This document discusses the role of physiotherapy in treating severe pediatric respiratory disease. It notes that while physiotherapy is commonly used to clear secretions in critically ill children, the evidence for its effectiveness is poor. Physiotherapy can cause significant physiological disturbances and potential harm. It may be beneficial in specific conditions like cystic fibrosis if secretions are significantly impacting lung function, but is not routinely indicated for ventilated children or those with conditions like bronchiolitis. A detailed individual assessment is required to determine if potential benefits outweigh risks for a given child. More high-quality research is still needed to establish best practices around physiotherapy in pediatric critical care.
Physiotherapy in wards
physiotherapy in ICU
physiotherapy in Cardiology
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physiotherapy in PICU
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Geriatric patients
Benefits of the chest physiotherapy in ward patients
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Physiotherapy in wards
physiotherapy in ICU
physiotherapy in Cardiology
physiotherapy in Gynecology
post operative physiotherapy
physiotherapy in PICU
Palliative patients physiotherapy
Geriatric patients
Benefits of the chest physiotherapy in ward patients
Benefits of Exercise Specific to Breast Cancer
THIS PRESENTATION INCLUDES DEFINITION, INDICATIONS, CONTRAINDICATIONS, AIMS, GOALS, PR TEAM, AND COMPONENTS OF THE PULMONARY REHABILITATION. THIS PRESENTATION IS MADE ONLY FOR LEARNING AND GUIDANCE PURPOSE.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
THIS PRESENTATION INCLUDES DEFINITION, INDICATIONS, CONTRAINDICATIONS, AIMS, GOALS, PR TEAM, AND COMPONENTS OF THE PULMONARY REHABILITATION. THIS PRESENTATION IS MADE ONLY FOR LEARNING AND GUIDANCE PURPOSE.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
1. Brenda Morrow (PhD)
Division of Paediatric Critical Care and Children’s Heart Disease,
University of Cape Town
Severe paediatric respiratory disease:
Does physiotherapy have a place?
2. • accepted as part of the care of critically ill infants and
children, largely due to risks of ETT obstruction.
– (Krause and Hoehn 2000; Stiller 2000)
• Short term, aim to remove obstructive secretions from the
airways thereby
– reducing work of breathing;
– improving delivery of mechanical ventilation;
– improving gaseous exchange;
– preventing and resolving respiratory complications;
– facilitating early weaning from the ventilator
• Main et al, 2004; Ntoumenopoulos et al, 2002; Wallis and Prasad, 1999;
Ciesla, 1996.
• Longer term, aim to
– Prevent postural deformities
– Improve exercise tolerance
– Return to optimal function
Chest Physiotherapy
3. • Poor evidence base
– Many paediatric studies do not specify which techniques
were used, their duration or the exact method of
application.
– Therefore not reproducible or generalisable.
– Study designs are often flawed, with the resulting evidence
being of a low level.
Chest Physiotherapy
4. • Randomised cross-over trial comparing
suctioning alone and chest
physiotherapy with suctioning
– CPT showed higher Vte, Crs,
alveolar deadspace
– No difference in PO2, PCO2 or pH
– Greater drop in Rrs in CPT group
– ± 30% respiratory function
deteriorated following both CPT
and suction!
– Unable to identify patients who
were more/less likely to respond to
treatment
• No standardisation of treatment
– Some hyperinflated, saline instilled
– Duration and application varied
• Main et al 2004; Main and Stocks
2004
– Intensive Care Medicine
5. • ? may do more harm than good
– Chalumeau et al, 2002; Krause and Hoehn, 2000; Wallis
and Prasad, 1999; Harding et al, 1998; Button et al, 1997;
Cross et al, 1992; Reines et al, 1982.
• CPT and suctioning may affect
– Respiratory system
– Cardiovascular system
– Central nervous system
– Metabolic demand.
Chest Physiotherapy
6. • CPT is met with the most pronounced variation in vital signs
when compared to any other routine ICU interventions.
– Weissman et al (1984) Crit Care Med
7. • hypoxia
• increased metabolic demand and O2 consumption
• cardiac arrythmias
• changes in blood pressure
• raised intracranial pressure and decreased cerebral
oxygenation
• gastro-oesophageal reflux
• pneumothoraces
• atelectasis and
• death.
