiovascular Physiology
Effective healthcare requires a deep comprehension of how the cardiovascular system functions under various conditions.
Applied physiology knowledge empowers healthcare practitioners to make informed decisions, diagnose disorders, and formulate targeted treatment plans.
Focus on Practical Applications in Healthcare
This presentation delves into the practical aspects of cardiovascular physiology that directly impact clinical practice.
We will explore how physiological concepts are translated into real-world medical scenarios and interventions.
By grasping the applied physiology of the cardiovascular system, healthcare providers can optimize patient care, enhance diagnostics, and improve treatment outcomes.
Throughout this presentation, we'll bridge the gap between theoretical understanding and its practical implications in the field of healthcare.
Understanding the Components
The cardiovascular system comprises three crucial components: the heart, blood vessels, and blood.
Heart: A muscular organ that pumps blood, ensuring a continuous flow throughout the body.
Blood Vessels: A network of tubes that transport blood to and from various tissues.
Blood: A specialized fluid that carries nutrients, oxygen, hormones, and removes waste products.
Role in Oxygen and Nutrient Delivery
Oxygen from the lungs and nutrients from the digestive system are transported to body tissues through the bloodstream.
These essential components are required for cellular metabolism and energy production.
Peripartum cardiomyopathy (PPCM) is a type of heart disease that affects women during the last month of pregnancy or in the first few months after delivery. It is characterized by a weakened and enlarged heart muscle, which makes it difficult for the heart to pump blood efficiently to the rest of the body. The exact cause of PPCM is unknown, but it is believed to be related to the hormonal changes and increased demands on the heart that occur during pregnancy. Symptoms of PPCM can include shortness of breath, fatigue, chest pain, swelling in the legs and feet, and palpitations. Treatment for PPCM usually involves medications to improve heart function and supportive care to manage symptoms. In severe cases, advanced treatments such as implantable devices or heart transplantation may be necessary. With early diagnosis and treatment, most women with PPCM can recover completely and go on to lead healthy lives.during pregnancy.
The diagnosis of PPCM is based on clinical symptoms, such as shortness of breath, fatigue, chest pain, and edema, along with imaging studies, such as echocardiography. Treatment for PPCM usually involves medications to improve heart function and supportive care to manage symptoms. These medications can include beta-blockers, ACE inhibitors, diuretics, and inotropic agents. In severe cases, advanced treatments such as mechanical circulatory support or heart transplantation may be necessary.
The prognosis for PPCM varies depending on the severity of the disease and the presence of underlying comorbidities. However, with early diagnosis and appropriate treatment, most women with PPCM can recover completely and go on to lead healthy lives. The recurrence rate of PPCM in subsequent pregnancies is approximately 20%, and women who have had PPCM are advised to avoid future pregnancies or undergo careful monitoring and management during pregnancy.
There are still many unanswered questions about PPCM, including its exact cause, optimal diagnostic and treatment strategies, and long-term outcomes. Further research is needed to better understand this complex and potentially life-threatening condition.
In conclusion, PPCM is a rare but serious form of heart disease that can occur during or after pregnancy. Early recognition and management of this condition are critical in preventing complications and improving outcomes for both the mother and the baby. Future research will continue to shed light on the pathophysiology and optimal management of PPCM.
Cardiac rehabilitation is a comprehensive program that aims to improve the health and quality of life of individuals with cardiovascular disease. This review article provides an overview of current evidence-based practices and the benefits of cardiac rehabilitation. The article discusses the components of cardiac rehabilitation, including medical evaluation, physical activity and exercise training, nutrition counseling and education, psycho social support and counseling, cardiac risk factor management, medication management, and tobacco cessation counseling. The article also discusses the effectiveness of cardiac rehabilitation in reducing mortality rates, improving functional capacity, and reducing the risk of future cardiovascular events. Additionally, the article explores the future directions of cardiac rehabilitation, including personalized medicine, technology integration, home-based programs, expanded target populations, and a multidisciplinary approach. Healthcare providers play a crucial role in encouraging and referring eligible patients to cardiac rehabilitation programs as part of their treatment plan. The review concludes that cardiac rehabilitation is an essential aspect of the management of cardiovascular disease and highlights the need for further research and development in this dynamic field.
