The document discusses sepsis and septic shock. It defines sepsis as a complex syndrome that develops due to an amplified and dysregulated host response to infection. Septic shock is presented as a form of shock that is a combination of distributive, cardiogenic and hypovolemic shock. Early diagnosis of septic shock requires a high index of suspicion and can be recognized through signs of altered perfusion before hypotension occurs. The document outlines treatments for septic shock including rapid fluid resuscitation and vasopressor support.
1. The document discusses guidelines for pediatric resuscitation from the International Liaison Committee on Resuscitation, including techniques for positioning, airway management, chest compressions, defibrillation, and post-resuscitation care.
2. Key recommendations include a compression to ventilation ratio of 15:2 for healthcare providers performing two-rescuer CPR, initial and subsequent doses of epinephrine at 10 mcg/kg, and consideration of induced hypothermia and tight glucose control for comatose children after resuscitation.
3. Factors that may indicate further resuscitative efforts are futile include most cardiac arrests associated with blunt trauma or septic shock, while certain characteristics like icy
The document reviews protocols for common basic life support medications including glucose, prescribed inhalers, nitroglycerin, epinephrine auto-injectors, and aspirin. It provides the generic and trade names, actions, indications, contraindications, side effects, dosages, and administration steps for each medication. It also defines online vs offline medical control and describes how EMTs must contact medical control to receive permission before administering certain medications.
This document provides guidelines for pediatric advanced life support. It outlines the assessment process using ABCDE (airway, breathing, circulation, disability, exposure) and recommendations for interventions. Key steps include establishing an open airway, providing ventilation, restoring adequate circulation through chest compressions and medications, treating for shock, and identifying and correcting any reversible causes of arrest. Special considerations are given for neonatal resuscitation and the management of pediatric trauma patients.
An 82-year-old male underwent an unanticipated right hemicolectomy for an ascending colon tumor. During insertion of a central venous catheter post-operatively, the guidewire was inadvertently pushed into circulation. Despite attempts to retrieve the wire at the hospital, it was identified in the femoral vein on x-ray and the patient was transferred to another hospital for retrieval. The wire was successfully retrieved without complications. The anesthesiologist reflected on how to prevent such an incident in the future, including more supervised practice and improved protocols for central line insertion.
1) The NASG (Non-Pneumatic Anti-Shock Garment) is used to stabilize patients experiencing postpartum hemorrhage (PPH) during transfer to higher levels of care. It applies circumferential pressure to the lower body to control bleeding and return blood to vital organs.
2) Patients experiencing uncontrolled Class II PPH or any Class III/IV PPH should be transferred to facilities with HDU/ICU capabilities. Prerequisites for safe transfer include obtaining consent, applying the NASG, ensuring availability of care at the receiving facility, and preparing referral documents.
3) The NASG is lightweight, reusable neoprene suit that is quickly and easily applied in 6 segments
The document summarizes updates to the 2015 pediatric advanced life support (PALS) guidelines compared to the 2010 guidelines. Key changes include more restrictive fluid administration for febrile illness in resource-limited settings, controversial recommendations around routine atropine use before intubation, using invasive hemodynamic monitoring to guide CPR if already in place, considering extracorporeal cardiopulmonary resuscitation for some cardiac arrest cases, and maintaining normothermia rather than induced hypothermia after resuscitation from cardiac arrest. The summary highlights maintaining appropriate oxygen saturation and carbon dioxide levels, as well as blood pressure, after cardiac arrest.
Fran Lockie, a Paediatric Emergency and retrieval specialist, gives an update on paediatric resuscitation. This talk was given at the Bedside Critical Care Conference 2012 on Daydream Island.
The document discusses pain management strategies for pediatric patients in emergency situations. It provides examples of analgesic plans for different pediatric cases, including a 6-year-old with a fall, a 4-year-old with diabetic ketoacidosis, and a 9-year-old needing immunizations. Non-pharmacological approaches like distraction, positioning, topical anesthetics and sucrose are recommended. Oral and intranasal medications like acetaminophen, ibuprofen, codeine, oxycodone, morphine and nitrous oxide may be used. Proper pain assessment and multimodal analgesia are emphasized.
1. The document discusses guidelines for pediatric resuscitation from the International Liaison Committee on Resuscitation, including techniques for positioning, airway management, chest compressions, defibrillation, and post-resuscitation care.
2. Key recommendations include a compression to ventilation ratio of 15:2 for healthcare providers performing two-rescuer CPR, initial and subsequent doses of epinephrine at 10 mcg/kg, and consideration of induced hypothermia and tight glucose control for comatose children after resuscitation.
3. Factors that may indicate further resuscitative efforts are futile include most cardiac arrests associated with blunt trauma or septic shock, while certain characteristics like icy
The document reviews protocols for common basic life support medications including glucose, prescribed inhalers, nitroglycerin, epinephrine auto-injectors, and aspirin. It provides the generic and trade names, actions, indications, contraindications, side effects, dosages, and administration steps for each medication. It also defines online vs offline medical control and describes how EMTs must contact medical control to receive permission before administering certain medications.
