Brain death occurs when there is irreversible cessation of all functions of the entire brain, including the brain stem. It can be caused by conditions that lead to loss of oxygen to the brain like cerebral anoxia, hemorrhage or trauma. Diagnosing brain death involves assessing for the absence of brain stem reflexes and response to stimuli, as well as a positive apnea test where the patient fails to breathe independently with high carbon dioxide levels. Ancillary tests like EEG, angiography or PET scans may be used to confirm the diagnosis when clinical assessment is limited.
Nurses as the primary care providers would be the immediate health care professional to assess the patient's response and to determine whether he is improving or deteriorating. Signs of brain death can be identified and reported early by a nurse with adequate knowledge.
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
Nurses as the primary care providers would be the immediate health care professional to assess the patient's response and to determine whether he is improving or deteriorating. Signs of brain death can be identified and reported early by a nurse with adequate knowledge.
Intracerebral hemorhage Diagnosis and managementRamesh Babu
About ICH - Diagnosis and management, Discussed the clinical presentation, evaluation, radiological features and management including recent guidelines
This is a presentation on brain death, its background, definition, related neurological conditions, criteria of brain death, brain stem reflexes, causes of coma, confounding factors, observation compatible with brain death, ancillary test, medical record documentation, prognosis, Management of brain death patient.
You tube link of this presentation
https://www.youtube.com/watch?v=3MzE5lHfglI&t=38s
This presentation consist information about Brain death with special emphasis to differences between Indian and Western Guidelines. Also consist information about Organ transplantation and related act.
This is a presentation on brain death, its background, definition, related neurological conditions, criteria of brain death, brain stem reflexes, causes of coma, confounding factors, observation compatible with brain death, ancillary test, medical record documentation, prognosis, Management of brain death patient.
You tube link of this presentation
https://www.youtube.com/watch?v=3MzE5lHfglI&t=38s
This presentation consist information about Brain death with special emphasis to differences between Indian and Western Guidelines. Also consist information about Organ transplantation and related act.
Death by Neurological Criteria and Organ Donation: Bill KnightSMACC Conference
Bill Knight explains the concept of death by neurological criteria and the complexities surrounding organ donation in such situations.
Bill discusses the process of dying, the definition of death, how to approach the neurologically dead patient and how to consider organ donation.
Death is a complex topic.
Due to advancements in medical technology and processes, the definition of death is a challenging one.
Bill talks at length about the definition of death by the neurological criteria. Dying is an active process, whereas death is an event.
The acceptance of death by the neurological criteria is often challenging as Bill will highlight. Bill talks about the care of the dying or dead patient.
There is a point at which care will transition from supporting the patient to supporting the organs. This is still good care.
There is an alignment of parallel intentions – first and foremost resuscitation of patients and then failing that, proceeding to considering and actioning organ donation. This is important due to the shortage of viable donor organ worldwide.
The donation process itself is complex. Bill provides his thoughts. He insists that an intensivist be involved as this has been shown to increase the number of viable and healthy organs made available.
The timing is also important. Available evidence does not support the need for immediate procurement after brain death. Taking time to optimise perfusion and allow recovery and cardiac function is appropriate and should be done.
Bill also discusses other treatment options at the time of death such as optimising endocrine function.
Finally, Bill will provide some practical considerations when communicating with the dead patient’s family. This involves being clear on your messaging. You are supporting organs, not life.
To reinforce this point, Bill suggests not examining or talking to the patient. He also recommends using all of the available hospital support services.
Similarly, it is best to not introduce the topic of organ donation to the family yourself as the treating clinician. Utilise the Organ Procurement Organisations (or similar services) and get them involved early to speak with the family.
Join Bill Knight in his talk on the North American perspective on Organ Donation, brain death and management of the brain dead donor prior to organ donation.
For more like this, head to our podcast page. #CodaPodcast
A stroke is a medical condition in which poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding.Both result in parts of the brain not functioning properly.
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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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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.
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
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.
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.
2. Brain Death
Out line
What is brain death?
Causes of Brain Death
Clinical evaluation of brain death
Brain Death Diagnosis
24 May 2016 brain death
3. Normal Brain Anatomy
24 May 2016 brain death
Cerebral Cortex
Brain Stem
Reticular
Activating
System
Receives multiple
sensory inputs
&
Mediates
Consciousness
(wakefulness)
5. Brain Stem : Functions
24 May 2016 brain death
Medulla
Cranial Nerve IX, X
Pharyngeal (Gag) Reflex
Tracheal (Cough) Reflex
Respiration
6. Death : Definition
Thanatology
Branch of science dealing with study of death
Death is the complete and irreversible stoppage of
Circulation
Respiration
Brain function (Tripod of life)
As long as oxygenated blood reaches brain stem, Life exists
….
