The hypothalamus controls body temperature through neurons that receive signals from temperature receptors in the skin and blood. These signals are integrated in the hypothalamus' temperature regulation center to maintain a normal temperature of around 37°C. Fever is defined as a temperature greater than 37.2°C in the morning or 37.7°C in the afternoon. Common causes of fever in the ICU include infections like ventilator-associated pneumonia as well as non-infectious causes like drug reactions. Blood cultures, sputum cultures, urine cultures and imaging tests may help diagnose the cause, and treatment is aimed at the underlying condition.
An excellent tool to treat refractory hypoxia. Target audience are ICU junior physicians and Respiratory Therapists. It will take away the fear of "What is APRV?" from your hearts and you will feel ready to give it a try.
An excellent tool to treat refractory hypoxia. Target audience are ICU junior physicians and Respiratory Therapists. It will take away the fear of "What is APRV?" from your hearts and you will feel ready to give it a try.
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
Updated global adult sepsis guidelines, released in October 2021 by the Surviving Sepsis Campaign (SSC), place an increased emphasis on improving the care of sepsis patients after they are discharged from the intensive care unit (ICU) and represent greater geographic and gender diversity than previous versions.
The new guidelines specifically address the challenges of treating patients experiencing the long-term effects of sepsis. Patients often experience lengthy ICU stays and then face a long, complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families are often uncertain how to coordinate care that promotes recovery and matches their goals of care.
Social networks in anatomy education workable modelsAkram Jaffar
Clarify the evolving role of social media as an instructional tool. Identify the most popular social media networks. Consider challenges faced by educators using social media. Relate the role social media can play in student centered and blended learning. Provide live examples.
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
Updated global adult sepsis guidelines, released in October 2021 by the Surviving Sepsis Campaign (SSC), place an increased emphasis on improving the care of sepsis patients after they are discharged from the intensive care unit (ICU) and represent greater geographic and gender diversity than previous versions.
The new guidelines specifically address the challenges of treating patients experiencing the long-term effects of sepsis. Patients often experience lengthy ICU stays and then face a long, complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families are often uncertain how to coordinate care that promotes recovery and matches their goals of care.
Social networks in anatomy education workable modelsAkram Jaffar
Clarify the evolving role of social media as an instructional tool. Identify the most popular social media networks. Consider challenges faced by educators using social media. Relate the role social media can play in student centered and blended learning. Provide live examples.
Common causes and approach to new fever in ICU, both infectious and non-infectious, including VAP (ventilator associated pneumonia), CLABSI (central line associated blood stream infections), CAUTI (catheter associated UTI), drug fever, fungal infections, postoperative fever.
Brief mention of SOFA scores, new Sepsis definitions (2016), Sepsis biomarkers (ex procalcitonin).
This presentation focuses on the entity known as pyrexia of unknown origin / fever of unknown origin. It demonstrates both common and rare causes, and the epidemiological trend, its clinical presentation, management and prognosis.
The entire scope of febrile neutropaenia in paediatrics subpopulation undergoin cancer chemotherapy including guidelines for risk stratification and mangement.
Fever and Hyperthermia and Pyrexia of unknown origin by Dr Mohammad Hussien for Medical Student .
Ass.Lecturer of Hepatogastroentrology at Kafrelsheikh University.
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
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A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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.
