1. Shock is defined as inadequate tissue perfusion resulting in cellular dysfunction. It can occur with normal or low blood pressure and results from various causes like sepsis, hemorrhage, cardiac failure, etc.
2. Early goal-directed therapy for septic shock involves rapid fluid resuscitation, antibiotics, and vasopressors to maintain adequate perfusion. Dopamine, norepinephrine, and epinephrine are commonly used vasopressors.
3. Cardiogenic shock results from inadequate cardiac output, usually from acute myocardial infarction or myocarditis. It requires fluids, inotropes like dobutamine, and revascularization when possible.
Anti anginal drugs, uses, mechanism of action, adverse effectsKarun Kumar
A presentation outlining the causes of angina, mechanism of action of various anti-anginal drugs, their uses and side effects alongwith contraindications
Anti anginal drugs, uses, mechanism of action, adverse effectsKarun Kumar
A presentation outlining the causes of angina, mechanism of action of various anti-anginal drugs, their uses and side effects alongwith contraindications
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
Scope: This subject is intended to impart the fundamental knowledge on various aspects
(classification, mechanism of action, therapeutic effects, clinical uses, side effects and
contraindications) of drugs acting on different systems of body and in addition,emphasis
on the basic concepts of bioassay. Objectives: Upon completion of this course the student should be able to
1. Understand the mechanism of drug action and its relevance in the treatment of
different diseases
2. Demonstrate isolation of different organs/tissues from the laboratory animals by
simulated experiments
3. Demonstrate the various receptor actions using isolated tissue preparation
4. Appreciate correlation of pharmacology with related medical sciences
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- 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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
1. Dr. RAGHU PRASADA M S
MBBS,MD
ASSISTANT PROFESSOR
DEPT. OF PHARMACOLOGY
SSIMS & RC.
1
2. Term “choc” – French for “push” or impact was
first published in 1743 by the physician LeDran
Belief – symptoms arose from fear or some
other form of altered cerebral function
Inadequate oxygen delivery to meet metabolic
demands
Results in global tissue hypoperfusion and
metabolic acidosis
Shock can occur with a normal blood pressure
and hypotension can occur without shock
3. • Inadequate systemic oxygen delivery activates
autonomic responses to maintain systemic oxygen
delivery
• Sympathetic nervous system
• NE, epinephrine, dopamine, and cortisol release
•Causes vasoconstriction, increase in HR, and
increase of cardiac contractility (cardiac output)
• Renin-angiotensin axis
• Water and sodium conservation and
vasoconstriction
• Increase in blood volume and blood pressure
4.
5. Progression of physiologic effects as shock ensues
Cardiac depression
Respiratory distress
Renal failure
DIC
Result is end organ failure
12. Airway Breathing Circulation
Establish 2 large bore IVs or a central line
Crystalloids
Normal Saline or Lactate Ringers-Up to 3 liters
Packed Red Blood Cells
O negative or cross matched
Control any bleeding
Arrange definitive treatment
13. TBW (42 L) = 2/3 of body weight (70 kg).
ICF (28 L) = 2/3 of TBW.
ECF (14 L) = 1/3 of TBW.
Interstitial fluid (ISF, 10.5 L) = ¾ of ECF
Intravascular fluid (IVF, 3.5 L) = ¼ of ECF.
14. “Crystalloids”
Normal saline (just NaCl).
Lactated ringers
Plasmalyte-balanced crystalloid solution with
multiple electrolye solution
Normosol-solution of balanced electrolytes in water
for injection.
Last 3 have K+ and other stuff (acetate, Mg++, etc.)
15. Crystalloids enter entire ECF: ISF (3/4 of ECF) and IVF
(1/4 of ECF).
3 or 4:1 for replacement of blood loss with crystalloid
Colloids only enter IVF (in short term– 16 hour half-
time for entrance into ISF)
1:1 replacement of blood loss with colloid
16. Blood trasfusion
Packed red cells- increase O2 carrying capacity
Plasma-fresh frozen plasma contains all stable
proteins-albumin, globulin and clotting factors
Normal human serum albumin-reduce edema,
hypovolemic shock
17. DEXTRAN-isolated from beet root
Inhibit rouleaux formation
HYDROXYETHYL STARCH-resistant to hydrolysis by
amylase, maintains blood volume longer
POLYVINYL PYROLIDINE (PVP)-synthetic water soluble
hydrophilic polymer
Gelatin polymers-HAEMACCEL-polypeptide dissolved
in electrolyte
DEXTROSE-5% in water
18. 18
Vasoactive drugs are an important pharmacologic
defense in the treatment of shock.
May be required to support BP in the early stages of
shock.
These agents may be needed to:
Enhance CO through the use of inotropic agents
Increase SVR through the use of vasopressors
21. 21
An endogenous precursor of norepinephrine with
multiple dose-related effects
stimulates alpha, beta and dopaminergic receptors.
