This document provides guidance on patient management in a surgical intensive care unit (SICU). It discusses indications for SICU admission including major surgeries, trauma, and medical complications. It outlines general care practices in the SICU such as airway management, feeding, infection control, and prevention of complications. The document also reviews criteria for mechanical ventilation, parameters for ventilator settings, weaning from ventilation, and discharge from the post-anesthesia care unit. It presents a case of a child with tracheal injury who required intubation and mechanical ventilation in the SICU.
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
These slides represent how to manage patients on a mechanical ventilator? Easy understanding of using ventilators. indication of mechanical ventilator use. How to wean a patient from a mechanical ventilator? How to fine-tune the ventilator settings?
PowerPoint presentation on ECMO (Extracorporeal Membrane Oxygenation). Part 2 focuses on Monitoring ECMO patients
Ventilatory strategies, Sedation and pain control, Weaning, Complications and recent advances in ECMO. For better understanding please have a look at ECMO part 1 before going through part 2.
A study to assess the effectiveness of structured teaching program on knowledge regarding care of patients after cardiac surgery among staff nurses at Shree Narayana, Hospital, Raipur, chhattisgarh.
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
- 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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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 Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. Patient management in
surgical ICU
by
Dr. Radhwan Hazem AL-Khashab
consultant anaesthesia & ICU
2020
ICU, AL-jamhory teaching hospital
3. What is meant by SICU?
A tertiary care facility in the hospital that provides a
state of the art medical care to critically ill patients
referred to it via different surgical department.
4. Indication of admission to
SICU
1. Surgical causes includes:
◼ Pre and post-operative patients of ASA IV and V,
undergoing major and ultra major surgeries.
◼ All craniotomy patients.
◼ All thoracotomy patients.
◼ All ultra major surgeries.
◼ Unstable multiple trauma patients.
5. 2- Severely injured patient : whether there is
indication for mechanical ventilation or not.
3-Medical factors : any previous medical problems in
which the anesthesia & surgery increase the severity of
pre-existing disease e.g. patient with COPD, restrictive
lung disease ,heart failure , uncontrolled DM or H.T. .
4- Perioperative complication :
Cardiac arrest , sudden hyper or hypotension, cardiac
dysrrhythmias , delay recovery from anaesthesia , oliguria
or anuria.
6. Generally speaking, any surgical patient who
requires continuous monitoring, 1:1 nursing
and /or continuous life support is a candidate
for SICU admission.
8. 1. CNS relating care:
Pain , agitation , psychosis: what are the
causes ?
Management :Can be relieved by analgesia ,
sedative & antipsychotic drugs respectively
,especially if pat. Remain in ICU > one week.
LOC: Neurological assessment mainly by GCS.
9. 2. Care of the eyes: Critical patients
especially coma patient need daily care of
both eyes.
Why?
This done by using eye medication , distal
water drops, plastering the lids
10. 3. Care of Airway :
Natural airways
Care of oral cavity especially unconscious pat.
To avoid dryness of oral cavity due to mouth
breathing & 2dry fungal infection.
How?
Artificial airways:
-Frequent bronchial washout by distal water or
normal saline injected into ETT or Ts, with aid of
ambu bag & sucker to lubricate the retained
secretion & prevent tubal obstruction by clot or
dry crust .
Technique?
11. Note :
Contraindication to use sodium bicarbonate as
irrigation fluid , this will cause damage to
alveolar cells (pneumocyte type 2 ,surfactant
producing cells) which lead to alveolar collapse.
12. 4. Alimentation:
Assessment of Nutritional Status
When to Feed?
Feeding Route:
1 - Enteral Feeding
2 - Parenteral Feeding:
- Central Access
- Peripheral Access
Monitoring to prevent complications.
13. 5. Prophylaxis of Gastric upset :
Indications :
preexisting gastric illness , H.C.>250mg/d,
burn>35%, head inj. ICU stay, patient On MV ,sepsis
, hepatic problems , S.C. inj., hypovolemic or
hypotensive pat.
Types of drugs used :
H2-receptor antagonists (ranitidine,famotidine).
PPI ( lansoprazole, omeprazole)..
14. 6. Fluids :
Aims : Tissue perfusion
O2 carrying capacity
Coagulation
What are the types of replacements :
Replacement of deficit.
Replacement of maintenance.
Replacement of loss (blood loss & 3rd space loss).
15. 7. DVT prophylaxis :
Site , Predisposing factors, prophylaxis &
treatment
8. Infection :
Nosocomial inf.
Acquired outside hosp.
Predisposing Factors: e.g.
Extremes of age
Immunocompromized
Invasive procedures…..etc.
16. 9.Renal : Monitoring of UOP is very
important in intensive patient :
oliguria is : If UOP < 0.5 ml/kg/h for
successive 2 h.
10. Prevention of bed sore: By using
pneumatic bed or changing position of pat. every 2
h.
12. Physiotherapy :
- Upper & lower limbs.
- Bladder
- Chest
17. 13. Other care:
*Bowel :bedridden pat. tend to develop
constipation
* Catheter.
14.MV:
care of pat. On MV.
Indication, setting ,weaning
18. Indication of E.T.T.
1. Comatose patient: ( head injury : 1ry or 2dry).
2. Loss of upper airway reflexes
,( comatose patient, neuronal & neuromuscular
diseases ,e.g. guillain barre , myasthenia gravis ).
3.In patient need mechanical ventilation.
4. Upper airway obstruction .e.g. vocal cord paralysis
, acute epiglotitis, F.B. inhalation , faciomaxillary inj
.
22. Indication of Mechanical Ventilation
1. Clinical parameters :-
❑ C.N.S.: Restlessness , coma , loss of reflexes.