• Chalumeau et al, 2002; Krause and Hoehn, 2000; Wallis and Prasad,
1999; Harding et al, 1998; Button et al, 1997; Cross et al, 1992;
Reines et al, 1982.
Complications
8. Complications
Neonates
• CPT ’s incidence of intracranial haemorrhages in preterm
infants with RDS
• Raval et al (1987) J. Perinatology
• Associated with encephaloclastic porencephaly
• Harding et al (1998) J. Pediatrics
• Potentially severe hypoxaemia
• Fox et al (1978) J. Pediatrics
• Arrhythmia, apnoea, BP, ICP
• Perlman and Volpe (1983) Pediatrics
• Evans (1992) J Perinatol.
• Reports of rib #’s and periosteal reactions
• Purchit et al (1975) Am J Dis Child.
10. The “ventilated child”?
Risk of
• VILI
• VAP
• O2 toxicity
• Hyperinflation
• Positional atelectasis and/or
consolidation
• Impaired mucociliary clearance
• Decreased FRC due to loss of
laryngeal braking
• Foreign body (ETT) and inadequate
humidification of vent gases →
increased amount/tenacity secretions
→ obstruction, infection, atelectasis
→ chronic disease
11. The “ventilated child”
• Do all ventilated children need “prophylactic” physiotherapy?
• Can “physiotherapy” prevent complications/infections?
• What IS physiotherapy???
• Good general nursing and ventilatory management
– Analgesia
– Regular changes in position and early mobilisation
– Lung protective ventilatory strategies
– Minimal effective FiO2
– Adequate humidification
– Impeccable hygiene and infection control practices
• Physiotherapists should engage in above holistic care practices
• BUT formal, “conventional” CPT not indicated routinely
– Schechter, 2007
12. The “ventilated child”
“In mechanically ventilated children, CPT cannot be regarded as a
standard treatment modality.
CPT must be considered as the most stimulating and disturbing
intensive care procedure in mechanically ventilated patients”
Krause et al (2000) Crit Care Med
13. What conditions might benefit
from CPT?
• Clear benefit
– Cystic fibrosis
• Schechter (2007) Resp Care
14. What conditions might benefit
from CPT?
• Probable benefit
– Atelectasis with mucus plugging
– Peroni and Boner (2000) Paediatr Respir Rev.
15. What conditions might benefit
from CPT?
• Probable benefit
– Neuromuscular disease
• Schechter (2007) Resp Care
16. What conditions might benefit
from CPT??
• Minimal to no benefit
– Acute asthma
• Asher et al, Pediatr pulmonol 1990
– Bronchiolitis
• Webb et al (1985) Arch Dis Child
• Nicholas et al (1999) Physiotherapy
• Cochrane Systematic Review (Perrotta et al 2005)
– Respiratory failure without atelectasis
– Prevention of post-extubation atelectasis in neonates
– Hyaline membrane disease
• Schechter (2007) Resp Care
– Prevention of atelectasis following surgery
• Reines et al, 1982
– Undrained pleural collections
17. Indications for CPT
• “indications or contraindications for or against
chest physiotherapy should never be formulated
on the basis of diagnostic entities but should
rather stem from a detailed analysis of the
prevailing individual pathophysiology.”
– Oberwaldner (2000) Eur Respir J
18. Indications for CPT
• and/or retention of secretions
– Impacting on lung mechanics and/or gaseous exchange
– Potential for further complications
• Acute lung/ lobar collapse due to mucus plugging
• Peroni and Boner (2000) Paediatr Respir Rev
• Decreased mobility (general/trunk)
• Potential postural deformities
• Poor exercise tolerance
19. • severely ill, unstable child
• coagulopathy (plt <100 with care, no Rx if plt < 50)
• pulmonary haemorrhage
• pulmonary oedema
• raised intracranial pressure
• pulmonary hypertension
• very premature infants
Contraindications and
precautions
20. CPT Modalities
• “…in the case of young children with
respiratory disease, we have few
effective therapies, and when [you
think] your only tool is a hammer,
everything starts to look like a nail.
• …patients have respiratory difficulties
from a variety of causes, but we have
one hammer, so we try it on
everybody.”