Low Dose (0.5 - 3 µg/kg/min)
Predominantly dopaminergic (DR) effects
Enhanced blood flow to renal and splanchnic beds
Moderate Dose (5 -10 µg/kg/min)
Positive inotropic effects (1)
High Dose (>10 µg/kg/min)
a-actions (vasoconstriction)
22. DRUG Common Uses
Phenylephrine Septic Shock, neurogenic
shock
Norepinephrine Septic shock
Epinephrine Anaphylaxis, ACLS, septic
shock
Dopamine Renal Insufficeny, septic
shock, cardiogenic shock
Dobutamine Cardiogenic shock (CS)
Isoproterenol bradycardia due to heart
block, effects HR
Milrinone Cardiogenic shock- in those
who don’t respond to
dobutamine
23. Epinephrine—catecholamine. Low doses stimulates
beta receptors (so increases CO), causes
bronchodilation as well. Larger doses act on alpha
receptors.
Drug of choice in anaphylaxis. Prevents release of
histamine, so reverses vasodilation and
bronchoconstriction.
Can be given IV, subcut or even via ETT.
24. Isoxsuprine(isoproterenol)—synthetic catecholamine.
Works exclusively on beta receptors. Increases heart
rate, myocardial contractility and variable BP effects.
Limited usefulness as vasopressor. Increases myocardial
oxygen consumption and decreases coronary flow.
Causes cardiac dysrhythmias.
25. Milrinone—used in combination with other agents in
cardiogenic shock.
Increases cardiac output and decreases SVR without
increasing heart rate or myocardial oxygen
consumption.
Improved CO then increases renal perfusion, thus
urinary output with decrease in circulating volume and
decreased cardiac workload.
26. Norepinephrine—catecholamine.
Primarily alpha 1 stimulation but also beta1 receptors.
Useful in cardiogenic and septic shock.
Does cause reduced renal blood flow so limits its long
term use.
Phenylephrine—adrenergic that stimulates alpha
receptors. Longer duration of action than
epinephrine. Reduction of renal and mesenteric blood
flow limits prolonged use.
27. Neosynephrine (phenyleprine)—adrenergic that
stimulates alpha receptors. Longer duration of
action than epinephrine. Reduction of renal and
mesenteric blood flow limits prolonged use.
28. Two or more of Criteria-Systemic Inflammatory
Response Syndrome (SIRS)
Temp > 38 or < 36 C
HR > 90
RR > 20
WBC > 12,000 or < 4,000
Plus the presumed existence of infection
Blood pressure can be normal!
29. Sepsis plus refractory hypotension
After bolus of 20-40 mL/Kg patient still has one of
the following:
SBP < 90 mm Hg
MAP < 65 mm Hg
MAP = [(2 x diastolic)+systolic] / 3
30. High fever
Diffuse rash with desquamation on the palms and
soles over subsequent 1-2 weeks
Hypotension (may be orthostatic) and evidence of
involvement of 3 other organ systems
Streptococcal TSS more frequently presents with focal
soft tissue inflammation and less commonly is
associated with diffuse rash.
Streptococcus pyogenes (group A Streptococcus)
S aureus
31.
32. • 2 large bore IVs
• NS IVF bolus- 1-2 L wide open (if no
contraindications)
• Supplemental oxygen
• Empiric antibiotics, based on suspected source, as
soon as possible
Antibiotics- Survival correlates with how quickly the
correct drug was given
Cover gram positive and gram negative bacteria
33. Zosyn(piperacillin+ tazobactum) 3.375 grams IV and
ceftriaxone 1 gram IV or
Imipenem 1 gram IV
Add additional coverage as indicated
Pseudomonas- Gentamicin or Cefepime
MRSA- Vancomycin
Intra-abdominal or head/neck anaerobic infections-
Clindamycin or Metronidazole
Asplenic- Ceftriaxone for N. meningitidis, H. infuenzae
Neutropenic – Cefepime or Imipenem
37. Often after ischemia, loss of LV function
Lose 40% of LV clinical shock ensues
CO reduction lactic acidosis, hypoxia
Stroke volume is reduced
Tachycardia develops as compensation
Ischemia and infarction worsens
38. Goals- Airway stability and improving myocardial
pump function
Cardiac monitor, pulse oximetry
Supplemental oxygen, IV access
Intubation will decrease preload and result in
hypotension -fluid bolus
39. AMI
Aspirin, beta blocker, morphine, heparin
If no pulmonary edema, IV fluid challenge
If pulmonary edema
Dopamine – will ↑ HR and thus cardiac work
Dobutamine – May drop blood pressure
Combination therapy may be more effective
PCI(Percutaneous Coronary Intervention) or thrombolytics
RV infarct
Fluids and Dobutamine (no NTG)
Acute mitral regurgitation or VSD
Pressors (Dobutamine and Nitroprusside)
40. Correct hypotension:
Fluid resuscitation to correct hypovolemia
Inotropic or Vasopressor support:
Dobutamine
Milrinone
Norepinephrine
Dopamine
Epinephrine
Oxygenation
If MI – ASA, Heparin, and Revascularization
If arrhythmia – correct arrhythmia
If extracardiac abnormality – reverse or treat cause
41. Clinical Signs: Shock, Hypoperfusion, CHF, Acute Pulm Edema
Most likely major underlying disturbance?