This document provides guidelines for pediatric advanced life support. It outlines the assessment process using ABCDE (airway, breathing, circulation, disability, exposure) and recommendations for interventions. Key steps include establishing an open airway, providing ventilation, restoring adequate circulation through chest compressions and medications, treating for shock, and identifying and correcting any reversible causes of arrest. Special considerations are given for neonatal resuscitation and the management of pediatric trauma patients.
An 82-year-old male underwent an unanticipated right hemicolectomy for an ascending colon tumor. During insertion of a central venous catheter post-operatively, the guidewire was inadvertently pushed into circulation. Despite attempts to retrieve the wire at the hospital, it was identified in the femoral vein on x-ray and the patient was transferred to another hospital for retrieval. The wire was successfully retrieved without complications. The anesthesiologist reflected on how to prevent such an incident in the future, including more supervised practice and improved protocols for central line insertion.
1) The NASG (Non-Pneumatic Anti-Shock Garment) is used to stabilize patients experiencing postpartum hemorrhage (PPH) during transfer to higher levels of care. It applies circumferential pressure to the lower body to control bleeding and return blood to vital organs.
2) Patients experiencing uncontrolled Class II PPH or any Class III/IV PPH should be transferred to facilities with HDU/ICU capabilities. Prerequisites for safe transfer include obtaining consent, applying the NASG, ensuring availability of care at the receiving facility, and preparing referral documents.
3) The NASG is lightweight, reusable neoprene suit that is quickly and easily applied in 6 segments
The document summarizes updates to the 2015 pediatric advanced life support (PALS) guidelines compared to the 2010 guidelines. Key changes include more restrictive fluid administration for febrile illness in resource-limited settings, controversial recommendations around routine atropine use before intubation, using invasive hemodynamic monitoring to guide CPR if already in place, considering extracorporeal cardiopulmonary resuscitation for some cardiac arrest cases, and maintaining normothermia rather than induced hypothermia after resuscitation from cardiac arrest. The summary highlights maintaining appropriate oxygen saturation and carbon dioxide levels, as well as blood pressure, after cardiac arrest.
Fran Lockie, a Paediatric Emergency and retrieval specialist, gives an update on paediatric resuscitation. This talk was given at the Bedside Critical Care Conference 2012 on Daydream Island.
The document discusses pain management strategies for pediatric patients in emergency situations. It provides examples of analgesic plans for different pediatric cases, including a 6-year-old with a fall, a 4-year-old with diabetic ketoacidosis, and a 9-year-old needing immunizations. Non-pharmacological approaches like distraction, positioning, topical anesthetics and sucrose are recommended. Oral and intranasal medications like acetaminophen, ibuprofen, codeine, oxycodone, morphine and nitrous oxide may be used. Proper pain assessment and multimodal analgesia are emphasized.
The document discusses the use of dopamine as a treatment for refractory septic shock in pediatrics. It presents arguments in favor of dopamine ("Pro"), noting that unlike adults, pediatric patients with fluid-refractory shock are often hypodynamic and respond well to inotrope and vasodilator therapy such as dopamine. The document reviews several studies that have tested the guidelines for hemodynamic support of newborns and children in septic shock, finding indirect and direct support for the utility and efficacy of the goal-directed recommendations. However, the choice of vasopressor remains open and controversial with many unanswered questions.
Congenital heart disease is a major concern for pediatricians. It affects around 8 in 1000 live births, with 3 in 1000 considered "critical" cases requiring early intervention. Life-threatening forms may not present obvious symptoms initially, making diagnosis difficult. Early recognition through a high index of suspicion is key to reducing mortality and morbidity. Certain heart defects can cause cardiovascular collapse if not treated emergently in the neonatal period. The diagnosis and management of ductus-dependent heart disease is especially challenging.
This document discusses scorpion envenomation and provides details about scorpion venom and the clinical effects of scorpion stings. It notes that scorpion stings are an important public health issue in tropical and subtropical regions, with over 1 million stings and 32,000 fatalities annually worldwide. The document describes the components of scorpion venom and how it causes an "autonomic storm" through the release of catecholamines. It outlines the clinical manifestations of scorpion stings, which can range from local effects to potentially fatal symptoms involving the cardiovascular, respiratory and neurological systems. The document focuses particularly on the cardiovascular impacts of venom from the Tityus serrulatus sc
This document discusses congenital heart disease in newborns. It notes that over half of congenital heart diseases are missed during routine neonatal examinations, and one third are missed at the 6 week examination. Early recognition and timely referral to a pediatric cardiologist is key to reducing mortality and morbidity from congenital heart diseases. Some life-threatening congenital heart diseases may not show obvious signs early after birth, making diagnosis difficult for pediatricians. The document provides classifications of congenital heart diseases, discusses common presentations in newborns, and emphasizes the importance of a high index of suspicion to properly diagnose and manage newborns with potential congenital heart issues.
