Fluid management in adults involves balancing fluid intake and losses to maintain homeostasis. The body contains total body water (TBW) divided between intracellular fluid (ICF) and extracellular fluid (ECF). Water and electrolyte requirements are met through maintenance fluids which are administered based on weight. Additional fluids must be given to replace deficits from fasting, ongoing losses, blood loss, and third spacing during surgery. Fluid status is monitored for signs of hypo- or hypervolemia, and fluid therapy is adjusted based on the patient's condition and fluid balance. Proper fluid management is critical in the perioperative period to prevent organ hypoperfusion.
Fluid and electrolytes management in post op patientsDr.Sonal Dixit
sonal dixit , mbbs , ms obg
After surgery modification in normal physiology of fluid and electrolytes balance.
- ACUTE STRESS leads to increased sympathetic stimuli- tachycardia, vasoconstriction & stress.
Increased ACTH stimulate adrenal gland which secretes large amount of hydrocortisone to fight acute stress and aldosterone which leads to Na retension and urinary loss of K.
Fluid Therapy is the administration of fluids to a patient as a treatment or preventative measure. It can be administered via an intravenous, intraperitoneal, intraosseous, subcutaneous and oral routes. 60% of total bodyweight is accounted for by the total body water.
Different fluids can be
cyrstalloids, colloids, hypertonic saline, hypotonic saline, ringer lactate.
This PPT gives an idea to MBBS students about the Type of fluids, Calculating the daily requirements as well as the drop rate to be used in day today clinical practice.
Fluid and electrolytes management in post op patientsDr.Sonal Dixit
sonal dixit , mbbs , ms obg
After surgery modification in normal physiology of fluid and electrolytes balance.
- ACUTE STRESS leads to increased sympathetic stimuli- tachycardia, vasoconstriction & stress.
Increased ACTH stimulate adrenal gland which secretes large amount of hydrocortisone to fight acute stress and aldosterone which leads to Na retension and urinary loss of K.
Fluid Therapy is the administration of fluids to a patient as a treatment or preventative measure. It can be administered via an intravenous, intraperitoneal, intraosseous, subcutaneous and oral routes. 60% of total bodyweight is accounted for by the total body water.
Different fluids can be
cyrstalloids, colloids, hypertonic saline, hypotonic saline, ringer lactate.
This PPT gives an idea to MBBS students about the Type of fluids, Calculating the daily requirements as well as the drop rate to be used in day today clinical practice.
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
Fluid and electrolyte management in surgical patients.KETAN VAGHOLKAR
Fluid and electrolyte management has to be aggressive. It is pivitol in speedy recovery in GI surgery. Changes should be anticipated and treated promptly. A detailed knowledge of this is essential for optimum management especially in the ICU.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
Fluid and electrolyte management in surgical patients.KETAN VAGHOLKAR
Fluid and electrolyte management has to be aggressive. It is pivitol in speedy recovery in GI surgery. Changes should be anticipated and treated promptly. A detailed knowledge of this is essential for optimum management especially in the ICU.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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.
- 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
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
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2 Case Reports of Gastric Ultrasound
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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
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
6. Biomedical Importance of Water
Homeostasis (CES)
Water distribution
PH maintenance
Maintain Electrolyte Concentration
Set of Fluid Balance
Depletion (dehydration)
Intoxication (over-hydration)
Osmotic & non osmotic mechanism
7. Body Fluid Compartments:
2/3
X 50~70%
lean body weight
TBW
3/4
Male (60%) > female (50%)
TBW(Total Body Water)=0.6xBW
ICF:
55%~75%
1/3
ECF
ICF=0.4xBW
ECF=0.2xBW
1/4
Extravascular
àInterstitial
fluid
Intravascular
àplasma
8. Mr.Iron, 60-Kg male, he has......IVW
Ans:
60Kg x 60%(man) x
1/3(ECF) x 1/4(IV) =
3kg intravascular water
(about 3000 ml plasma)
16. Maintenance Fluid:
Water require, Rule:
100-50-20(60kg=2300ml/day)
100ml/kg/d(for 1st 10kg) +50ml/kg/d(for 2nd 10kg)+20ml/kg/d(per add 1 kg)
4-2-1(60kg=100ml/hr=2400ml/day)
4ml/kg/hr(for 1st 10kg) +2ml/kg/hr(for 2nd 10kg)+1ml/kg/hr(per add 1 kg)
1.5ml/kg/hr(60kg=90ml/hr=2160ml/day)
Electrolytes require:
- Na+: 2-3mmol/kg/day
- K+: 1~2mmol/kg/day
Glucose supplement(if NPO):
100~150g dextrose/per day
"Two stereoisomers (isomeric molecules
whose atomic connectivity is the same but
whose atomic arrangement in space is
different.) of the aldohexose sugars are
known as glucose, only one of which (Dglucose) is biologically active. This form
(D-glucose) is often referred to as dextrose
monohydrate, or, especially in the food
industry, simply dextrose (from
dextrorotatory glucose).
