This document discusses CVP and PCWP monitoring. It begins by outlining the cardiac cycle and then defines CVP as the pressure in the thoracic vena cava near the right atrium. Factors that can increase or decrease CVP are described. CVP monitoring involves inserting a catheter into a vein to measure pressure in the right atrium. The document then discusses PCWP monitoring, which involves advancing a catheter into the pulmonary artery to measure pressure. Normal ranges for various hemodynamic parameters are provided. Contraindications for PA catheter use are also outlined.
Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
Assessment of haemodynamics a critically ill patient and its management has always been a matter if debate. Over time a lot of studies and therapeutic interventions have been carried out. This presentation is a review of such interventions and their impact on the outcome.
This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
central venous pressure and intra-arterial blood pressure monitoring. invasiv...prateek gupta
central venous pressure and intra-arterial blood pressure monitoring. various sites for cvp and Ibp insertion. working principle for cvp and ibp. indication and complication. various waveform of cvp and ibp
Assessment of haemodynamics a critically ill patient and its management has always been a matter if debate. Over time a lot of studies and therapeutic interventions have been carried out. This presentation is a review of such interventions and their impact on the outcome.
This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
central venous pressure and intra-arterial blood pressure monitoring. invasiv...prateek gupta
central venous pressure and intra-arterial blood pressure monitoring. various sites for cvp and Ibp insertion. working principle for cvp and ibp. indication and complication. various waveform of cvp and ibp
Pulmonary artery catheterisation, Cardiac surgeries, Non cardiac surgeries, LVEDD and PA pressure relationship, Technique and complications of PA placement
Preoperative preparation for thoracic surgerySaneesh P J
The preoperative teaching process is best approached as a team effort, and multiple modalities often must be used so that the patient becomes a knowledgeable and willing member of the team. This perspective is described in case of preparation for thoracic surgery.
Rational choice of inotropes and vasopressors in intensive care unitSaneesh P J
The presentation introduces commonly used interpose and vasopressors; their classification; and how to choose the drug in ICU. Clinical scenarios - cariogenic shock; neurocritical care; septic shock and anaphylactic shock are elaborated.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
8. Central Venous Pressure
Venous pressure is a term that represents the average
blood pressure within the venous compartment.
The term "central venous pressure" (CVP) describes
the pressure in the thoracic vena cava near the right
atrium
therefore CVP and right atrial pressure are essentially the
same
9. Central Venous Pressure
CVP is a major determinant of the filling pressure and
therefore the preload of the right ventricle, which
regulates stroke volume
13. CVP monitoring
In CVP monitoring, a catheter is inserted
through a vein and advanced until its tip lies in
or near the right atrium
Because no major valves lie at the junction of
the vena cava and right atrium, pressure at
end diastole reflects back to the catheter
14. CVP monitoring
When connected to a manometer, the catheter
measures central venous pressure (CVP), an index of
right ventricular function
CVP monitoring helps to assess cardiac function, to
evaluate venous return to the heart, and to indirectly
gauge how well the heart is pumping
15. The phlebostatic axis is the reference point for zeroing
the hemodynamic monitoring device. This reference
point is important because it helps to ensure the
accuracy of the various pressure readings.
4th intercostal space, mid-axillary line
Level of the atria
20. CVP waves
Waveform Phase of cardiac
cycle
Mechanism
a wave End diastole Atrial contraction
c wave Early systole Isometric ventricular contraction;
Tricuspid motion towards RA
x descent Mid systole Atrial relaxation; descent of base
v wave Late systole Systolic filling of atrium
y descent Early diastole Early ventricular filling
h wave Mid- to late diastole Diastolic plateau
23. CVP abnormalities
Condition Characteristics
Atrial fibrillation Loss of a wave
Prominent c wave
AV dissociation Cannon a wave
Tricuspid regurgitation Tall systolic c-v wave
Loss of x descent
Tricuspid stenosis Tall a wave
Attenuation of y descent
Pericardial constriction Tall a and v waves; Steep x and y descents M
or W configuration
Cardiac tamponade Dominant x descent
Attenuated y descent
Respiratory variations Measure pressure at end-expiration
24. CVP – Atrial fibrillation
absence of the a wave
prominent c wave
preserved v wave and y
descent
25. CVP – AV dissociation
Early systolic Cannon a
wave
Retrograde conduction of the nodal impulse throughout the atrium
causes atrial contraction to occur during ventricular systole while the
tricuspid valve is closed
26. CVP – Tricuspid regurgitation
Tall systolic c-v wave
Loss of x descent
In this example, the a wave is not seen because of atrial fibrillation
27. CVP – Tricuspid stenosis
End-diastolic a wave is
prominent
Diastolic y descent is
attenuated
Tricuspid stenosis increases mean CVP
28. CVP & Intrathoracic pressure
CVP measurement is influenced by
changes in intrathoracic pressure.