Ivf commercialization in element in gynaecologydrhemantzaveri
IVF has become more common and accepted as a treatment for infertility. Previously seen as a last resort, it is now often a first choice for many couples. The success rates of IVF, while lower than natural conception, have increased over time due to improvements in technology and techniques. However, there are still risks associated with IVF treatment, including potential side effects of fertility drugs, higher risk pregnancies, and birth defects. The future of IVF may include new technologies like robotic sperm, but it also raises ethical issues around human cloning and commercialization of fertility treatment.
The document discusses strategies to prevent lung injury in preterm infants requiring mechanical ventilation. It notes that preterm infants have structurally immature lungs that are often surfactant deficient, fluid filled, and not supported by a stiff chest wall, making them highly susceptible to lung injury from ventilation. It emphasizes establishing and maintaining an optimal functional residual capacity to prevent atelectrauma through techniques like nasal CPAP, early surfactant administration, and lung recruitment maneuvers while aiming to use the lowest possible oxygen levels and pressures to avoid volutrauma and oxygen toxicity. The goal is to open and stabilize recruited areas of the lung to allow for a more homogeneous distribution of tidal volumes without overinflation.
Necrotizing enterocolitis (NEC) is a devastating disease that primarily affects premature infants. It was first described in the 1960s but the incidence and associated mortality have not changed significantly despite advances in neonatal care. NEC can cause pneumatosis intestinalis, portal venous gas, intestinal perforation, and systemic complications. It remains difficult to prevent and treat. Differential diagnoses include conditions seen in term infants associated with drug use or anomalies, and spontaneous intestinal perforations seen in very preterm infants without feeding. NEC costs over $500 million annually in the US due to increased hospitalization time and risk of short bowel syndrome requiring long-term care.
This document discusses anaemia during pregnancy. It begins by praising Allah for the opportunity to finalize this document. It aims to increase knowledge about anaemia during pregnancy and its dangers. The document reviews factors that can cause anaemia during pregnancy such as age, parity, and nutritional status. It discusses how anaemia can impact the pregnancy, birth process, and fetus by increasing risks like abortion, premature birth, and low birth weight. The conclusion is that anaemia is a low red blood cell count that reduces oxygen delivery, and it recommends increasing public health education in Indonesia to prevent infections and promote better health.
This document discusses anaemia during pregnancy in Indonesia. It begins with an introduction and then provides background information on anaemia during pregnancy, including definitions, pathophysiology, types, signs and symptoms, and impacts on pregnancy, childbirth, the postpartum period, and the fetus. It also covers diagnosis and management of anaemia during pregnancy, distinguishing between light, medium, and severe anaemia. The goal is to increase understanding of anaemia during pregnancy and its impacts in order to improve prevention and management.
La immunoterapia "aspecifica" e la flora intestinaleeventslearnig
This document discusses the relationship between the intestinal flora and non-specific immunotherapy. It begins with an overview of innate and adaptive immunity as it relates to the flora, macrophages, dendritic cells, and regulatory and effector T cells. It then discusses research questions around the microbiome-host organism relationship, the microbiota's role in intestinal immune system maturation, the impact of diet on microbiota composition, and translational research. Methods for microbiota characterization are also reviewed. The document then discusses intestinal dysbiosis and its links to inflammatory diseases. It reviews probiotic administration studies related to allergy prevention and their effects on eczema and IgE levels. Finally, it summarizes the effects of probiotics like LGG
Vaccination rates among adults in Europe are lower than recommended levels despite evidence that vaccines prevent deadly diseases in older populations. To improve rates by 2020, efforts should focus on increasing vaccination among healthcare workers, empowering consumers with independent information on immunization, and promoting immunization as part of a cultural norm of healthy aging. Behavioral economics approaches could also help convince more adults to receive recommended vaccines.
Chorioamnionitis is a serious complication of pregnancy and a major cause of maternal and perinatal morbidity and mortality world over. This PowerPoint provides the basics of chorioamnionitis with emphasis on its etiologic role in fetal and neonatal infections.
Effects of covid19 in pregnant women
Risk of covid19 on newborn baby
Methods to detect covid19 in newborn baby and pregnant women
Preventive measures to protect the pregnant women and the foetus
Mode of delivery
Way of transmission of covid19 from mother to baby
Effects of covid19 in foetus
Sessione dolore pelvico cronico: prevenzione e diagnosiGLUP2010
This document discusses chronic pelvic pain, including summaries of several guidelines and studies. It notes that arriving at a diagnosis for chronic pelvic pain is challenging due to the many dimensions that must be considered. Basic investigations should rule out well-defined pathologies while further investigations help subtype pain syndromes. Persistent condom use can reduce the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, and infertility following an initial episode. Central changes in the nervous system can maintain pain perception in the absence of acute injury and influence psychological factors.