17. Mr.Iron, 60-Kg male, NPO
Maintenance Fluid......
1. Daily Na Requirement=3meq/kg ×60kg=180meq
Daily K Requirement=1meq/kg ×60kg=60meq
2. Maintenance water=2300ml=2.3L
3. 【Na】of fluid=180meq÷2.3L=
78meq/L≒1/2 normal saline
4. 0.9%NaCl=154meq/L
18. MAINTENANCE vs. REPLACEMENT
n Maintenance:
• Provide normal daily requirements:
• Water: 2.5 L
• Sodium ½ or ¼ NS
• KCl 40-60 meq
n Example:
D5 ½ NS with KCL 20 meq/L running at 100 ml/hr
21. Parenteral Fluid Therapy:
Crystalloids:
- contain Na as the main osmotically
active particle
- useful for volume expansion (mainly
interstitial space)
- for maintenance infusion
- correction of electrolyte abnormality
22. Crystalloids:
Isotonic crystalloids
- Lactated Ringer’s, 0.9% NaCl
- only 25% remain intravascularly
Hypertonic saline solutions
- 3% NaCl
Hypotonic solutions
- D5W, 0.45% NaCl
- less than 10% remain intravascularly, inadequate for fluid
resuscitation
23. Colloid Solutions:
Contain high molecular weight
substancesàdo not readily migrate across
capillary walls
Preparations
- Albumin: 5%, 25%
- Dextran
- Gelofusine
- Voluven
28. NPO and other deficits
• NPO deficit =number of hours NPO x
maintenance fluid requirement.
• Bowel prep may result in up to 1 L fluid
loss.
29. Third Space Losses
• Isotonic transfer of ECF from functional body
fluid compartments to non-functional
compartments.
• Depends on location and duration of surgical
procedure, amount of tissue trauma, ambient
temperature, room ventilation.
Department of Anesthesiology
Uniformed Services University of the Health Sciences
30. Replacing Third Space Losses
• Superficial surgical trauma: 1-2 ml/kg/hr
• Minimal Surgical Trauma: 3-4 ml/kg/hr
- head and neck, hernia, knee surgery
• Moderate Surgical Trauma: 5-6 ml/kg/hr
- hysterectomy, chest surgery
• Severe surgical trauma: 8-10 ml/kg/hr (or more)
- AAA repair, nehprectomy
Department of Anesthesiology
Uniformed Services University of the Health Sciences
34. Other factors
• Ongoing fluid losses from other sites:
- gastric drainage
- ostomy output
- diarrhea
- PTGBD, T-tube
• Replace volume per volume with crystalloid solutions
35. Blood Loss
• Replace 3 cc of crystalloid solution per cc of blood
loss (crystalloid solutions leave the intravascular
space)
• When using blood products or colloids replace blood
loss volume per volume
36. Example
• Mr.Michelin, 62 y/o male, 80 kg, for hemicolectomy
• NPO after 2200, surgery at 0800, received bowel prep
• 3 hr. procedure, 500 cc blood loss
• What are his estimated intraoperative fluid
requirements?
37. Example (cont.)
• Ans:
• Fluid deficit: 1.5 ml/kg/hr x 10 hrs = 1200 ml + 1000
ml for bowel prep = 2200 ml
• Maintenance: 1.5 ml/kg/hr x 3hrs = 360mls
• Third Space Losses: 6 ml/kg/hr x 3 hrs =1440 mls
• Blood Loss: 500ml x 3 = 1500ml
• Total = 2200+360+1440+1500=5500mls
41. Orthostatic Hypotension
• Systolic blood pressure decrease of greater than
20mmHg from supine to standing
• Indicates fluid deficit of 6-8% body weight
- Heart rate should increase as a compensatory
measure
- If no increase in heart rate, may indicate
autonomic dysfunction or antihypertensive drug
therapy
42. Clinical Diagnosis of Hypovolemia:
Thorough history taking: poor intake, GI
bleeding…etc
BUN : Creatinine > 20 : 1
- BUN↑: hyperalimentation, glucocorticoid
therapy, UGI bleeding
Increased specific gravity
Increased hematocrit
Electrolytes imbalance
Acid-base disorder
45. Management of Hypervolemia:
Prevention is the best way
Guide fluid therapy with CVP level or
pulmonary wedge pressure
Diuretics
Increase oncotic pressure: FFP or
albumin infusion (may followed by diuretics)
Dialysis
46.
47. Summary
• Fluid therapy is critically important during the
perioperative period.
• The most important goal is to maintain hemodynamic
stability and protect vital organs from hypoperfusion
(heart, liver, brain, kidneys).
• All sources of fluid losses must be accounted for.
• Good fluid management goes a long way toward
preventing problems.