Mark Little builds a framework for the clinical approach to patients with suspected poisoning or envenomation. Particularly useful in a country where everything is trying to kill you.
Fran Lockie is a Paediatric Emergency and Retrieval physician currently based in Adelaide. He is quickly becoming a leading expert in paediatric TBI and so was the perfect person to give this talk. The audio that goes with these slides is on Intensive Care Network (www.intensivecarenetwork.com). If you like these sorts of presentations, come to Cairns Bedside Critical care this September where we've got a great line up of speakers and we're doing it all again.
Free handy references about Acute Coronary Syndromes Algorithm from the ACLS Certification Institute.
View all ACLS algorithms at http://www.aclscertification.com/
1) Paediatric intensive care involves some differences compared to adult intensive care, including specific considerations for airway management, ventilation, fluids, and vasopressors in children.
2) Management of conditions such as sepsis, cardiac disease, and traumatic brain injury also has some distinctions in paediatric patients, including earlier use of interventions like ECMO and different drug choices or dosing.
3) Conditions particularly seen in paediatric intensive care include bronchiolitis, pertussis, and non-accidental injury, which present challenges in diagnosis and optimal treatment approaches.
Sdc smacc kids are just little adults in resusSimon Carley
1. While children are not simply small adults, many resuscitation skills are transferable between adult and pediatric populations.
2. Unplanned transfers of sicker and younger patients from one hospital to another revealed they experienced more complications and higher mortality, suggesting delays or errors in initial treatment.
3. Resuscitation of pediatric patients requires age-appropriate consideration of factors like fluid administration, ventilation settings, and therapeutic endpoints to restore physiology while drawing on experience from adult resuscitation.
This document contains a quiz with 10 multiple choice questions about various topics in nephrology and hypertension in pregnancy. For each question, the correct answer is identified and a brief explanation of the relevant concept is provided. The questions cover topics such as gestational hypertension, intradialytic phosphate kinetics, dialysis prescriptions in pregnancy, immunosuppressive drugs in pregnancy, membranous nephropathy, acute hypertension treatment in pregnancy, electrolyte abnormalities in acute myeloid leukemia, ANCA-associated vasculitis, factors associated with increased FGF23 in CKD, and the effects of estrogen on mesangial cells.
Patent Ductus Arteriosus - news and views on diagnosis and managementStefan Johansson
The document discusses the diagnosis and management of patent ductus arteriosus (PDA) in preterm infants. It notes that while PDA is common in preterms, there is still uncertainty around its significance and appropriate treatment. The author advocates using echocardiography to diagnose PDA based on ductal blood flow patterns and structural measurements. Current practice in Stockholm involves early screening echos and targeted treatment for high-risk infants, with conservative management for more stable preterms. While treatments can close the PDA, the long-term benefits remain unclear given the heterogeneous patient population. Further research is still needed to determine optimal PDA evaluation and management.
Fran Lockie is a Paediatric Emergency and Retrieval physician currently based in Adelaide. He is quickly becoming a leading expert in paediatric TBI and so was the perfect person to give this talk. The audio that goes with these slides is on Intensive Care Network (www.intensivecarenetwork.com). If you like these sorts of presentations, come to Cairns Bedside Critical care this September where we've got a great line up of speakers and we're doing it all again.
Free handy references about Acute Coronary Syndromes Algorithm from the ACLS Certification Institute.
View all ACLS algorithms at http://www.aclscertification.com/
1) Paediatric intensive care involves some differences compared to adult intensive care, including specific considerations for airway management, ventilation, fluids, and vasopressors in children.
2) Management of conditions such as sepsis, cardiac disease, and traumatic brain injury also has some distinctions in paediatric patients, including earlier use of interventions like ECMO and different drug choices or dosing.
3) Conditions particularly seen in paediatric intensive care include bronchiolitis, pertussis, and non-accidental injury, which present challenges in diagnosis and optimal treatment approaches.
Sdc smacc kids are just little adults in resusSimon Carley
1. While children are not simply small adults, many resuscitation skills are transferable between adult and pediatric populations.
2. Unplanned transfers of sicker and younger patients from one hospital to another revealed they experienced more complications and higher mortality, suggesting delays or errors in initial treatment.
3. Resuscitation of pediatric patients requires age-appropriate consideration of factors like fluid administration, ventilation settings, and therapeutic endpoints to restore physiology while drawing on experience from adult resuscitation.
This document contains a quiz with 10 multiple choice questions about various topics in nephrology and hypertension in pregnancy. For each question, the correct answer is identified and a brief explanation of the relevant concept is provided. The questions cover topics such as gestational hypertension, intradialytic phosphate kinetics, dialysis prescriptions in pregnancy, immunosuppressive drugs in pregnancy, membranous nephropathy, acute hypertension treatment in pregnancy, electrolyte abnormalities in acute myeloid leukemia, ANCA-associated vasculitis, factors associated with increased FGF23 in CKD, and the effects of estrogen on mesangial cells.
Patent Ductus Arteriosus - news and views on diagnosis and managementStefan Johansson
The document discusses the diagnosis and management of patent ductus arteriosus (PDA) in preterm infants. It notes that while PDA is common in preterms, there is still uncertainty around its significance and appropriate treatment. The author advocates using echocardiography to diagnose PDA based on ductal blood flow patterns and structural measurements. Current practice in Stockholm involves early screening echos and targeted treatment for high-risk infants, with conservative management for more stable preterms. While treatments can close the PDA, the long-term benefits remain unclear given the heterogeneous patient population. Further research is still needed to determine optimal PDA evaluation and management.