It fluctuates with respiration.
Decreases in spontaneous
inspiration.
Increases in positive pressure
ventilation.
29. CVP & Intrathoracic pressure
CVP should be taken at the end expiration.
PEEP applied to the airway at the end of exhalation,
may be partially transmitted to the intrathoracic
structures ► measured CVP will be higher.
33. PA catheterisation
The pulmonary artery (PA) catheter (or Swan- Ganz
catheter) was introduced into routine practice in
operating rooms and intensive care units in the 1970s
The catheter provides measurements of both CO and
PA occlusion pressures and was used to guide
hemodynamic therapy, especially when patients
became unstable
34. PA catheterisation
The pulmonary artery (PA) catheter (or Swan- Ganz
catheter) was introduced into routine practice in
operating rooms and intensive care units in the 1970s
The catheter provides measurements of both CO and
PA occlusion pressures and was used to guide
hemodynamic therapy, especially when patients
became unstable
Perioperative intensive care; Cardiac anesthesia
36. PA catheter
PA catheter can be used to
guide goal-directed
hemodynamic therapy to
ensure organ perfusion in
shock states
7 - 9 FR catheter
4 lumens
110-cm long
Polyvinylchloride body
37.
38. Pressure guidance is used to ascertain the localization of
the PA catheter in the venous circulation and the heart
Upon entry into the right atrium, the central venous pressure
tracing is noted
39. Passing through the tricuspid valve right ventricular
pressures are detected
Higher systolic pressure than
seen in the right atrium,
although the end-diastolic
pressures are equal
40. At 35 to 50 cm depending upon patient size, the catheter will
pass from the right ventricle through the pulmonic valve into
the pulmonary artery
A diastolic step-up compared
with ventricular pressure
41. When indicated the balloon- tipped catheter will wedge or
occlude a pulmonary artery branch.
Similar morphology to right atrial pressure, although the a-c and v
waves appear later in the cardiac cycle relative to ECG
42. PA pressure equilibrates with that of the left atrium which,
barring any mitral valve pathology, should be a reflection of
left ventricular end-diastolic pressure
43. From a right internal jugular vein puncture site, the right atrium
should be reached when the PAC is inserted 20 to 25 cm, the right
ventricle at 30 to 35 cm, the pulmonary artery at 40 to 45 cm, and the
wedge position at 45 to 55 cm.
45. 0
120
PAWP a-c and v waves appear to occur later in the cardiac cycle
compared with CVP trace
46. PA catheter: Uses
There is no consensus on standards for PA catheter
use
PA catheters should only be used when a specific
clinical question regarding a patient’s hemodynamic
status can not be satisfactorily investigated by clinical
or noninvasive assessments
…. when the clinician is in need of knowing an in-depth
and continuous assessment of hemodynamics in order
to properly guide changes in the management of a
patient
47. PA catheter: Measurements
Parameter Normal range Relevance
CVP 0-6mmHg Volume status & RV function;
correlates with RVEDP
RVP 20-30 / 0-6mmHg RV function and volume
PAP 20-30 / 6-10 mmHg State of PVR and RV function
PAWP 4-12mmHg LV function; correlates with LVEDP
Stroke vol. 60-80ml
SV index 33-47ml/beat/m2 SV adjusted to body surface area
(BSA)
48. PA catheter: Measurements
Parameter Normal range
Cardiac Output 4 – 8 L/min
Cardiac Index 2.5 – 4 L/min/m2
Pulmonary Vascular Resistance 20-120 dynes/sec/cm5
Systemic Vascular Resistance 750-1500 dynes/sec/cm5
RV stroke work
LV stroke work
SvO2 (Mixed Venous O2
saturation)
60 -75%