Outline of CPR manual
I. Introduction
A. Definition of CPR
1. Explanation of what CPR stands for
2. Definition of CPR as a life-saving technique
B. Importance of CPR
1. Statistics on cardiac arrest and survival rates
2. Explanation of why CPR is crucial for saving lives
C. Objective of the manual
1. Explanation of what readers will learn from the manual
2. Statement of the manual's purpose
II. Getting Started with CPR
A. Assessing the situation
1. Importance of assessing the situation before starting CPR
2. Factors to consider when assessing the situation
B. Checking for responsiveness
1. Explanation of how to check for responsiveness
2. Importance of checking for responsiveness
C. Activating the emergency response system
1. Explanation of when to activate the emergency response system
2. Step-by-step guide to activating the emergency response system
III. Basic Life Support Techniques
A. Key components of basic life support
1. Explanation of the components of basic life support
2. Importance of each component
B. The ABCs of CPR
1. Explanation of the ABCs of CPR
2. Importance of each step in the ABCs of CPR
C. Performing chest compressions
1. Explanation of how to perform chest compressions
2. Importance of proper chest compression technique
D. Delivering rescue breaths
1. Explanation of how to deliver rescue breaths
2. Importance of proper rescue breath technique
E. Utilizing an automated external defibrillator (AED)
1. Explanation of what an AED is and how it works
2. Step-by-step guide to using an AED
F. Administering medications during CPR
1. Explanation of medications used during CPR
2. Dosages and administration guidelines for each medication
IV. Advanced Life Support Techniques
A. Advanced airway management
1. Explanation of advanced airway management techniques
2. Importance of advanced airway management in CPR
B. Advanced monitoring techniques
1. Explanation of advanced monitoring techniques
2. Importance of advanced monitoring in CPR
C. Invasive interventions
1. Explanation of invasive interventions
2. Importance of invasive interventions in CPR
D. Extracorporeal membrane oxygenation (ECMO)
1. Explanation of ECMO
2. Importance of ECMO in CPR
V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes
1. Explanation of factors that influence CPR outcomes
2. Importance of understanding these factors
B. Strategies for improving CPR outcomes
1. Explanation of strategies for improving CPR outcomes
2. Importance of implementing these strategies
C. The role of high-quality CPR in improving outcomes
1. Explanation of what high-quality CPR is
2. Importance of performing high-quality CPR
VI. Special Considerations in CPR
A. CPR in special populations
1. Explanation of special populations that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
B. CPR in special settings
1. Explanation of special settings that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
C.
I. Introduction
A. Brief explanation of World Hypertension Day
B. Importance of addressing hypertension as a global health issue
C. Overview of the objectives of the presentation
II. Understanding Hypertension
A. Definition and classification of hypertension
B. Prevalence and global burden of hypertension
C. Risk factors and causes of hypertension
D. Health implications and complications associated with hypertension
III. World Hypertension Day 2023
A. Background and significance of World Hypertension Day
B. Theme and key messages for World Hypertension Day 2023
C. Activities and events organized worldwide to raise awareness
IV. Goals and Objectives
A. Key goals set for World Hypertension Day 2023
B. Promoting prevention and early detection of hypertension
C. Encouraging healthy lifestyle modifications
D. Enhancing public knowledge about hypertension management
V. Initiatives and Campaigns
A. Overview of global initiatives and campaigns
B. Collaborations with international organizations, NGOs, and healthcare professionals
C. Campaign materials and resources available for public use
VI. Strategies for Hypertension Prevention and Control
A. Implementing population-level interventions
B. Screening and diagnosis strategies
C. Lifestyle modifications (diet, physical activity, stress management)
D. Pharmacological management and treatment guidelines
VII. Public Awareness and Education
A. Importance of raising public awareness about hypertension
B. Educational campaigns and resources for the general public
C. Role of healthcare professionals in educating patients
VIII. Impact and Achievements
A. Highlighting the impact of previous World Hypertension Day campaigns
B. Success stories and achievements in hypertension prevention and control
C. Lessons learned and areas for improvement
IX. Conclusion
A. Recap of the key points discussed
B. Call to action for individuals, communities, and policymakers
C. Encouragement to spread awareness and take steps towards hypertension prevention
. Introduction
A. Definition and prevalence of hypertension in the elderly
B. Importance of managing hypertension in this population
II. Risk Factors and Complications
A. Common risk factors for hypertension in the elderly