Case Studies (Clinical Pharmacy Assignment)
Case Studies
Case Study 1. Drug Related Problem
Case Study 2. Alcohol Toxicity
Case Study 3. Patient Counseling
Case Study 4. Peptic Ulcer
Case Study 5. Drug and the Newborn
Case Study 6. Night time Anxiety
Case Study 7. Clostridium Difficile
Case Study 8. Epilepsy and Pregnancy
Case Study 9. Parkinsonism
Case Study 10. Treatment May Be Worse Than Condition
1. Pulse oximetry screening involves measuring oxygen saturation levels in newborns to detect critical congenital heart defects.
2. Seven heart defects can be detected including hypoplastic left heart syndrome and transposition of the great arteries.
3. Screening involves measuring pre-ductal and post-ductal saturations, with differences or low levels indicating need for further testing.
This document summarizes the stations and tasks involved in an OSCE (Objective Structured Clinical Examination) in pediatrics. It describes the history taking, physical exam, counseling, and diagnostic skills that would be evaluated at each station, including assessing a child with cough and wheezing, examining respiratory system, counseling parents of a child with asthma, evaluating lung anatomy and function, interpreting tests, and diagnosing and managing various respiratory conditions.
The document describes several stations for an OSCE exam involving pediatrics cases.
Station A involves demonstrating intraosseous access on a model. Station B involves taking a history to determine the cause of early puberty in a 7-year-old girl. Station C involves counseling a parent about managing and prognosis for a 6-year-old boy with hyperactive behavior. Station D involves performing a clinical exam including surface markings of the right kidney on a child presenting with hematuria. Station E demonstrates the six steps of handwashing. Stations F and G present pediatric emergency scenarios and allow questions about management.
The document discusses several medical cases:
1. A case of lissencephaly with findings of absent cerebral convolutions and enlarged ventricles, associated with Miller-Dieker syndrome.
2. A case of tuberous sclerosis seen on CT with subependymal calcifications consistent with the condition and associated with angiomyolipomas.
3. Uses and complications of PICC lines including thrombosis, fracture, embolism, infection, leakage and DVT are discussed.
1. The patient's blood tests show she is RH-negative and non-immune to rubella. The doctor advises avoiding contact with infected individuals and discusses potential complications if the baby is RH-positive.
2. The patient smokes, drinks alcohol, and uses heroin. The doctor counsels her to stop these substances as they can harm fetal development. Support services are offered.
3. The patient will have STI testing due to multiple sexual partners and no condom use. Follow up is scheduled and any concerns before then should be reported.
1) The objectives of the noon conference were to review warm autoimmune hemolytic anemia (AIHA), including diagnostic criteria, clinical presentation, and treatment.
2) A case study was presented of a 27-year-old woman with systemic lupus erythematosus (SLE) and new onset fatigue and shortness of breath. Her lab results were consistent with warm AIHA.
3) Warm AIHA was discussed in detail, including diagnostic criteria of anemia, elevated LDH, low haptoglobin, positive direct antiglobulin test; clinical presentation of anemia, hemolysis, associated conditions; and first-line treatment of high dose corticosteroids.
This document provides guidance on treating pediatric seizures in a pre-hospital setting. It reviews basic seizure first aid, classifications, status epilepticus as a medical emergency, management of febrile seizures which are usually benign, and evaluation after a first unprovoked seizure. The key steps are protecting the airway, giving rescue medications if a seizure lasts over 5 minutes, and transporting to the emergency department for evaluation of prolonged, complex, or repeated seizures.
This document summarizes the care of a 73-year-old woman with stage 3 ovarian cancer who presented with worsening shortness of breath. Initial treatment for congestive cardiac failure in the emergency department provided some relief. However, she deteriorated with multi-organ failure and increasing oxygen needs. A discussion was had about her poor prognosis with multi-organ failure in the context of advanced cancer. It was decided that further critical care would not be beneficial and she was made comfortable with best supportive care.
In preparing for your 2019 PANRE, you need to study differently based on core content and levels of knowledge. Here are sample questions for the 2019 PANRE.
This document discusses the evaluation and management of acute coronary syndrome (ACS) and ST-segment elevation myocardial infarction (STEMI). It begins by outlining the epidemiology of cardiovascular disease and ACS. It then reviews the history, physical exam findings, EKG findings, biomarkers, and risk scores used to evaluate patients with potential ACS. Various treatment options for STEMI are discussed including thrombolytics, percutaneous coronary intervention (PCI), anticoagulants, antiplatelets, and beta blockers. Complications of STEMI and strategies to reduce door-to-balloon times for PCI are also summarized.
This case presentation summarizes a 36-year-old male admitted with acute ischemic stroke presenting with right hemiparesis and reduced vision in the right eye. Diagnostic workup including CT scan revealed an acute infarct in the left occipito-parietal region. He was diagnosed with acute ischemic stroke and treated with medications including aspirin, clopidogrel, atorvastatin, and mannitol. His symptoms improved over his hospital stay and he was discharged on aspirin and clopidogrel with counseling on medication adherence and lifestyle modifications to prevent further complications.
BCC4: Anthony Delaney on Traumatic Brain Injury in the Real WorldSMACC Conference
Delaney helps highlight recent research into pre-hospital intubation and intracranial pressure monitoring for patients with TBI. This talk was recorded at Bedside Critical Care Conference 4 and is available with the Intensive Care Network on Libsyn and on www.intensivecarenetwork.com
The document lists several common herbal medicines and their uses and cautions, including St. John's wort for depression which can interact with sulfonamide antibiotics, garlic for hypertension which should be avoided with aspirin, and ginger root for nausea which can interact with Coumadin. It provides information on potential benefits, drug interactions and cautions for each herbal medicine listed. The document serves as a reference for nurses on key herbal medicines and factors to consider when patients take them.
