Simple medical student presentation about distributive shock, type and pathophysiology of each septic shock, anaphylactic shock, neurogenic shock
including management, prognosis and disposition of patient..
brief info of type of inotropes and when to start.
Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs.
there is the introduction part of the torso trauma,
check out my next ppts for further more about torso trauma.
contents are in following order...
introduction
mechanism of injury
junctional zones of torso
tension pneumothorax
cardiac temponade
massive hemothorax
etc.
check out all slides
ARDS - Diagnosis and Management
Visit www.medicalgeek.com for more
http://www.medicalgeek.com/lecture-notes/36156-ards-diagnosis-management-presentation-ppt-pdf.html#post89045
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Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs.
there is the introduction part of the torso trauma,
check out my next ppts for further more about torso trauma.
contents are in following order...
introduction
mechanism of injury
junctional zones of torso
tension pneumothorax
cardiac temponade
massive hemothorax
etc.
check out all slides
ARDS - Diagnosis and Management
Visit www.medicalgeek.com for more
http://www.medicalgeek.com/lecture-notes/36156-ards-diagnosis-management-presentation-ppt-pdf.html#post89045
https://www.facebook.com/MedicalGeek
https://only4medical.wordpress.com/
http://www.facebook.com/group.php?gid=129413628862&ref=nf
http://groups.yahoo.com/group/only4medical/
Multiple Organ Dysfunction Syndrome (MODS).Pinky Rathee
The presence of altered organ function in a client who is acutely ill such that hemeostasis cannot be maintained without intervention. MODS is present when two or more organs fail .MODS results from SIRS
DEFINITION
• Myxedema coma is a rare life-threatening condition.It is the decompensated state of severe hypothyroidism in whichthe patient is hypothermic and unconscious.The condition occurs most often among elderly women in the winter months and appears to be precipitated by cold.
• Myxedema coma, occasionally called myxedema crisis, is a rare life- threatening clinical condition that represents severe hypothyroidism with physiological decompensation. The condition usually occurs in patients with long-standing, undiagnosed hypothyroidism and is usually precipitated by infection, cerebrovascular disease, heart failure, trauma, or drug therapy.
• Myxedema is also used to describe the dermatologic changes that occur in hypothyroidism which refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area.
This presentation is about the causes and mechanisms of central and peripheral cyanosis. It also contain some general information about different scenarios of cyanosis.
Multiple Organ Dysfunction Syndrome (MODS).Pinky Rathee
The presence of altered organ function in a client who is acutely ill such that hemeostasis cannot be maintained without intervention. MODS is present when two or more organs fail .MODS results from SIRS
DEFINITION
• Myxedema coma is a rare life-threatening condition.It is the decompensated state of severe hypothyroidism in whichthe patient is hypothermic and unconscious.The condition occurs most often among elderly women in the winter months and appears to be precipitated by cold.
• Myxedema coma, occasionally called myxedema crisis, is a rare life- threatening clinical condition that represents severe hypothyroidism with physiological decompensation. The condition usually occurs in patients with long-standing, undiagnosed hypothyroidism and is usually precipitated by infection, cerebrovascular disease, heart failure, trauma, or drug therapy.
• Myxedema is also used to describe the dermatologic changes that occur in hypothyroidism which refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area.
This presentation is about the causes and mechanisms of central and peripheral cyanosis. It also contain some general information about different scenarios of cyanosis.
