Pre-operative assessment involves evaluating patients before surgery to ensure the procedure is still appropriate, identify any medical issues, and develop a perioperative plan. A full medical history is taken, physical exam performed, and tests ordered. Patients are counseled on pre-op fasting, medication management, and consent. Appropriate antibiotics and measures are arranged based on surgery type and risk level. The goal is to optimize patient safety and reduce surgical risk.
Hassan Mohamed Ali
Associate professor of anesthesia and pain management, Anesthesia department, Cairo University.
MB.B.ch, M Sc, M.D, FCAI, DESA
Meeqat General Hospital, Madinah Munawarah
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
Prof. mridul M. panditrao, discusses the fundamental aspects of Problems of Dental Chair anesthesia, conscious sedation, The management and his own experience
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
Hassan Mohamed Ali
Associate professor of anesthesia and pain management, Anesthesia department, Cairo University.
MB.B.ch, M Sc, M.D, FCAI, DESA
Meeqat General Hospital, Madinah Munawarah
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
Prof. mridul M. panditrao, discusses the fundamental aspects of Problems of Dental Chair anesthesia, conscious sedation, The management and his own experience
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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!
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. OUTLINE
• INTRODUCTION
• SYSTEMS OF PREOPERATIVE ASESSMENT
• SYSTEMIC APPROACH TO PRE
OP EVALUATION
• PREOPERATIVE CHECKLIST
• TAKE HOME MESSAGE
3. INTRODUCTION
• Preoperative assessment process to ensure that
the proposed procedure remains appropriate –
that the presenting complaint still warrants an
operation and that the patient has made an
informed decision to proceed.
• Early identification of these patients allows time
to optimize their pre-existing medical illness and
plan perioperative management so as to reduce
risk.
4. • In addition, preoperative assessment offers an opportunity to perform routine
clerical tasks and also to advise patients about fasting, how to manage their
routine medications and what will happen on the day of surgery.
• Patients scheduled for elective procedures will generally attend a pre-operative
assessment 2-4 weeks before the date of their surgery.
6. SYSTEMIC
APPROACH TO PRE
OP EVALUATION
HISTORY TAKING
• A standard history should be taken. A set of fixed
questions are needed to determine 'fitness' for
surgery.
• Surgery specific symptoms ( including features
not present), onset , duration and exacerbating
and relieving factors should also be documented
7. • Cardiovascular history : High blood pressure , chest pains palpitations,
syncope, dyspnoea, and poor exercise tolerance
• Respiratory system history : History of smoking , productive cough,
wheeze, dyspnoea, or stridor present.
• Drug history: A full drug history - some medications require stopping or altering
prior to surgery
• Past Surgical and Anaesthetic History
8. EXAMINATION
General
• Anemia , jaundice, cyanosis, nutritional status , sources of infection
• Airway assesment
• The airway examination is completed by systematic inspection of the mouth opening,
thyromental distance, neck mobility, and the size of the tongue in relation to the oral cavity
• The patient is observed in frontal and profile views . The size of the tongue in relation to
the oral cavity can be graded by using the Mallampati classification.
9.
10. (REVISED CARDIAC INDEX LEE CRITERIA)
• Cardiovascular
• Pulse , blood pressure , bruits,
peripheral oedema
• Stress ECG, stress echocardiogram,
myocardial scintigraphy- IHD
• Patients with any suggestion of valvular
heart disease or poor left ventricular
function, an echocardiogram should be
done : EF < 30% is associated with
poor patient outcomes
11. Respiratory
• Respiratory rate and effort, chest expansion, and percussion note, breath sounds,
oxygen saturation
• Lung function test- assess individuals with known or suspected respiratory disease
Neurological
• Consciousness level, cognitive function, sensation, muscle power, tone and
reflexes
Renal disease
• Underlying conditions leading to chronic renal failure such as diabetes mellitus,
hypertension and IHD – should be stabilized before elective surgery
• Appropriate measures should be taken to treat acidosis , hypocalcemia and
hypercalcemia
13. PRE OPERATIVE
INVESTIGATIONS
• FBC
• Renal profile and electrolytes
• ECG
• CXR
• Clotting screen
• LFT, TFT
• Other indicated investigations; HbA1c,
glucose, urinalysis, ABG
14. ANTIBIOTICS
• Appropriate antibiotic prophylaxis in surgery
depends on the most likely pathogens
encountered during the surgical procedure.
• The expected wound classification of the
planned operative procedure is helpful for
deciding the appropriate antibiotic spectrum
and is considered before ordering or
administering any preoperative medication.
15.
