This document provides an overview of cardiogenic shock, including its definition, pathophysiology, etiology, clinical presentation, diagnosis, and management. Cardiogenic shock is defined as inadequate tissue perfusion due to the heart's inability to pump an adequate amount of blood, despite adequate intravascular volume. It results from a severe reduction in cardiac output and stroke volume. The most common cause is severe left ventricular dysfunction following acute myocardial infarction, though right ventricular failure can also cause cardiogenic shock. Management involves general support measures, pharmacological therapy including inotropes and vasopressors, hemodynamic management, mechanical support such as IABP, and early reperfusion when possible. Early invasive management and treatment of mechanical complications can increase
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Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02Afroza Prioty
A small overview on cardiogenic shock which sometimes becomes a burning issue for the medical personnels and to combat the situation, the measures should be taken immediately and urgently.
a clinical syndrome that results from inadequate tissue perfusion.
Hypovolemic shock - Blood or fluid loss, both leading to a decreased circulating blood volume, diastolic filling pressure, and volume.
Cardiogenic shock - due to cardiac pump failure related to loss of myocardial contractility/functional myocardium or structural/mechanical failure of the cardiac anatomy and characterized by elevations of diastolic filling pressures and volumes
Extra-cardiac/obstructive shock - due to obstruction to flow in the cardiovascular circuit and characterized by either impairment of diastolic filling or excessive afterload
Distributive shock - caused by loss of vasomotor control resulting in arteriolar/venular dilatation leading to a decrease in preload, with decreased, normal, or elevated cardiac output, depending on the presence of myocardial depression.
Kaplan Cardiac Anesthesia
Braunwald Textbook Of Cardiovascular Medicine
Fundamentals Of Cardiology For USMLE
Hensley Martin Practical Approach To Cardiac Anesthesia
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Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02Afroza Prioty
A small overview on cardiogenic shock which sometimes becomes a burning issue for the medical personnels and to combat the situation, the measures should be taken immediately and urgently.
a clinical syndrome that results from inadequate tissue perfusion.
Hypovolemic shock - Blood or fluid loss, both leading to a decreased circulating blood volume, diastolic filling pressure, and volume.
Cardiogenic shock - due to cardiac pump failure related to loss of myocardial contractility/functional myocardium or structural/mechanical failure of the cardiac anatomy and characterized by elevations of diastolic filling pressures and volumes
Extra-cardiac/obstructive shock - due to obstruction to flow in the cardiovascular circuit and characterized by either impairment of diastolic filling or excessive afterload
Distributive shock - caused by loss of vasomotor control resulting in arteriolar/venular dilatation leading to a decrease in preload, with decreased, normal, or elevated cardiac output, depending on the presence of myocardial depression.
Kaplan Cardiac Anesthesia
Braunwald Textbook Of Cardiovascular Medicine
Fundamentals Of Cardiology For USMLE
Hensley Martin Practical Approach To Cardiac Anesthesia
WWW
Rational choice of inotropes and vasopressors in intensive care unitSaneesh P J
The presentation introduces commonly used interpose and vasopressors; their classification; and how to choose the drug in ICU. Clinical scenarios - cariogenic shock; neurocritical care; septic shock and anaphylactic shock are elaborated.
The basics of autoregulation of Gloemrular filtration rate. This ppt deals with basic renal physiology, tubuloglomerular feedback, myogenic reflex, juxtaglomerular apparatus and renin angiotensin aldosterone system in brief. P.S.- The ppt has animations so kindly view in slide/presentation mode
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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
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.
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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:
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ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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- Prix Galien International Awards Ceremony
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
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3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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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
4. Shock
• A significant reduction of systemic tissue perfusion, resulting in
decreased oxygen delivery to the tissues
• This creates an imbalance between oxygen delivery and oxygen
consumption
Rapid initial resuscitation (usefully driven by protocol) is fundamental for
improved outcome, since “time is tissue”
6. Definition of Cardiogenic shock (CS)
• CS is a clinical condition of inadequate tissue (end-organ)
perfusion due to the inability of the heart to pump an adequate
amount of blood in the presence of adequate intravascular
volume
Simply
Pump failure to the point of tissue hypo perfusion
7. PATHOPHYSIOLOGY
• Systemic hypotension, which is present in most patients with
cardiogenic shock, is defined as a persistent systolic blood
pressure below 80 to 90 mmHg or a mean blood pressure 30
mmHg lower than the patient's baseline level
• In cardiogenic shock, hypotension results from a decrease in
stroke volume and a severe reduction in the cardiac index
(<1.8 L/ min per m2 without support or <2.0 to 2.2 L/min per
m2 with support)
8. PATHOPHYSIOLOGY
• The fall in blood pressure may in part be moderated by a marked
elevation in systemic vascular resistance (SVR)
• However, the combination of a low cardiac output and elevated
SVR may result in a marked reduction in tissue perfusion.