Here are the key concepts needed to work through the growth problems cases:
- Phases of childhood growth: infancy, childhood, adolescent growth spurt
- Fusion of epiphyses and its role in limiting final adult height
- Precocious and delayed puberty definitions
- Tanner staging of pubertal development
- Orchidometer for testicular volume assessment
- Measurement of height and height velocity
- Estimation of final adult height from mid-parental height
- Features of Turner syndrome
Understanding these concepts will help in formulating differential diagnoses, guiding appropriate history taking and examinations, and selecting investigations. Let me know if you need any clarification or have additional questions!
The patient, a 59-year-old obese female, presented with right calf pain and swelling after prolonged periods of television watching without breaks. Diagnostic testing revealed deep vein thrombosis (DVT) in the right leg and pulmonary embolisms (PE). She was started on anticoagulation therapy with heparin and rivaroxaban. Her symptoms improved and she was discharged with lifestyle and medication recommendations to prevent further clots.
This document contains 21 stations that describe various respiratory conditions, devices, and exam findings related to pediatrics. Key information includes:
- A spacer with mask is the appropriate device for a child under 3 with asthma.
- A child with daily asthma symptoms, nightly symptoms over 1x/week, and PEF 60-80% of personal best has moderate persistent asthma.
- A 7 year old with a respiratory rate of 35, wheezing, and mild work of breathing has a pulmonary severity score of 3, indicating mild asthma exacerbation.
- Multiple rib fractures, pneumothoraces, and neck soft tissue air were seen on a presented chest X-ray.
A 42-year old male patient presented with symptoms of right-sided body weakness, slurred speech, and loss of consciousness. He was diagnosed with a hemorrhagic stroke caused by a left capsulaganglionic bleed based on his MRI results. He was treated with medications to control blood pressure and prevent further complications. Through physical therapy and treatment, the patient's symptoms improved and he was discharged upon being able to follow commands and having normal vital signs.
The document discusses various topics in neuroanatomy and neuroimaging for emergency medicine, including types of brain herniation, hydrocephalus, spinal injury classifications, vertebral artery dissection, and interpretations of common findings on CT scans such as subdural hematomas and hemorrhages in the basal ganglia. Diagrams and images are provided to illustrate anatomical structures and pathologies.
Case Studies (Clinical Pharmacy Assignment)
Case Studies
Case Study 1. Drug Related Problem
Case Study 2. Alcohol Toxicity
Case Study 3. Patient Counseling
Case Study 4. Peptic Ulcer
Case Study 5. Drug and the Newborn
Case Study 6. Night time Anxiety
Case Study 7. Clostridium Difficile
Case Study 8. Epilepsy and Pregnancy
Case Study 9. Parkinsonism
Case Study 10. Treatment May Be Worse Than Condition
1. Pulse oximetry screening involves measuring oxygen saturation levels in newborns to detect critical congenital heart defects.
2. Seven heart defects can be detected including hypoplastic left heart syndrome and transposition of the great arteries.
3. Screening involves measuring pre-ductal and post-ductal saturations, with differences or low levels indicating need for further testing.
This document summarizes the stations and tasks involved in an OSCE (Objective Structured Clinical Examination) in pediatrics. It describes the history taking, physical exam, counseling, and diagnostic skills that would be evaluated at each station, including assessing a child with cough and wheezing, examining respiratory system, counseling parents of a child with asthma, evaluating lung anatomy and function, interpreting tests, and diagnosing and managing various respiratory conditions.
The document describes several stations for an OSCE exam involving pediatrics cases.
Station A involves demonstrating intraosseous access on a model. Station B involves taking a history to determine the cause of early puberty in a 7-year-old girl. Station C involves counseling a parent about managing and prognosis for a 6-year-old boy with hyperactive behavior. Station D involves performing a clinical exam including surface markings of the right kidney on a child presenting with hematuria. Station E demonstrates the six steps of handwashing. Stations F and G present pediatric emergency scenarios and allow questions about management.
The document discusses several medical cases:
1. A case of lissencephaly with findings of absent cerebral convolutions and enlarged ventricles, associated with Miller-Dieker syndrome.
2. A case of tuberous sclerosis seen on CT with subependymal calcifications consistent with the condition and associated with angiomyolipomas.
3. Uses and complications of PICC lines including thrombosis, fracture, embolism, infection, leakage and DVT are discussed.
1. The patient's blood tests show she is RH-negative and non-immune to rubella. The doctor advises avoiding contact with infected individuals and discusses potential complications if the baby is RH-positive.
2. The patient smokes, drinks alcohol, and uses heroin. The doctor counsels her to stop these substances as they can harm fetal development. Support services are offered.
3. The patient will have STI testing due to multiple sexual partners and no condom use. Follow up is scheduled and any concerns before then should be reported.
1) The objectives of the noon conference were to review warm autoimmune hemolytic anemia (AIHA), including diagnostic criteria, clinical presentation, and treatment.
2) A case study was presented of a 27-year-old woman with systemic lupus erythematosus (SLE) and new onset fatigue and shortness of breath. Her lab results were consistent with warm AIHA.
3) Warm AIHA was discussed in detail, including diagnostic criteria of anemia, elevated LDH, low haptoglobin, positive direct antiglobulin test; clinical presentation of anemia, hemolysis, associated conditions; and first-line treatment of high dose corticosteroids.
This document provides guidance on treating pediatric seizures in a pre-hospital setting. It reviews basic seizure first aid, classifications, status epilepticus as a medical emergency, management of febrile seizures which are usually benign, and evaluation after a first unprovoked seizure. The key steps are protecting the airway, giving rescue medications if a seizure lasts over 5 minutes, and transporting to the emergency department for evaluation of prolonged, complex, or repeated seizures.
This document summarizes the care of a 73-year-old woman with stage 3 ovarian cancer who presented with worsening shortness of breath. Initial treatment for congestive cardiac failure in the emergency department provided some relief. However, she deteriorated with multi-organ failure and increasing oxygen needs. A discussion was had about her poor prognosis with multi-organ failure in the context of advanced cancer. It was decided that further critical care would not be beneficial and she was made comfortable with best supportive care.
