A 17-year-old female presented with loss of consciousness after ingesting 8 grams of carbamazepine tablets. She was comatose on examination. After supportive care including cimetidine, tube feeding, and dialysis, her mental status improved and she was discharged. Carbamazepine toxicity can cause seizures, arrhythmias, respiratory depression, and coma. Treatment involves supportive care, activated charcoal, and enhanced elimination methods like hemodialysis for severe cases.
This document provides an overview of neuroleptic malignant syndrome (NMS). It begins with a case vignette of a 45-year-old woman who developed NMS after being prescribed haloperidol and fluphenazine. The document then covers the diagnostic criteria of NMS, risk factors, pathophysiology, laboratory findings, differential diagnosis, management including discontinuing antipsychotics and supportive care, prognosis which includes potential mortality, and conclusions regarding NMS.
This document provides an overview of poisoning in children, including common toxins, clinical presentations, management principles, and case examples. The main points are:
1. Common toxins in children include acetaminophen, iron, organophosphates, and hydrocarbons. Clinical presentations depend on the toxin but may include gastrointestinal, neurological, or respiratory symptoms.
2. Management follows the ABCs - airway, breathing, circulation - along with decontamination using activated charcoal or whole bowel irrigation. Specific antidotes are given when available.
3. Case examples demonstrate iron poisoning presenting with GI bleeding, organophosphate poisoning with cholinergic symptoms, and acetaminophen overdose
1. Paracetamol and barbiturate overdoses are common causes of acute liver failure and can be fatal at high doses. N-acetylcysteine treatment may help if given within 24 hours of ingestion.
2. Tricyclic antidepressant overdoses can cause seizures, cardiac toxicity, and serotonin syndrome due to their anticholinergic and sodium channel blocking effects. Treatment involves monitoring, sodium bicarbonate, and overdrive pacing or magnesium for cardiac issues.
3. Prompt supportive care including airway management and decontamination measures are important for managing overdoses of these common drugs to prevent complications and death.
This document discusses malaria, including its lifecycle, clinical features, treatment guidelines, and recent updates. It describes the pre-erythrocytic and erythrocytic stages of malaria's lifecycle. It outlines the symptoms and stages of malaria infection. It provides treatment guidelines for Plasmodium vivax, Plasmodium falciparum, severe malaria, and chemoprophylaxis. It also mentions drug resistance and the RTS,S malaria vaccine currently in clinical trials.
This document provides information on the clinical presentation, investigation, and treatment of malaria. It discusses how malaria commonly presents with symptoms like fever, chills, sweats, and headaches. It also covers severe complicated malaria and its symptoms. For investigation, it recommends examining blood films under microscopy, using rapid diagnostic tests, and PCR. It provides treatment guidelines for uncomplicated and severe falciparum malaria, including recommended drugs and dosages. It also discusses specific treatment considerations for populations like pregnant women, those with hepatic or renal impairment, children, and prevention through chemoprophylaxis.
Olanzapine is a thienobenzodiazepine derivative of clozapine. It is well absorbed orally with a mean half-life of 31 hours, allowing for once daily dosing. It has high affinity for serotonin, dopamine, histamine, and adrenergic receptors. Olanzapine is effective for schizophrenia, bipolar disorder, and agitation, but can cause weight gain, hyperlipidemia, and extrapyramidal symptoms.
This document provides an overview of neuroleptic malignant syndrome (NMS). It begins with a case vignette of a 45-year-old woman who developed NMS after being prescribed haloperidol and fluphenazine. The document then covers the diagnostic criteria of NMS, risk factors, pathophysiology, laboratory findings, differential diagnosis, management including discontinuing antipsychotics and supportive care, prognosis which includes potential mortality, and conclusions regarding NMS.
This document provides an overview of poisoning in children, including common toxins, clinical presentations, management principles, and case examples. The main points are:
1. Common toxins in children include acetaminophen, iron, organophosphates, and hydrocarbons. Clinical presentations depend on the toxin but may include gastrointestinal, neurological, or respiratory symptoms.
2. Management follows the ABCs - airway, breathing, circulation - along with decontamination using activated charcoal or whole bowel irrigation. Specific antidotes are given when available.
3. Case examples demonstrate iron poisoning presenting with GI bleeding, organophosphate poisoning with cholinergic symptoms, and acetaminophen overdose
1. Paracetamol and barbiturate overdoses are common causes of acute liver failure and can be fatal at high doses. N-acetylcysteine treatment may help if given within 24 hours of ingestion.
2. Tricyclic antidepressant overdoses can cause seizures, cardiac toxicity, and serotonin syndrome due to their anticholinergic and sodium channel blocking effects. Treatment involves monitoring, sodium bicarbonate, and overdrive pacing or magnesium for cardiac issues.
3. Prompt supportive care including airway management and decontamination measures are important for managing overdoses of these common drugs to prevent complications and death.
This document discusses malaria, including its lifecycle, clinical features, treatment guidelines, and recent updates. It describes the pre-erythrocytic and erythrocytic stages of malaria's lifecycle. It outlines the symptoms and stages of malaria infection. It provides treatment guidelines for Plasmodium vivax, Plasmodium falciparum, severe malaria, and chemoprophylaxis. It also mentions drug resistance and the RTS,S malaria vaccine currently in clinical trials.
