CPR – or Cardiopulmonary Resuscitation – is an emergency lifesaving procedure performed when the heart stops beating. Immediate CPR can double or triple chances of survival after cardiac arrest.
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
CPR – or Cardiopulmonary Resuscitation – is an emergency lifesaving procedure performed when the heart stops beating. Immediate CPR can double or triple chances of survival after cardiac arrest.
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
AED is a portable type of external defibrillator that automatically diagnose the ventricular fibrillation in a patient.
Automatic refers to the ability to autonomously analyze the patients condition.AED is provided with self-adhesive electrodes instead of hand held paddles
Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest.
ENDOTRACHEAL TUBE INTUBATION II Parts II Details II Clinical DiscussionSwatilekha Das
What is endotracheal intubation?
Endotracheal intubation is a procedure by which a tube is inserted through the mouth down into the trachea (the large airway from the mouth to the lungs). Before surgery, this is often done under deep sedation. In emergency situations, the patient is often unconscious at the time of this procedure.
For detailed information plz watch the slides till end.......
And plz like, share and comment and follow......
Bag and Mask Ventilation By Sakun Rasaily @Ram K Dhamalaramdhamala11
Bag and mask Ventilation Presented by Sakun Rasaily,
(Pediatric Nurse, Pediatric ward , B.P. Koirala Institute of Health Science
Dharan, Sunsari (Nepal)
Advanced cardiac life support or advanced cardiovascular life support (ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest, stroke and other life-threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.
AED is a portable type of external defibrillator that automatically diagnose the ventricular fibrillation in a patient.
Automatic refers to the ability to autonomously analyze the patients condition.AED is provided with self-adhesive electrodes instead of hand held paddles
Cardiopulmonary resuscitation (CPR) is an emergency procedure that combines chest compressions often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest.
ENDOTRACHEAL TUBE INTUBATION II Parts II Details II Clinical DiscussionSwatilekha Das
What is endotracheal intubation?
Endotracheal intubation is a procedure by which a tube is inserted through the mouth down into the trachea (the large airway from the mouth to the lungs). Before surgery, this is often done under deep sedation. In emergency situations, the patient is often unconscious at the time of this procedure.
For detailed information plz watch the slides till end.......
And plz like, share and comment and follow......
Bag and Mask Ventilation By Sakun Rasaily @Ram K Dhamalaramdhamala11
Bag and mask Ventilation Presented by Sakun Rasaily,
(Pediatric Nurse, Pediatric ward , B.P. Koirala Institute of Health Science
Dharan, Sunsari (Nepal)
Advanced cardiac life support or advanced cardiovascular life support (ACLS) refers to a set of clinical interventions for the urgent treatment of cardiac arrest, stroke and other life-threatening medical emergencies, as well as the knowledge and skills to deploy those interventions.
comprehensive presentation on 2D echo use in ICu set up. helpful in finding causes of shock and also in monitoring of fluid status in critically ill patients.
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
2. Briefly explain how these functions are carried out
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
2. INTRODUCTION:
Cardiopulmonary resuscitation is a life saving
procedure in case of sudden cardiac arrest
Every individual should know how to give effective
CPR
The basic principles of resuscitation are an integral
part of training for many health care providers
(HCPs).
Timely interventions for cardiac arrest victims have
the potential to be truly lifesaving.
3. Sudden cardiac arrest is defined as the cessation of
effective cardiac mechanical activity as confirmed
by the absence of signs of circulation.
Sudden cardiac arrest is the most common fatal
manifestation of cardiovascular disease and a
leading cause of death.
4. CHAIN OF SURVIVAL:
The chain of survival:
Immediate recognition that cardiac arrest has
occurred and activation of the emergency response
system
Application of effective CPR
Early defibrillation (if applicable)
Advanced cardiac life support
Initiation of post-resuscitation care
5. IMMEDIATE RECOGNITION OF CARDIAC ARREST
For CPR to be effective in restoring spontaneous
circulation, it must be applied immediately at the
time of cardiac arrest.
Pulse checks are often unreliable, even when
performed by experienced personnel, so prolonged
attempts to detect a pulse may result in a delay in
initiating CPR, prolonged pulse checks are to be
avoided.
Delays in initiating CPR are associated with worse
outcome and CPR should be started immediately if
the patient is unresponsive and either has agonal
gasps or is not breathing.
6. CHEST COMPRESSIONS
In CPR, chest compressions are used to circulate
blood to the heart and brain until a pulse can be
restored.
The mechanism by which chest compressions
generate cardiac output is through an increase in
intra-thoracic pressure plus direct compression of
the heart.
With the patient lying in the supine position, the
rescuer applies compressions to the patient’s
sternum.
