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/
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
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.
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.
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
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
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
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.
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
Dehradun #ℂall #gIRLS Oyo Hotel 8107221448 #ℂall #gIRL in Dehradun
Exsanguinating trauma - from CPR to EPR
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