Post-Cardiac Arrest Syndrome:
Epidemiology, Pathophysiology, Treatment, and Prognostication
A Consensus Statement From the International Liaison Committee on Resuscitation
Circulation. 2008;118:2452-2483
Sudden cardiac arrest (SCA) is an event caused by a problem with the heart's "electrical" system. SCA occurs when the heart suddenly stops beating. The heart’s electrical system sends signals to the heart to beat much too fast. The heart cannot beat that fast, so the heart muscle just quivers. Blood and oxygen do not reach vital organs like the brain. Then it stops altogether. The heart needs immediate treatment from an electrical shock (defibrillation) to restart the electrical system. If SCA is not treated within 7-10 minutes, it leads to sudden cardiac death.
Post-Cardiac Arrest Syndrome:
Epidemiology, Pathophysiology, Treatment, and Prognostication
A Consensus Statement From the International Liaison Committee on Resuscitation
Circulation. 2008;118:2452-2483
Sudden cardiac arrest (SCA) is an event caused by a problem with the heart's "electrical" system. SCA occurs when the heart suddenly stops beating. The heart’s electrical system sends signals to the heart to beat much too fast. The heart cannot beat that fast, so the heart muscle just quivers. Blood and oxygen do not reach vital organs like the brain. Then it stops altogether. The heart needs immediate treatment from an electrical shock (defibrillation) to restart the electrical system. If SCA is not treated within 7-10 minutes, it leads to sudden cardiac death.
In the United States each year approximately 75,00 children develop severe sepsis, ap-proximately 6,800 of whom will die. Many of these cases may include missed or delayed diagnosis. As an EMS provider you play a decisive role in the identification and early treatment of these critically ill children. This program will show EMS providers how to identify, assess, and begin treatment for pediatric patients with sepsis as well as how to coordinate care with emergency department and critical care staff. This program is in-tended for both advanced and basic providers whether working or not your EMS system currently has formal sepsis alert protocols. Learn the latest updates and take home the knowledge of how you can make the biggest difference for our littlest patients.
For more information go to www.RomDuck.com
Electrocardiographic passing phenomenon (flying phenomenon or yasser’s phenom...YasserMohammedHassan1
The new “Passing phenomenon” is a transient electrocardiographic change that spontaneously reversed within a few seconds to a few minutes without any medical interventions and apparent hemodynamic impact. Reassurance is immediate therapy. The electrophysiological study is the future advised investigation
Defibrillation -cardioversion Cardioversion is a medical procedure by which a...jagan _jaggi
Defibrillation is a technique used in emergency medicine to terminate ventricular fibrillation or pulseless ventricular tachycardia. It uses an electrical shock to reset the electrical state of the heart so that it may beat to a rhythm controlled by its own natural pacemaker cells.
Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs.
Don't Forget A & B!
Over 500,000 patients per year suffer sudden cardiac arrest. Despite advances in our understanding and management of cardiac arrest, less than 15% of patients survive to hospital discharge with meaningful neurologic survival. In recent years, the focus of cardiac arrest resuscitation has been the delivery of high-quality chest compressions and early defibrillation for those with a shockable rhythm. As a result, airway interventions and ventilation now follow attempts to optimize circulation in cardiac arrest patients. Though high-quality CPR and early defibrillation are essential in the initial stages of resuscitation, advanced airway placement and appropriate ventilation are critical to overall patient survival.
Dr. Winters' discusses the current literature on the timing of advanced airway placement, oxygenation, and ventilation for the cardiac arrest patient. In addition, he discusses optimal targets for oxygenation and ventilation in the patient with return of spontaneous circulation from sudden cardiac arrest.
In the United States each year approximately 75,00 children develop severe sepsis, ap-proximately 6,800 of whom will die. Many of these cases may include missed or delayed diagnosis. As an EMS provider you play a decisive role in the identification and early treatment of these critically ill children. This program will show EMS providers how to identify, assess, and begin treatment for pediatric patients with sepsis as well as how to coordinate care with emergency department and critical care staff. This program is in-tended for both advanced and basic providers whether working or not your EMS system currently has formal sepsis alert protocols. Learn the latest updates and take home the knowledge of how you can make the biggest difference for our littlest patients.