16. • Prophylactic antibiotics are not generally required for clean (class I) cases except in the
setting of indwelling prosthesis placement or when bone is incised.
• Patients who undergo class II procedures benefit from a single dose of an appropriate
antibiotic administered before the skin incision.
• Contaminated (class III) cases require mechanical preparation or parenteral antibiotics with
aerobic and anaerobic activity.
• Dirty or infected cases often require the same antibiotic spectrum, which can be continued
into the postoperative period in the setting of ongoing infection or delayed treatment
• The appropriate antibiotic is chosen before surgery and administered within 60 minutes
before surgical incision
17. PRE OP FASTING
• Patients are advised not to take solids within 6
hours and clear fluids (isotonic drinks and
water) within 2 hours before anaesthesia to
avoid the risk of acid aspiration.
• If the surgery is delayed, oral intake of clear
fluids should be allowed until 2 hours before
surgery or intravenous fluids should be started,
especially in vulnerable groups of patients,e.g.
children, the elderly and diabetics.
• Patients can continue to take their specified
routine medications with sips of water in the
NBM period.
18. REVIEW OF
MEDICATION
• Patients taking cardiac drugs including beta
blockers and antiarrhythmics, anticonvulsants,
antihypertensives, or psychiatric drugs are
advised to take their medications with a sip of
water on the morning of surgery.
• Oral hypoglycaemics should be withold to avoid
hypoglycaemic episodes during preoperative
fasting.
• Drugs that are associated with an increased risk
for perioperative bleeding are withheld before
surgery.
• Clopidogrel (Plavix) is withheld for 7 to 10
days,
• Aspirin stopped 1 week before surgery.
• Warfarin usually stopped 5 days before
surgery
19. CONSENT
Consent should be both voluntary and informed.
The discussion between the surgeon and patient
should:
● give the patient the information required to make
a decision;
● be tailored to the individual patient;
● explain all reasonable treatment options;
● should be written and recorded on a form;
● the key points of the discussion should be
recorded in the case notes.
20. • For consent to be given, the patient must have capacity, which includes the ability
to understand the information provided, to retain and use the information to make
a decision and to indicate what that decision is.
• The surgeon should presume the patient has capacity for consent unless during
the process it is demonstrated that this is not the case. The person obtaining
consent must be appropriately experienced to do so.
• Consent from children below 18 should be obtain from the caretaker
21. ARRANGING AN
OPERATIVE ROOM
• The date, place and time of operation should be
matched with availability of personnel.
• Appropriate equipment and instruments should
be made available.
• The operating list should be distributed as early
as possible to all staff who are involved in
making the list run smoothly.
• Prioritise patients, e.g. children and diabetic
patients should be placed at the beginning of
the list; life- and limb-threatening surgery should
take priority; cancer patients need to be treated
early.
22. TAKE HOME MESSAGE
Assess the risks and
benefits of the
proposed surgery
1
Identify any condition
that may require
intervention prior to
admission and surgery
and take appropriate
actions
2
Perform necessary
investigation and
review the results
3
Obtain informed
consent and prepare
pre op documentation
4
23. SOURCES
• Bailey and Love’s Short Practice of
Surgery 27th Edition
• Sabiston Textbook of Surgery 20th
Edition
A brief history of why the patient first attended and what procedure they have subsequently been scheduled for. One should also confirm the side on which the procedure will be performed (if applicable)
Cardiovascular disease, including hypertension; exercise tolerance is a useful indicator of cardiovascular fitness and, particularly for patients undergoing major surgery, can help predict their risk of post-operative complications and level of care needed post-operatively. Screening questions may elucidate undiagnosed disease and prompt further investigation, e.g. the presence of exertional chest pain, syncopal episodes, or orthopnoea (sensation of breathlesness in the recumbent position relieved by sitting or standing)
Respiratory disease, as adequate oxygenation and ventilation is essential in reducing the risk of acute ischaemic events in the peri-operative period. Questions including whether the patient is able to lie flat for a prolonged period or has a chronic cough are key as these may preclude spinal anaesthesia; also screen for symptoms and signs of obstructive sleep apnoea, if the patient has any risk factors . Increasing severity of symptoms generally indicates worsening of the condition.
A full drug history is required, as some medications require stopping or altering prior to surgery EXAMPLE. Ask about any known allergies, both drug and non-drug allergies
Past Surgical History:
Has the patient had any previous operations? If so, what, when, and why? If the patient is having a repeat procedure, this can significantly change both the surgical time and ease of operation, and hence influence the anaesthetic technique used
Past Anaesthetic History
Has the patient had anaesthesia before? If so, for what operation and what type of anaesthesia? Were there any problems? Did the patient experience any post operative nausea and vomiting?