In preparing for your 2019 PANRE, you need to study differently based on core content and levels of knowledge. Here are sample questions for the 2019 PANRE.
This document discusses the evaluation and management of acute coronary syndrome (ACS) and ST-segment elevation myocardial infarction (STEMI). It begins by outlining the epidemiology of cardiovascular disease and ACS. It then reviews the history, physical exam findings, EKG findings, biomarkers, and risk scores used to evaluate patients with potential ACS. Various treatment options for STEMI are discussed including thrombolytics, percutaneous coronary intervention (PCI), anticoagulants, antiplatelets, and beta blockers. Complications of STEMI and strategies to reduce door-to-balloon times for PCI are also summarized.
This case presentation summarizes a 36-year-old male admitted with acute ischemic stroke presenting with right hemiparesis and reduced vision in the right eye. Diagnostic workup including CT scan revealed an acute infarct in the left occipito-parietal region. He was diagnosed with acute ischemic stroke and treated with medications including aspirin, clopidogrel, atorvastatin, and mannitol. His symptoms improved over his hospital stay and he was discharged on aspirin and clopidogrel with counseling on medication adherence and lifestyle modifications to prevent further complications.
BCC4: Anthony Delaney on Traumatic Brain Injury in the Real WorldSMACC Conference
Delaney helps highlight recent research into pre-hospital intubation and intracranial pressure monitoring for patients with TBI. This talk was recorded at Bedside Critical Care Conference 4 and is available with the Intensive Care Network on Libsyn and on www.intensivecarenetwork.com
The document lists several common herbal medicines and their uses and cautions, including St. John's wort for depression which can interact with sulfonamide antibiotics, garlic for hypertension which should be avoided with aspirin, and ginger root for nausea which can interact with Coumadin. It provides information on potential benefits, drug interactions and cautions for each herbal medicine listed. The document serves as a reference for nurses on key herbal medicines and factors to consider when patients take them.
Here are the key concepts needed to work through the growth problems cases:
- Phases of childhood growth: infancy, childhood, adolescent growth spurt
- Fusion of epiphyses and its role in limiting final adult height
- Precocious and delayed puberty definitions
- Tanner staging of pubertal development
- Orchidometer for testicular volume assessment
- Measurement of height and height velocity
- Estimation of final adult height from mid-parental height
- Features of Turner syndrome
Understanding these concepts will help in formulating differential diagnoses, guiding appropriate history taking and examinations, and selecting investigations. Let me know if you need any clarification or have additional questions!
The patient, a 59-year-old obese female, presented with right calf pain and swelling after prolonged periods of television watching without breaks. Diagnostic testing revealed deep vein thrombosis (DVT) in the right leg and pulmonary embolisms (PE). She was started on anticoagulation therapy with heparin and rivaroxaban. Her symptoms improved and she was discharged with lifestyle and medication recommendations to prevent further clots.
This document contains 21 stations that describe various respiratory conditions, devices, and exam findings related to pediatrics. Key information includes:
- A spacer with mask is the appropriate device for a child under 3 with asthma.
- A child with daily asthma symptoms, nightly symptoms over 1x/week, and PEF 60-80% of personal best has moderate persistent asthma.
- A 7 year old with a respiratory rate of 35, wheezing, and mild work of breathing has a pulmonary severity score of 3, indicating mild asthma exacerbation.
- Multiple rib fractures, pneumothoraces, and neck soft tissue air were seen on a presented chest X-ray.
A 42-year old male patient presented with symptoms of right-sided body weakness, slurred speech, and loss of consciousness. He was diagnosed with a hemorrhagic stroke caused by a left capsulaganglionic bleed based on his MRI results. He was treated with medications to control blood pressure and prevent further complications. Through physical therapy and treatment, the patient's symptoms improved and he was discharged upon being able to follow commands and having normal vital signs.
The document discusses various topics in neuroanatomy and neuroimaging for emergency medicine, including types of brain herniation, hydrocephalus, spinal injury classifications, vertebral artery dissection, and interpretations of common findings on CT scans such as subdural hematomas and hemorrhages in the basal ganglia. Diagrams and images are provided to illustrate anatomical structures and pathologies.
The document discusses the results of a study on the impact of COVID-19 lockdowns on air pollution. Researchers analyzed data from dozens of countries and found that lockdowns led to an average decline of nearly 30% in nitrogen dioxide levels over cities. However, they also observed that this improvement was temporary and air pollution rebounded once lockdowns were lifted as vehicle traffic increased again. Overall, the study highlights how stay-at-home orders can provide short-term benefits to air quality but sustained changes are needed to maintain those improvements.
The document outlines the steps of the Advanced Trauma Life Support protocol. It includes: 1) preparing equipment and summoning a trauma team, 2) performing triage on multiple casualties, 3) conducting a primary survey to address life threats like airway, breathing, circulation, disability and exposure, 4) providing resuscitation as needed, 5) using adjuncts like monitoring, IVs and diagnostics, 6) performing a full secondary survey and history, 7) using additional adjuncts, 8) continued re-evaluation of the patient, and 9) arranging for their definite care. The protocol aims to quickly identify and treat life threats in a trauma patient.
Oli Flower's presentation on seizures and Status Epilepticus given at SMACC Gold. He focuses on history, management and prognostication. Must be watched as slides and audio together for full effect! Go to intensivecarenetwork.com for much more on this!
Cartner, Michaela— Cardiac Surgery... then Cardiac ArrestSMACC Conference
1) The document provides guidance on assessing and treating deteriorating cardiac surgical patients in a safe and systematic way.
2) It emphasizes manipulating factors like heart rate, rhythm, preload, contractility, and afterload to optimize cardiac output and shock management in these patients.