2. PHYSIOLOGY
• Body temperature is controlled by the
hypothalamus
• Neurons in pre-optic ant hypothal & post
hypothal
• Receive two kinds of signals
• Peripheral N transmit info from warmth/cold receptors
of skin
• Other from temp of blood bathing the region
• Both signals are integrated by Temp
Regulation Centre (TRC) of hypothalamus
• Maintain normal temp
• In neutral temp environment
• Humans produces more heat than is needed
• To maintain core body temp at 37°C
2
3. TEMPERATURE
MEASUREMENT
Mean oral temp = 36.8° ± 0.4°C (98.2°
± 0.7°F)
Lowest at 6 A.M. and highest between 4 to
6 PM
Maximum normal oral temp
37.2°C (98.9°F) at 6 AM
37.7°C (99.9°F) at 4 PM (99 %)
Fever Definition ( Harrison)
A.M temperature of >37.2°C (>98.9°F) or
P.M. temperature of >37.7°C (>99.9°F)
3
4. TEMPERATURE
MEASUREMENT
Normal daily temp variation is 0.5°C (0.9-
1°F)
During febrile illness diurnal variation is
higher
Daily temp variation is fixed in early
childhood
Elderly individuals have reduced ability to
develop fever even in severe infections
Rectal temp 0.4°C (0.7°F) > oral readings
Lower-esophageal temp reflects core temp
5. TEMPERATURE
MEASUREMENT
Tympanic membrane (TM)
thermometer
Measure radiant heat from TM & ear canal
TM values are 0.8°C (1.6°F) < rectal
temp
In women who menstruate AM temp
lower in the 2 weeks before ovulation
It rises by ~0.6°C (1°F) with ovulation
Remains at that level until menses occur
6. DEFFINITION OF FEVER IN
ICU
The Society of Critical Care
Medicine practice parameters
define fever in the ICU as
a temperature > 38.3°C (
101°F).Unless the patient has other
features of an infectious process,
only a temperature > 38.3°C (
101°F) warrants further
investigation.
7. EPIDEMIOLOGY
Fever complicates up to 70 percent of all ICU
admissions and is often due to an infection
In one observational study of 24,204 adult ICU
admissions, fever ≥39.5ºC (103 ºF) was associated
with an increase in mortality (20 versus 12 percent)
8. FEVER PATTERNS
Most patients have remittent or intermittent
fever that, when due to infection, usually follow
a diurnal variation.
Sustained fevers have been reported in
patients with Gram-negative pneumonia or CNS
damage.
The appearance of fever at different time points
in the course of a patient’s illness may however
provide some diagnostic clues.
Fevers that arise > 48 h after institution of
mechanical ventilation may be secondary to a
developing pneumonia.
Fevers that arise 5 to 7 days postoperatively may be
related to abscess formation.
Fevers that arise 10 to 14 days post institution of
antibiotics for intra-abdominal abscess may be due to
fungal infections.
9. CAUSES OF FEVER IN THE ICU
Any disease process that results in the release of the
proinflammatory cytokines IL-1, IL-6, and TNF- will
result in the development of fever
Infections are the commonest cause of fever in ICU
patients, many noninfectious inflammatory
conditions cause the release of the proinflammatory
cytokines with a febrile response.
Similarly, it is important to appreciate that not all
patients with infections are febrile.
Approximately 10% of septic patients are hypothermic
and 35% are normothermic at presentation.
Septic patients who fail to develop a temperature have a
significantly higher mortality than febrile septic patients
The reason that patients with established infections fail
to develop a febrile response is unclear; however,
preliminary evidence suggests that this aberrant
response is not due to diminished cytokine production.
13. NONINFECTIOUS CAUSES
For reasons that are not entirely clear, most noninfectious
disorders usually do not lead to a fever > 38.9°C (102°F);
therefore, if the temperature increases above this
threshold, the patient should be considered to have an
infectious etiology as the cause of the fever.
However, patients with drug fever may have a temperature
> 102°F.
Similarly, fever secondary to blood transfusion may be >
102°F.
On the basis of the number of medications administered to
patients in the ICU, one would expect drug fever to be a
relatively common event.
Drug fever should be considered in patients with an
otherwise unexplained fever, particularly if they are
receiving ß-lactam antibiotics.
Drug fever is usually characterized by high spiking
temperatures and shaking chills. It may be associated with
a with leukocytosis and eosinophilia. Relative bradycardia,
although commonly cited, is uncommon.
14. NONINFECTIOUS CAUSES
ATELECTASIS is commonly implicated as a
cause of fever. Standard ICU texts list
atelectasis as a cause of fever, although
they provide no primary source.