This document provides information on the clinical presentation, investigation, and treatment of malaria. It discusses how malaria commonly presents with symptoms like fever, chills, sweats, and headaches. It also covers severe complicated malaria and its symptoms. For investigation, it recommends examining blood films under microscopy, using rapid diagnostic tests, and PCR. It provides treatment guidelines for uncomplicated and severe falciparum malaria, including recommended drugs and dosages. It also discusses specific treatment considerations for populations like pregnant women, those with hepatic or renal impairment, children, and prevention through chemoprophylaxis.
Olanzapine is a thienobenzodiazepine derivative of clozapine. It is well absorbed orally with a mean half-life of 31 hours, allowing for once daily dosing. It has high affinity for serotonin, dopamine, histamine, and adrenergic receptors. Olanzapine is effective for schizophrenia, bipolar disorder, and agitation, but can cause weight gain, hyperlipidemia, and extrapyramidal symptoms.
This document discusses a case of neonatal diabetes mellitus (NDM) in an infant. Key points:
1. The infant presented with hyperglycemia after birth and was diagnosed with NDM after ruling out other causes.
2. Treatment with NPH insulin was initially tried but glycemic control remained inadequate.
3. Insulin glargine was then started and provided much better glycemic control with no episodes of hypoglycemia.
4. NDM is a rare condition characterized by persistent hyperglycemia within the first month of life requiring insulin treatment. It can be transient or permanent and is caused by defects in insulin secretion or beta cell development.
This document discusses a case of neonatal diabetes mellitus (NDM) in an infant. Key points:
1. The infant presented with hyperglycemia after birth and was diagnosed with NDM after ruling out other causes.
2. Treatment with NPH insulin was initially tried but glycemic control remained inadequate.
3. Insulin glargine was then started and provided excellent glycemic control with no episodes of hypoglycemia, allowing the infant to be shifted to a step-down unit.
4. NDM is a rare condition characterized by persistent hyperglycemia within the first month of life requiring insulin treatment. It can be transient or permanent and is caused by defects in insulin secretion
Pyridoxine-dependent epilepsy (PDE) is a rare genetic disorder characterized by seizures that are resistant to conventional anti-epileptic drugs but respond to pyridoxine (vitamin B6). The document discusses the presentation, diagnosis, treatment and outcomes of PDE. It highlights that PDE is caused by a deficiency in the enzyme antiquitin which results in accumulation of toxic metabolites and secondary deficiency of pyridoxal phosphate, an important neurotransmitter cofactor. Immediate intravenous pyridoxine administration can stop seizures and biochemical testing can confirm the diagnosis. Lifelong pyridoxine supplementation is the primary treatment and leads to better neurological outcomes when started early.
ANAESTHESIA MANAGEMENT IN PATIENTS OF NEUROMUSCULAR DISORDERS.pptxSumit Tyagi
This document discusses the anesthetic management of patients with neuromuscular disorders like myasthenia gravis. It covers pre-operative assessment including predicting risk of post-op crisis. Intra-operative considerations include use of non-depolarizing muscle relaxants like cisatracurium in reduced doses and monitoring. Extubation is done using sugammadex after ensuring recovery of neuromuscular function. Post-op management focuses on physiotherapy, resuming anticholinesterases cautiously and monitoring for respiratory failure.
This document defines nephrotic syndrome and describes its causes, clinical features, investigations, and management. Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It is usually caused by damage to the glomeruli, which allows protein to leak from the blood into the urine. Primary nephrotic syndrome of unknown cause is most common in children. Complications include edema, hypertension, infection risk, and thrombosis. Investigations help determine the underlying cause, and management focuses on treating symptoms, complications, and any identified causes.
Carbamazepine is an anticonvulsant medication used to treat seizures and trigeminal neuralgia. It works by stabilizing neuronal membranes and limiting seizure activity. Common brand names include Tegretol and Carbatrol. Carbamazepine comes in tablet, capsule, suspension, and extended release forms. Dosage varies depending on age, indication, and other factors. Adverse effects include dizziness, nausea, and potential hematologic issues. Due to risks like aplastic anemia, regular monitoring is required during carbamazepine therapy.
Pulse therapy involves administering high doses of drugs intermittently to enhance therapeutic effects and reduce side effects. It is commonly used in dermatology to treat conditions like pemphigus vulgaris. The most common agents used are methylprednisolone and dexamethasone, administered intravenously in high doses over 2-3 hours. Pulse therapy works through both genomic and non-genomic mechanisms at the cellular level to produce powerful anti-inflammatory effects. It provides indications, contraindications, administration protocols, mechanisms of action, and modifications for pulse therapy.
This document provides information on the management of acetaminophen (APAP) toxicity. It discusses the history of APAP use, its widespread presence in over-the-counter medications, pharmacological actions, pharmacokinetics, toxicity risks, stages of poisoning, and treatment with N-acetylcysteine (NAC). It emphasizes the importance of timely NAC administration based on the Rumack-Matthew nomogram to prevent hepatic damage from APAP overdose. Two case studies demonstrate the application of these principles in clinical practice.