The Mallampati examination is performed with the patient sitting and the head in a neutral position, the mouth opened as wide as possible, and the tongue protruded maximally. The observer views the oral and pharyngeal structures that are evident. In general, patients in whom the uvula, tonsillar pillars, and soft palate are visible (class I) are easy to mask ventilate and intubate. Patients in whom only the hard palate is visible, a class IV airway, have a higher likelihood of being difficult to mask ventilate and intubate. However, the Mallampati classification is only one component of the airway examination and must be used in conjunction with other aspects of the airway examination and the patient’s history to provide a complete airway assessment.
The airway examination is completed by systematic inspection of the mouth opening, thyromental distance, neck mobility, and the size of the tongue in relation to the oral cavity
The patient is observed in frontal and profile views . The size of the tongue in relation to the oral cavity can be graded by using the Mallampati classification. The Mallampati examination is performed with the patient sitting and the head in a neutral position, the mouth opened as wide as possible, and the tongue protruded maximally. The observer views the oral and pharyngeal structures that are evident. In general, patients in whom the uvula, tonsillar pillars, and soft palate are visible (class I) are easy to mask ventilate and intubate. Patients in whom only the hard palate is visible, a class IV airway, have a higher likelihood of being difficult to mask ventilate and intubate. However, the Mallampati classification is only one component of the airway examination and must be used in conjunction with other aspects of the airway examination and the patient’s history to provide a complete airway assessment.
Systemic approach to pre op evaluation
Cardiovascular
It is important to identify the patients who have a high perioperative risk of major adverse
cardiovascular events (MACE) including myocardial infarction (MI), and make appropriate
arrangements to reduce this risk. Patients at high risk are those with ischaemic heart disease (IHD),
congestive cardiac failure (CCF), arrhythmias, severe peripheral vascular disease, cerebrovascular
disease or significant renal impairment, especially if they are undergoing major intra-abdominal or
intra-thoracic surgery.
In patients with ischaemic heart disease the cardiac and coronary reserve can be evaluated using a
stress test (stress ECG, stress echocardiogram, myocardial scintigraphy). In patients with any
suggestion of valvular heart disease or poor left ventricular function, an echocardiogram should be
obtaine; an ejection fraction of less than 30% is associated with poor patient outcomes.
Pulmonary
Postoperative respiratory complications, such as pneumonia, are a major cause of morbidity and
mortality especially after major abdominal and thoracic surgery. A patient’s current respiratory status
should be compared with their ‘normal state’. A preoperative chest radiograph or scan is useful in a
patient with known emphysematous bullae, pulmonary cancer, metastasis or effusions. Patients on
oral steroid treatment, oxygen therapy or who have a forced expiratory volume in the first second
(FEV1) less than 30% of predicted value (for age, weight and height), have severe disease are at risk
of pneumonia and respiratory failure in the postoperative period.
Neurological
In patients with a history of stroke, pre-existing neurological deficit should be recorded. These patients may be on anti-platelet or anticoagulant
Renal disease
Underlying conditions leading to chronic renal failure such as diabetes mellitus, hypertension and
ischaemic heart disease, should be stabilised before elective surgery. Appropriate measures should be
taken to treat acidosis, hypocalcaemia and hyperkalaemia of greater than 6 mmol/L. Arrangements
should be made to continue peritoneal or haemodialysis until a few hours before surgery. After the
final dialysis before surgery, a blood sample should be sent for FBC and U&Es.
In the acute setting, patients who have a stable volume status can undergo surgery without
preoperative dialysis, provided that no other indication exists for emergency dialysis
Diabetic patients
Diabetes and associated cardiovascular and renal complications should be controlled to as near normal
level as possible before a surgery. Any history of hyper- and hypoglycaemic episodes, and hospital
admissions, should be noted. HbA1c levels should be checked. For elective surgery, HBA1c of <69
mmol/mol is recommended. Lipid-lowering medication should be started in patients who are in a high
risk group for cardiovascular complications of diabetes. If the operation is in the morning, patient is
advised to omit the morning dose of medication and breakfast. Though tight control of blood sugar is
not needed, the patient’s blood sugar levels should be checked 2 hourly. For those on the afternoon
list, breakfast can be given with half their regular dose of intermediate-acting insulin (or full dose oral
antidiabetic agents) and then managed with regular blood sugar checks 2hourly. An intravenous
insulin sliding scale should be started for insulin-dependent diabetes mellitus patients undergoing
major surgery, or if blood sugar is difficult to control for other reasons.