B. Potential complications associated with uncontrolled hypertension
III. Diagnostic Process
A. Blood pressure measurement techniques and guidelines
B. Target blood pressure goals for elderly patients
C. Identification of secondary causes of hypertension
IV. Non-Pharmacological Management
A. Lifestyle modifications
1. Dietary recommendations (e.g., DASH diet, sodium reduction)
2. Weight management and physical activity
3. Smoking cessation and alcohol moderation
B. Stress management and relaxation techniques
V. Pharmacological Management
A. First-line antihypertensive medications
B. Considerations for drug selection in the elderly
1. Drug interactions and comorbidities
2. Adverse effects and tolerability
C. Individualized treatment approach based on patient characteristics
VI. Monitoring and Follow-Up
A. Frequency of blood pressure monitoring
B. Importance of medication adherence
C. Adjusting treatment based on patient response
D. Collaborative care and involvement of healthcare professionals
VII. Special Considerations
A. Polypharmacy and medication management
B. Management of hypertension in frail and institutionalized elderly
C. Cognitive impairment and medication adherence
VIII. Controversies and Challenges
A. Blood pressure targets and guidelines in the elderly
B. Conflicting evidence on specific antihypertensive agents
C. Adherence issues and barriers to effective management
IX. Conclusion
A. Summary of key points discussed
B. Importance of comprehensive management in elderly patients
C. Future directions in hypertension management for the elderly
I. Introduction
A. Definition of CPR
1. Explanation of what CPR stands for
2. Definition of CPR as a life-saving technique
B. Importance of CPR
1. Statistics on cardiac arrest and survival rates
2. Explanation of why CPR is crucial for saving lives
C. Objective of the manual
1. Explanation of what readers will learn from the manual
2. Statement of the manual's purpose
II. Getting Started with CPR
A. Assessing the situation
1. Importance of assessing the situation before starting CPR
2. Factors to consider when assessing the situation
B. Checking for responsiveness
1. Explanation of how to check for responsiveness
2. Importance of checking for responsiveness
C. Activating the emergency response system
1. Explanation of when to activate the emergency response system
2. Step-by-step guide to activating the emergency response system
III. Basic Life Support Techniques
A. Key components of basic life support
1. Explanation of the components of basic life support
2. Importance of each component
B. The ABCs of CPR
1. Explanation of the ABCs of CPR
2. Importance of each step in the ABCs of CPR
C. Performing chest compressions
1. Explanation of how to perform chest compressions
2. Importance of proper chest compression technique
D. Delivering rescue breaths
1. Explanation of how to deliver rescue breaths
2. Importance of proper rescue breath technique
E. Utilizing an automated external defibrillator (AED)
1. Explanation of what an AED is and how it works
2. Step-by-step guide to using an AED
F. Administering medications during CPR
1. Explanation of medications used during CPR
2. Dosages and administration guidelines for each medication
IV. Advanced Life Support Techniques
A. Advanced airway management
1. Explanation of advanced airway management techniques
2. Importance of advanced airway management in CPR
B. Advanced monitoring techniques
1. Explanation of advanced monitoring techniques
2. Importance of advanced monitoring in CPR
C. Invasive interventions
1. Explanation of invasive interventions
2. Importance of invasive interventions in CPR
D. Extracorporeal membrane oxygenation (ECMO)
1. Explanation of ECMO
2. Importance of ECMO in CPR
V. Improving Outcomes in CPR
A. Factors influencing CPR outcomes
1. Explanation of factors that influence CPR outcomes
2. Importance of understanding these factors
B. Strategies for improving CPR outcomes
1. Explanation of strategies for improving CPR outcomes
2. Importance of implementing these strategies
C. The role of high-quality CPR in improving outcomes
1. Explanation of what high-quality CPR is
2. Importance of performing high-quality CPR
VI. Special Considerations in CPR
A. CPR in special populations
1. Explanation of special populations that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
B. CPR in special settings
1. Explanation of special settings that require unique CPR techniques
2. Importance of understanding these unique CPR techniques
C. CPR during a pandemic
1
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
- 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
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Arterial Blood Gas Analysis Toufiqur Rahman
1. Dr. Md.Toufiqur
Rahman
MBBS, FCPS, MD, FACC, FESC, FRCPE, FSCAI,
FAPSC, FAPSIC, FAHA, FCCP, FRCPG
Associate Professor of Cardiology
National Institute of Cardiovascular Diseases(NICVD),
Sher-e-Bangla Nagar, Dhaka-1207
Consultant, Medinova, Malibagh branch
Honorary Consultant,Apollo Hospitals, Dhaka and
Arterial Blood Gas
Analysis
CRT 2014
Washing
ton DC,
USA
2. HISTORY
The first arterial puncture was performed in 1912 by
Hurter, a German physician.