Mechanical Ventilator use in ICU
Brought concept of “Brain Death”
24 May 2016 brain death
7. Brain Death
Ireversible destruction of the brain,with the
resulting total absence of all cortical and
brainstem functions,although spinal cord
refleves may remain
24 May 2016 brain death
9. 3 clinical findings necessary to confirm
irreversible cessation of all functions of the
entire brain, including brain stem
Coma (with a known cause)
Absence of brainstem reflexes
Apnoea
24 May 2016 brain death
13. Brain Death : Mechanism
24 May 2016 brain death
Neuronal Injury
Decreased Intracranial
Blood Flow
Neuronal Swelling
Increased Intracranial
Pressure
ICP > MAP is
incompatible
with life
14. 4 Steps in Determining
Brain Death
The Clinical Evaluation
The Neurologic Assessment
Ancillary Test
Documentation
15. Clinical evaluation of brain death
Irreversible coma
Known etiology and or reversible causes ruled out
Must have an absence of
Hypothermia (>32.50C)
Neuromuscular blockade and Shock
Significant levels of sedatives
Severe metabolic distrubance and Endocrine abnormalities
Poisoning
24 May 2016 brain death
16. Absence of cortical functions
No spontaneous movement, eye opening, or movement
or response after auditory, verbal, or visual commands
Cerebral motor response to pain
Supraorbital ridge, the nail beds, trapezius
Motor responses may occur spontaneously during
apnea testing (spinal reflexes)
Spinal arcs are intact!
24 May 2016 brain death
17. Absence of brain stem
function-1)Pupillary reflex
2)Corneal reflex
3)Gag reflex
4)Cough reflex
5)Oculocephalic reflex (doll’s eye reflex)
6)Oculovestibular reflex (caloric reflex)
7)No integrated motor response to pain
8)Apnea testing
24 May 2016 brain death
18. Pupillary reflex-
pupils may be midposition or dilated (4 to 9 mm)
Absent pupillary light reflex
IV atropine does not markedly affect response
Paralytics do not affect pupillary size
Topical administration of drugs and eye trauma may
influence pupillary size and reactivity
24 May 2016 brain death
19. Corneal reflex-
Corneal reflexes are absent in brain death
Corneal reflexes - tested by using a cotton-tipped
swab
.
There is no blink response to direct corneal stimulation.
24 May 2016 brain death
20. Oculocephalic reflex
Rapidly turn the head 90° on both sides
Normal response = deviation of the eyes to the
opposite side of head turning
Brain death = oculocephalic reflexes are absent (no
Doll’s eyes) = no eye movement in response to head
movement
24 May 2016 brain death
22. Vestibularocular reflex
No eye movements within 3 mints after irrigating each
tympanic membrane (if intact) sequentially with 50 ml
ice water for 30 to 45 seconds while the head of the
supine patient is elevated 30 degrees
Retained vestibulocular reflex
24 May 2016 brain death
23. Cold calorics interpretation
Not comatose
Nystagmus; both eyes slow toward cold, fast to midline
Coma with intact brainstem
Both eyes tonically deviate away cold water
No eye movement
Brainstem injury / death
Movement only of eye on side of stimulus
Internuclear ophthalmoplegia
Suggests brainstem structural lesion
24 May 2016 brain death
24. Brain Death : Apnoea Test
Pre-requisites
Body Temperature > 36° C
Systolic Blood Pressure ≥ 100 mm Hg
Normal Electrolytes profile
Normal PaCO2 (35-45 mm Hg)
Pre-Oxygenation
100% Oxygen via Tracheal Cannula for 10 min
Achieve PaO2 = 200 mm Hg
Monitor PaO2 with pulse oximetry
24 May 2016 brain death
25. Brain Death : Apnoea Test
Reduce Ventilation frequency to 10/min
Reduce PEEP to 5 Cm H2O
Take 1st Blood sample for Blood Gas analysis
Disconnect Ventilator
Deliver 100% O2 by catheter through ET tube
@ 6 L/min
Observe for Respiratory Movement
Atleast for 8 – 10 min
24 May 2016 brain death
26. Interpreting the test
The apnea test is POSITIVE (i.e., supports the
diagnosis of brain death) if:
There are no respiratory efforts during the test AND
Repeat ABG shows PCO2 > 60 mm Hg.
24 May 2016 brain death
27. Interpreting the test
The apnea test is INDETERMINATE if:
after 10 minutes, the patient demonstrates no
respiratory effort, but the PCO2 is < 60 mm Hg.
The apnea test is NEGATIVE (i.e., does NOT
support the diagnosis of brain death) if:
the patient demonstrates any respiratory effort at any
time during the test.
Cease the test and reconnect the ventilator immediately
upon observing respiratory effort.
24 May 2016 brain death
28. The Apnea Test
If the patient becomes unstable at any point
during the Apnea Test (i.e. SBP drops less than
90, significant desaturation on pulse-oximetry,
observance of cardiac arrhythmias, etc.), the test
should be aborted.
The Apnea Test should not “induce a code!”
24 May 2016 brain death
29. Movements originating from the spinal cord
or peripheral nerve which occur in brain
death
Spontaneous 'spinal' reflexes in the limbs
Respiratory-like movements
Sweating, blushing, tachycardia
Normal BP
Normal osmolar control mechanism
Deep tendon reflexes, Babinski's reflex
Facial myokymias
24 May 2016 brain death
30. Brain Death
Ancillary Confirmatory Testing
Recommended when
Proximate cause of coma is not known or
When confounding clinical conditions limit clinical
examination
EEG
Cerebral Angiography
PET : Glucose Metabolic Studies
Dynamic Nuclear Scan
Somato-Sensory Evoked Potential
24 May 2016 brain death
33. PET
Glucose Metabolism Studies
24 May 2016 brain death
“Hollow-skull sign”
of brain death
Cerebral metabolism
globally reduced ~50%
Normal
Nature Rev Neurosci 2005;6:899-909
34. Dynamic Nuclear Brain Scan
24 May 2016 brain death
“Hollow-skull sign” of brain death
NEJM 2001;344:1215-1221