The kidney performs important functions like fluid balance, acid-base balance, and waste elimination. Around 20-30% of ICU patients develop acute kidney injury (AKI). Options for renal replacement therapy include intermittent hemodialysis, peritoneal dialysis, and continuous renal replacement therapy (CRRT). CRRT avoids rapid fluid and electrolyte shifts and is suitable for hemodynamically unstable patients. It removes waste through diffusion and convection using dialysate and replacement fluids.
A very simple yet comprehensive presentation to understand the concept of CRRT and its implementation in Intensive Care Unit. Intended for the very beginners in ICU. After going through the presentation you will be able to say "Now I know it!"
Hemodialysis is a treatment to filter wastes and water from your blood; In hemodialysis, the blood is cleaned outside the body using a dialysis machine and then sent back into the body.
Hemodialysis is a treatment to filter wastes and water from your blood, as your kidneys did when they were healthy. Hemodialysis helps control blood pressure and balance important minerals, such as potassium, sodium, and calcium, in your blood.
Hemodialysis is one way to treat advanced kidney failure and can help you carry on an active life despite failing kidneys.
Mechanism of Hemodialysis:
Hemodialysis is a procedure by which waste products and excess water are removed from a patient’s blood. This is done by directly removing blood from the patient’s circulation, passing it through the dialysis filter, and then returning it directly back into the circulation.
Apparatus needed:
Dialyzer or dialysis filter
Dialysate (dialysis solution)
Tubing for transport of blood and dialysate
Machine that powers and monitors the filtration
Hemodialysis has 5 main steps which are as follows:
1.Two sets of tubing are connected to the patient’s dialysis access:
Connected directly to central venous catheter
Two needles inserted into AVF/AVG and taped down
2. Azotemic blood pumped from patient into dialysis filter
3. Dialysis filter removes toxins primarily through diffusion:
Dialysis filter is a plastic cylinder filled with thousands of tiny individual tubes composed of the filtering material.
Blood flows through the inside of the tiny tubes in one direction.
Dialysis fluid (dialysate) flows on the outside of the tiny tubes (but still within the single plastic cylinder that contains them) in the opposite direction.
The opposing directions of blood and dialysate result in maximal concentration gradients that drive the diffusion of toxins:
Known as “countercurrent” mechanism
Also results in correction of electrolyte/acid–base abnormalities via diffusion.
4. Dialysis filter removes excess water from the blood through ultrafiltration.
Suction force is applied by the dialysis machine across the dialysis filter.
Water is pulled from the blood side into the dialysate side.
5. Clean blood and waste-filled dialysate exit the dialysis filter.
Clean blood is pumped back into the patient’s Circulation.
Waste-filled dialysate is disposed of (including the excess water from the patient’s body that was removed during ultrafiltration).
Chronic dialysis
3–4 hours each session
3 times a week (Monday/Wednesday/Friday or Tuesday/Thursday/Saturday)
Acute dialysis:
Treatment duration and daily schedule are
Variable.
Priscriptions: The nephrologist may control many variables within the dialysis procedure:
Duration of treatment
Ultrafiltration goal
Anticoagulation
Electrolyte composition of the dialysate
Speed of blood flow and dialysate flow
Presented by: Mohammadsaleh Moallem
Dialysis and Urolithiasis and its dietary managementSyeda Yousra
Dialysis : principle, types, working ,dietary management its drawbacks and prevention
Urolithiasis :types , causes, most prone regions, diets for recovery and further prevention and treatment.
In medicine, dialysis is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. This is referred to as renal replacement therapy.
A very simple yet comprehensive presentation to understand the concept of CRRT and its implementation in Intensive Care Unit. Intended for the very beginners in ICU. After going through the presentation you will be able to say "Now I know it!"
Hemodialysis is a treatment to filter wastes and water from your blood; In hemodialysis, the blood is cleaned outside the body using a dialysis machine and then sent back into the body.
Hemodialysis is a treatment to filter wastes and water from your blood, as your kidneys did when they were healthy. Hemodialysis helps control blood pressure and balance important minerals, such as potassium, sodium, and calcium, in your blood.