Therapeutic drug monitoring of cardiovascular agentsranjith lucky
This document discusses therapeutic drug monitoring of cardiovascular agents. It provides details about amiodarone and digoxin, including their clinical uses, mechanisms of action, dosing, toxicity, and monitoring. For amiodarone, it describes factors affecting drug concentrations, toxic effects, and patient tips. For digoxin it outlines dosing in various populations, factors influencing concentrations, side effects, and monitoring therapy.
This document provides an overview of emerging topics in clinical toxicology. It discusses new therapies for toxicological emergencies such as high-dose insulin for calcium channel blocker overdose. Intralipid emulsion is emerging as a treatment for local anesthetic toxicity. Methylene blue shows promise for ifosfamide-induced encephalopathy. Commonly encountered toxins like quetiapine now cause more ICU admissions. "New drugs" like synthetic cannabinoids can cause unpredictable effects. Recommendations for snake antivenom and redback spider antivenom use have also changed in recent years. The document emphasizes that a risk assessment approach is key to managing poisonings.
This document provides information on several second-generation or atypical antipsychotic medications including clozapine, olanzapine, quetiapine, risperidone, paliperidone, ziprasidone, aripiprazole, and carbamazepine. It describes the indications, mechanisms of action, pharmacokinetics, dosages, drug interactions, and side effects of each drug. It also discusses risks of weight gain and diabetes associated with some of these medications and monitoring parameters for patients taking them.
1) Early studies showed steroids improved survival for lupus patients compared to no treatment, and high-dose steroids worked better than low-dose.
2) Later trials added cytotoxic drugs to steroids and found fewer unfavorable outcomes for lupus nephritis patients.
3) A randomized trial found low-dose IV cyclophosphamide as effective as high-dose IV cyclophosphamide for lupus nephritis, with fewer infectious side effects from the lower dose.
This document discusses various treatment options for epilepsy including medications, surgery, ketogenic therapy, and Vagus Nerve Stimulation (VNS). It provides details on the mechanisms of different anti-epileptic drugs and their histories of use. Safety during seizures is emphasized, including proper response, potential injuries, and documentation. Home rescue medications like Diastat and Midazolam are outlined. Open communication between healthcare providers is encouraged.
This document defines epilepsy and seizures, describes different types of seizures and epilepsy, and outlines treatment approaches. Epilepsy is defined as recurrent unprovoked seizures, while seizures are excessive electrical discharges in the brain causing uncontrolled muscle spasms or altered consciousness. Seizures can be focal or generalized onset. Treatment involves anti-epileptic drugs, with choices based on seizure type. Status epilepticus is a medical emergency requiring benzodiazepines or other drugs to stop prolonged seizures.
Cyclophosphamide is a synthetic antineoplastic drug that is converted in the liver to active forms with chemotherapeutic activity. It is an alkylating agent that alters DNA structure and interferes with cell growth. Cyclophosphamide is used to treat various cancers such as lymphoma, multiple myeloma, leukemia, and retinoblastoma. It has potential adverse effects including nausea, vomiting, alopecia, hemorrhagic cystitis, and bone marrow suppression. Nursing care involves frequent monitoring of blood counts and symptoms as well as educating patients about contraception and potential side effects.
Diamox (acetazolamide) is a carbonic anhydrase inhibitor used to treat glaucoma and seizures by lowering intraocular pressure and abnormal neuronal firing. It works by inhibiting carbonic anhydrase in the eye, kidneys, and central nervous system. Common side effects include fatigue, nausea, and hypokalemia. Nursing responsibilities involve monitoring for side effects and assessing response to treatment by checking intraocular pressure, seizure activity, and edema. Patients should be advised to use sun protection and report any adverse reactions or symptoms.
A 34-year-old British woman presented to the emergency department 30 minutes after ingesting approximately 100 acetaminophen tablets with alcohol in a suspected suicide attempt. She was treated with activated charcoal and intravenous N-acetylcysteine. On the first day of admission she developed abdominal pain and vomiting. Her liver function tests remained normal during her 3-day admission before she discharged herself against medical advice to return to the UK. Paracetamol overdose is commonly seen and requires prompt treatment with N-acetylcysteine to prevent liver damage from toxic metabolite accumulation if ingestion exceeds toxic thresholds.
The document discusses the neuroanatomy and neurolocalization of the basal ganglia and thalamus. It describes the basal ganglia as a collection of gray matter nuclei involved in motor control. It notes their role in initiating and modulating movement. It then describes the specific nuclei of the basal ganglia - the caudate, putamen, globus pallidus, subthalamic nucleus, and substantia nigra. It also discusses the direct and indirect pathways between these nuclei and their role in movement. Finally, it briefly discusses some movement disorders associated with lesions in different basal ganglia structures.
