The document discusses various aspects of human body water content and distribution. It notes that water makes up 50-60% of total body weight, with 40% being intracellular fluid, 20% extracellular fluid, and 15% interstitial fluid. It also discusses fluid compartments, mechanisms of fluid movement, electrolyte concentrations, fluid requirements, types of intravenous fluids and their properties, and considerations in fluid resuscitation.
Holley analyses the cascade of events in bleeding trauma patients leading to Australia's latest evidenced-based guidelines on transfusion protocols in critical bleeding.
Holley analyses the cascade of events in bleeding trauma patients leading to Australia's latest evidenced-based guidelines on transfusion protocols in critical bleeding.
Powerpoint slides for Association of Anaesthetists Winter Scientific Meeting, London, Jan 2011.
"Which fluids and when?"
Speaker Dr Craig Morris, Derby, UK
fluid optimization concept based on dynamic parameters of hemodynamic monitoringSurendra Patel
Recent advances in hemodynamic monitoring to assess fluid responsiveness of patients in acute circulatory failure is based on dynamic parameters like SPV, PPV, SVV and PVI. These parameters are more accurate than static but needs advanced and sensitive monitoring tools.
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.
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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.
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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.
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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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
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ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
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
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
20. Intake and output must be balanced.
Intake---N fluid ingested—2100 +from
metabolism(200)=2300ml
output—urine-1400+feces(100)
-sweat-100
- insensible loses—skin-
350+lungs350ml
Subject to variation environmental condition and
disease states
21. Weight Water requirement
0-10 kg 4mL/kg/hr
10-20 kg 40mL/hr +2ml/kg/hr for each kg>10kg
>20kg 60ml/hr +1ml/kg/hr for each
kg>20kg
for 60kg man this = 100ml/hr or 2400 ml/24 hrs
for normal people!!
24. Crystalloids
relatively large volume
for resus
Ideal for repleshing
third space loss
Less fear of allergic
reaction
Used as diluent for
ionotropic
adminstration
Colloids
Lesser volume better
expander more
duration
Allergic reaction seen
as well interfearance
with blood
crossmatch
25. R.L hartmen “solution,
balanced salt solution
Isotonic -isobaric- iso-
osmolar- crystalloid
solution.
Concentrations of ions—
Na-131mEq/l
calcium-2mEq/l
bicarbonate-29mEQ/L AS
LACTATE
K+ 5MeQ/L, CL- 110mEq/l
Ph-6.5,osmolarity-279
mosm/L
Normal saline Isotonic
isobaric 0.9% w/vsolution
Na+/cl- =154mEq/l Ph-5.0
0smolarity -308mosm/L
--common maintainence
fluid till other are made
available
---in treatment of diabetic
ketoacidosis—2 litres
--upper intestinal
obstruction and
hypochloremia
26. RL-Solutions provides
electrolytes with lactate.
Lactate is rapidly metabolized
in liver to bicarbonate helps in
correction of acidosis
Mild to moderate hypovolemia
due to any cause
As a maintainence fluid
Preloading before spinal
anaesthesia
Risk—Lactic acidosis
hyperkalemia
NS-Only fluid compatible with
blood.
Flushing of dialysis set with
saline Surgeons use for –
washing crush injuries
peritoneal lavage
under water seal bottle
Can be used as diluent for
medication
NS-RISK-Hyperchloraemic
metabolic acidosis more likely
with renal insufficiency
27. FULFILLS INDICATIONS OF BOTH 5% DEX
AND .9% SALINE
Useful particularly in pediatric patient
Safely be used as maintainence fluid.
Avoid for surgical procedures as dex best media
for bacterial growth
Can be used along with blood
28. It provides calories –each gm of glucose 4 kcal.
--used to correct water deficit
--used to correct hypoglycemia
--used as carrier for giving drugs
dopamine,
aminophylline,noradrenaline,insulin,SNP
29. Higher concentration is irritant to vien.
Avoid extravasation
Water intoxication,odema states
Should not be given along with blood transfusion
Avoid in known hyperglycemic as maintainence
fluid
30. Hemaccel 3.5% poly gelatin
Na 145/cl 145 k-5.1, ca++-6.25mEq/l
Mol wt 30,000 pH 7.3
Half life 4-6hr
Use in mod to severe shock.
Priming solution
31. Citrated blood should not be mixed.
Produces histamine release/anaphylactic
Dose should not increase 1000ml in 24 hrs.
Careful in digitalized patient
Avoid in hepatic renal and CCF
However unlike other colloids does not cause
agglutination and Rolex formation
32. 6% SOLUTION mol wt-2,00,000da
Dose 20ml/kg in 24 h
These are hyperoncotic and cause intravascular
volume expansion
Duration 12-24 hrs
The incidence of anphylactoid reaction is low
33. IT interferes PL Aggregation and coagulation.
Thermo osmalarity-308mosm/l
Ability to with draw fluid from interstital space in to
intravascular compartment
It should be cautiously used in presence of renal
failure
34. Dextran 40/ rheomacrodex
--IT decreases viscosity of blood.