IWO Meeting 16 November 2022 - ASBMR young talent: Silvia Storoni (Amsterdam): Prevalence and Hospital Admissions in Patients With Osteogenesis Imperfecta in The Netherlands: A Nationwide Registry Study
This document provides an overview of bloodborne pathogens and universal precautions for Whitnall School District employees. It discusses OSHA regulations regarding bloodborne pathogens in schools and the district's exposure control plan. Key information covered includes common bloodborne diseases (HIV, hepatitis B, hepatitis C), modes of transmission, steps to reduce risk like wearing gloves and handwashing, and treating all bodily fluids as potentially infectious.
This document discusses anaemia during pregnancy. It begins by defining anaemia as a low red blood cell or haemoglobin level. It then outlines several dangers of anaemia during pregnancy for both the mother and fetus, such as risk of abortion, premature birth, and low birth weight. The document also reviews factors that can contribute to anaemia, such as the mother's age, parity, and nutritional status. In conclusion, it emphasizes the importance of public health efforts to prevent anaemia through counseling and education on healthy nutrition and infection prevention during pregnancy.
This document discusses anaemia during pregnancy. It begins by defining anaemia as a low red blood cell or haemoglobin level. It then outlines several dangers of anaemia during pregnancy for both the mother and fetus, such as risk of abortion, premature birth, and low birth weight. The document also reviews factors that can contribute to anaemia, including the mother's age, parity, and nutritional status. It emphasizes the importance of nutrition and recommends counselling to increase public health awareness and prevention of anaemia during pregnancy.
This document discusses the importance of obstetricians and neonatologists in ensuring healthy pregnancies and infant outcomes. Without their care and training, pregnant women and babies face serious health risks. Obstetricians provide prenatal care to monitor the health of the mother and fetus, while neonatologists specialize in caring for premature and sick newborns. The document cites statistics on infant mortality rates in Western countries and notes that donations can help families afford necessary baby supplies.
Cardiac and respiratory support 2017 [modo de compatibilidade]Antonio Souto
O documento discute o suporte cardiorrespiratório no paciente pediátrico, abordando tópicos como transporte de oxigênio, hipóxia, insuficiência respiratória, choque e reanimação cardiopulmonar.
O documento discute as diretrizes para ressuscitação cardiopulmonar em crianças, incluindo técnicas de compressão torácica, ventilação, acesso venoso, drogas e cuidados pós-ressuscitação. As recomendações são baseadas em evidências de estudos internacionais sobre o tema.
The document discusses the use of dopamine as a treatment for refractory septic shock in pediatrics. It presents arguments in favor of dopamine ("Pro"), noting that unlike adults, pediatric patients with fluid-refractory shock are often hypodynamic and respond well to inotrope and vasodilator therapy such as dopamine. The document reviews several studies that have tested the guidelines for hemodynamic support of newborns and children in septic shock, finding indirect and direct support for the utility and efficacy of the goal-directed recommendations. However, the choice of vasopressor remains open and controversial with many unanswered questions.
Congenital heart disease is a major concern for pediatricians. It affects around 8 in 1000 live births, with 3 in 1000 considered "critical" cases requiring early intervention. Life-threatening forms may not present obvious symptoms initially, making diagnosis difficult. Early recognition through a high index of suspicion is key to reducing mortality and morbidity. Certain heart defects can cause cardiovascular collapse if not treated emergently in the neonatal period. The diagnosis and management of ductus-dependent heart disease is especially challenging.
This document discusses scorpion envenomation and provides details about scorpion venom and the clinical effects of scorpion stings. It notes that scorpion stings are an important public health issue in tropical and subtropical regions, with over 1 million stings and 32,000 fatalities annually worldwide. The document describes the components of scorpion venom and how it causes an "autonomic storm" through the release of catecholamines. It outlines the clinical manifestations of scorpion stings, which can range from local effects to potentially fatal symptoms involving the cardiovascular, respiratory and neurological systems. The document focuses particularly on the cardiovascular impacts of venom from the Tityus serrulatus sc
This document discusses congenital heart disease in newborns. It notes that over half of congenital heart diseases are missed during routine neonatal examinations, and one third are missed at the 6 week examination. Early recognition and timely referral to a pediatric cardiologist is key to reducing mortality and morbidity from congenital heart diseases. Some life-threatening congenital heart diseases may not show obvious signs early after birth, making diagnosis difficult for pediatricians. The document provides classifications of congenital heart diseases, discusses common presentations in newborns, and emphasizes the importance of a high index of suspicion to properly diagnose and manage newborns with potential congenital heart issues.