The document outlines an approach to evaluating neurologic patients based on three key questions: 1) Is the problem neurological? 2) Where is the lesion located? And 3) What is the lesion? It emphasizes using the neurological exam and patient history, particularly the temporal profile of symptoms, to help localize and identify the nature of the lesion. By considering features like acute vs. chronic onset and focal vs. diffuse signs, the differential diagnosis can be narrowed down. This systematic approach aids in evaluating complex neurologic presentations.
This document discusses a case of neonatal diabetes mellitus (NDM) in an infant. Key points:
1. The infant presented with hyperglycemia after birth and was diagnosed with NDM after ruling out other causes.
2. Treatment with NPH insulin was initially tried but glycemic control remained inadequate.
3. Insulin glargine was then started and provided much better glycemic control with no episodes of hypoglycemia.
4. NDM is a rare condition characterized by persistent hyperglycemia within the first month of life requiring insulin treatment. It can be transient or permanent and is caused by defects in insulin secretion or beta cell development.
This document discusses a case of neonatal diabetes mellitus (NDM) in an infant. Key points:
1. The infant presented with hyperglycemia after birth and was diagnosed with NDM after ruling out other causes.
2. Treatment with NPH insulin was initially tried but glycemic control remained inadequate.
3. Insulin glargine was then started and provided excellent glycemic control with no episodes of hypoglycemia, allowing the infant to be shifted to a step-down unit.
4. NDM is a rare condition characterized by persistent hyperglycemia within the first month of life requiring insulin treatment. It can be transient or permanent and is caused by defects in insulin secretion
Pyridoxine-dependent epilepsy (PDE) is a rare genetic disorder characterized by seizures that are resistant to conventional anti-epileptic drugs but respond to pyridoxine (vitamin B6). The document discusses the presentation, diagnosis, treatment and outcomes of PDE. It highlights that PDE is caused by a deficiency in the enzyme antiquitin which results in accumulation of toxic metabolites and secondary deficiency of pyridoxal phosphate, an important neurotransmitter cofactor. Immediate intravenous pyridoxine administration can stop seizures and biochemical testing can confirm the diagnosis. Lifelong pyridoxine supplementation is the primary treatment and leads to better neurological outcomes when started early.
ANAESTHESIA MANAGEMENT IN PATIENTS OF NEUROMUSCULAR DISORDERS.pptxSumit Tyagi
This document discusses the anesthetic management of patients with neuromuscular disorders like myasthenia gravis. It covers pre-operative assessment including predicting risk of post-op crisis. Intra-operative considerations include use of non-depolarizing muscle relaxants like cisatracurium in reduced doses and monitoring. Extubation is done using sugammadex after ensuring recovery of neuromuscular function. Post-op management focuses on physiotherapy, resuming anticholinesterases cautiously and monitoring for respiratory failure.
This document defines nephrotic syndrome and describes its causes, clinical features, investigations, and management. Nephrotic syndrome is characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It is usually caused by damage to the glomeruli, which allows protein to leak from the blood into the urine. Primary nephrotic syndrome of unknown cause is most common in children. Complications include edema, hypertension, infection risk, and thrombosis. Investigations help determine the underlying cause, and management focuses on treating symptoms, complications, and any identified causes.
Carbamazepine is an anticonvulsant medication used to treat seizures and trigeminal neuralgia. It works by stabilizing neuronal membranes and limiting seizure activity. Common brand names include Tegretol and Carbatrol. Carbamazepine comes in tablet, capsule, suspension, and extended release forms. Dosage varies depending on age, indication, and other factors. Adverse effects include dizziness, nausea, and potential hematologic issues. Due to risks like aplastic anemia, regular monitoring is required during carbamazepine therapy.
Pulse therapy involves administering high doses of drugs intermittently to enhance therapeutic effects and reduce side effects. It is commonly used in dermatology to treat conditions like pemphigus vulgaris. The most common agents used are methylprednisolone and dexamethasone, administered intravenously in high doses over 2-3 hours. Pulse therapy works through both genomic and non-genomic mechanisms at the cellular level to produce powerful anti-inflammatory effects. It provides indications, contraindications, administration protocols, mechanisms of action, and modifications for pulse therapy.
This document provides information on the management of acetaminophen (APAP) toxicity. It discusses the history of APAP use, its widespread presence in over-the-counter medications, pharmacological actions, pharmacokinetics, toxicity risks, stages of poisoning, and treatment with N-acetylcysteine (NAC). It emphasizes the importance of timely NAC administration based on the Rumack-Matthew nomogram to prevent hepatic damage from APAP overdose. Two case studies demonstrate the application of these principles in clinical practice.
Therapeutic drug monitoring of cardiovascular agentsranjith lucky
This document discusses therapeutic drug monitoring of cardiovascular agents. It provides details about amiodarone and digoxin, including their clinical uses, mechanisms of action, dosing, toxicity, and monitoring. For amiodarone, it describes factors affecting drug concentrations, toxic effects, and patient tips. For digoxin it outlines dosing in various populations, factors influencing concentrations, side effects, and monitoring therapy.