For more information go to www.RomDuck.com
Electrocardiographic passing phenomenon (flying phenomenon or yasser’s phenom...YasserMohammedHassan1
The new “Passing phenomenon” is a transient electrocardiographic change that spontaneously reversed within a few seconds to a few minutes without any medical interventions and apparent hemodynamic impact. Reassurance is immediate therapy. The electrophysiological study is the future advised investigation
Defibrillation -cardioversion Cardioversion is a medical procedure by which a...jagan _jaggi
Defibrillation is a technique used in emergency medicine to terminate ventricular fibrillation or pulseless ventricular tachycardia. It uses an electrical shock to reset the electrical state of the heart so that it may beat to a rhythm controlled by its own natural pacemaker cells.
Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs.
Don't Forget A & B!
Over 500,000 patients per year suffer sudden cardiac arrest. Despite advances in our understanding and management of cardiac arrest, less than 15% of patients survive to hospital discharge with meaningful neurologic survival. In recent years, the focus of cardiac arrest resuscitation has been the delivery of high-quality chest compressions and early defibrillation for those with a shockable rhythm. As a result, airway interventions and ventilation now follow attempts to optimize circulation in cardiac arrest patients. Though high-quality CPR and early defibrillation are essential in the initial stages of resuscitation, advanced airway placement and appropriate ventilation are critical to overall patient survival.
Dr. Winters' discusses the current literature on the timing of advanced airway placement, oxygenation, and ventilation for the cardiac arrest patient. In addition, he discusses optimal targets for oxygenation and ventilation in the patient with return of spontaneous circulation from sudden cardiac arrest.
Niklas Nielsen talks about the TTM trial as seen through a 2019 lens.
The video and references from the talk and all the rest of the goodness from The Big Sick 2019 in Zermatt is up at
https://scanfoam.org/
Polytrauma and multiple traumata are medical terms describing the condition of a person who has been subjected to multiple traumatic injuries. This will be more prevalent in our country
Chest pain Case Presentation with managementMuqtasidkhan
CASE presentation of chest pain types, causes, investigations, management. cardiac vs non cardiac pain. life threatening chest pain. MI, ACS, PNEUMOTHORAX, PE, GERD, AORTIC DISSECTION.
Cliff Reid and Brian Burns are known world wide for their work in prehospital education, training and research, most notably at the Greater Sydney Area HEMS service.
We were fortunate to have them come visit at the repel REPEL course (http://repel.dk/) and they kindly agreed to give a talk each at Odense University Hospital.
These slides accompany the talk that you can see here: https://scanfoam.org/cliff-reid-training-hems-teams/
Here's Cliff's talk with 10 lessons from his many years developing a world class HEMS training programme.
Visit the GSA HEMS homepage for loads of more content:
https://sydneyhems.com/
Also, Cliff has a lot of related teachings on his blog:
http://resus.me/
Sänkt medvetande - Jonathan Ilicki for scanFOAMMads Astvad
Talk from Jonathan Ilicki about decreased level of consciousness. Leave your mnemonics behind.
Full talk at https://scanfoam.org/the-unconscious-patient-10-ways-to-improve-management/
Stuart Duffin is an intensive care doctor & anaesthetist working in Stockholm, Sweden. In this talk from #SWEETS17 he looks at the difficulties front line clinicians face when predicting prognisis in severe traumatic brain injury. How can we possibly be able to look reliably into the future to allow us to make the right decisions? How can we avoid falling into the fallacy of the self fullfilling prophecy and not even knowing it?
Full talk: http://scanfoam.org/prognosis-in-tbi-a-hard-nut-to-crack/
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
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
Exsanguinating trauma, from CPR to EPR - Samuel Tisherman
1. Exsanguinating trauma:
From CPR to EPR
Samuel A. Tisherman, MD
Professor
Department of Surgery, Program in Trauma
University of Maryland School of Medicine
2. Disclosures
• Co-author of patent
– “Emergency Preservation and Resuscitation Method”