Heel of one hand is placed over the lower half of
the sternum and the heel of the other hand on top
in an overlapping and parallel fashion.
7. The recommended compression depth in adults is 2
inches. The recommended rate of compression is 100
or more per minute. “Push hard, push fast” is now the
American Heart Association (AHA) mantra for CPR
instruction
In addition, incomplete recoil of the chest impairs the
cardiac output that is generated, and thus the chest
wall should be allowed to recoil completely between
compressions.
Owing to rescuer fatigue, the quality of chest
compressions predictably decreases as the time
providing chest compressions increases, and the
persons providing chest compressions (even
experienced professionals) may not perceive fatigue
or a decrease in the quality of their compressions.
Therefore, it is recommended that rescuers
performing chest compressions rotate every 2
minutes.
8. The quality of CPR is a critical determinant of
surviving a cardiac arrest event.
Minimization of interruptions in chest compressions
is imperative.
Potential reasons for “hands off” time include pulse
checks, rhythm analysis, switching compressors,
procedures (e.g., airway placement), and pauses
before defibrillation (“preshock pause”).
All of these potential reasons for interruptions must
be minimized. Pauses related to rotating
compressors or pulse checks should take no longer
than a few seconds.
Eliminating (or minimizing) preshock pauses has
been associated with higher likelihood of ROSC
and improved clinical outcome.
9. DEFIBRILLATION
The next critically important action in the
resuscitation of patients with cardiac arrest due to
pulseless ventricular arrhythmias (i.e., VF or
pulseless VT) is rapid defibrillation (D Fib).
Delays in defibrillation are clearly deleterious, with a
sharp decrease in survival as the time to
defibrillation increases.
With the advent of automatic external defibrillators
(AEDs) and their dissemination into public places,
both elements of effective CPR can be performed
by lay rescuers in the field for patients with out-of-
hospital cardiac arrest.
Rapid application of D fib can improve the survival
chances.
10. RESCUE BREATHING
The most recent AHA recommendations regarding
ventilation during CPR depends on who the rescuer is
(i.e., trained HCPs versus lay person).
For trained HCPs, the recommended ventilation strategy
is a cycle of 30 chest compressions to two breaths until
an endotracheal tube is placed
After that continuous chest compressions with one
breath every 6 to 8 seconds after the endotracheal tube
is placed.
Excessive ventilations can be deleterious from a
hemodynamic perspective and should be avoided.
Increased intra-thoracic pressure
Reduction in the cardiac output generated by CPR
Excessive ventilation could also potentially result in
alkalemia.
11. For lay persons who are attempting CPR in the field
for a victim of out-of-hospital cardiac arrest, rescue
breathing is no longer recommended.
The recommended strategy is compression-only (or
“hands-only”) CPR.
The rationale is that compression-only CPR can
increase the number of effective chest
compressions that are delivered to the patient (i.e.,
minimizes interruptions for rescue breaths), and
does not require mouth-to-mouth contact.
Hands-only CPR has become the preferred
technique to teach lay rescuers
13. ADVANCED CARDIAC LIFE SUPPORT
There are several additional elements of
resuscitation that are intended specifically for
trained professionals (e.g., advanced cardiac life
support [ACLS]), and these elements include
pharmacologic therapy.
CPR quality:
Push hard and fast (> 2 inches compression at 100-
120/min) and allow complete chest recoil
Minimize interruption
Avoid excessive ventilation
Rotate compressor every 2 min
30:2 compression ventilation ratio
If EtCO2 < 10 mmHg and Relaxation phase
diastolic pressure < 20 mmHg; improve CPR
14. Defibrillation:
Biphasic:
First as per manufacturer recommendation (initial
120- 200 J)
If unknown, give maximum available
Second or subsequent doses should be equivalent
or higher.
Monophasic: 360 J
15. Drug therapy:
IV or IO epinephrine: 1 mg every 3 to 5 mins
IV or IO amiodarone: 300 mg bolus and then 150.
Through ET tube: 2-2.5 mg
Vasopressin (40 mg IV/IO) can be substituted for
the first or second dose of epinephrine.
Advanced airway:
Endotracheal intubation or supraglottic airway
Waveform capnography to confirm and monitor ET
tube placement.
Once confirmed, give 1 breath every 6 sec; i.e. 10
breaths/ min with continuous chest compression
16. Return of spontaneous circulation (ROSC):
Pulse and blood pressure
Abrupt sustain increase in ETCO2 > 40 mmHg
Spontaneous intra arterial pressure waves with
intra arterial monitoring.
Insufficient evidence to recommend routine
administration of sodium bicarbonate during CPR.
The provision of a precordial thump may be
considered in a monitored arrest due to pulseless
ventricular tachycardia if a defibrillator is not
immediately available
A precordial thump is no longer recommended for
ventricular fibrillation.