This document provides an overview of emerging topics in clinical toxicology. It discusses new therapies for toxicological emergencies such as high-dose insulin for calcium channel blocker overdose. Intralipid emulsion is emerging as a treatment for local anesthetic toxicity. Methylene blue shows promise for ifosfamide-induced encephalopathy. Commonly encountered toxins like quetiapine now cause more ICU admissions. "New drugs" like synthetic cannabinoids can cause unpredictable effects. Recommendations for snake antivenom and redback spider antivenom use have also changed in recent years. The document emphasizes that a risk assessment approach is key to managing poisonings.
This document provides information on several second-generation or atypical antipsychotic medications including clozapine, olanzapine, quetiapine, risperidone, paliperidone, ziprasidone, aripiprazole, and carbamazepine. It describes the indications, mechanisms of action, pharmacokinetics, dosages, drug interactions, and side effects of each drug. It also discusses risks of weight gain and diabetes associated with some of these medications and monitoring parameters for patients taking them.
1) Early studies showed steroids improved survival for lupus patients compared to no treatment, and high-dose steroids worked better than low-dose.
2) Later trials added cytotoxic drugs to steroids and found fewer unfavorable outcomes for lupus nephritis patients.
3) A randomized trial found low-dose IV cyclophosphamide as effective as high-dose IV cyclophosphamide for lupus nephritis, with fewer infectious side effects from the lower dose.
This document discusses various treatment options for epilepsy including medications, surgery, ketogenic therapy, and Vagus Nerve Stimulation (VNS). It provides details on the mechanisms of different anti-epileptic drugs and their histories of use. Safety during seizures is emphasized, including proper response, potential injuries, and documentation. Home rescue medications like Diastat and Midazolam are outlined. Open communication between healthcare providers is encouraged.
This document defines epilepsy and seizures, describes different types of seizures and epilepsy, and outlines treatment approaches. Epilepsy is defined as recurrent unprovoked seizures, while seizures are excessive electrical discharges in the brain causing uncontrolled muscle spasms or altered consciousness. Seizures can be focal or generalized onset. Treatment involves anti-epileptic drugs, with choices based on seizure type. Status epilepticus is a medical emergency requiring benzodiazepines or other drugs to stop prolonged seizures.
Cyclophosphamide is a synthetic antineoplastic drug that is converted in the liver to active forms with chemotherapeutic activity. It is an alkylating agent that alters DNA structure and interferes with cell growth. Cyclophosphamide is used to treat various cancers such as lymphoma, multiple myeloma, leukemia, and retinoblastoma. It has potential adverse effects including nausea, vomiting, alopecia, hemorrhagic cystitis, and bone marrow suppression. Nursing care involves frequent monitoring of blood counts and symptoms as well as educating patients about contraception and potential side effects.
Diamox (acetazolamide) is a carbonic anhydrase inhibitor used to treat glaucoma and seizures by lowering intraocular pressure and abnormal neuronal firing. It works by inhibiting carbonic anhydrase in the eye, kidneys, and central nervous system. Common side effects include fatigue, nausea, and hypokalemia. Nursing responsibilities involve monitoring for side effects and assessing response to treatment by checking intraocular pressure, seizure activity, and edema. Patients should be advised to use sun protection and report any adverse reactions or symptoms.
A 34-year-old British woman presented to the emergency department 30 minutes after ingesting approximately 100 acetaminophen tablets with alcohol in a suspected suicide attempt. She was treated with activated charcoal and intravenous N-acetylcysteine. On the first day of admission she developed abdominal pain and vomiting. Her liver function tests remained normal during her 3-day admission before she discharged herself against medical advice to return to the UK. Paracetamol overdose is commonly seen and requires prompt treatment with N-acetylcysteine to prevent liver damage from toxic metabolite accumulation if ingestion exceeds toxic thresholds.
The document discusses the neuroanatomy and neurolocalization of the basal ganglia and thalamus. It describes the basal ganglia as a collection of gray matter nuclei involved in motor control. It notes their role in initiating and modulating movement. It then describes the specific nuclei of the basal ganglia - the caudate, putamen, globus pallidus, subthalamic nucleus, and substantia nigra. It also discusses the direct and indirect pathways between these nuclei and their role in movement. Finally, it briefly discusses some movement disorders associated with lesions in different basal ganglia structures.
The document outlines an approach to evaluating neurologic patients based on three key questions: 1) Is the problem neurological? 2) Where is the lesion located? And 3) What is the lesion? It emphasizes using the neurological exam and patient history, particularly the temporal profile of symptoms, to help localize and identify the nature of the lesion. By considering features like acute vs. chronic onset and focal vs. diffuse signs, the differential diagnosis can be narrowed down. This systematic approach aids in evaluating complex neurologic presentations.
This document provides an overview of paraplegia including its causes, clinical presentation, evaluation, and management. Key points include:
- Paraplegia is weakness or paralysis of the lower extremities caused by lesions of the spinal cord or peripheral nerves. It can affect motor, sensory, and autonomic functions.
- Lesion localization is determined through assessment of sensory, motor, reflex, and autonomic functions to localize the level of injury.
- Common complications include autonomic dysreflexia, pain, spasticity, and bladder/bowel dysfunction. Treatment involves managing the underlying cause and associated complications through various pharmacological, surgical, and rehabilitative approaches.