3) For hemorrhage and cardiac tamponade, early recognition and reopening of the chest within 10 minutes of arrest can increase survival rates by over 50% for cardiac arrest patients after cardiac surgery.
Liz Crowe delves into the deeper issues surrounding critical care and religion. She explores how religion influences patients and their families, why doctors can push against faith, and how the healthcare community can integrate an acceptance of faith into their care.
The Sim revolution. Jon Gatward on the future of simulation in critical care. Strategies for pulling it off, no matter your resources. See smacc.net.au and intensivecarenetwork.com for more.
This is a presentation which contains basics of polytrauma management,ATLS, triage, critical decision making skills, application of Glasgow coma scale and complications of different management strategies, if not applied properly.
The document discusses Class IIa and IIb recommendations from the American Heart Association guidelines regarding resuscitation technology including impedance threshold devices, mechanical piston devices, and load distributing bands. It notes that incremental benefits of technologies are significant when combined, and that cooling unconscious adult patients with spontaneous circulation to 32-34°C for 12-24 hours may be beneficial if the initial rhythm was ventricular fibrillation. The American Heart Association does not endorse any particular products.
The document discusses the importance of properly oxygenating, committing to, and confirming correct placement of an endotracheal tube during intubation. It notes that failure to do these three things can lead to "lethal airway sins" and references an airline crash caused by a pilot becoming incapacitated when no one confirmed correct placement of his oxygen mask. It advocates for checklists and protocols like RSI, RSA, DSI, NODESAT, and VORTEX to help avoid errors during intubation and proper oxygenation.
This Talk is a Summary of:
1. Review the Importance of Quality in CPR
2. Discuss the Safety of “Hands-on” Defibrillation
3. Evaluate Manual vs Mechanical CPR
The document outlines steps for intubation including preparing, anticipating challenges, ensuring oxygenation and ventilation through various means including initially placing an endotracheal tube, addressing a failed intubation by continuing oxygenation and ventilation, planning for a surgical airway if intubation and ventilation cannot be achieved, and successfully performing a surgical airway with the bottom line being oxygenation and ventilation were maintained.
Stuart Lane on prognostication post out of hospital cardiac arrestSMACC Conference
Always controversial, always entertaining, the fearsome but loveable Geordie Stuart Lane gives an excellent summary of a core ICU topic: managing out of hospital cardiac arrests. Nearly at the end of the BCC3 series - and in only a month we're doing it all again, this time in tropical Cairns - come and join us.
Pediatric toxicology exposures are common, though deaths are rare. Key factors include determining substance and dose ingested, which can be difficult. While many exposures are harmless, some like button batteries or hydrocarbons can cause severe injury. Outcomes depend on prompt diagnosis and management, including decontamination or enhanced elimination. Poison centers provide expert guidance on substance toxicity and treatment.
Common drug induced liver injury in children -dr. harshad devarbhaiSanjeev Kumar
This document discusses common drug-induced liver injury in children. It presents two case studies of pediatric patients who developed acute liver failure after receiving multiple drug treatments. Liver enzyme levels increased dramatically in both patients, and one child died of hyperacute liver failure while the other died shortly after admission. The document reviews the challenges of pediatric drug-induced liver injury given differences in drug metabolism and formulations in children. Common culprit drugs identified are antituberculosis medications, acetaminophen, and anti-epileptic drugs. Younger age is a risk factor for valproate hepatotoxicity. Prompt identification and discontinuation of the offending drug is important to prevent serious outcomes like acute liver failure.
Screening for any disorder in individuals is a strategy used for identifying a disease before the onset of signs or symptoms, thus enabling earlier detection and management with the aim to reduce morbidity and mortality.
Carle Palliative Care Journal Club for 7/3/18Mike Aref
Journal club review of "Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial" by D. Hui et. al. in JAMA. 2017 Sep 19;318(11):1047-1056.
Approach to drug poisoning in adults by Dr Alaa Elmassryalaa massry
This document provides information on drug overdoses and poisonings. It begins with an introduction by Dr. Alaa Eldeen Elmassry. It then poses questions about the epidemiology, toxidrome patterns, therapy, and specific poisonings clinicians may face. The rest of the document addresses these questions and topics, covering areas like cyanide poisoning treatment, opiate overdose signs, toxic ingestion differentials, effects of overdose vs. therapeutic doses, gastric decontamination, paracetamol overdose facts, poisoning statistics, toxic syndromes, vital signs and examinations in poisonings, and diagnostic tests.
This document reviews signs and symptoms of substance abuse and overdose for various classes of drugs. It provides protocols for poisoning/intoxication calls including treatment with activated charcoal, naloxone, and syrup of ipecac. Special considerations are discussed for common calls involving alcohol intoxication, illegal drug use, and intentional overdose/suicide attempts.
This document contains the questions and answers from a Jeopardy-style medical knowledge competition. There are 5 categories with 5 questions in each category worth $100 to $500. The categories include case reports, specialty talks, clinic didactics, inpatient curriculum, and MKSAP specials. The questions cover a wide range of medical topics from lupus nephritis to C. difficile risk factors to syncope workup.
Talk given on 29 Sep 2015 at the Royal College of Emergency Medicine annual meeting.
Key areas:
What are the issues with sepsis in children?
How will it apply to the UK Sepsis CQUIN?
The Paediatric Sepsis 6 and screening for sepsis in children.
Additional notes following main talk.
The document discusses the 2012 Joint Commission National Patient Safety Goals. It provides 3 goals: 1) improve patient identification, 2) improve communication among caregivers, and 3) improve safety of medication use. It also presents several case studies on medication errors and discusses root causes, prevention strategies, and recommendations to reduce errors.
Weitzman Institute Webinar Series: Pediatric Genetics and GenomicsCHC Connecticut
1. The document discusses the role of the primary care physician (PCP) in caring for patients with metabolic diseases, including newborn screening follow-up.