Ivf commercialization in element in gynaecologydrhemantzaveri
IVF has become more common and accepted as a treatment for infertility. Previously seen as a last resort, it is now often a first choice for many couples. The success rates of IVF, while lower than natural conception, have increased over time due to improvements in technology and techniques. However, there are still risks associated with IVF treatment, including potential side effects of fertility drugs, higher risk pregnancies, and birth defects. The future of IVF may include new technologies like robotic sperm, but it also raises ethical issues around human cloning and commercialization of fertility treatment.
The document discusses strategies to prevent lung injury in preterm infants requiring mechanical ventilation. It notes that preterm infants have structurally immature lungs that are often surfactant deficient, fluid filled, and not supported by a stiff chest wall, making them highly susceptible to lung injury from ventilation. It emphasizes establishing and maintaining an optimal functional residual capacity to prevent atelectrauma through techniques like nasal CPAP, early surfactant administration, and lung recruitment maneuvers while aiming to use the lowest possible oxygen levels and pressures to avoid volutrauma and oxygen toxicity. The goal is to open and stabilize recruited areas of the lung to allow for a more homogeneous distribution of tidal volumes without overinflation.
Necrotizing enterocolitis (NEC) is a devastating disease that primarily affects premature infants. It was first described in the 1960s but the incidence and associated mortality have not changed significantly despite advances in neonatal care. NEC can cause pneumatosis intestinalis, portal venous gas, intestinal perforation, and systemic complications. It remains difficult to prevent and treat. Differential diagnoses include conditions seen in term infants associated with drug use or anomalies, and spontaneous intestinal perforations seen in very preterm infants without feeding. NEC costs over $500 million annually in the US due to increased hospitalization time and risk of short bowel syndrome requiring long-term care.
This document discusses anaemia during pregnancy. It begins by praising Allah for the opportunity to finalize this document. It aims to increase knowledge about anaemia during pregnancy and its dangers. The document reviews factors that can cause anaemia during pregnancy such as age, parity, and nutritional status. It discusses how anaemia can impact the pregnancy, birth process, and fetus by increasing risks like abortion, premature birth, and low birth weight. The conclusion is that anaemia is a low red blood cell count that reduces oxygen delivery, and it recommends increasing public health education in Indonesia to prevent infections and promote better health.
This document discusses anaemia during pregnancy in Indonesia. It begins with an introduction and then provides background information on anaemia during pregnancy, including definitions, pathophysiology, types, signs and symptoms, and impacts on pregnancy, childbirth, the postpartum period, and the fetus. It also covers diagnosis and management of anaemia during pregnancy, distinguishing between light, medium, and severe anaemia. The goal is to increase understanding of anaemia during pregnancy and its impacts in order to improve prevention and management.
La immunoterapia "aspecifica" e la flora intestinaleeventslearnig
This document discusses the relationship between the intestinal flora and non-specific immunotherapy. It begins with an overview of innate and adaptive immunity as it relates to the flora, macrophages, dendritic cells, and regulatory and effector T cells. It then discusses research questions around the microbiome-host organism relationship, the microbiota's role in intestinal immune system maturation, the impact of diet on microbiota composition, and translational research. Methods for microbiota characterization are also reviewed. The document then discusses intestinal dysbiosis and its links to inflammatory diseases. It reviews probiotic administration studies related to allergy prevention and their effects on eczema and IgE levels. Finally, it summarizes the effects of probiotics like LGG
Vaccination rates among adults in Europe are lower than recommended levels despite evidence that vaccines prevent deadly diseases in older populations. To improve rates by 2020, efforts should focus on increasing vaccination among healthcare workers, empowering consumers with independent information on immunization, and promoting immunization as part of a cultural norm of healthy aging. Behavioral economics approaches could also help convince more adults to receive recommended vaccines.
Chorioamnionitis is a serious complication of pregnancy and a major cause of maternal and perinatal morbidity and mortality world over. This PowerPoint provides the basics of chorioamnionitis with emphasis on its etiologic role in fetal and neonatal infections.
Effects of covid19 in pregnant women
Risk of covid19 on newborn baby
Methods to detect covid19 in newborn baby and pregnant women
Preventive measures to protect the pregnant women and the foetus
Mode of delivery
Way of transmission of covid19 from mother to baby
Effects of covid19 in foetus
Sessione dolore pelvico cronico: prevenzione e diagnosiGLUP2010
This document discusses chronic pelvic pain, including summaries of several guidelines and studies. It notes that arriving at a diagnosis for chronic pelvic pain is challenging due to the many dimensions that must be considered. Basic investigations should rule out well-defined pathologies while further investigations help subtype pain syndromes. Persistent condom use can reduce the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, and infertility following an initial episode. Central changes in the nervous system can maintain pain perception in the absence of acute injury and influence psychological factors.
IWO Meeting 16 November 2022 - ASBMR young talent: Silvia Storoni (Amsterdam): Prevalence and Hospital Admissions in Patients With Osteogenesis Imperfecta in The Netherlands: A Nationwide Registry Study
This document provides an overview of bloodborne pathogens and universal precautions for Whitnall School District employees. It discusses OSHA regulations regarding bloodborne pathogens in schools and the district's exposure control plan. Key information covered includes common bloodborne diseases (HIV, hepatitis B, hepatitis C), modes of transmission, steps to reduce risk like wearing gloves and handwashing, and treating all bodily fluids as potentially infectious.