This document provides an overview of techniques for examining pathologic reflexes, meningeal signs, and monofilament tests in neurologic examinations. It discusses the objective of gaining knowledge and skills in these areas. For pathologic reflexes, it describes what they are, examples like Babinski's reflex, and their significance. It covers various reflexes tested in the lower and upper extremities. For meningeal signs, it explains that signs are elicited when meninges are inflamed, defines meningismus, and describes techniques like assessing nuchal rigidity.
The auditory system allows humans to perceive sound. Sound waves travel through the external ear, middle ear bones, and inner ear fluid before causing hair cells to bend, stimulating nerve impulses that the brain interprets as sound. The cochlea contains the organ of Corti with hair cells connected to the cochlear nerve. Auditory pathways project from the cochlear nuclei to the brainstem and auditory cortex. Clinical exams include otoscopy, tuning fork tests, audiometry to evaluate air and bone conduction thresholds and speech discrimination.
The document provides an overview of the approach and management of acute kidney injury (AKI). It discusses definitions of AKI, etiologic diagnosis, prevention and management strategies. Regarding management, it focuses on identifying at-risk patients, fluid therapy, treatment of underlying conditions, managing complications, preventing further kidney damage, and initiating renal replacement therapy in a timely manner. Fluid management is emphasized as crucial to both preventing and treating AKI, with judicious use of fluids and diuretics recommended depending on the clinical scenario.
This document provides an outline for taking a thorough neurologic history. It emphasizes establishing rapport with the patient and asking open-ended questions to understand the chief complaint, history of present illness including symptom progression, past medical history, family history, social history, and review of systems. A skillful neurologic history focuses on determining the temporal course and characteristics of symptoms to identify the affected anatomic structures and likely etiologies.
This document summarizes the principles of managing acute stroke. It discusses the importance of timeliness in evaluation and treatment. The general approach involves assessing airway, breathing, circulation, neurological status, blood glucose, and performing a non-contrast CT scan. Key aspects of care include preventing complications through proper positioning, oxygenation, feeding, and rehabilitation strategies. Specific topics covered are dysphagia screening and management, infection prevention, deep vein thrombosis prophylaxis, and management of cerebral edema, fever, and blood pressure/glucose levels to protect the ischemic brain tissue. The presenter notes gaps in the local hospital's stroke management capabilities compared to recommended guidelines.
The document discusses the anatomy and functions of the diencephalon, thalamus, and hypothalamus. It describes the major parts and nuclei of the thalamus, their connections, and clinical effects of lesions. The thalamus is divided into anterior, posterior, medial, and lateral regions. Lesions can cause sensory and motor deficits as well as disturbances to alertness, mood, memory and executive function depending on the nuclei affected. The hypothalamus connects various regions of the brain and regulates autonomic, neuroendocrine, and behavioral functions. Anterior and posterior hypothalamic lesions have different clinical effects.
This document discusses different types of apraxia, which is the loss of the ability to perform purposeful skilled movements, caused by degenerative diseases. It describes five main types: limb-kinetic apraxia affects finger dexterity; ideomotor apraxia involves errors in pantomiming tool use; dissociation and conduction apraxia involve disconnection between brain areas; ideational apraxia is an inability to sequence multi-step actions; and conceptual apraxia is a loss of tool knowledge. The document provides details on testing, error types, pathophysiology, and diseases associated with each apraxia type.
This document provides an overview of a presentation on mental state examinations. It outlines learning objectives, suggested schemes for psychiatric and neurological examinations, and details on specific components of the neurological examination including consciousness, orientation, attention, memory, speech and language, abstract thinking, and calculations. Examples of tests that can be used to evaluate each component are also described.
This document summarizes a seminar on stance and gait abnormalities. It begins with an outline of the topics to be covered, including the anatomical and physiological bases of stance and gait, the gait cycle, and common gait abnormalities. The document then reviews normal and abnormal stances and gaits, caused by conditions such as hemiplegia, diplegia, cerebellar dysfunction, foot drop, and myopathies. It provides guidance on evaluating patients with gait disorders through history, physical exam testing of gait, balance, and posture.
This document provides an overview of ocular motility disorders, including:
1. The anatomy and function of the extraocular muscles and neural control centers.
2. Classification of abnormal eye movements including types (e.g. saccades, smooth pursuit) and causes (e.g. myopathies, nerve palsies).
3. Specific disorders are described in detail such as internuclear ophthalmoplegia, Parinaud's syndrome, and progressive supranuclear palsy.