د/باسم السيد
Management of shocked patient
المحاضرة التي قدمت يوم الثلاثاء 8 ابريل 2014 في دار الحكمة بالقاهرة
من فعاليات مشروع اعداد طبيب حكيم ناجح بالتعاون مع معتمد باتحاد الاطباء العرب
و ضمن موديول الطوارئ و التخدير و العناية المركزة
1. General Post COVID19 Management
2. Post COVID19 Management Protocol In Primary Care
3. Post COVID19 Respiratory Management Protocol
4. Organizing Pneumonia In COVID19
5. Post COVID19 Management Protocol For Immunocompromised Patient On Immunosuppressant/ Chemotherapy
6. Post COVID19 Management Protocol For Kidney Diseases
7. Post COVID19 Management And Protocol In Obstetrics Patient
8. Post COVID19 Management And Protocol In Children
9. Post COVID19 Follow Up Rehabilitation Recommendations
10. Management Of Psychological Issues In Post COVID19 Infection
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
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
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
1. Distributive shock
• Inadequate perfusion of tissues through
misdistribution of blood flow
• Cardiac pump and blood volume are normal
but blood is not reaching the tissues
5. • Systemic Inflammatory Response Syndrome
(SIRS) - a syndrome characterized by presence of
two or more of the following clinical criteria
- Temperature >38, <36
- HR>90
- Respiratory rate >20b/m, PaCO2 <32 mm of hg
- WBC <4, >12
6. • Sepsis: SIRS with a clearly established focus
of infection
• Septicemia: is a condition when there is
prolonged presence of bacteria in the blood
accompanied by systemic reaction
• Septic Shock: refers to severe sepsis which is
not responsive to intravenous fluid infusion
for resuscitation and requires inotropic or
vasopressor agent to maintain SBP
7. • Multiple organ dysfunction (MODS)- altered
function of more than one organ system in an
actually ill patient requiring medical
intervention homeostasis.
15. Treatment
• Septic shock is a medical emergency that requires
prompt and sufficient resuscitation
• Aims
• To improve hemodynamic state
• Restore tissues perfusion
• Eliminate toxin from body
16. Preshock or
compensated shock
Shock or
decompensated shock
Irreversible shock
• Reversible with
interventions
• Perfusion and oxygen
delivery are relatively
normal despite the
insult.
• No overt signs of
organ dysfunction ±
mild laboratory signs
of organ dysfunction
(e.g., mildly elevated
creatinine, troponin,
or lactate)
• Reversible with
interventions
• Perfusion and oxygen
delivery are
abnormal.
• Overt signs of organ
dysfunction are
present.
• Permanent organ
dysfunction
• Progression to
multisystem organ
failure
1. Recognize signs of shock (0-5min)
17. • Shock index (SI):
• heart rate (HR; beats/min) / SBP (mm Hg)
• SI of 0.5–0.7: Normal
• SI > 0.9: indicates critical bleeding and
transfusion requirement
• qSOFA (quick Sequential (sepsis-related)
Organ Failure Assessments) score:
• Presence of 2 of the following 3 criteria
indicates a worse outcome:
• SBP < 100 mm Hg
• Respiratory rate > 22/min
• Altered mental status
18. Compensated shock:
• Tachycardia: to compensate for CO
• Tachypnea: to compensate for metabolic
acidosis
• Hypotension: systolic blood pressure (SBP)
< 90 mm Hg, mean arterial pressure (MAP)
< 65 mm Hg in normotensive individuals or
higher in patients with uncontrolled
hypertension
• Decreased capillary refill
• Cold and clammy skin
19. Decompensated shock:
signs of organ failure
• Confusion/altered mental status: central
nervous system (CNS) hypoperfusion
• Oliguria (< 0.5 mL/kg/hr) in a patient without
a history of renal disease: renal hypoperfusion
20. • Bilateral rales: pulmonary edema due to left
heart failure or acute respiratory distress
syndrome
• Warm distal extremities, capillary refill in < 2
seconds, and bounding pulses: high CO
• Cool extremities, delayed capillary refill, weak
pulses, and a narrow pulse pressure: low CO
• Reduced JVP (< 8 cm): hypovolemic shock
21. 2. Assess ABCs (0-5 min)
• Provide 100% oxygen at high flow rate (15L)
• Goal: arterial oxygen saturation of 92%–95%
• Indications for endotracheal intubation and
mechanical ventilatory support:
• Significant hypoxemia (PaO2 < 60 mm Hg or
oxygen saturation < 90%)
• Hypoventilation (rising partial pressure of carbon
dioxide (pCO2))
• Significantly altered level of consciousness
• Inability to protect airways with risk of aspiration
• Persistent metabolic acidosis with pH < 7.20
22. 3. Establish IV access and place on monitor
• 2 large-bore peripheral IVs (PIVs) preferred: if
difficult IV, place IO access per PALS
guidelines; 1 PIV may be sufficient unless
vasoactive drugs needed (see Step No. 6,