This document discusses anaemia during pregnancy. It begins by defining anaemia as a low red blood cell or haemoglobin level. It then outlines several dangers of anaemia during pregnancy for both the mother and fetus, such as risk of abortion, premature birth, and low birth weight. The document also reviews factors that can contribute to anaemia, such as the mother's age, parity, and nutritional status. In conclusion, it emphasizes the importance of public health efforts to prevent anaemia through counseling and education on healthy nutrition and infection prevention during pregnancy.
This document discusses anaemia during pregnancy. It begins by defining anaemia as a low red blood cell or haemoglobin level. It then outlines several dangers of anaemia during pregnancy for both the mother and fetus, such as risk of abortion, premature birth, and low birth weight. The document also reviews factors that can contribute to anaemia, including the mother's age, parity, and nutritional status. It emphasizes the importance of nutrition and recommends counselling to increase public health awareness and prevention of anaemia during pregnancy.
This document discusses the importance of obstetricians and neonatologists in ensuring healthy pregnancies and infant outcomes. Without their care and training, pregnant women and babies face serious health risks. Obstetricians provide prenatal care to monitor the health of the mother and fetus, while neonatologists specialize in caring for premature and sick newborns. The document cites statistics on infant mortality rates in Western countries and notes that donations can help families afford necessary baby supplies.
Cardiac and respiratory support 2017 [modo de compatibilidade]Antonio Souto
O documento discute o suporte cardiorrespiratório no paciente pediátrico, abordando tópicos como transporte de oxigênio, hipóxia, insuficiência respiratória, choque e reanimação cardiopulmonar.
O documento discute as diretrizes para ressuscitação cardiopulmonar em crianças, incluindo técnicas de compressão torácica, ventilação, acesso venoso, drogas e cuidados pós-ressuscitação. As recomendações são baseadas em evidências de estudos internacionais sobre o tema.
O documento discute a exposição tóxica em crianças, destacando que a maioria das exposições são acidentais e ocorrem na residência. Apresenta dados sobre casos notificados no Brasil e discute a abordagem geral do paciente intoxicado, incluindo estabilização, descontaminação e uso de antídotos. Conclui que a prevenção é o principal tratamento e que procedimentos iatrogênicos de descontaminação ainda são comuns.
Suporte básico de vida em pediatria 2013Antonio Souto
[1] O documento discute as diretrizes de 2010 da American Heart Association para ressuscitação cardiopulmonar e atendimento de emergência cardiovascular em pediatria. [2] As diretrizes enfatizam a importância de uma ressuscitação cardiopulmonar de alta qualidade com compressões torácicas profundas e rápidas. [3] O documento também discute técnicas de ventilação, acesso venoso, uso de drogas como a epinefrina e critérios para cessar os esforços de ressuscitação.
O documento discute as diretrizes para ressuscitação cardiopulmonar em crianças, incluindo técnicas de compressão torácica, ventilação, drogas e cuidados pós-ressuscitação.
Este documento discute disfunção respiratória (pulmonar) grave. Em 3 frases:
1) A disfunção respiratória ocorre quando o sistema respiratório não consegue manter os níveis normais de oxigênio e gás carbônico no sangue.
2) Ela pode ser classificada como tipo I (hipoxêmica) ou tipo II (hipercápnica) dependendo dos níveis de oxigênio e gás carbônico no sangue.
3) O diagnóstico é feito através de
O documento discute o uso de drogas vasoativas, especificamente noradrenalina, no tratamento de choque séptico em pediatria. Há controvérsias sobre o tema devido à escassez de estudos clínicos controlados e às recomendações não serem baseadas em evidências sólidas. O estado hemodinâmico em choque séptico é heterogêneo e variável, tornando difícil a definição de protocolos universais.
O documento discute distúrbios ácido-básicos. A gasometria fornece informações sobre o pH, eletrólitos, gás carbônico e oxigênio no sangue para diagnosticar tais distúrbios. Um pH abaixo de 7.35 indica acidemia enquanto um pH acima de 7.45 indica alcalemia. É importante analisar o pH, gás carbônico e bicarbonato para determinar se o distúrbio primário é respiratório ou metabólico.
O documento discute o tratamento do traumatismo cranioencefálico grave em crianças, abordando os seguintes pontos: a fisiopatologia da lesão primária e secundária, a classificação e fatores associados à gravidade, o atendimento inicial e medidas para estabilização e redução da pressão intracraniana, além de exames complementares e o monitoramento da pressão intracraniana.