19. POST RESUSCITATION CARE
Even if ROSC is achieved with CPR and
defibrillation, cardiac arrest victims are at extremely
high risk of dying in the hospital, and many who
survive sustain permanent crippling neurologic
squeal.
After ROSC, global ischemia/reperfusion (I/R) injury
results in potentially devastating neurologic
disability. The primary cause of death among post
resuscitation patients is brain injury.
the post resuscitation care is now considered to be
a crucial fifth link in the chain of survival paradigm.
20. KEY FACTORS TO CONSIDER AFTER
RESUSCITATION FROM CARDIAC ARREST
Immediate tasks
Re-evaluate ABCDE
12-lead ECG
Treat precipitating causes
Re-evaluate oxygenation and ventilation
Temperature control (cool)
Early goals
Continue respiratory support
Maintain cerebral perfusion
Treat and prevent cardiac arrhythmias
Determine and treat the cause of the arrest
21. SPECIFIC TASKS
Maintain haemodynamics (SBP > 100 mmHg)
Maintain adequate oxygenation ( 94–98%)
Maintain normal pH and normocarbia (e.g. 35–
40 mmHg
Treat hyperglycaemia (>180mg/dL), but avoid hypogly-
caemia
Consider therapeutic hypothermia (unless
contraindicated)
Maintain appropriate sedation
Treat seizures
Continue search to identify underlying cause(s) and
trauma related to resuscitation
Consider specific treatment for underlying cause (e.g.
percutaneous coronary intervention, thrombolytics)
Consider prophylactic antiarrhythmics
Consider transfer to resuscitation centre
22. THERAPEUTIC HYPOTHERMIA
Therapeutic hypothermia (TH) is a treatment strategy of
rapidly reducing the patient’s body temperature after
ROSC for the purposes of protection from neurologic
injury.
The body temperature is typically reduced to 33° to 34°
C for 12 to 24 hours. After ROSC the severity of the
reperfusion injury can be mitigated, despite the fact that
the initial ischemic injury has already occurred.
Reperfusion injury refers to tissue and organ system
injury that occurs when circulation is restored to tissues
after a period of ischemia, and is characterized by
inflammatory changes and oxidative damage that are in
large part a consequence of oxidative stress.
23. Neuronal cell death after I/R injury is not
instantaneous, but rather a dynamic
process.
TH may protect the brain by attenuating or
reversing all of the following patho-
physiologic processes:
Disruption of cerebral energy metabolism,
Mitochondrial dysfunction,
Loss of calcium ion homeostasis,
Cellular excito-toxicity,
Oxygen free radical generation
Apoptosis.
24. The current AHA guidelines for CPR and
emergency cardiovascular care recommend 12 to
24 hours of TH for comatose survivors of out-of-
hospital cardiac arrest due to VF or pulseless VT.
TH may also be considered for victims of in-hospital
cardiac arrest and other arrest rhythms.
Methods for inducing TH:
specialized external or intravascular cooling
devices for targeted temperature management
Combination of conventional cooling methods such
as ice packs, cooling blankets, and cold (4° C) IV
saline infusion.
25. Regardless of what method is used, effective
achievement of target temperature may be aided by
the use of a uniform physician order set for TH
induction.
The current recommendation is to maintain TH for
12 to 24 hours.
Whether or not a longer duration of therapy could
be beneficial is currently unknown.
26. SELECTION OF CANDIDATES FOR TH
If a patient does not follow verbal commands after
ROSC is achieved, this indicates that the patient is
at risk for brain injury and TH should be strongly
considered.
If a patient is clearly following commands
immediately after ROSC, then significant brain
injury is less likely and it is probably reasonable to
withhold TH.
27. PROBLEMS WITH TH
Shivering with TH induction
Bradycardia
“Cold diuresis” resulting in hypovolemia and electrolyte
derangements
Hyperglycemia
Coagulopathy
Increased risk of secondary infection.
Complications are often not severe when they do occur
Risk of anoxic brain injury usually greatly outweighs the
risks of complications.
fever must be avoided.
Fever is clearly detrimental in brain-injured patients
because it increases cerebral metabolic rate.
28.
29. NEUROLOGIC PROGNOSTICATION
Neurologic prognostication is often extremely
difficult in the first few days after resuscitation from
cardiac arrest.
Neurologic prognostication immediately (e.g., first
24 hours) after resuscitation from cardiac arrest is
especially unreliable.
Recommendation is to wait a minimum of 72 hours
after ROSC before neurologic prognostication
If there are zero signs of neurologic improvement
over 2 or more consecutive days, typically deem
neurologic prognostication to be reliable at that
time.