– Michael Schechter (2007)
25. Improve V/Q
matching
Clear secretions
Reexpand
collapsed lobes
Positioning
• No head-down tilt
– Increases systemic BP with potential for IVH
• Crane et al. 1978
– Increases GOR
• Button et al. 2003
– Increases ICP
• Emery and Peabody 1983
– Diaphragm at mechanical disadvantage
• Vivian-Beresford et al. 1987
– May increase venous return thereby increasing work of heart
– The upright position increases end expiratory lung volume,
optimises oxygenation and prevents VAP
• Stark et al. 1984; Dellagrammaticas et al. 1991; Drakulovich et al
28. • Deep breathing exercises
• Localised expansion techniques
• PEP therapy
• Active Cycle of Breathing Technique
• Autogenic drainage
Reexpand
collapsed lobes
Clear secretions Weaning
Breathing exercises
29. Chest manipulations
• Mucus liquefies on agitation (thixotropic)
• Mechanical energy transmitted through
chest wall with percussion/vibes
• Liquid secretions moved centrally by
gravity / cough / Forced Expiratory
Technique
Clear secretions
Reexpand
collapsed lobes
30. Suctioning
• Needed in patients with
artificial airway or ineffective
cough.
• Complications include
– hypoxia
– arrythmia’s
– mucosal trauma
– pneumothorax
– ICP
– bacteraemia
– loss of ciliary function
– atelectasis
Clear secretions
31. • Some complications can be
prevented/minimised by
– Adequate sedation and analgesia /
paralysis
– Preoxygenating
– Using correct sized catheter
– reducing suction pressures
– Limiting depth of insertion
– Correct technique
– Only suctioning when indicated
– No routine use of saline
– Humidification
• Morrow and Argent (2008) Pediatr
Crit Care Med
Clear secretions
Suctioning
33. Case examples
Haemodynamically unstable
child with RUL collapse
• Ask – how much does RUL impact
on oxygenation?
• Answer – NOT MUCH!
• If this is the only focal problem, CPT
risks >>>> benefits
• DO NOT TREAT!
34. Case examples
Haemodynamically unstable child
with R lung collapse
• Ask – is the collapse causing significant
hypoxia?
• IF YES: potential benefits of CPT >> risks
• IF NO: wait until more stable before treating
• TAKE NECESSARY PRECAUTIONS
• TRIAL OF TREATMENT
35. Case examples
Child with raised ICP
• CPT and suction causes ICP,
MABP and cerebral perfusion
pressure
– Parsons and Shogan (1984), Heart Lung
36. Child with raised ICP
Consider CPT if
• Respiratory pathology is affecting CO2 elimination
– increased PaCO2 further increases ICP.
• Severe hypoxia caused by amenable lung pathology
– anaerobic metabolism lowers pH → dilates blood vessels
→ further increases ICP.
Case examples
37. Child with raised ICP
Type of treatment
• Depends on ICP, other injuries, general condition.
• Ensure adequate sedation, analgesia and/or paralysis
– Painful stimuli and stress increase metabolic demands, BP
and ICP
• Monitor ICP, BP, HR
• Consider brief preintervention hyperventilation
– reflex cerebrovascular constriction
• Keep Rx to minimum
• Supine may be best position with head up.
Case examples
38. Infants with pulmonary hypertension
• Pulmonary Hypertensive crisis
– May cause systemic hypovolaemia due to decreased flow
• Risk of sudden cardiac arrest!
Case examples
39. Infants with pulmonary hypertension
• Common factors triggering a crisis include:
– Hypoxia
– Hypercarbia
– Suctioning
– Pain
– Atelectasis
– Noise
– Cold
– Agitation
Case examples
40. Infants with pulmonary hypertension
Consider CPT
• If large segment collapse with mucus plugging
• Retained secretions with hypoxia
If you treat
• Take appropriate precautions
• Monitor PAP throughout
• Sedation and analgesia++, paralyse if necessary
Case examples
41. • Potential benefits for specific patients
• Careful clinical and radiological assessment
• Determine risk:benefit for each patient
• Holistic approach.
• RESEARCH NEEDED!
Chest Physiotherapy
42. “In the meantime, those involved in the
management of paediatric respiratory
disorders should avoid the unnecessary
distress to both the child and family of
useless treatment and the potentially serious
consequences of inappropriate intervention”
– Wallis and Prasad (1999), Arch Dis Child
43. "Our success will and must be measured in the happiness and welfare of our children."
Nelson Mandela