Este documento fornece uma introdução sobre vinhos, abordando tópicos como enólogos, sommeliers, vinhos varietais e de corte, escolha de taças, decantação, rolhas, leitura de rótulos e serviço de vinho na temperatura correta. O autor sugere formas de aproveitar melhor a experiência com vinhos, como cursos, visitas a vinícolas e experimentação de diferentes estilos e países.
Este documento fornece protocolos de conduta para a UTI Neonatal/Berçário do Hospital Padre Albino em Catanduva, incluindo diretrizes sobre suporte hidroeletrolítico, nutricional, ventilatório e prevenção de infecção neonatal.
1) The document discusses acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS), which are characterized by compromised gas exchange and damage to the lungs following various direct or indirect insults.
2) ALI/ARDS results in diffuse alveolar damage caused by the release of inflammatory cytokines and mediators from activated macrophages that disrupt the alveolar-capillary membrane.
3) The standard treatment focuses on supportive care and mechanical ventilation with a lung protective strategy to prevent further lung injury, while the effectiveness of pharmacotherapy remains limited due to insufficient evidence.
Conduta médica na unidade de emergênciaAntonio Souto
This document provides guidance and policies for medical staff working in a pediatric emergency and neonatal intensive care unit. It outlines expectations for timely arrival, focusing on work duties during shifts, keeping personal phone calls from interfering with patient care, prohibiting food in patient areas, and maintaining a professional appearance. Policies also cover treating patients and families with respect, prioritizing quality care and teamwork, and ensuring cleanliness. Medical students are to identify themselves as such and have orders co-signed. The document aims to help develop assessment and management skills for pediatric emergencies.
Este documento descreve o caso de um menino de 12 anos que apresentou choque séptico devido a uma infecção grave em sua perna esquerda. Ele foi internado em uma unidade de terapia intensiva pediátrica onde recebeu tratamento intensivo, incluindo antibióticos, suporte hemodinâmico e cirurgia. Apesar dos esforços, seu estado clínico permaneceu instável nos primeiros dias de internação.
Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. It most commonly affects children under 10 and is increasing worldwide. The primary cause is infection by Shiga toxin-producing Escherichia coli, especially E. coli O157:H7. Symptoms include bloody diarrhea and renal impairment. Treatment is supportive with fluid management and dialysis if needed. Antibiotics are not recommended due to increased risk of HUS. Outcomes range from full recovery to chronic renal failure or death in severe cases.
Princípíos básicos de ventilação mecânicaAntonio Souto
O documento discute os princípios básicos da ventilação pulmonar mecânica e foi escrito por Dr. Antonio Souto, coordenador médico da UTI Pediátrica e Neonatal do Hospital Padre Albino.
O documento discute as peculiaridades da consulta pediátrica em comparação com pacientes adultos, incluindo a necessidade de obter a história dos pais e da criança, e como os pais podem influenciar com suas próprias interpretações. Ele também descreve os procedimentos para a anamnese e exame físico de uma criança, enfatizando a importância de ganhar a confiança da criança e dos pais.
O documento aborda conceitos sobre o RN prematuro, incluindo definição, fatores de risco, particularidades clínicas e cuidados necessários. As principais informações são: 1) RN prematuro é aquele nascido com menos de 37 semanas ou com peso menor que 2,5kg; 2) Os principais fatores de risco são idade materna extrema, tabagismo, drogas e condições socioeconômicas desfavoráveis; 3) Os principais desafios clínicos são termorregulação, distúrbios respiratórios
O documento discute o tratamento da criança queimada, incluindo:
1) A importância do atendimento inicial e da reposição fluida adequada para prevenir o choque;
2) As formulas de Parkland e Carvajal para calcular a reposição fluida inicial baseada na superficie corporal queimada;
3) A necessidade de monitorar cuidadosamente a resposta ao tratamento e ajustar a reposição fluida de acordo com os sinais vitais e urinários da criança.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Cosmetology and Trichology Courses at Kosmoderma Academy PRP (Hair), DR Growt...
