1) ECMO and ECCO2R are being re-examined as alternatives to invasive mechanical ventilation for critically ill patients, as the technologies have improved.
2) Specifically, ECMO is being used instead of mechanical ventilation for some patients awaiting lung transplantation, with promising results.
3) While ECMO and ECCO2R may help reduce ventilator-induced lung injury and duration of mechanical ventilation, more research is still needed to determine if they can fully replace invasive mechanical ventilation.
ECMO, DEFINITION, ETIOLOGY, INDICATION, CONTRAINDICATION, TYPES OF ECMO, VENOVENOUS ECMO, VENO ARTERIAL ECMO, NURSING CARE OF PATIENT ON ECMO, WEANING FROM ECMO,
ECMO, DEFINITION, ETIOLOGY, INDICATION, CONTRAINDICATION, TYPES OF ECMO, VENOVENOUS ECMO, VENO ARTERIAL ECMO, NURSING CARE OF PATIENT ON ECMO, WEANING FROM ECMO,
A lecture highlighting the role of Echocardiography as a major hemodynamic monitoring tool in the Intensive Care settings and the assessment of loading conditions.
A brief yet comprehensive coverage of ICU role in ECMO cases. Presentation has been prepared in order to help ICU fellows and registrars to understand the importance of their role and to know necessary actions they have to take in case of need.
Ventilatory management of Acute Hypercapnic Respiratory FailureVitrag Shah
Presentation on ventilatory management in Acute Hypercapnic Respiratory Failure
Updated information till 17/8/16
For powerpoint format, contact dr.vitrag@gmail.com
http://www.medicalgeek.com/presentation/36513-ventilatory-management-acute-hypercapnic-respiratory-failure-presentation.html
Download review articles and guidelines for ventilatory management in COPD & Asthma
http://www.medicalgeek.com/articles-and-news/36514-articles-ventilatory-management-copd-asthma.html
Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
A lecture highlighting the role of Echocardiography as a major hemodynamic monitoring tool in the Intensive Care settings and the assessment of loading conditions.
A brief yet comprehensive coverage of ICU role in ECMO cases. Presentation has been prepared in order to help ICU fellows and registrars to understand the importance of their role and to know necessary actions they have to take in case of need.
Ventilatory management of Acute Hypercapnic Respiratory FailureVitrag Shah
Presentation on ventilatory management in Acute Hypercapnic Respiratory Failure
Updated information till 17/8/16
For powerpoint format, contact dr.vitrag@gmail.com
http://www.medicalgeek.com/presentation/36513-ventilatory-management-acute-hypercapnic-respiratory-failure-presentation.html
Download review articles and guidelines for ventilatory management in COPD & Asthma
http://www.medicalgeek.com/articles-and-news/36514-articles-ventilatory-management-copd-asthma.html
Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
Utilizacion del ECMO en el distress respiratorio. Presentacion de sesiones cientificas del departamento de cirugia cardiaca de la clinica universidad de navarra
There might be no safe ventilation. Much too often, all there is for us to measure at the bedside are nothing but global indicators of stress/strain, more or less refined. Heterogeneity at the alveolar level-inhomogeneities or stress raisers - render global parameters less useful than previously predicted. In fact, Mead had already stated it through his work on stress distribution at the alveolar level.
ECMO (VA ECMO) might be regarded as one other way of decatecholaminization (M.Singer). Stop stressing the already stressed heart. Unfortunately, fem-fem VA ECMO still needs inotropic support to lessen the LV distension. Levosimendan and IABP combined could help decrease the catecholamine usage in this context.
Abstract Lung Abscess is a liquefactive necrosis of the lung tissue and arrangement of cavitation (in excess of 2 cm) containing necrotic debris and liquid brought about by parenchymal infection. It very well may be brought about by yearning, which may happen during changed cognizance and it for the most part causes a discharge filled depression. In addition, liquor addiction is the most widely recognized condition inclining to lung abscesses. Lung abscess is viewed as essential (60%) when it comes about because of existing lung parenchymal process and is named auxiliary when it entangles another procedure, e.g., vascular emboli or follows rupture of extrapulmonary abscess into lung. There are a few imaging strategies which can distinguish the material inside the thorax, for example, electronic tomography (CT) output of the thorax and ultrasound of the thorax. Broad Spectrum anti-biotics to cover blended vegetation is the pillar of treatment. Pneumonic physiotherapy and postural drainage are additionally significant. Surgeries are required in specific patients for pneumonic resection Keywords: Lung abscess, anti-bodies, video-assissted thoracoscopic medical procedure (VATS), thoracoscopy
Extracorporeal membrane oxygenation, also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an
adequate amount of gas exchange or perfusion to sustain life. The technology for ECMO is largely derived from cardiopulmonary bypass, which provides shorter-term support with arrested native circulation.
This intervention has mostly been used on children, but it is seeing more use in adults with cardiac and respiratory failure. ECMO works by removing blood from the person's body and artificially removing the carbon dioxide and oxygenating red blood cells. Generally, it is used either post-cardiopulmonary bypass or in late stage treatment of a person with profound heart and/or lung failure, although it is now seeing use as a treatment for cardiac arrest in certain centers, allowing treatment of the underlying cause of arrest while circulation and oxygenation are supported.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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
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
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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.
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
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
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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.
1. Assistant Professor of Critical Care
Cairo University
Will ECCO2R & ECMO
Replace Invasive
Mechanical Ventilation?
2. Extracorporeal membrane oxygenation
(ECMO) is not a newly developed
technique.
The main aim of ECMO development was
trying to maintain tissue oxygenation
through bypassing the lungs when other
strategies fail.