Hemodialysis is one way to treat advanced kidney failure and can help you carry on an active life despite failing kidneys.
Mechanism of Hemodialysis:
Hemodialysis is a procedure by which waste products and excess water are removed from a patient’s blood. This is done by directly removing blood from the patient’s circulation, passing it through the dialysis filter, and then returning it directly back into the circulation.
Apparatus needed:
Dialyzer or dialysis filter
Dialysate (dialysis solution)
Tubing for transport of blood and dialysate
Machine that powers and monitors the filtration
Hemodialysis has 5 main steps which are as follows:
1.Two sets of tubing are connected to the patient’s dialysis access:
Connected directly to central venous catheter
Two needles inserted into AVF/AVG and taped down
2. Azotemic blood pumped from patient into dialysis filter
3. Dialysis filter removes toxins primarily through diffusion:
Dialysis filter is a plastic cylinder filled with thousands of tiny individual tubes composed of the filtering material.
Blood flows through the inside of the tiny tubes in one direction.
Dialysis fluid (dialysate) flows on the outside of the tiny tubes (but still within the single plastic cylinder that contains them) in the opposite direction.
The opposing directions of blood and dialysate result in maximal concentration gradients that drive the diffusion of toxins:
Known as “countercurrent” mechanism
Also results in correction of electrolyte/acid–base abnormalities via diffusion.
4. Dialysis filter removes excess water from the blood through ultrafiltration.
Suction force is applied by the dialysis machine across the dialysis filter.
Water is pulled from the blood side into the dialysate side.
5. Clean blood and waste-filled dialysate exit the dialysis filter.
Clean blood is pumped back into the patient’s Circulation.
Waste-filled dialysate is disposed of (including the excess water from the patient’s body that was removed during ultrafiltration).
Chronic dialysis
3–4 hours each session
3 times a week (Monday/Wednesday/Friday or Tuesday/Thursday/Saturday)
Acute dialysis:
Treatment duration and daily schedule are
Variable.
Priscriptions: The nephrologist may control many variables within the dialysis procedure:
Duration of treatment
Ultrafiltration goal
Anticoagulation
Electrolyte composition of the dialysate
Speed of blood flow and dialysate flow
Presented by: Mohammadsaleh Moallem
Dialysis and Urolithiasis and its dietary managementSyeda Yousra
Dialysis : principle, types, working ,dietary management its drawbacks and prevention
Urolithiasis :types , causes, most prone regions, diets for recovery and further prevention and treatment.
In medicine, dialysis is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. This is referred to as renal replacement therapy.
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
Renal replacement therapy is a supportive care often required in critically ill patients who develop acute renal failure and its complications. Complexity arises when such patients become hemodynamically unstable and pose special challenge to critical care clinicians in ICU to carefully choose dialytic modality to tackle volume and solute overload. This presentation is about short description of modalities of RRT and current evidence regarding initiation, dose and type of modality.
AKI in the ICU
Principles of RRT
Modes of RRT
Indications for RRT
Optimal timing: When to start
Optimal modality: What Modality and Where ??
Optimal dosing- How Much?
Summary and Conclusions
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
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Crrt
1. Introduction
• Main functions of the kidney:
maintenance of fluid balance
maintenance of acid base balance
elimination of waste products
• 20 –30 % of ICU patients develop AKI
• Many ICU are already on IHD
3. Intermittent Hemodialysis
• The gold standard
• Usually 2 –3 times a week for 3 –4 hours
• Involves a vascular access
• Pump, filter, dialysate& anticoagulation
5. Peritoneal Dialysis
• Simple and cheap, but …….
• Poor solute clearance
• Poor uremic control
• Risk of peritoneal infection
• Mechanical impedance
– Pulmonary and cardiovascular function
6. Continuous Renal Replacement Ther
• Concept-dialyze patients more physiolog
• Avoids the accumulation of waste produc
• Avoids the rapid shifts in volume & osmo
• Avoids disadvantages of Peritoneal Dialy
7. Advantages
• Precise volume control
• Very effective control of uremia and ↑ K⁺
• Rapid control of metabolic acidosis
• Suitable for hemodynamicallyunstable pt
• Improved nutritional support
– (no need for volume restriction)
8. Advantages
• Needs minimal training
• Safer for patients with TBI & CVS disorde
• May have an effect in sepsis
• Probable advantage in terms of renal rec
15. Ultrafiltration
• The passage of water through a membra
under a pressure gradient.