Not all patients fall into this hemodynamic profile
9. • Patients with confirmed cardiogenic shock developing within
36 hours of an acute MI, the mean left ventricular ejection
fraction on echocardiography was unexpectedly high at 31 %
• Furthermore, calculated systemic vascular resistance varied
widely and on average was not elevated despite vasopressor
use
• Thus, in some patients, post-MI shock is accompanied by
relative vasodilation rather than vasoconstriction
PATHOPHYSIOLOGY
SHOCK TRIAL
10. • The most likely explanation for vasodilation in the setting of
cardiogenic shock is the presence of a systemic inflammatory
state similar to that seen with sepsis
• Approximately half of all CS patients have small or normal LV
size, which represents failure of the adaptive mechanism of
acute dilation to maintain stroke volume in the early phase of MI
PATHOPHYSIOLOGY
SHOCK TRIAL
11.
12. Etiology
• Severe dysfunction of the left ventricle (LV) is the most
common presentation of cardiogenic shock in the setting of
acute myocardial infarction
• The majority of patients have an acute ST elevation MI, but
cardiogenic shock also occurs in approximately 2.5 percent of
patients with a non-ST elevation MI
13. Etiology
• Severe right ventricular (RV) failure is a cause of, or a major
contributor to, cardiogenic shock in 5% of cases and is typically
seen with an inferior MI
Such patients do not develop pulmonary congestion unless there is
concurrent involvement of the LV
18. • General Support Measures
• Antithrombotics
• Blood sugar control
• Treat hypoxemia
• We should have a low threshold to institute ventilatory support
whether noninvasive or invasive
MANAGEMENT
19. MANAGEMENT
• Pharmacological Treatment
• inotropic and vasopressor agents, which should be used in the
lowest possible doses
• Higher vasopressor doses are associated with poorer survival
• Inotropics has a central role , but it increase myocardial ATP
consumption such that short term hemodynamic improvement
occurs at the cost of increased oxygen demand when the heart is
already failing and supply is already limited
20. • Hemodynamic Management
• PA (Swan-Ganz) catheterization is frequently performed to
confirm the diagnosis of CS, to ensure that filling pressures are
adequate, and to guide changes in therapy
• There has been a decline in PA catheter use relating to
controversy sparked by a prospective observational study that
suggested that PA catheters were associated with poor
outcome
• No such association has been shown in CS
• Clinical assessment with echocardiography is a reasonable
alternative
21. • The American College of Cardiology/American Heart
Association (ACC/AHA) guidelines recommend norepinephrine
for more severe hypotension because of its high potency
• Although both dopamine and norepinephrine have inotropic
properties, dobutamine is often needed in addition
MANAGEMENT
22. • Mechanical Support: IABP
• Use of an IABP improves coronary and peripheral perfusion via
diastolic balloon inflation and augments LV performance via
systolic balloon deflation with an acute decrease in afterload
• Reperfusion
• The earlier the better
• Best benefit within 1st 3 Hrs
• But up to 48 Hrs post incident proved to have survival benefit
MANAGEMENT
23. Right Ventricle
• RV dysfunction may cause or contribute to CS.
• Predominant RV shock represents only 5% of cases of CS
complicating MI
• RV failure may limit LV filling via a decrease in CO, ventricular
interdependence, or both
• Patients with CS due to RV dysfunction have very high RV end-
diastolic pressure, often >20 mm Hg
• RV end-diastolic pressure of 10 to 15 mm Hg has been
associated with higher output than lower or higher pressures
• The common practice of aggressive fluid resuscitation for RV
dysfunction in shock may be misguided
MANAGEMENT
24. Treatment of CS Due to
Mechanical Complications
• It was previously thought that optimal timing involves a
balance of operating before the onset of multiorgan system
failure with delaying surgery to allow scarring of involved
myocardium for better stability of repair
• The unpredictability of rapid deterioration and death with VSR
and papillary muscle rupture makes early surgery necessary
even though there may be apparent hemodynamic
stabilization with IABP
MANAGEMENT
25. Management of Special Conditions
• LV outflow obstruction is critical in patients with hypotension,
because diuretics and inotropic agents exacerbate obstruction
• Treatment of CS with hypertrophic obstructive
cardiomyopathy includes volume resuscitation and β-blockade
• Pure α-agonists may also be used to increase afterload,
increasing cavity size and decreasing obstruction
26. To Conclude
• Recent evidence challenges the notion that patients with CS
are a “lost cause.” In fact, an early invasive approach can
increase short- and long-term survival and can result in
excellent quality of life.
• Rememnber
• Early perfusion
• Early surgery for mechanical complications even if apparantly
stable on IABP
• Low triger for MV
• Least needed vasopressors
• RV/CS >> traditional excessive fluids to preserve preload is not
optimal ( RVEDP 10 to 15 mmHg is optimal)