History
3. History
The theory was to develop a membrane
lung that can withstand hydrostatic pressure
and is permeable to gas exchange
4. Bramson
ECMO
machine
Use of the Bramson Membrane Lung
J. Donald Hill, MD; Thomas G. O’Brien, MD’ James J. Murray, MD’ Leon Dontigny, MD; MI
Bramson, ACGI, J.J. Osbprm. MD; and F. Gerbode, MD
6. Challenges
Challenge was the mode of bypass in
respiratory failure which changed from
Veno- Arterial (VA) to Veno-venous
(VV) sparing a lot of potentially life
threatening complications.
7. Challenges
Challenge was the associated coagulopathy:
1. Coagulation system activation through tissue
factor activation.
2. Platelet adhesion and activation resulting in
thrombocytopenia and thrombasthenia.
3. Massive anticoagulation use to prevent
thrombosis of the older huge membrane lungs
with consequent bleeding and need for
massive blood transfusion .
8. Challenges
Was hemolysis created by the roller pump
and early generation centrifugal pumps
which improved with newer centrifugal
magnetically driven pumps.
9. Challenges
Was the thrombogenicity and inflammatory
response which markedly improved after
development of heparin coated and bioline
coated circuits that need less anticoagulation
and less inducer of inflammatory response.
14. Caveats of this first study:
“Outdated” devices
Veno-arterial bypass only
ECMO weaned systematically at D5
Prolonged MV before randomization
“Old-fashioned” MV
Profound anticoagulation
19. ELSO registry from 1986–2006.
1,473 patients with severe respiratory
failure 50% survived to hospital discharge.
Median age was 34 years.
Most patients (78%) supported with
venovenous ECMO.
25. When hypercapnia is the driving
force behind the need for invasive
mechanical ventilation, ECCO2R could
facilitate discontinuation of positive-
pressure ventilation by rapidly removing
carbon dioxide, thereby reducing minute
ventilation, work of breathing, and
dynamic hyperinflation.
26. This can be achieved by using much
lower flows than nedded on ECMO
with consequently smaller cannulae and
membrane sizes.
ECCO2R
27.
28.
29. Luciano Gattinoni, JAMA 1986;256:881-886
43 patients, uncontrolled study
Low-flow veno-venous CO2 removal device
• ECCO2-R
To avoid lung injury from conventional MV, the
lungs were kept "at rest"
• 3-5 breaths/min
• “Low” peak airway pressure, 35-45 cm H2O
Survival: 21/43 (48.8%) patients
Lung function improved in 31(72.8%) patients
Blood loss: 1800±850mL/day…
30. Morris, AH, AJRCCM,
Randomized controlled clinical trial
40 patients with severe ARDS
Extracorporeal CO2 removal:
• ECCO2R
• Low-flow veno-venous device
Survival at 30 days not significantly different:
• 42% in the 19 mechanical ventilation
• 33% in the 21 ECCO2R patients (P = 0.8)
• All deaths occurred within 30 days of
randomization
Study stopped for futility.
>30% patients with severe hemorrhage.
42. Invasive mechanical ventilation is associated with
numerous problems:
Ventilator-associated lung injury,
Ventilator associated pneumonia, dynamic
hyperinflation, suboptimal delivery of
aerosolized medications,
Patient discomfort, reduced oral intake and
mobility.
Crit Care med 2008; 36:1614-1419.,Proc Am Thorac Soc
2008; 5:530-535.Am J Respir Crit Care Med 1999;
159:1249-1256. Resp. Care 2002; 47:1279-1288,
discussion 1285-1289.
43. Deconditioning may occur without
aggressive physical therapy, and invasive
mechanical ventilation is associated with high
1- and 5-year mortality rates.
44.
45. ECMO as Bridge to Lung
Transplantation Invasive mechanical
ventilation is considered a relative
contraindication to lung transplantation,
as it often leads to poor post-transplant
outcomes (44, 45).
51. Centers have reported successfully
starting ECMO instead of invasive
mechanical ventilation, bypassing the
ventilator entirely.
The specific patient populations for
whom these strategies are most appropriate
have yet to be defined.
52. ARDS net strategy might not protect
against tidal hyperinflation
• When Pplat remains >28-30 cm H2O
Further decrease of Vt
• From 6 to 5, 4 or 3 ml/kg IBW
• To decrease Pplat <25 cm H2O
• To further reduce VILI
• With sufficient PEEP to prevent lung
derecruitment
53. Reducing Vt causes hypercapnia
Induced Hypercapnia might cause…
• Pulmonary hypertension
• Decreased myocardial contractility
• Decreased renal blood flow
• Elevated intracranial pressure
• Release of endogenous catecholamine
Induced Hypercapnia should be controlled by
extracorporeal CO2 removal
• “CO2 dialysis”
• Low-flow devices
56. The use of extracorporeal support
inherently introduces risks that would not
otherwise be present wit conventional
mechanical ventilation alone, including
hemorrhage, thrombosis, and catheter
associated infections.
57.
58. For acute decompensation of COPD
In case of failure of NIV
• To prevent intubation and MV
After intubation
• To permit rapid extubation
To allow patient ambulation and
rehabilitation of the patient
59.
60.
61.
62.
63. ECMO and ECCO2R are revisited in critically
ill patients with better technologies and safety
profile.
Classically VV ECMO is still considered as
salvage treatment in acute respiratory failure
when standard treatment fails.
ECMO is being used instead of mechanical
ventilation in patients waiting for
transplantation with encouraging results
64. ECMO and ECCO2R might be helpful in
reducing VILI and decreasing ventilator
days.
Whether ECMO and ECCO2R can
replace invasive mechanical ventilation
is yet to be studied.