2. It describes a case example of a newborn with elevated levels on newborn screening suggestive of a urea cycle defect who was urgently referred and treated, with the ammonia levels normalizing quickly with treatment.
3. Resources for PCPs on newborn screening conditions and referral guidelines are provided.
The document discusses the 2012 Joint Commission National Patient Safety Goals. It aims to improve patient identification, communication among caregivers, and medication safety. Case studies are presented that illustrate medication errors related to issues like look-alike drugs, lack of labeling, and failure to clarify orders. The document emphasizes clear communication, questioning inconsistencies, and following safety protocols to prevent errors.
Cholesterol screening in children aims to identify those with familial hypercholesterolemia (FH), a genetic disorder associated with premature cardiovascular disease. Screening is recommended between ages 1-9 using a reliable cholesterol test, with treatment including statins shown to reduce cardiovascular risks. While screening can effectively detect FH in its pre-symptomatic stage, barriers include cost and ensuring agreed-upon treatment policies are in place.
Cholesterol Screening in Children and Young Adults.pptxZawMinChit1
Cholesterol screening in children aims to identify those with familial hypercholesterolemia (FH), a genetic disorder associated with premature cardiovascular disease. Screening is recommended between ages 1-9 using a reliable cholesterol test, with the goal of early detection to allow effective lipid-lowering treatment and reduce long-term health risks. While screening raises some costs, cascade screening of families is more cost-effective than other strategies given the ability to identify cases across generations. Guidelines from major health organizations provide agreed-upon policies to help ensure screening benefits outweigh harms.
In collaboration with the New England Regional Genetics Network, the Weitzman Institute aims to improve access to genetics services for underserved populations by offering primary care provider educational support through a free five-part webinar series that aims to enhance provider knowledge, practice, and attitudes regarding genetic services.
Laboratory tests play an important role in psychiatry by helping with diagnosis, monitoring treatment, and detecting potential side effects or medical comorbidities. Key tests include blood tests to evaluate thyroid, liver, kidney, and metabolic function, as well as tests for infections. Monitoring tests are important when prescribing medications like antipsychotics that can affect metabolic parameters and increase risk of conditions like diabetes. Laboratory evaluations can help optimize treatment safety and effectiveness in psychiatry.
This document summarizes research on potential biological causes and treatments for autism spectrum disorders and other neurodevelopmental conditions. It discusses findings of intestinal and immune system abnormalities, nutritional deficiencies, toxic metals, and the potential roles of infections, vaccines, and mercury exposure. Treatments addressed include specialized diets, supplements, chelation, and targeting specific biomarkers like ammonia levels and essential fatty acids.
This document summarizes research on potential biological causes and treatments for autism spectrum disorders and other neurodevelopmental conditions. It discusses intestinal and immune system abnormalities, nutritional deficiencies, toxic metals, and the rationale for treating these factors through dietary changes and supplements. Specific treatments mentioned include gluten/casein-free diets, probiotics, sulfur supplements, chelation therapy, and targeting yeast, parasites, and Clostridia overgrowth. Concerns about mercury in vaccines and their relationship to autism prevalence are also outlined.
This document provides guidance on assessing and managing a poisoned child. It discusses the common causes of pediatric poisoning, important clinical assessments like vital signs and physical exam findings, key investigations like lab tests and toxicology screens, and general treatment approaches focusing on supportive care, decontamination, enhanced elimination, and antidotes. The toxidromes of various substance classes are also reviewed to help identify the potential toxin. A thorough history and physical exam tailored to potential exposures is emphasized for diagnosis and management of the poisoned child.
Adverse drug reaction , types ,Detection and Reporting,severity and seriousness(Hartwig'severity assessment), preventibility(Schumock and thornston) and predictability, causality assessment Naranjo"s algotithm, WHO UMC causality scale
Systematic review of 26 studies with 55,792 patients found that dedicated neurocritical care (NCC) was associated with decreased risk of mortality (17% relative risk reduction) and decreased risk of poor functional outcomes (17% relative risk reduction) in critically ill brain-injured adults. A survey of Australian ICUs found limited availability of NCC, with only 4 centers specializing in it and 9 employing an intensivist subspecializing in NCC. Continuous EEG monitoring was found to have higher sensitivity for detecting nonconvulsive seizures than routine EEG monitoring, and was associated with reduced in-hospital mortality, though barriers to its universal use include infrastructure and personnel requirements.
CORTICAL SPREADING DEPOLARISATION IN NEUROLOGICAL DISEASE – AN INTRODUCTION
By Toby Jeffcote
Cortical spreading depolarization (CSD) is a spreading loss of ion homeostasis, altered vascular response, change in synaptic architecture, and subsequent depression in electrical activity following an inciting neurological injury.
It was first described by Leão in 1944, a disturbance in neuronal electrophysiology has since been demonstrated in a number of animal studies, and recently a few human studies that examine the occurrence of this depolarizing phenomenon in the setting of a variety of pathological states, including migraines, cerebrovascular accidents, epilepsy, intracranial hemorrhages, and traumatic brain injuries. The onset of CSD has been demonstrated experimentally following a disruption in the neuronal environment leading to glutamate-induced toxicity. This initial event leads to pathological changes in the activity of ion channels that maintain membrane potential. Recovery mechanisms such as sodium-potassium pumps that aim to restore homeostasis fail, leading to osmolar shifts of fluid, swelling of the neuron, and ultimately a measurable depression in cortical activity that spreads in the order of millimeters per minute. Equally important is the resulting change in vascular response. In healthy tissue, increased electrical activity is coupled with release of vasodilatory factors such as nitric oxide and arachidonic acid metabolites that increase local blood flow to meet increased energy expenditure. In damaged tissue, not only is the restorative vascular response lacking but a vasoconstrictive response is promoted and the ischemia that follows adds to the severity of the initial injury. Tissue threatened by this ischemic response is then at elevated risk for CSD propagation and falls into a vicious cycle of electrical and hemodynamic disturbance. Efforts have been made to halt this spreading cortical depression using N-methyl-D-aspartate receptor antagonists and other ion channel blockers to minimize the damaging effects of CSD that can persist long after the triggering insult.