below)
• Consider labs on IV placement: blood gas,
lactate, glucose, ionized calcium, CBC,
cultures (glucose check through finger stick
preferred for rapid result)
23. 4. Fluid and electrolyte resuscitation (5-15min)
• Push 20 mL/kg fluid (isotonic crystalloid) IV/IO over 5-
20min or faster if needed (reassess for signs of shock)
• Repeat 20 mL/kg bolus push of fluid (up to 60 mL/kg)
until clinical symptoms improve or patient develops
respiratory distress/rales/ hepatomegaly
• May continue to require additional fluid above 60
mL/kg (fluid refractory)
• Fluid needs may approach 200 mL/kg in warm septic
shock (warm extremities, flash capillary refill)
24. Correct hypoglycemia:
• Glucose dosage: 0.5-1 g/kg IV/IO (max that can be
administered through a peripheral vein is 25% dextrose
in water) (see alternative treatments immediately
below)
Correct hypocalcemia for low ionized calcium:
• Calcium gluconate 100 mg/kg IV/IO (max 2g) PRN
• Calcium chloride 20 mg/kg IV/IO PRN ( Note: central
line administration preferred over 60min in nonarrest
situation)
25. 5. Infection control (5-60min)
• Immediate considerations:
• Administer antibiotics immediately after
cultures obtained (blood, urine, +/- CSF/
sputum)
• Do not delay antibiotics because of delay in
obtaining cultures; initial antibiotics should be
given within 1h
26. 6. Fluid-refractory shock (persisting after 60 mL/kg
fluid) (15-60 min)
• Central line placement and arterial monitoring if not already
established; vasopressors should not be delayed for line
placements
• Warm shock (warm extremities, flash capillary refill):
• 1st line: Norepinephrine 0.1- 2 mcg/kg/min IV/IO
infusion, titrate
• 2nd line: Vasopressin 0.01U-0.07U/min, fixed dose
• Cold shock (cool extremities, delayed capillary refill):
• Epinephrine 0.1-1 mcg/kg/min IV/IO infusion, titrate
• Normotensive shock (impaired perfusion but normal blood
pressure):
• Dopamine 2-20 mcg/kg/min IV/IO, titrate
• if continued poor perfusion, consider dobutamine
infusion 2-20 mcg/kg/min IV/IO, titrate (may cause
hypotension, tachycardia)
27. 7. Shock persists following vasopressor initiation
(60 min)
• SvO2 < 70% (cold shock): Transfuse Hgb >10 g/dL;
optimize arterial saturation through oxygen therapy,
ventilation; epinephrine 0.1-1 mcg/kg/min IV/IO
infusion, titrate to desired effect
• SvO2 < 70% (normal BP but impaired perfusion):
Transfuse Hgb >10 g/dL; optimize arterial saturation
through oxygen therapy, ventilation; consider addition
of milrinone 0.25-0.75 mcg/kg/min IV/IO (titrate to
desired effect) or nitroprusside 0.3-5 mcg/kg/min IV/IO
(titrate to desired effect)
• SvO2 >70% (warm shock): Norepinephrine 0.1-2
mcg/kg/min IV/IO infusion, titrate to desired effect;
consider vasopressin 0.2-2 mU/kg/min infusion, titrate
to desired effect
28. 8. Fluid refractory and vasopressor-
dependent shock (60 min)
• Consider adrenal insufficiency
• Hydrocortisone 2 mg/kg (max 100mg) IV/IO bolus;
obtain baseline cortisol level; if unsure, consider
ACTH stimulation test; duration depends on
response, laboratory evaluation
9. Continued shock -> refer
• Consider cardiac output measurement to direct
further therapy
• Consider extracorporeal membrane oxygenation
(ECMO)
10. Supplemental therapies
29. Prognosis
• Poor prognostic factor
- Advanced age
- Immunosuppression
- Infection
- Need for inotropes for >24hrs
- Availability and mode of treatment
30. Prevention
• Early recognition
• Prompt treatment of infection
• Meticulous surgical treatment
• Pre op antibiotics
• Aseptic technique
31. Anaphylactic shock
• A type of distributive shock that result from
wide spread systemic allergic reaction to an
antigen
• Anaphylaxis: reaction sudden life threatening
because the process immunologic of allergen-
antibody reaction
• rapid onset,
• biphasic course (resolve and return in 1-3h with
same severity)
32. • Sensitization stage
• Asymptomatic; 1st antigen exposure
• Allergen is recognized by antigen-presenting cells
→ presented to naive T cells → T cells
differentiate into Th2 cells
• Th2 cells release interleukins (IL-4, IL-5, IL-13) →
switches B cells to increase IgE antibody
production → IgE antibodies bind to mast cells
and basophils (via FcεRI receptors)
• Reaction / effector stage
• Early (minutes)
• Late (4-12 hours, peak 6-9 hours)
33. Large quantities of inflammatory
mediators released
rapid systemic vasodilation and
vascular permeability
hypotension and extensive
tissue edema
fluid in the lungs and
constriction of airways
shortness of breath and lethal
suffocation
cardiovascular collapse and loss
of consciousness
34.