FEBRILE REACTIONS
complicate about 0.5% of blood transfusions
More common following platelet transfusion.
Antibodies against membrane antigens of
transfused leukocytes and/or platelets are
responsible for most febrile reactions to cellular
blood components.
Febrile reactions usually begin within 30 min to 2
h after a blood-product transfusion is begun.
The fever generally lasts between 2 h and 24 h
and may be preceded by chills.
An acute leucocytosis lasting up to 12 h
commonly occurs following a blood transfusion.
15. NONINFECTIOUS CAUSES
ARDS may progress to a "chronic" stage characterized
by pulmonary fibroproliferation and fevers
ACALCULOUS CHOLECYSTIS occurs in approximately
1.5% of critically ill patients. An important
"noninfectious" cause of fever in critically ill patients, as
it is frequently unrecognized and therefore potentially
life threatening
The pathophysiology of acalculous cholecystitis is related
to the complex interplay of a number of pathogenetic
mechanisms, including gallbladder ischemia, bile stasis with
inpissation in the absence of stimuli for emptying of the
gallbladder, positive-end expiratory pressure, and
parenteral nutrition.
Bacterial invasion of the gallbladder appears to be a
secondary phenomenon.
The diagnosis of acalculous cholecystitis is often
exceedingly difficult and requires a high index of suspicion.
Pain in the right upper quadrant is the finding that most
often leads the clinician to the correct diagnosis, but it may
frequently be absent.
16. NONINFECTIOUS CAUSES
The most difficult patients are those recovering from
abdominal sepsis who deteriorate again, misleadingly
suggesting a flare-up of the original infection.
Rapid diagnosis is essential because ischemia may
progress rapidly to gangrene and perforation, with
attendant increase in the already high morbidity and
mortality
The diagnosis should therefore be considered in every
critically ill patient who has clinical findings of sepsis
with no obvious source
Ultrasound is the most common radiologic investigation
used in the diagnosis of acalculous cholecystitis
Features include increased wall thickness, intramural
lucencies, gallbladder distension, pericholecystic fluid,
and intramural sludge. Wall thickness 3 mm is reported
to be the most important diagnostic feature on
ultrasound examination, with a specificity of 90% and a
sensitivity of 100%.
Percutaneous cholecystostomy may be the procedure of
choice
Posterative fever upto 48 Hrs.
17.
18. VENTILATOR-ASSOCIATED
PNEUMONIA
occurs in approximately 25% of
patients undergoing mechanical
ventilation
Fagon and colleagues reported an
attributable mortality of 27%.
Diagnosis of VAP remains one of the
most difficult clinical dilemmas in
critically ill patients receiving
mechanical ventilation
initial empiric antibiotic regimen must
be broad and cover both Gram-
positive and negative organisms,
19. DIAGNOSTIC APPROACH
A thorough review of the medical history and a full physical
examination should be performed whenever a patient develops
an unexplained fever in the ICU.
Blood cultures are the only mandatory diagnostic tests in patients
with a new fever
SPUTUM..
indicated for febrile patients with any of the following findings
new sputum production; a change in the color, amount, or
thickness of their sputum.
a new or progressive pulmonary infiltrate.
an increased respiratory rate.
an increased minute volume; a decreased tidal volume;
decreased oxygenation.
needing more ventilatory support; or requiring more inspired
oxygen.
20. DIAGNOSTIC APPROACH
URINE .
Urinalysis and urine culture are
indicated for febrile patients with
○ a urethral catheter.
○ urinary obstruction.
○ renal calculi.
○ recent genitourinary surgery or trauma,
or neutropenia.
21. DIAGNOSTIC APPROACH
CHEST IMAGING
A chest radiograph is worthwhile in
many patients with
respiratory symptoms or signs.