• Driving pressure can be
+ve(push fluid through the filter)
–ve(pull fluid to other side of filter)
• Pressure gradient is created by effluent p
17. Convection
• Movement of solutes through a membran
the force of water.
“solvent drag”
• The water pulls the molecules along with
it flows through the membrane.
• Can remove middle and large molecules,
well as large fluid volumes.
• Maximized by using replacement fluids.
21. Adsorption
• Adsorptionis the removal of solutes from
blood because they cling to the membra
– Think of an air filter. As the air passes throug
impurities cling to the filter itself.
– Eventually the impurities will clog the filter a
will need to be changed.
• The same is true in blood purification. Hi
levels of adsorptioncan cause filters to cl
and become ineffective
24. Replacement Fluids
• Used to increase the amount of convecti
solute removal in CRRT.
• Replacement fluids do not replace a
• Fluid removal rates are calculated
independently of replacement fluid rates
• The common replacement fluid is 0.9% s
• Can be pre or post filter.
26. Comparison Pre & Post Dilutio
PRE-FILTER
– Increases filter life
– Increases convective
transport
– Reduced solute clearance
– Some of delivered
replacement fluid lost by
hemofiltration
– Lower anticoagulation
requirements
– Higher UF required given
loss of replacement fluid
through filter
POST-FILTER
– No solute dilution,
improved diffusion and
solute clearance
– Increased
hemoconcentration
– Higher delivered dose
of hemofiltration
27. Indications
• Acidemia(pH <7.1)
• Electrolytes
– Hyperkalemia(K⁺ > 6.5 mEq/L)
– Severe dysnatremia(Na⁺ <115 or >160 mEq/L)
• Ingestions (Toxins, Drugs)
• Overload/ Oliguria(urine output <200 mL/12
• Uremia (urea >30 mg/dL)
– Uremic encephalopathy
– Uremic pericarditis
– Uremic neuro-myopathy
A E I O U
29. Timing
• Inadequate data available to answer this
• Observational data suggests better outco
are associated with early RRT initiation
Getting et al 1999
2
. Urea 15.2 vs33.7 conferred survival benefit.
Roncoet al 2000
3
and Saudanet al 2006
4
both dose/outcome studies suggested an early
start.
Liu et al 2006
5
observational PICARD study (Urea 27) suggested an early start
– RENAL study, NEJM 2009, 1508 pts.
– Demirkilic2004, Elahi2004, Piccini2006
31. • CRRT includes several treatment modalities
that use a veno-venous access.
• The choice will depend on the needs of the
patient and on the preference of the
physician.
CRRT Modalities
32. • Removal of ultrafiltrateat low rates
• without administration of a substitution solution.
• The purpose is to prevent or treat volume ove
• when waste product removal or pH correction isn’
necessary.
• Primary indication for SCUF -fluid overload
• Mechanism of water transport is Ultrafiltratio
• No dialysate or replacement fluid is used.
33. • Other solutes are removed but are neglig
• The amount of fluid in the effluent bag is
same as the amount removed from the p
• Removal rates are closer to 100 ml/hour
35. Let’s Revise
• Primary therapeutic goal:
– Safe management of fluid
• Primary indications:
– Fluid overload without metabolic imbalance
• Principle used:
Ultrafiltration
• Therapy characteristics:
– No dialysateor substitution solutions
Fluid removal only
36. • Blood flow:
80 –200 ml/min
• Duration:
(as advised by the physician)
• Ultrafiltration:
20-100 ml/hr (or total volume)
• Anticoagulation…. Acc to physician
• Dialysate…….. NO
• Replacement fluid….. NO
37. • An extremely effective method of solute remov
is indicated for uremia or severe pH or electrol
imbalance with or without fluid overload.