❑ Resp.sys.: Apnea , tachypnea , resp. M. fatigue .
❑ C.V.S.: dysrrhythmias , severe hypotension.
23. 2. Mechanical parameters :-
❑ R.R. > 35 B.P.M.
❑ VT < 5 ml/kg. (tidal volume: each normal
breath cycle 6-10ml/kg).
❑ Vital capacity < 15 ml /kg.
( vital capacity : maximum volume of gas that
can be exhaled after maximal inspiration 60 –
70ml/kg).
❑ RSBI: RR/Vt(L) > 100. (60-100)
❑ VD/Vt > 0.6 (normally less than 0.3)
25. Parameter of ventilator setting
1. Tidal volume : 6-10 ml/kg.
2. Respiratory rate : 10-18 BPM.
3. FIO2 ( O2 %): start with 100% & then decrease
according to SPO2 % every 4-6 h
4. PEEP: up to 5 cm/H2O.if there is no
hemodynamic disturbances.
5. Modes of ventilation:
-CMV: In patient with no any ventilatory
effort e.g.: spinal cord inj. above C3, or postop.
Residual muscle relaxant effect
-SIMV: In patient with insufficient ventilation.
26. Note:
O2% of inspired gas shouldn't be given
above 50% more than 10-20 h in adult age
& not more than 5-10h in pediatric age
group , because this may lead to O2 toxicity
with respiratory & non respiratory
complication.
27. Monitoring of ICU patient
1. Pulse rate
2. Blood pressure
3. Respiratory rate
4. Temperature.
5. SpO2: Measured by pulse oximeter which show any
evidence of hypoxemia, the normal value is above 90%
which correspond PaO2 of about 60 mmHg,
Note : tissue hypoxia start when SpO2 decrease below
75%which correspond PaO2 40 mmHg , so it's very
important to continue monitoring SpO2 frequently .
28.
29. 5. ECG.
6. UOP : Oliguria , UOP< 0.3- 0.5 ml/kg for successive
two hours.
7. ETco2: This measure the concentration of CO2 in
exhaled gases which reflect the intra-alveolar
concentration of CO2, it's 4-5mmHg less than PaCO2 . (
normal value for PaCO2 35-45 mmHg).
8. Invasive parameter this done in certain cases &
not routinely, which includes : IBP , CVP , PAP ,ABG ,
9. Monitoring of mechanical ventilator parameters ;
O2% ,VT , RR ,Airway pressure, minute ventilation &
disconnection alarms.
30. Monitoring chart
التعليمي الجمهوري مستشفى
الجراحي واإلنعاش ألمركزة العناية وحدة
المريض اسم:الطبيب
أالختصاصي:
ألعمر:اإلحالة مكان:
األولي التشخيص:تأريخ و وقت
الدخول:
Date of chart :- / /2007
االقدم المقيم الدوري المقيم
notedrugsOUT
PUT
ML
IN
PUT
ML
GCStempSPO2
%
RR
(BPM)
BP
S/D
)PR
(B/M
Time
31. Criteria for weaning From mechanical
ventilation
1.Clinical parameters:-
1. C.N.S. : Patient conscious ,oriented, ,intact reflexes
(e.g.: Gag &cough reflex).
2. Resp.sys .:Good M. power ,normal & regular breathing
.
3. C.V.S. :Normal hemodynamic state.
4. Metabolic state: No metabolic disorder
(i.e. no acidosis or alkalosis ).& No temp. Abnormality).
34. *Activity: 2 = move four limbs.
1= move two limbs.
0= no movement.
*Respiration: 2 = normal regular breath & able to
cough.
1 = shallow breathing ( dyspneic).
0 = apnea
35. *Circulation : 2 = Bp ( 20% +/-) of preanaesthetic
reading.
1 = Bp( 20% - 50 %+/-) of preanaesthetic
reading.
0 = Bp ( > 50% +/-) of preanaesthetic
reading.
*Consciousness : 2 = fully awake.
1 = arrousable on calling.
0 = non responding.
36. SpO2 : 2 = >92% on room air.*
1 = need O2 therapy to maintain SpO2 >90%.
0 = < 90% on O2 therapy.
*Scoring : patient can be discharged
from PACU when Score > 9 .
37. Case presentation :
M.A.4 years female sustained an blast injury to neck
associated with tracheal injury , patient developed aspiration of
blood to both lung , so patient developed sign of respiratory
distress , tracheostomy done for her.
38. Clinical assessment
The child was distressed , tachycardia , tachypnea, agitated.
SPO2 = 60-66% on T-piece.
HR = 133-159 /BPM
RR > 47 /min.
PH =7.29
PaCO2 > 52 mmHg
So patient have many parameters for MV , at start a SIMV
used to support her condition after stabilization of
metabolic state changed to PSV.
39. SIMV parameters:-
* Vt = 165 ml.
* frequency = 20+spontaneous breaths about
22 BPM
* PEEP = 5 cm/ H2O.
* FIO2 = 100 % at start.
* I/E =1/1.9
40. Patient start to improve in which an SPO2 = 89 – 92%
& patient become quit .
CXR show diffuse opacities of both lungs.
On examination there was a sign of bronchospasm , so
start treatment which includes ( bronchodilator,
systemic steroids, nebulization with beta 2 agonist) in
addition to bronchial hygiene therapy.
On next few hours
41. On 2nd day with frequent bronchial lavage ,
the patient show more signs of improvement
of vital signs & hemodynamic parameters &
ABG result.
42. On 3rd day patient gets a good criteria for
weaning (SPo2 =91-93%), (HR=121-129
BPM),(PH=7.33),(PaCO2=39 mmHg).
So weaning starts & continue for few hours.
The patient discharged from SICU few days
later with complete improvement.