--it improves micro circulation.
--plasma half life 6-12hrs
--dose 20 cc/kg/24hrs
--it does not interfere with blood gp and
crossmatch
35. Accumulation and tissue storage
Effects on renal function
Coagulopathy and bleeding risk
Increase in amylase levels
Anaphylactic potentials
Cost factors
36. New generation colloids-0.4 Molar
substitution==degradation factor
hydroxyl ethyl group
No risk of accumulation even with dosages increased
from 20ml/kg---50ml/kg
No effects on renal and coagulopathy
Quest for the new colloid--
Balanced colloid solution like volulyte will end the debate
41. Fluid resuscitation in uncontrolled
bleeding is deleterious
Delayed resuscitation is valid in trauma
systems with short response times
(<20 minutes to hospital from injury)
Attempts to control bleed should be given
greater importance
42. Fluids (pre-op) 2.4 L 0.4 L (p<0.001)
Survival 62% 70% (p=0.04)
ARDS/ renal failure 30% 23% (p=0.08)
Sepsis/ infection
Hospital days 14+24 11+19 (p=0.006)
N Engl J Med 1994;
331:1105-1109.
598 patients; penetrating torso injury
Field systolic BP <90 mm Hg (58+35)
309 289
Immediate fluids Delayed until induction
46. PERIPHERIAL INTRACATH 16G
Same gauze central line
Hagen poiseuille equation rate @{radius} 4th
power
inversely proportional to length
:;; infusion through central catheter will be as
much as 75% less than infusion rate through
peripheral cathter of equal diameter
47. Fluid resuscitation may consist of natural or
artificial colloids or crystalloids
No evidenced-based support for one type
of fluid over another
•Crystalloids have a much larger volume of
distribution compared to colloids
•Crystalloid resuscitation requires more fluid to
achieve the same endpoints as colloid
•Crystalloids result in more edema
Choi PTL. Crit Care Med 1999;27:200-210.
Cook D. Ann Intern Med 2001;135:205-208.
Schierhout G. BMJ 1998;316:961-964.
Fluid Therapy: Choice of FluidFluid Therapy: Choice of Fluid
Grade C
Dellinger, et. al. Crit Care Med 2004, 32: 858-873.
48. Fluid challenge in patients with suspected
hypovolemia may be given
500 - 1000 mL of crystalloids over 30 mins
300 - 500 mL of colloids over 30 mins
Repeat based on response and tolerance
Input is typically greater than output due to
venodilation and capillary leak
Most patients require continuing aggressive
fluid resuscitation during the first 24 hours of
management
Fluid Therapy: Fluid ChallengeFluid Therapy: Fluid Challenge
Grade E
Dellinger, et. al. Crit Care Med 2004, 32: 858-873.
49. Central venous pressure (CVP) 8–12 mmHg
– Mean arterial pressure (MAP) 65 mmHg
– Urine output 0.5 ml/kg h1
– Central venous (superior vena cava) or mixed
venous oxygen saturation 70%.
Rationale. Early goal-directed therapy
(EGDT)
51. Blood Pressure—not a sensitive marker until
blood loss >30%
NIBP-spuriously low measurement in patient with
hypovolemia (vasoconstrictor response)
Direct IAP better ?
Cardiac filling pressures
CVP—limitation—Indirect measure
52. Change in CVP measured before
and 5 mins after bolus of fluid
◦0-3 mmHg: underfilled
◦3-5 mmHg: adequately filled
◦5-7 mmHg: overfilled
53. 1 a wave is due to atrial
contraction
2.c wave due to buldging
of tricuspid valve in rt
atrium
3 x descent depicts atrial
relaxation
4 v due to rise in atrial
pressure before the
tricuspid valve opens
5 y decent is due to atrial
emptying as blood enters
ventricles
No evidence-based support for one type of crystalloid over another No studies that are specific to sepsis population Note: since development of these guidelines the preliminary results of the SAFE (Fluid resuscitation with Albumin vs. Saline) study results have been reported at the Society of Critical Care Medicine National Scientific Meeting held in Feb. 2004. This randomized controlled trial of over 7,000 patients demonstrated that in the subset of severe sepsis patients there was a mortality benefit with albumin over saline (RR .087; CI 0.74-1.02). This data set was locked in late 2003; therefore, final manuscript publication is pending.
Fluid Challenge describes the initial volume expansion period in which the patient’s response is closely monitored. Fluid Challenge must be clearly separated from an increase in maintenance fluid administration Response may be measured by increase in blood pressure and urine output Tolerance may be measured by evidence of intravascular volume overload Input/output ratio is of no utility to judge fluid resuscitation during this time period