Choque séptico 2013
1. Sepse
Choque séptico
Antonio Souto
acasouto@bol.com.br
Médico coordenador
Unidade de Medicina Intensiva Pediátrica
Unidade de Medicina Intensiva Neonatal
Hospital Padre Albino
Professor de Pediatria nível II
Faculdades Integradas Padre Albino
Catanduva / SP
2. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
http://www.scielo.br/pdf/jped/v78n6/7806449.pdf
3. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
4. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
Shock is the major cause of death in children
regardless of disease category
Joseph A. Carcillo, M.D
5. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
Shock was commonly not recognized
Fewer patients were referred for shock than had shock
(335 vs 1803)
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
referred
for
shock
shock
referred for shock
not referred for shock
shock
no shock
7
%
37%
6. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
7. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
8. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
Bone et al. Chest 1992;101:1644
SepsisSepsisSepsisSIRS Severe SepsisSevere SepsisSevere Sepsis
Systemic Inflammatory Response Syndrome
SIRS criteria
• Temp < 96.8° or > 100.4° F
• HR > 90
• RR > 20 or PCO2 < 32
• WBC < 4 or > 12 or bands > 10%
Septic ShockSeptic ShockSeptic Shock
9. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
SepsisSepsisSepsisSIRS Severe SepsisSevere SepsisSevere Sepsis Septic ShockSeptic ShockSeptic Shock
10. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
SepsisSepsisSepsisSIRSSIRSSIRS Severe Sepsis Septic ShockSeptic ShockSeptic Shock
Sepsis plus Organ Dysfunction
• Elevated Creatinine
• Elevated INR
• Altered Mental Status
• Elevated Lactate
• Hypotension that responds to fluid
11. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
SepsisSepsisSepsisSIRSSIRSSIRS Severe SepsisSevere SepsisSevere Sepsis Septic Shock
Severe Sepsis and Hypotension
• Hypotension that does NOT
respond to fluid (30 cc/kg bolus)
12. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
13. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
14. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
15. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
16. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
Sepsis is a complex syndrome that develops when the initial,
appropriate host response to an infection becomes amplified,
and is then dysregulated.
Genetic variations
•disrupt innate immune sensing of infectious organisms and the ability of the
immune system to respond to infection
•diversity of the clinical presentation of sepsis
•the response to current medical treatment
•the genetic predisposition to infection in each individual patient.
17. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
18. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
19. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
20. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
21. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
22. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
23. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
24. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
Figure 1. FACTORS AFFECTING OXYGEN DELIVERY
DO2
CaO2
CO
SV
HR
Oxygenation
Hgb
A-a gradient
DPG
Acid-Base Balance
Blockers
Competitors
Temperature
Drugs
Conduction System
Ventricular
Compliance
EDV
ESV Contractility
CVP
Venous Volume
Venous Tone
Afterload Blockers
Temperature Competitors
Drugs Autonomic Tone
Metabolic Milieu
Ions
Acid Base
Temperature
Drugs
Toxins
Influenced By
Influenced By
Influenced By
Influenced By
25. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
What is Shock?
• A physiologic state characterized by
– Decrease in tissue perfusion
– Inadequate oxygen delivery
• Delivery isn’t keeping up with
demand
26. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
Septic Shock
• Combination
– Distributive
– Cardiogenic
– Hypovolemic
• Most common form of Shock
• On a continuum from SIRS to Septic Shock
27. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
28. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
29. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
30. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
31. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
32. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
Clinical PresentationClinical Presentation
•• Early diagnosis requires a high index of suspicionEarly diagnosis requires a high index of suspicion
•• Diagnosis is made through the physical examination focused on tiDiagnosis is made through the physical examination focused on tissuessue
perfusionperfusion
•• Extreme hypotension is a late andExtreme hypotension is a late and premorbidpremorbid signsign
33. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
“…with a high index of suspicion…septic
shock can be recognized early (before
hypotension) by a triad of signs…” Carcillo
et.al, 2002
•Hypo/hyperthermia
•Altered mental status
•Peripheral vasodilation/constriction
34. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
Carcillo et al. defined septic shock in pediatric patients
Tachycardia (which may be absent in the
hypothermic patient) with signs of decreased
perfusion including decreased peripheral
pulses compared with central pulses, altered
alertness, flash capillary refill or capillary refill
>2 secs, mottled or cool extremities, or
decreased urine output
International pediatric sepsis consensus conference: Definitions for sepsis and organ
dysfunction in pediatrics*
35. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
36. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
37. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
38. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
39. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
Carcillo JA, Davis AL, Zaritsky
A. Role of early fluid
resuscitation in pediatric septic
shock. JAMA.1991; 266 :1242 –
1245
40. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
41. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
42. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
20 ml/Kg a cada 5’
60 ml/Kg em 15’
43. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
44. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
45. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
46. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
DopaminaDopamina
DopaminaDopamina
DobutaminaDobutamina
AdrenalinaAdrenalina
Choque frioChoque frio Choque quenteChoque quente
NorNor--adrenalinaadrenalina
ChoqueChoque
refratrefratáário ario a
volumevolume
ChoqueChoque
refratrefratáário ario a
volumevolume
dopaminodopamino
resistenteresistente
47. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
48. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
49. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
50. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
51. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
52. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
Volume 115(2), February 1999, pp 462-474
Inadequate Antimicrobial Treatment of
Infections: A Risk Factor for Hospital
Mortality Among Critically III Patients
Kollef, Marin H. MD, FCCP; Sherman, Glenda RN; Ward, Suzanne RN; Fraser,
Victoria J. MD
53. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
54. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
55. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
56. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
57. Dr. Antonio Souto acasouto@terra.com.br 2013
UTI Pediátrica & Neonatal Hospital Padre Albino
Gustav Klimt
(Baumgarten, Viena,
14 de julho de 1862
— Viena, 6 de fevereiro de 1918)
foi um pintor simbolista austríaco