• Particularly good at removal of large molecule
because CVVH removes solutes via convection
• Convective removal of waste products (small a
large molecules) utilizing a substitution solutio
• pH is affected with the buffer contained in the
substitution solution.
38. • Solutes can be removed in large quantiti
while easily maintaining a net zero or ev
positive fluid balance in the patient.
• The amount of fluid in the effluent bag is
equal to the amount of fluid removed fro
the patient plus the volume of replaceme
fluids administered.
• No dialysate is used.
40. Let’s Revise
• Primary therapeutic goal:
– Solute removal and safe fluid management
• Primary indications:
– Uremia, severe acid/base or electrolyte imbala
– Removal of larger mol wt substances
• Principle used:
convection
• Therapy characteristics:
– Substitution solution to drive
– No dialysatesolution
Effective at removing small and large molecules
41. • Blood flow:
80 –200 ml/min
• Duration:
As advised by physician
• Ultrafiltration:
20-100 ml/hr (or total volume)
• Replacement Fluid:
1000 –2000 ml/hr,preor post filter
• Anticoagulation
• Dialysate…. NO
Dosage:
30ml/kg/hr
70x30=2100ml
Replacement fluid
So
This Replacement can be
divided into pre & post filte
Depending upon physician
Ex, 500 pre and 1500ml po
(All can be pre or post)
42. • Effective for removal of small to medium sized m
• Solute removal occurs primarily due to diffusion
• No replacement fluid is used.
• Dialysateis run on the opposite side of the filter.
• Fluid in the effluent bag is equal to the amount o
removed from the patient plus the dialysate.
• Continuous diffusive removal of waste products
molecules) utilizing a dialysis solution.
• pH is also affected with the buffer contained in t
dialysate.
44. • Blood flow:
80 –200 ml/min
• Duration:
As advised by physician
• Ultrafiltration:
20 -100 ml/hr (or total volume)
• Anticoagulation:
• Dialysate:
600 –1800 ml/hr (up to 3 lit/hr).
• Replacement fluid….NO
Dosage:
45ml/kg/hr
70x45=3150ml
Dialysatefluid
So
Dialysatecan be 3 liters /
45. Let’s Revise
• Primary therapeutic goal:
– Solute removal and safe management of fluid volume
• Primary indications:
– Uremia, severe acid/base or electrolyte imbalance
• Principle used:
Diffusion
• Therapy characteristics:
– Requires dialysatesolution to drive diffusion
– No substitution solution
Effective at removing small to medium molecu
46. • The most flexible of all the therapies, an
combines the benefits of diffusionand
convectionfor solute removal.
• The use of replacement fluid allows adeq
solute removal even with zero or positiv
fluid balance for the patient.
47. • Amount of fluid in the effluent bag equals the fl
removed from the patient plus the dialysate an
replacement fluid.
• Dialysate on the opposite side of the filter and
replacement fluid either before or after the filte
• Continuous diffusive and convective removal o
waste products (small and large molecules)
• Utilizing both dialysate and substitution solutio
• pH is also affected with the buffer contained in
dialysate and substitution solution.
49. Let’s Revise
• Primary therapeutic goal:
– Solute removal and safe management of fluid volume
• Primary indications:
– Uremia, severe acid/base or electrolyte imbalance
– Removal of large molecular weight substances is required
– Unstable haemodunamics
• Principle used:
diffusion and convection
• Therapy characteristics:
– Requires dialysatefluid and substitution solution
drive diffusion and convection
• Effective at removing small, medium and la
molecules
50. • Blood flow:
80 –200 ml/min
• Duration:
As advised by the physician
• Ultrafiltration:
20-100 ml/hr (or total volume)
• Anticoagulation:
• Dialysate:
600 –1800 ml/hr (up to 3 lit/hr)
• Replacement fluid:
1000-2000 ml/hr, pre or post filter(up to 3 lit/hr)
Dosage:
45ml/kg/hr
70x45=3150ml
½ as Dialysate& ½ as
Replacement fluid
So
1500ml as Dialysate
1500ml as Replacement
be divided into pre & po
filter
Depending upon physicia
Ex, 500 pre and 1000ml p