Employing Hurter’s radial artery puncture technique,
W.C.Stadie measured oxygen saturation in patients with
pneumonia and showed that cyanosis of critically ill patients
resulted from incomplete oxygenation of hemoglobin
(Stadie 1919).
3. Over the next 40 years blood gas measurements were more of
a laboratory research tool.
It was not until the 1950s that electrodes were developed that
could rapidly and reproducibly measure PaO2, PaCO2 and pH.
In 1953 Leland Clark invented the platinum oxygen electrode,
a prototype that evolved into the first modern blood gas
electrode(Clark 1953,Clark1957).
HISTORY
4. Development of commercially viable pH and PCO2 electrodes
soon followed and by the mid -1960s several university centers
were able to provide pH, PaCO2 and PaO2 measurements on
arterial blood.
In 1973 the first commercially available automated blood gas
machine was introduced (ABLI from Radiometer), and this was
soon followed by machines from other companies (Severinghaus
1986 ).
HISTORY
5. Recent Developments
Non invasive measurements are now available for some of
the results of ABG;
Pulse Oximeter for SpO2
End tidal Gas analysis for PCO2
In Neonates and children skin electrodes for measuring
PO2& PCO2 have found wide application.
Now devices are being developed for continuous blood
gases with fiber optic intra arterial sensors
6. With these improvements the ABG measurements of shifted
from the experimental and developmental stages into clinical
arena.
ABG is probably the single most useful test for pulmonary
function, as arterial levels of O2, CO2, & pH reflect the end
result of ventilation perfusion & gas exchange.
Recent Developments
7. Information Obtained from an ABG:
Acid base status
Oxygenation
Dissolved O2 (pO2)
Saturation of hemoglobin
CO2 elimination
Levels of carboxyhemoglobin and methemoglobin
8. Indications of ABG
1. Routine in all cases of Open-heart surgery
2. Patient under mechanical ventilation
3. In case of thoracic trauma or underlying lung
contusion ABG determines where ventilator is
required or not.
9. 4. Integral part in he management of
premature neonates.
5. To determine acidosis or alkalosis,
whether these are respiratory or
metabolic.
6. In a hypoxaemic patient due to any cause.
Indications of ABG
11. Which Artery to Choose?
The radial artery is superficial, has collaterals and
is easily compressed. It should almost always be
the first choice.
Other arteries (femoral, dorsalis pedis, brachial)
can be used in emergencies.
12.
13.
14. Specimen collection
Arterial bloods are obtained from any Arterial sources, (usually
radial, brachial or femoral).
If multiple samples are to be drawn over a period time (as in case
of cardiac surgery) an indwelling arterial line is placed, which is
perfused with heparinised saline to prevent thrombus formation.
Arterial punctures are painful & result hyperventilation. Use of
L/A can result more patient comfort & accurate data.
15. Blood specimen are best collected in the
heparinized glass syringe. Heparine is used
to displace the air form the syringe & no air
should be permitted to enter the syringe
during collection.
Ideally sample should be analysed straight
away. Otherwise it can be capped & stored
in crushed ice.
Specimen collection
16. Storage at room temp. results rise in PCO2
& fall in pH & PO2 due to blood
metabolism.