Celia Bradford takes us through the latest on the management of subdural haemorrhage (SDH). She covers acute SDH, chronic SDH and middle meningeal artery embolisation, a novel treatment for chronic SDH management in certain circumstances.
Andy Neill - More neuroanatomy pearls for neurocritical careSMACC Conference
Andy Neill shares some more neuroanatomy wisdom that's highly practical for anyone working with neuro emergencies. This time he covers brain herniation syndromes, hydrocephalus, extradural vs subdural haematomas, cervical spinal imaging, vertebral artery dissection and "things you read on CT reports but don't know what they mean"!
Andrew Udy talks about Brain Tissue Oxygen Monitoring:
It’s Not What You’ve Got It’s What You Do With It
The BONANZA Trial
Andrew Udy talks about the ongoing BONANZA Trial which is assessing whether an algorithm that incorporates both ICP and brain tissue oxygen (PbTO2) can improve outcomes after traumatic brain injury (TBI). Like with all monitoring, how the PbTO2 is interpreted and managed is critical and the devil is in the detail!
More on BONANZA here
More on BOOST3 here
R. Loch Macdonald, M.D., Ph.D.
Community Neurosciences Institute
Fresno, California, USA
Angiographic vasospasm and more accurately, delayed cerebral ischemia, continue to contribute to morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). It is known that angiographic vasospasm is common after SAH, occurring in two-thirds of patients. Cerebral infarctions that developed days after the SAH have been attributed to angiographic vasospasm, occuring in about a third of patients, although this has always been controversial. Angiographic vasospasm theoretically can only damage the brain by restricting blood flow but there is no easy, accurate, widely available method to measure cerebral blood flow and this is not the measurement we need. Blood flow depends on metabolic demand so what we need to know to determine if angiographic vasospasm is causing ischemia is oxygen extraction fraction in the brain tissue supplied the the spastic artery. Without this measurement, the attribution of ischemia to vasospasm is subjective. Since angiographic vasospasm is essentially the only detectable delayed phenomenon after SAH, we focus on it and apply tremendous resources to preventing or reversing the vasospasm. Undoubtedly angiographic vasospasm can cause cerebral infarctions, but it has to be severe and flow limiting. But SAH is a complex disease. There are many other causes for cerebral infarctions after SAH, the most common being due to the aneurysm repair procedure. And a given degree of vasospasm may cause infarction in a volume-depleted patient with poor collateral blood supply but not in a patient without these things. There also are hypodense brain lesions after SAH that are due to intracerebral hemorrhages. There can be hypodensities in the brain directly under usually thick SAH where the brain dies. This observation in particular supports a role for cortical spreading depolarizations/ischemia as a cause of infarction after SAH. Other macromolecular processes that are hypothesized to cause brain damage after SAH include microthromboembolism, changes in the microcirculation, delayed brain cell apoptosis and capillary transit time heterogeneity. Determining the importance of these things is hindered by the lack of an easy way to detect them in patients. It is also known that poor grade patients, who presumably have more early brain injury and ischemia than good grade patients, are more prone to delayed cerebral ischemia, suggesting increased sensitivity to secondary insults of the already injured brain. We also assume delayed neurological deterioration when attributed to vasospasm or delayed cerebral ischemia, is purely due to ischemia. While knowledge about what happens pathophysiologically after SAH is increasing, management of delayed cerebral ischemia still focuses on detecting angiographic vasospasm and then augmenting the blood pressure to improve cerebral blood flow or dilating the spastic arteries with balloons or drugs.
By Catherine Bell and Andrew Udy
Catherine Bell takes us through how to troubleshoot problems commonly encountered when looking after patients who have an external ventricular drain (EVD) in situ. Issues with using brain tissue oxygen monitors are also discussed. A highly practical session aimed at bedside clinicians.
There is no such thing as mild, moderate and severe TBI - by Andrew UdySMACC Conference
Part 2 of a debate over the classification of TBI. Andrew Udy then argues that this classification is fundamentally flawed. He discusses the issues with the Glasgow Coma Scale, and therefore the follow-on issues in TBI classification, including all the confounders to the GCS, the issues with timing of the score as well as GCS not taking baseline function or specifics subtypes of TBI into account. He makes teh argument that biomarkers may better categorise the diffuse entity we call TBI.
TBI Debate - Mild, moderate and severe categories workSMACC Conference
Andrew Chow, Intensivist with a neurosurgical background, argues that the current categorisation system for traumatic brain injury (TBI) works, and makes sense! He tackles us through the history of this system, and why it’s important to differentiate different types of TBI. The arguments in favour of this categorisation include the consistency and benefits of a universal language, the implications for triage and management, and the fact that this system has been endorsed by all major organisations
Dr Nick Little is an experienced Neurosurgeon who's looked after patients with traumatic brain injury for his whole career. Here he discusses the difficulties of prognostication following traumatic brain injury (TBI). He talks about the statistics of outcomes following mild, moderate and severe TBI and then goes on to tackle the harder topic of how we try to work out what an individual would want if they knew the spectrum of outcomes that they may face. The issues with the clinical examination findings we use to prognosticate are covered, as well as which imaging findings he finds most helpful. He also mentions the difficulties with current prognostic calculators.
Historically, when it came to brain injury, ketamine had a bad rap. Much of that dogma was dispelled in the last decade, and ketamine is now frequently used as an induction agent in acute brain injury, especially traumatic brain injury, due to it’s favorable effects on haemodynamics.