Acute Pulmonary
Edema
Hypovolemia Low-output
cardiogenic shock
Arrhythmia
Administer
Furosemide
Morphine
Oxygen intubation
Nitroglycerin
Dopamine
Dobutamine
Administer
Fluids
Blood transfusions
Cause-specific
interventions Check Blood Pressure
Brady
cardia
Tachyc
ardia
Check Blood Pressure
Systolic BP
(>100 mm Hg)
Systolic BP
(NO
signs/sympto
ms of shock)
Systolic BP
(signs/symptoms
of shock)
Systolic BP (<70 mm
Hg + signs/symptoms
of shock)
See Sec. 7.7 in
ACC/AHA Guidelines
for patients with
STEMI
ACE
Inhibitors
Nitroglycerin Dobutamine Dopamine Norepinephrine
Systolic BP
(>100 mm
Hg)
Further Diagnostic/Therapeutic Considerations (for non-hypovolemic
shock)
Diagnostic / Therapeutic
Pulmonary artery catheter, Intra-aortic balloon pump,
echo, angiography, etc Reperfusion revascularization 41
42. • Anaphylaxis – a severe systemic hypersensitivity
reaction characterized by multisystem
involvement
• IgE mediated
• Anaphylactoid reaction – clinically
indistinguishable from anaphylaxis, do not
require a sensitizing exposure
• Not IgE mediated
43. Pruritus, flushing, urticaria appear
Throat fullness, anxiety, chest tightness,
shortness of breath and lightheadedness
Finally- Altered mental status, respiratory
distress and circulatory collapse
44. ABC’s
Angioedema and respiratory compromise require
immediate intubation
IV, cardiac monitor, pulse oximetry
IVFs, oxygen
Epinephrine
Second line
Corticosteriods
H1 and H2 blockers
45. Epinephrine
0.3 mg IM of 1:1000
Repeat every 5-10 min as needed
Caution with patients taking beta blockers- can
cause severe hypertension due to unopposed
alpha stimulation
For CV collapse, 1 mg IV of 1:10,000
If refractory, start IV drip
46. Corticosteroids
Methylprednisolone 125 mg IV
Prednisone 60 mg PO
Antihistamines
H1 blocker- Diphenhydramine 25-50 mg IV
H2 blocker- Ranitidine 50 mg IV
Bronchodilators
Albuterol nebulizer
Atrovent nebulizer
Magnesium sulfate 2 g IV over 20 minutes
Glucagon
For patients taking beta blockers and with refractory
hypotension
1 mg IV q5 minutes until hypotension resolves
47. • Occurs after acute spinal cord injury
• Sympathetic outflow is disrupted leaving
unopposed vagal tone
• Results in hypotension and bradycardia
• Spinal shock- temporary loss of spinal reflex activity
below a total or near total spinal cord injury (not the
same as neurogenic shock, the terms are not
interchangeable)
48. Loss of sympathetic tone results in warm and dry skin
Shock usually lasts from 1 to 3 weeks
Any injury above T1 can disrupt the entire sympathetic
system
Higher injuries = worse paralysis
49. A,B,Cs
Remember c-spine precautions
Fluid resuscitation
Keep MAP at 85-90 mm Hg for first 7 days
Thought to minimize secondary cord injury
If crystalloid is insufficient use vasopressors
Search for other causes of hypotension
For bradycardia
Atropine
Pacemaker
50. Methylprednisolone
Used only for blunt spinal cord injury
High dose therapy for 23 hours
Must be started within 8 hours
Controversial- Risk for infection, GI bleed
51. Tension pneumothorax
Air trapped in pleural space with 1 way valve,
air/pressure builds up
Mediastinum shifted impeding venous return
Chest pain, SOB, decreased breath sounds
Confirmation -CXR
Rx: Needle decompression, chest tube
52. Cardiac tamponade
Blood in pericardial sac prevents venous return to
and contraction of heart
Related to trauma, pericarditis, MI
Beck’s triad: hypotension, muffled heart sounds, JVD
Diagnosis: large heart CXR, echo
Rx: Pericardiocentisis
54. Aortic stenosis
Resistance to systolic ejection causes decreased
cardiac function
Chest pain with syncope
Systolic ejection murmur
Diagnosed with echo
Vasodilators (NTG) will drop pressure!
Rx: Valve surgery