4. Nystagmus is classified and mechanisms are discussed.
Motor neuron diseases affect motor neurons, leading to muscle weakness and atrophy. Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease in adults, characterized by both upper and lower motor neuron signs that spread to multiple body regions. While there is no cure for ALS, a multidisciplinary approach including symptomatic treatments can help manage the disease.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
Physiology and chemistry of skin and pigmentation, hairs, scalp, lips and nail, Cleansing cream, Lotions, Face powders, Face packs, Lipsticks, Bath products, soaps and baby product,
Preparation and standardization of the following : Tonic, Bleaches, Dentifrices and Mouth washes & Tooth Pastes, Cosmetics for Nails.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Assessment and Planning in Educational technology.pptxKavitha Krishnan
In an education system, it is understood that assessment is only for the students, but on the other hand, the Assessment of teachers is also an important aspect of the education system that ensures teachers are providing high-quality instruction to students. The assessment process can be used to provide feedback and support for professional development, to inform decisions about teacher retention or promotion, or to evaluate teacher effectiveness for accountability purposes.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
2. Outlines
• INTRODUCTION ON CASE PRESENTATION
HISTORY
PHYSICAL EXAMINATION
INVESTIGATION
MANAGEMENT
• MECHANISM OF ACTION KINETICS,OVERDOSE AND TOXICITY
• CLINICAL APPROACH
• SPECIFIC SELECTED DRUG DISCUSSION
• OPTIONS OF MANAGEMENT
• COMMENT ON THE CASE
• REFERENCE
9/12/2022
3. HISTORY
• A 17 years old female from Addis Ababa Presented
with loss of consciousness of 03hrs duration
• She was found unconscious at her room
• 4 empty drug strips were claimed to be found
• Each tablet contains 200 mg and each strip contain 10 tabs so she
took a total of 8000mg(8g)
• The drug was used by one of her family and she was having
a fight with her grandma before she went to her bedroom
9/12/2022
4. • She was found unconscious by the next morning
• She was taken to LHC Lavage was done despite the change in mentation
• She was not improving and was brought to our ER
• She is a college student and gets easily angry
• Her cousin diagnosed to have epilepsy and was on antiepileptic drug
• No hx of vomiting or diarrhea
• No hx of abnormal body movement
• No hx of previous suicidal attempt
9/12/2022
5. Physical examination
General Appearance Comatose
BP--141/88 PR—105 RR----17 SPO2---96 TEMP---ATT
HEENT—pink conjunctiva nonicterious sclera
Chest--- clear and good air entry bilaterally
Cvs------s1 and s2 are well heard
no murmur or gallop
Abd------ soft, flat and moves with respiration
no sign of fluid collection
Mss----no rash deformity
Cns----GCS E1V1M5 7/15
PUPILS are midsized , equal and reactive to light bilaterally
no motor preference
9/12/2022
6. Investigation
CBC
WBC 11,000 REMARK
LYM % 9.5 N
NEUTRO% 88% H
RBC% 5.76 N
HGB 14.4 N
MCV 77
HCT 44.2 N
Serum electrolyte K--------------4.2
Na----------------143
N
Renal function UREA ----------4
CR------------------0.68
?
N
ECG RBS 88
9/12/2022
7. 9/12/2022
• Rhythm ---sinus and regular
• Rate --------100bpm
• Normal axis
• Normal p,qrs and t waves
• No segment abnormality
8. management
Supportive mx like
Cimetidine 200mg iv bid
Ng tube feeding 300ml/3hr
RBS qid
Vital follow up
Next day sent for dialysis, she was dialyzed for around
an hour and gained her consciousness transferred to the
ER
Followed for 4 hrs. discharged improved with psychiatry
link and follow up
9/12/2022
10. carbamazepine
• Carbamazepine, an iminostilbene compound
• introduced in the United States in 1974 for the treatment of
trigeminal neuralgia and is specific analgesic for trigeminal neuralgia
• It has become a first-line drug for the
treatment of generalized and partial complex seizure disorders
• expanded use for pain syndromes, psychiatric illnesses, and
drug withdrawal reactions.
9/12/2022
11. • Structurally related to cyclic antidepressants
• available for oral administration as
• chewable tablets of 100 mg, tablets of 200 mg,
• XR tablets of 100, 200, and 400 mg, and
• suspension of 100 mg/5 mL (teaspoon).
• its structural formula is
Carbamazepine (Tegretol)
9/12/2022
13. pharmacokinetics
• suspension, conventional tablets, and XR tablets delivered equivalent amounts of drug to the systemic
circulation.
• suspension was absorbed somewhat faster, and the XR tablet slightly slower, than the
• conventional tablet.
• bioavailability of the XR tablet was 89% compared to suspension
• Usual adult therapeutic levels are between 4 and 12 µg/mL
• In polytherapy, the concentration of it and concomitant drugs may be increased or decreased
• chronic oral administration of suspension, plasma levels peak at approximately 1.5 hours
• 4-5 peak hours after administration of conventional Tegretol tablets
• 3-12 hours after administration of Tegretol-XR tablets
• After oral carbamazepine, 72% of the administered radioactivity was found in the urine and 28% in the
feces 3% of unchanged
9/12/2022
14. Cont….
• Carbamazepine is slowly and erratically absorbed from GI
• peak levels may be delayed for 6–24 hours,
• It is 75–78% protein bound with a volume of distribution (Vd) of approximately 1.4
L/kg (up to 3 L/kg after overdose
• Has enterohepatic recycling
• The parent drug is metabolized by cytochrome P-450, and 40% is converted to its
10,11-epoxide, which is as active as the parent compound
• The elimination half-life is variable and is subject to autoinduction of P-450
• the half-life of carbamazepine is approximately 18–55 hours (initially) to 5–26
hours (with chronic use). The half-life of the epoxide metabolite is approximately
5–10 hours.