However a new application of ketamine is now being explored - whether ketamine may be able to reduce secondary brain injury.
Managing Complications of Chronic SCI by Bonne LeeSMACC Conference
20 million people around the world are living with a spinal cord injury (SCI). The medical issues they develop over the years differ to any other patient cohort.
These complications include autonomic dysreflexia, management of pressure areas, specific infections, nuanced peri-operative care and highly specific issues such as baclofen pump management and syringomyelia
Do look at the NeuroResus section on this and listen to Spinal Rehab Specialist Bonne Lee talk about this side of SCI care.
Keywords
SCI, spinal, spinal cord injury, autonomic dysreflexia, pressure areas, infection, peri-operative care, baclofen pump, syringomyelia, chronic SCI, spinal trauma, spinal rehab, incomplete SCI
Tania is a neurologist and epileptologist with expertise in continuous EEG (cEEG) and status epilepticus (SE). This talk covers what a seizure is, what status is, including focal and generalised status epilepticus.
So why do we do cEEGs for patients with suspected SE?
To confirm the diagnosis
To see if patient just post ictal or still seizing
To establish that the clinical and electric seizures have stopped
To see if burst suppression is achieved
To exclude other differential diagnoses
She makes a good argument for why cEEG is such an important tool in managing SE.
In the questions after the talk, the issue of availability of cEEG in the Australian setting was discussed. Limited montage EEGs are discussed including their pros and cons.
Stuart Browne is a Neuro Rehab specialist from Sydney. These slides accompany a talk he gave at the Brian Symposium in 2023. He discusses what "severe disability" really means.
Severe disability is more common than many realise - about 6% of the Australian population.
Stuart discusses how health is more than simply physical recovery and how it is a multidimensional construct. He covers how permanent disability doesn't necessarily equate to a poor quality of life. He also discusses the long timespan of recovery, which is often much longer than appreciated.
He specifically discusses "Locked-in Syndrome" and how the survivors have surprisingly positive self-reported health-related quality of life and well-being.
Stuart also covers how severely disabled people face various forms of discrimination.
Shree Basu is a Paediatirc Intensivist in Sydney. These slides from the Brain Symposium 2023 accompany the talk she gave. She discusses how Paediatric stroke presents, what neuroimaging is required and what interventions are available, including thrombolysis and the role of endovascular thrombectomy.
Hypertensing Spinal Cord Injury - gold standard or wacky?SMACC Conference
This document discusses the concept of maintaining higher blood pressure levels, known as hypertension, after a spinal cord injury to improve spinal cord perfusion pressure and reduce secondary injury. It notes that while animal studies and some human trials have shown improved neurological outcomes, the evidence is still limited. It calls for larger randomized controlled trials in humans that also incorporate multi-modal monitoring and standardized outcome measures to further evaluate if inducing hypertension after spinal cord injury should be considered the gold standard of care.
Mark Weedon takes us through the increasingly utilised concept of an optimal cerebral perfusion pressure (CPPopt) for each unique patient. He discusses the background to CPPopt, including intrcranial pressure (ICP), the Monroe Kelly hypothesis, neurovascular coupling, and cerebral autoregulation in health and following brain injury. He shows how intracranial pressure is affected by intracranial compliance and how this affects ICP waveforms. Cerebral perfusion pressure in relation to the Brain Trauma Foundation guidelines is covered including management of elevated ICP (EICP). The currently recommended tiered approach to managing cerebral perfusion pressure and EICP is mentioned citing recent guidelines. He uses a clinical case of a TBI to illustrate how the CPPopt can be ascertained and used to guide therapy, including the easy to perform “MAP Challenge”. Mark also describes the Pressure Reactivity Index (PRx) and how it can be used as a target for therapy. Finally, he covers the exciting results of the preliminary COGiTATE pilot study.
Social Worker Victoria Whitfield and Bereavement councilor Louise Sayers discuss the power of words when health professionals are communicating topics around of death and serious injury with relatives and patients in critical care. They use role plays to bring theories to life.
Sepsis and Antimicrobial Stewardship - Two Sides of the Same CoinSMACC Conference
Undertreatment of sepsis can lead to mortality, while overdiagnosis and overtreatment can increase future risk of antimicrobial resistance. Antimicrobial stewardship aims to balance these risks by prioritizing patient safety and appropriate antimicrobial use. Data shows variability in appropriateness of antimicrobial prescribing between different types of hospitals. Embedding antimicrobial stewardship principles throughout sepsis diagnosis and treatment, from initial microbiology testing to post-treatment review, can help standardize care and optimize outcomes.
Being able to prognosticate in the aftermath of a traumatic brain injury (TBI) is important as it assists with counselling patients and families. Moreover, it helps rationally allocate healthcare resources.
However, due to the heterogenous nature of TBI and variable pre brain injury patient factors and post brain injury course, this has proven to be a difficult task.
Large cohort studies have enabled improved accuracy in the prediction of 6 month mortality and unfavourable outcome.
Furthermore, many of the factors that contribute to long-term outcome have also emerged. However, it is not yet possible to use them in prediction algorithms or mathematical models.
There is emerging evidence that pre injury psychosocial and demographic factors may be of more relevance than injury severity. Moreover, that 'outcome' becomes increasingly subjective and complex as the post injury duration increases.
We end with three brief vignettes which highlight the fraught nature of long term outcome prediction.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- 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
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
12. Approach to a
poisoning arrest
• Continue CPR and
resuscitation for prolonged
periods
• Tachyarrythmias may need
correction of electrolyte and
acid base abnormalities
• Use of antidotes
• Non standard drug therapies
• Seek urgent advice from
toxicologist
13. Resuscitation
COMA
If under 40 yrs age: 80% chance your diagnosis is
a toxicology one
14. Quetiapine:
No 1 cause of DSP coma needing intubation
in Australia.