It may detect a new or progressive
pulmonary infiltrate.
distinguish pneumonia from
tracheobronchitis, or identify a respiratory
source of fever other than pneumonia or
tracheobronchitis
Computed tomography (CT) should be
reserved for the clarification of abnormal
chest radiographic findings.
22. DIAGNOSTIC APPROACH
S.CHEMISTRY
Done for LFT, Urine fucntions,
electrolyte imbalance
TFT(THYROID FUCTION TEST)
Done if thyroid storm is suspected
23.
24. Blood Cultures
B/C should be obtained in patients with a new fever
when clinical evaluation does not strongly suggest a
noninfectious cause
Skin Preparation
The site of venipuncture should be cleaned with either
2% chlorhexidine gluconate in 70% isopropyl alcohol
(2% alcoholic chlorhexidine), or 1–2% tincture of iodine
(iodine in alcohol). Povidone iodine (10%), although
acceptable, is a less efficient agent.
When blood is to be inoculated into a culture or
transport tube, the needle used for venipuncture should
not be replaced by a sterile needle. The risk of a needle
stick injury during the switch in needles is currently
thought to outweigh the risk of contamination
25. Blood Cultures
Blood Volume and Collection System
One blood culture is defined as a sample of 20–30
mL of blood drawn at a single time from a single
site, regardless of how many bottles or tubes the
laboratory may use to process the specimen.
The sensitivity of B/C → obtaining the cultures
before the initia-tion of anti-infective therapy and
the volume of blood drawn
26. Blood Cultures
Number of Cultures and Sites
3-4 B/C with adequate volume (20–30 mL each) are
drawn within the first 24 hrs of suspected bacteremia
or fungemia
Each culture should be drawn by separate venipuncture
or through a separate intravascular device but not
through multiple ports of the same intravascular
catheter
There is no evidence that the yield of cultures drawn
from an artery is different from the yield of cultures
drawn from a vein.
Culture from the device (+) and from venipuncture (-);
the positive culture may represent a contaminant or a
catheter-related infection, but clinical judgment rather
than any rigid criteria is needed to interpret the
significance of discordant results
27. Blood Cultures
Labeling
Blood cultures should be clearly
labeled with the exact time, date,
and anatomic site or catheter lumen
from which blood is drawn and also
include other information
(concomitant antimicrobial therapy)
that may be appropriate.
28. Recommendations for
Obtaining
Blood Cultures
1. 3-4 B/C within the first 24 hrs of the onset of fever
(level 2)
2. Additional B/Cx2: suspicion of continuing or
recurrent bacteremia or fungemia or 48–96 hrs after
initiation of appropriate therapy for
bacteremia/fungemia. (level 2).
3. P’ts without an indwelling vascular catheter, obtain
at least two blood cultures using strict aseptic
technique from peripheral sites by separate
venipunctures after appropriate disinfection of the skin
(level 2).
4. 2% chlorhexidine gluconate in 70% isopropyl alcohol,
but tincture of iodine is equally effective. 30 secs of
drying time before proceeding with the culture
procedure. Povidone iodine is an acceptable alternative,
but it must be allowed to dry for 2 mins (level 1)
29. Recommendations for
Obtaining
Blood Cultures
5. The injection port of the blood culture bottles should
be wiped with 70–90% alcohol before injecting the
blood sample into the bottle to reduce the risk of
introduced contamination (level 3)
6. P’t with intravascular catheter→one B/C from
venipuncture and at least one culture from
intravascular catheter. Obtaining blood cultures
exclusively through intravascular catheters yields
slightly less precise information than information
obtained when at least one culture is drawn by
venipuncture (level 2).
7. Label the blood culture with the exact time, date,
and anatomic site from which it was taken (level 2).
8. Draw 20–30 mL of blood per culture (level 2).
31. REFERRENCES
Critical Care medicine 2008
UPtoDate 2012
Harrison book of Medicine
Guidelines for evaluation of new fever in critically ill
adult patients: 2008 update from the American
College of Critical Care Medicine and the Infectious
Disease Society of America.