Capillary samples are used from finger.
Heel, ear lobe. PCO2 & pH results on
capillary blood are close to those of
arterial blood taken at the same time. The
PO2 is less reliable.
Specimen collection
17. Why an ABG instead of Pulse
oximetry?
Pulse oximetry uses light absorption at two
wavelengths to determine hemoglobin saturation.
Pulse oximetry is non-invasive and provides
immediate and continuous data.
18. Collection Problems:
Type of syringe
Plastic vs. glass
Use of heparin
Air bubbles
Specimen handling and transport
20. Why an ABG instead of Pulse
oximetry?
Pulse oximetry does not assess ventilation
(pCO2) or acid base status.
Pulse oximetry becomes unreliable when
saturations fall below 70-80%.
Technical sources of error (ambient or
fluorescent light, hypoperfusion, nail polish,
skin pigmentation)
Pulse oximetry cannot interpret
methemoglobin or carboxyhemoglobin.
21. One blood sample & Two sets of tests
One Blood sample
Blood gas refers to any element or compound that is a gas under
ordinary condition and that is also dissolved to some extant in our
blood.
Not all blood gases are routinely measured & not all blood gas
measurements are of true blood gases. CO2 & O2 are routinely
measured as their partial pressure PaCO2 & PaO2.
CO is measured as %COHb,
N2, Helium & others are not measured at all
22. Two sets of tests
All blood gas machine to measure pH, PaCO2 & PaO2 and to
calculate HCO3 value.
A co-oximeter can measure Hb content and values related to
Hb binding; SaO2 %COHb, & %MetHb. From this information
the atrerial O2 content (CaO2) can be calculated
The one vs two machine arrangement is the case in most
laboratories.However newer technology now ncorporates
both machine within a single console so that both sets of
measurements (Blood gas & co-oximetery) can be made
from a single entered sample.
24. Electrolyte Measurements
Over the past decade many blood gas labs have taken-on an
additional task; measuring electrolytes in the arterial sample
(Na+
, K+
, Cl-
, HCO3
-
& Ca++
Mg++
)
Electrolytes measurement acts as an aid to understanding
Acid-Base status.
25. What Other information is needed
to interpret blood gas data?
Information about the patients immediate environment
FIO2, PB
Additional Lab data, for example
Previous ABG report, electrolytes, blood sugar, BUN
Hb% or HCT
CXR & pulmonary function test
Clinical information, including history & clinical exam.
Respiratory rate & Other vital signs,
Degree of respiratory effort, mental status & state of tissue perfusion.
26. How much physiology do you need to
know for proper ABG interpretation?
Knowledge of some basic pulmonary physiology is crucial for
understanding ABG data.
There are three physiologic processes and four equations
important in interpretation of ABG.
30. The PCO2
equation puts into physiologic perspective one of
the most common of all clinical observations: a patient's
respiratory rate and breathing effort. The equation states
that alveolar PCO2
(PACO2
) is directly proportional to the
amount of CO2
produced by metabolism and delivered to
the lungs (VCO2
) and inversely proportional to the alveolar
ventilation (VA). While the derivation of the equation is for
alveolar PCO2
, its great clinical utility stems from the fact
that alveolar and arterial PCO2
can be assumed to be equal.
Thus:
PCO2
=VCO2
x 0.863 / VA
where VA=VE-VD
31. The constant 0.863 is necessary to equate dissimilar units
for VCO2
(ml/min) and VA (L/min) to PACO2
pressure
units (mm Hg). Alveolar ventilation is the total amount
of air breathed per minute (VE; minute ventilation)
minus that air which goes to dead space per minute
(VD). Dead space includes all airways larger than alveoli
plus air entering alveoli in excess of that which can take
part in gas exchange.
Even when alveolar and arterial PCO2
are not equal (as in
states of severe ventilation-perfusion imbalance), the
relationship expressed by the equation remains valid:
PaCO2
~ VCO2
/ VA
32. PaCO2
vs. alveolar ventilation (VA).