9/12/2022
15. TOXICICTY
• Acute ingestion of more than 10 mg/kg could result in a blood
level
above the therapeutic range of 4–12 mg/L
• The recommended maximum daily dose is 1.6–2.4 g in adults
(35 mg/kg/day in children).
• Death has occurred after adult ingestion of 3.2–60 g, but
survival has been reported after an 80-g ingestion.
• Life-threatening toxicity occurs after ingestion of 5.8–10 g in
adults and 2g (148 mg/kg)
9/12/2022
16. signs and Symptoms of toxicity
• The first signs and symptoms appear after 1-3 hours
• Neuromuscular disturbances are the most prominent
• Cardiovascular disorders are generally milder, and severe cardiac complications occur only when
very high doses (>60 g)have been ingested.
Respiration: Irregular breathing, respiratory depression.
•
Cardiovascular System
• conduction disorders like Atrioventricular (AV) block and bradycardia
• Based on its structural similarity to tricyclic antidepressants may cause QRS and QT interval prolongation
and myocardial depression,Tachycardia, hypotension or hypertension, shock
• Nervous System Ataxia, nystagmus, ophthalmoplegia, movement disorders (dyskinesia,
adiadochokinesia dystonia) Motor restlessness, muscular twitching, tremor, athetoid
movements, opisthotonos drowsiness, dizziness, mydriasis,, ballism, psychomotor disturbances,
dysmetria. Initial hyperreflexia, followed by hyporeflexia.
Gastrointestinal Tract: Nausea, vomiting.
Kidneys and Bladder: Anuria or oliguria, urinary retention.
9/12/2022
17. Cont…
• After an acute overdose, manifestations of intoxication may be delayed for
several hours because of erratic absorption.
• Cyclic coma and rebound relapse of symptoms may be caused by continued absorption
from a tablet mass as well as enterohepatic circulation of the drug.
• Chronic use has been associated with bone marrow depression, hepatitis,
renal disease, cardiomyopathy, hyponatremia, and exfoliative dermatitis
• Carbamazepine has also been implicated in rigidity-hyperthermia syndromes (eg,
neuroleptic malignant syndrome and serotonin syndrome) in combination with other drug
9/12/2022
19. Diagnosis
• is based on a history of exposure and clinical signs and symptoms along with elevated serum
levels
• Obtain a stat serum carbamazepine level and repeat levels every 4–6 hours to rule out
delayed or prolonged absorption
• Serum levels greater than 10 mg/L are associated with ataxia and nystagmus. Serious
intoxication (coma, respiratory depression, seizures) is likely
with serum levels greater than 40 mg/L, although there is poor correlation
between levels and severity of clinical effects
• The epoxide metabolite may be produced in high concentrations after
overdose. It is nearly equipotent, and may cross-react with some carbamazepine
immunoassays to a variable extent
• Carbamazepine can produce a false-positive test for tricyclic antidepressants on drug
screening
• CBC, electrolytes, glucose, arterial blood gases or oximetry, and EC
9/12/2022
21. 1. Supportive care
• Maintain an open airway and assist ventilation if necessary
Administer supplemental oxygen.
• Treat seizures, coma, hyperthermia, and arrhythmias if they
occur
• Asymptomatic patients should be observed for a minimum of 6
hours after ingestion, and for at least 12 hours if an extended-
release preparation was
ingested.
9/12/2022
23. 2.Drug and antidotes
• There is no specific antidote
• Sodium bicarbonate is of unknown value for QRS prolongation
• Physostigmine is not recommended for anticholinergic
effects of toxicity.
9/12/2022
24. 3.decontamination
• Prehospital
• Administer activated charcoal if available.
• Hospital.
• Administer activated charcoal
• Gastric lavage is not necessary after small to moderate ingestions if
activated charcoal can be given promptly
• For massive ingestions, consider additional doses of activated
charcoal and possibly whole-bowel irrigation
9/12/2022
27. 4.Inhanced Elimination
• Repeat or multi dose activated charcoal is effective and may increase clearance by up to
50%
• with obtundation and ileus, and there is no demonstrated benefit on morbidity or mortality.
• Charcoal haemoperfusion, haemodiafiltration is highly effective and may be indicated for
severe intoxication (eg, status epilepticus, cardiotoxicity, serum level > 60mg/L) unresponsive
to standard treatment
• High-flux (more porous noncellulosic membranes with increased permeability,
particularly to larger molecules) and high efficiency (a standard cellulosic
membranes with a larger surface area ) hemodialysis is also reportedly effective
• Peritoneal dialysis does not effectively remove carbamazepine.
• Plasma exchange has been used in children
9/12/2022
28. indications for dialysis
• Intractable seizure
• Life threatening
dysrhythmias
• Respiratory depression
requiring MV
• Prolonged coma
• Significant toxicity
9/12/2022