35. Management
Airway head neutral position (slight
extended)
oxygen supplement
Limit exposure Stop drug, remove source
Drugs IM Adrenaline/Epinephrine 0.3-
0.5mg, every 5 min, repeated 3
times)
consider IV Glucagon 1mg every
5min if not respond
36. Management
Steroids IV hydrocortisone 200mg STAT
(up to 500mg)
Anti-
histamines
IV Piriton 10mg STAT
Fluid normal saline bolus 1-2L
can add inotropes (norad)
37. Complementary treatment
- Bronchial spasm
- B-2 agonist: ventolin nebulizer
- IV MgSO4 2.47g in 20cc NS over 20min
- Aminophylline 7mg with 10- 20 ml of 0.9&
NaCl followed 9mg/kg/24 hours( divided
into 3 dose)
- seizures- diazepam, phenobarbital, midazolam
- bradycardia- IV Atropine 0.5-1mg (max 3mg)
38. DISPOSITION
• Unstable/ refractory patient -> ICU
• Moderate to severe sx -> admit for observation
• Mild sx -> observe in ED, allow discharge after 4
hours if sx free
• 3 days antihistamines & prednisolone
• TCA stat if symptoms not improving/worsening
• Epinephrine autoinjector
• Medic-alert bracelet
40. • Neurogenic shock is a medical condition which
occurs as a result of disturbance in the
sympathetic outflow causing loss of vagal tone
• Experiences neurogenic shock after injury to
the spinal cord and when there is disruption in
the blood circulation throughout the body due
to injury/ illness.
41. • It is a serious and life-threatening condition, which
requires prompt medical attention without any delay. If
the treatment is delayed, then it causes irreversible
tissue damage and even death.
• Out of the different types of the shocks, neurogenic
shock is the most difficult to manage, mainly because
of the irreversible damage to the tissues.
• Neurogenic shock mainly affects the spinal cord; the
function of which is transmitting neural signals from
the brain to the entire body and back.
42. Different!
• Spinal shock: Temporary loss of spinal
reflex activity below a total or near total
spinal cord injury
• Loss of sympathetic tone results in warm &
dry skin, no systemic instability
• Shock usually lasts from 1 to 3 weeks
• NOT TRUE SHOCK
Its either spinal shock only or neurogenic shock
associated with spinal shock.
No neurologic shock only.
43.
44.
45. • Most common causes is
spinal injury above T6.
• Most rare form of shock
48. • Hypovolemic- with fluid
• Observe for fluid overload
• Vasopressors
• Hypothermia - thermal blanket
• Treat hypoxia
• Maintain ventilator support
49. • Observe for bradycardia- major Dysarrthemia
• Observe for DVT- Venous pooling in
extremities make patients high risk
• Use prevention modalities
50. • Alpha agonist to augment tone if perfusion
still in adequate
• Dopamine(>10 mcg/kg per min)
• Ephedrie(12.5-25mg iv every 3-4 hour)
• Treat bradycardia with atropine 0.5-1mg doses
to maximum 3 mg
• May need transcutaneous or transvenous
pacing temporarily