• Grant support
– US Department of Defense
• Off label use
– Saline
– Cardiopulmonary bypass pumps and cannulas
11. Nielsen N et al. N Engl J Med, 2013.
Targeted Temperature Management: 33 vs 36oC
12. 2015 ERC/AHA Guidelines: Post-cardiac Arrest Care
• Comatose (ie, lack of meaningful
response to verbal commands) adults
• Targeted temperature management
–32°C to 36°C
–At least 24 hours after achieving goal
• Prevent fever for >72 hrs
13. Traumatic Cardiac Arrest and TTM
• Shock Trauma Center
• 2008-2010
• 6 pt with coma after arrest during initial assessment
• 32-34oC for 24 h
• Median ISS 27, median arrest duration 8 min
• No complications of hypothermia
• Outcome
– 1 died (had prehospital arrest)
– 2 D/C’d to chronic care, GCS 11-Trached
– 3 D/C’d to active rehab
Tuma, et al. J Trauma, 2011.
21. Emergency Preservation and Resuscitation
• “Protection and preservation of the organism during
circulatory arrest of 2 h or longer for transportation and
control of bleeding during pulselessness followed by delayed
resuscitation.”
• Could allow survival from otherwise lethal insults
23. Predisposition in Trauma Patients
• Exposure (field and trauma bay)
– Opening of body cavities
• Blood loss
• Infusion of cold fluids
• Limited heat production
– Shock
– Sedation, anesthesia, EtOH, drugs
26. PA Trauma Outcome Study
• Statewide trauma registry
• 38,520 trauma patients (2000-2002)
– 1,921 (5%) hypothermic on admission (<35oC)
• Adjusted for everything possible
– Age
– Injury severity
– Mechanism of injury
– Route of temp measurement
• Odds ratio for death 3.03 (2.62-3.5)
Crit Care Med, 2005.
38. Drug list
Adenosine
Thiopental
Thio/Phenytoin
MK801
YM872
Nimodipine
Diltiazem
Lidocaine
Insulin/glucose
W7
Cyclohexamide
Tempol
Cyclosporine A
39. Drug list
Adenosine
Thiopental
Thio/Phenytoin
MK801
YM872
Nimodipine
Diltiazem
Lidocaine
Insulin/glucose
W7
Cyclohexamide
Tempol
Cyclosporine A
40.
41. Prolonged HS->arrest, EPR
CPR group
EPR group
MAP
Continuous bleeding Cardiac arrest CPB
Spleen transection
HS time
CPR:124±11 min
SA: 128±17 min
Splenectomy
Wu et al. Circulation, 2006.
42. Prolonged HS->arrest, EPR
Overall Performance
Category CPR
EPR-I
(hypo-12h)
EPR-II
(hypo-36)
5 Dead
4 Coma
3 Severe disability
2 Moderate disability
1 Normal
Wu et al. Circulation, 2006.
*
*Seizures
49. Specific aims
• Rapidly identify potential candidates for EPR within 5 min of
pulselessness.
• Rapidly induce EPR by infusing ice-cold saline to attain a
tympanic membrane temperature (Tty) of 10oC.
• Following hemostasis, delayed resuscitation will be via
cardiopulmonary bypass (CPB).
• Survival without significant neurologic deficits.
50. Subject Inclusion Criteria
• 18 - 65 yo
• Signs of life (pulse, respirations,
reactive pupils, or spontaneous
movement) present within 5 min of
ED/TRU arrival or in the ED/TRU or OR
• Remains pulseless after OCCPR and no
response to clamping aorta
51. Subject Exclusion Criteria
• No signs of life for > 5 min
• Traumatic brain injury
• Electrical asystole
• Obvious non-survivable injury
• Massive tissue trauma involving multiple sites
• Pregnancy
• Prisoner
54. Outcome
• Survival to D/C without major neuro sequelae
• Direct complications of the technique
• Coagulopathy
• Organ system failures
• Survival (28 d)
• Neurologic function (12 months)
60. Community consultation/Public disclosure
http:/ / nyti.ms/ 1pX2UEl
HEALTH | NYT NOW
Killinga Patient toSave HisLife
By KATE MURPHY JUNE 9, 2014
PITTSBURGH — Trauma patients arriving at an emergency room here after
sustaining a gunshot or knife wound may find themselves enrolled in a startling
medical experiment.
Surgeons will drain their blood and replace it with freezing saltwater.
Without heartbeat and brain activity, the patients will be clinically dead.
And then the surgeons will try to save their lives.
Researchers at the University of Pittsburgh Medical Center have begun a