The relationship is shown for carbon
Dioxide production rates of 200 l/min
and 300 ml/min. Changes in PaCO2
Are shown for a one liter decrease
Short Horizontal lines) inVA
starting at two Different PaCO2
values, 30 and 60 mm Hg. A decrease
in alveolar ventilation in the
hypercapnic patient will result in a
Greater rise in PaCO2
than will the
sameVA change when PaCO2
is low
or normal. Also, note that an increase
in carbon dioxide production when
VA is fixed will result in an increase
in PaCO2
33. PaO2 & Alveolar-Arterial PO2
difference
The alveolar gas equation for calculating PAO2
is essential
to understanding any PaO2
value and in assessing if the
lungs are properly transferring oxygen into the blood. Is
a PaO2
of 28 mm Hg abnormal? How about 55 mm Hg?
95 mm Hg? To clinically interpret PaO2
one has to also
know the patient's PaCO2
, FIO2
(fraction of inspired
oxygen) and the PB
(barometric pressure), all
components of the equation for PAO2
:
1-FIO2
PAO2
= FIO2
(PB
-PH20
) - PACO2
[FIO2
+ ------------- ]
R
34. The abbreviated equation below is useful for clinical
purposes; in this version alveolar PO2
equals inspired
PO2
(PIO2
) minus arterial PCO2
x 1.2, assuming the R
value is 0.8 (and assuming identical values for arterial
and alveolar PCO2
). Water vapor pressure in the airways
is dependent only on body temperature and is 47 mm
Hg at normal body temperature (37 degrees C).
PAO2
= FIO2
(PB
-47) - 1.2(PaCO2
)
35. Ambient FIO2
is the same at all altitudes, 0.21.
It is usually not necessary to measure PB
if you
know its approximate average value where the
blood was drawn
If PIO2
is held constant and PaCO2
increases,
PAO2
and PaO2
will always decrease.
36. The alveolar-arterial PO2
difference, notated
P(A-a)O2
, varies normally with age and FIO2
.
Up to middle age, breathing ambient air,
normal P(A-a)O2
ranges between 5 and 20
mm Hg. Breathing an FIO2
of 1.0 the normal
P(A-a)O2
ranges up to about 110 mm Hg
If P(A-a)O2
is increased above normal there is
a defect of gas transfer within the lungs; this
defect is almost always due to V-Q imbalance.
37. Because of several assumptions in clinical use
of the alveolar gas equation, precision in
calculating PAO2
is not achievable.
Fortunately an estimate of P(A-a) O2
is usually
sufficient for clinical purposes.
Since oxygen enters the pulmonary capillary
blood by passive diffusion, it follows that in a
steady state the alveolar PO2
must always be
higher than the arterial PO2
38. Physiologic causes of Low PaO2
Respiratory cause Effects on
P(A-a)O2 PaO2/FIO2
Pulmonary R-L shunt; Increased Decreased
Vent-perfusion imbalance Increased Decreased
Diffusion barrier Increased Decreased
Hypoventilation ( PaCO2) Normal Decreased
39. Physiologic causes of Low PaO2
Non-Respiratory cause Effects on
P(A-a)O2 PaO2/FIO2
Cardiac R-L shunt Increased Decreased
Decreased PIO2 Normal Normal
Low mixed venous O2 content Increased Decreased
40. PaO2, SaO2 & Oxygen content
(Oxygen Content Equation )
All physicians know that hemoglobin carries
oxygen and that anemia can lead to severe
hypoxemia. Making the necessary
connection between PaO2
and O2
content
requires knowledge of the oxygen content
equation.
CaO2
= (SaO2
x Hb x 1.34) + .003(PaO2
)
41. The oxygen carrying capacity of one gram of
hemoglobin is 1.34 ml. With a hemoglobin
content of 15 grams/dl blood and a normal
hemoglobin oxygen saturation (SaO2
) of 98%,
arterial blood has a hemoglobin-bound oxygen
content of 15 x .98 x 1.34 = 19.7 ml O2
/dl
blood.
42. An additional small quantity of O2
is carried
dissolved in plasma: .003 ml O2
/dl
plasma/mm Hg PaO2
, or .3 ml O2
/dl plasma
when PaO2
is 100 mm Hg. Since normal CaO2
is 16-22 ml O2
/dl blood, the amount
contributed by dissolved (unbound) oxygen is
very small, only about 1.4% to 1.9% of the
total
43. Given normal pulmonary gas exchange (i.e., a
normal respiratory system), factors that lower
oxygen content - such as anemia, carbon
monoxide poisoning, methemoglobinemia,
shifts of the oxygen dissociation curve - do not
affect PaO2
. PaO2
is a measurement of pressure
exerted by uncombined oxygen molecules
dissolved in plasma; once oxygen molecules
chemically bind to hemoglobin they no longer
exert any pressure.
44. PaO2
affects oxygen content by determining,
along with other factors such as pH and
temperature, the oxygen saturation of
hemoglobin (SaO2
). The familiar O2
-
dissociation curve can be plotted as SaO2
vs.
PaO2
and as PaO2
vs. oxygen content
47. When hemoglobin content is adequate, patients can have a
reduced PaO2
(defect in gas transfer) and still have sufficient
oxygen content for the tissues (e.g., hemoglobin 15 grams%,
PaO2
55 mm Hg, SaO2
88%, CaO2
17.8 ml O2
/dl blood).
Conversely, patients can have a normal PaO2
and be profoundly
hypoxemic by virtue of a reduced CaO2
. This paradox - normal
PaO2
and hypoxemia - generally occurs one of two ways: 1)
anemia, or 2) altered affinity of hemoglobin for binding
oxygen.
48. A common misconception is that anemia affects PaO2
and/or
SaO2
; if the respiratory system is normal, anemia affects neither
value. (In the presence of a right to left intrapulmonary shunt
anemia can lower PaO2
by lowering the mixed venous oxygen
content; when mixed venous blood shunted past the lungs mixes
with oxygenated blood leaving the pulmonary capillaries,
lowering the resulting PaO2
.
49. With a normal respiratory system mixed venous blood is
fully oxygenated - as much as allowed by the alveolar PO2
-
as it passes through the pulmonary capillaries.)
51. The Henderson-Hasselbalch
Equation
Of the four equations in this paper, the
Henderson-Hasselbalch is the one with which
physicians are most familiar. The H-H equation
is repeatedly emphasized in basic science
courses and in renal and pulmonary
pathophysiology lectures; students hear about
it on many occasions.
52. The bicarbonate buffer system, quantitatively
the largest in the extracellular fluid,
instantaneously reflects any blood acid-base
disturbance in one or both of its buffer
components (HCO3
-
and PACO2
). The ratio of
HCO3
-
to PACO2
determines pH and
therefore the acidity of the blood:
53. pH=pK + log HCO3
-
/ 0.03(PaCO2
)
pH is the negative logarithm of the hydrogen ion
concentration, [H+
], in nM/L (nM = nanomole = 1
x 10-9
moles; pH 7.40 = 40 nM/L [H+
]). Because of
the negative logarithm, small numerical changes of
pH in one direction represent large changes of [H+
]
in the other direction . An 0.1 unit fall in pH from
7.4 to 7.3 represents a 25% increase in [H+
]; a
similar percentage change in serum sodium would
increase its value from a normal 140 mEq/L to 175
mEq/L!
54. pH and Hydrogen Ion Concentration
Blood pH [H+
] (nM/L) % Change from normal
Acidemia
7.00 100 + 150
7.10 80 + 100
7.30 50 + 25
Normal
7.40 40
Alkalemia
7.52 30 - 25
7.70 20 - 50
8.00 10 - 75
55. Unfortunately, the logarithmic nature of pH and the fact
that acid-base disorders involve simultaneous changes in
three biochemical variables and in the function of two organ
systems (renal and respiratory), have all combined to made
acid-base a difficult subject for many clinicians.
If any of the three H-H variables is truly abnormal the
patient has an acid-base disturbance without exception. Thus
any patient with an abnormal HCO3
-
or PaCO2
, not just
abnormal pH, has an acid-base disorder. Most hospitalized
patients have at least one bicarbonate measurement as part
of routine serum electrolytes; this is usually called the 'CO2
'
or 'total CO2
' when measured in venous blood.
56. The simplified version of the H-H equation eliminates
the log and the pK, and expresses the relationships
among the three key values
pH ~ HCO3
-
/ PaCO2
This version is sufficient for describing the four primary
acid-base disturbances and their compensatory changes
If the numerator is first to change the problem is either
metabolic acidosis (reduced HCO3
-
) or metabolic
alkalosis (elevated HCO3
-
); if the denominator is first to
change the problem is either respiratory alkalosis
(reduced PaCO2
) or respiratory acidosis (elevated
PaCO2
).
57. By convention 'acidosis' and 'alkalosis' refer to in-vivo physiologic
derangements and not to any change in pH. Each primary acid-base
disorder arises from one or more specific clinical conditions, e.g.,
metabolic acidosis from diabetic ketoacidosis or hypoperfusion lactic
acidosis; metabolic alkalosis from diuretics or nasogastric
suctioning; etc. Thus the diagnosis of any primary acid-base disorder
is analogous to diagnoses like "anemia" or "fever"; a specific cause
must be sought in order to provide proper treatment.
58. Because of the presence of more than one acid-base disorder
('mixed disorders') a patient with any acidosis or alkalosis may
end up with a high, low or normal pH. For example, a patient
with obvious metabolic acidosis from uremia could present
with a high pH due to a concomitant metabolic alkalosis (which
may not be as clinically obvious). Acidemia (low pH) and
alkalemia (high pH) are terms reserved for derangements in
blood pH only.
59. Compensation for a primary disorder takes place when the other
component in the H-H ratio changes as a result of the primary
event; these compensatory changes are not classified by the terms
used for the four primary acid-base disturbances. For example, a
patient who hyperventilates (lowers PaCO2
) solely as compensation
for metabolic acidosis does not have a primary respiratory alkalosis
but simply compensatory hyperventilation.
60. This terminology helps separate diagnosable and treatable
clinical disorders from derangements in acid-base that exist only
because of the primary disorder.
Compensatory changes for acute respiratory acidosis and
alkalosis, and metabolic acidosis and alkalosis,occur in a
predictable fashion, making it relatively easy to spot the
presence of a mixed disorder in many situations. For example,
single acid-base disorders do not lead to normal pH.
61. Two or more disorders can be manifested by normal pH when
they are opposing, e.g., respiratory alkalosis and metabolic acidosis
in a septic patient. Although pH can end up in the normal range
(7.35-7.45) in single disorders of a mild degree when fully
compensated, a truly normal pH with abnormal HCO3
-
and PaCO2
should make one think of two or more primary acid-base
disorders. Similarly, a high pH in a case of acidosis or a low pH in a
case of alkalosis signifies two or more primary disorders.
62. Maximal respiratory compensation for a metabolic disorder takes
about 12-24 hours and maximal renal compensation for a
respiratory disorder takes up to several days. As a rule of thumb, in
maximally compensated metabolic acidosis the last two digits of the
pH approximate the PaCO2
. For example, a patient with a disease
causing uncomplicated metabolic acidosis over 24 hours' duration,
whose pH is 7.25, should have a PaCO2
equal or close to 25 mm
Hg. In metabolic alkalosis respiratory compensation is more
variable and there is no simple relationship by which to predict the
final PaCO2
63.
64. How to calculate the degree of
compensation
Scale of compensation
Primary change
(for 1unit change)
Compensation
(scale of change)
M Acidosis pH HCO3 mEq/L 1.2 PCO2mmHg
M Alkalosis pH HCO3 mEq/L 0.5 PCO2 mmHg
R Acidosis pH PCO2 mmHg 0.35 HCO3 mEq/L
R alkalosis pH PCO2 mmHg 0.5 HCO3 mEq/L
65. Summary of Acid-Base balance
pH PCO2 HCO3 BE
Met.
Acidosis
Uncompensated N
Compensated N
Met.
Alkalosis
Uncompensated N
Compensated N
Resp.
Acidosis
Uncompensated N N
Compensated N
Resp.
Alkalosis
Uncompensated N N
Compensated N
66. Conclusion
It should be remembered that there is always more
than a single explanation for any given set of blood
gas results. So it is not possible to make a diagnosis
on the basis of these result alone, which must
always be considered together with the pt.’s
history, heamodynamic parameters & other
investigations.