FLUID THERAPY AND ELECTROLYTE MANAGEMENT final.pptx
•Download as PPTX, PDF•
2 likes•243 views
This document discusses fluid therapy and electrolyte management. It compares different intravenous fluid options, including their electrolyte compositions, advantages, and disadvantages. Saline is the cheapest fluid but can cause hyperchloremic acidosis. Ringer's lactate is cheaper than balanced salt solutions but can cause metabolic alkalosis in some cases. Plasmalyte and Sterofundin have a higher strong ion difference which helps correct acidosis, but they are more costly. The document also notes factors that increase water requirements such as fever, burns, and gastrointestinal losses.
Report
Share
Report
Share
Recommended
Fluid therapy
This document discusses intravenous fluid therapy and transfusion therapy. It provides details on fluid compartments in the body, various intravenous fluid solutions including crystalloids, colloids, isotonic, hypotonic and hypertonic solutions. It describes how to assess fluid status and calculate fluid requirements during surgery. Complications of blood transfusion are outlined as well as components of blood that can be transfused. Vigilance is important when administering blood products due to risks of transfusion reactions and disease transmission.
Inotropes
This document discusses various inotropic drugs used to increase the contractility of the heart. It describes the mechanisms and indications for commonly used inotropes like dobutamine, dopamine, epinephrine, milrinone and digoxin. Precise dosing guidelines and dilution methods are provided for each drug. Potential side effects and nursing considerations are also summarized for safe administration of inotropic therapy.
Crystalloids
Crystalloid solutions are aqueous solutions of low-molecular-weight ions (salts) with or without glucose. They are used to provide maintenance of water, electrolytes, and intravascular fluid volume. Common crystalloid solutions include normal saline (0.9% NaCl), Ringer's lactate, dextrose 5% in water, and dextrose normal saline. Each solution has different properties and indications/contraindications depending on its electrolyte content and osmolarity. Crystalloids are distributed between intravascular and extracellular fluid spaces after administration and have a more transient hemodynamic effect than colloid solutions.
Iv fluids
The document discusses essential questions to consider before prescribing intravenous fluids, including whether the patient needs fluids, if it is for resuscitation, replacement, or maintenance, assessing the patient's electrolyte status, determining the safest administration route, and choosing the appropriate fluid. It also covers fluid physiology, types of IV fluids, principles of fluid prescribing, risks of overhydration, monitoring patients, and comparing crystalloids versus colloids. The key aspects are determining the clinical need and goals of fluid therapy, conducting an electrolyte assessment, choosing a simple and safe administration method, and selecting the fluid that best matches the patient's condition and needs.
Management of Pain in the ICU
Clinical Practice Guidelines for the Management of Pain in Adult Patients in the ICU
Crit Care Med 2013; 41:263–306
Inotropes
This document discusses inotropes, which are drugs that increase the force of myocardial contraction. It defines inotropes and discusses their physiological effects and classification. Various endogenous and exogenous inotropic agents are described in detail, including their mechanisms of action, indications, dosages, pharmacokinetics and side effects. Sympathomimetic drugs like epinephrine, norepinephrine and dopamine are discussed as conventional positive inotropic agents.
IV FLUIDS PART1
DIFFERENT TYPES OF IV FLUIDS
FLUID COMPARTMENTS & VARIOUS MODELS
HOW IV FLUIDS ARE DISTRIBUTED AMONG VARIOUS COMPARTMENTS
ADVERSE EFFECTS
Arterial line analysis
1) An arterial line allows continuous monitoring of a patient's blood pressure by connecting an arterial catheter to a pressure transducer. The transducer converts pressure oscillations into an electrical waveform displayed on a monitor.
2) The arterial waveform provides information about cardiovascular physiology and hemodynamics. An accurate waveform depends on proper catheter placement, monitoring equipment setup, and avoiding issues like dampening or resonance.
3) Key portions of the arterial waveform include the anacrotic limb, representing ventricular ejection; the dicrotic notch, indicating aortic and pulmonary valve closure; and stroke volume variance seen with respiration. Proper waveform analysis guides fluid and pressor management.
Recommended
Fluid therapy
This document discusses intravenous fluid therapy and transfusion therapy. It provides details on fluid compartments in the body, various intravenous fluid solutions including crystalloids, colloids, isotonic, hypotonic and hypertonic solutions. It describes how to assess fluid status and calculate fluid requirements during surgery. Complications of blood transfusion are outlined as well as components of blood that can be transfused. Vigilance is important when administering blood products due to risks of transfusion reactions and disease transmission.
Inotropes
This document discusses various inotropic drugs used to increase the contractility of the heart. It describes the mechanisms and indications for commonly used inotropes like dobutamine, dopamine, epinephrine, milrinone and digoxin. Precise dosing guidelines and dilution methods are provided for each drug. Potential side effects and nursing considerations are also summarized for safe administration of inotropic therapy.
Crystalloids
Crystalloid solutions are aqueous solutions of low-molecular-weight ions (salts) with or without glucose. They are used to provide maintenance of water, electrolytes, and intravascular fluid volume. Common crystalloid solutions include normal saline (0.9% NaCl), Ringer's lactate, dextrose 5% in water, and dextrose normal saline. Each solution has different properties and indications/contraindications depending on its electrolyte content and osmolarity. Crystalloids are distributed between intravascular and extracellular fluid spaces after administration and have a more transient hemodynamic effect than colloid solutions.
Iv fluids
The document discusses essential questions to consider before prescribing intravenous fluids, including whether the patient needs fluids, if it is for resuscitation, replacement, or maintenance, assessing the patient's electrolyte status, determining the safest administration route, and choosing the appropriate fluid. It also covers fluid physiology, types of IV fluids, principles of fluid prescribing, risks of overhydration, monitoring patients, and comparing crystalloids versus colloids. The key aspects are determining the clinical need and goals of fluid therapy, conducting an electrolyte assessment, choosing a simple and safe administration method, and selecting the fluid that best matches the patient's condition and needs.
Management of Pain in the ICU
Clinical Practice Guidelines for the Management of Pain in Adult Patients in the ICU
Crit Care Med 2013; 41:263–306
Inotropes
This document discusses inotropes, which are drugs that increase the force of myocardial contraction. It defines inotropes and discusses their physiological effects and classification. Various endogenous and exogenous inotropic agents are described in detail, including their mechanisms of action, indications, dosages, pharmacokinetics and side effects. Sympathomimetic drugs like epinephrine, norepinephrine and dopamine are discussed as conventional positive inotropic agents.
IV FLUIDS PART1
DIFFERENT TYPES OF IV FLUIDS
FLUID COMPARTMENTS & VARIOUS MODELS
HOW IV FLUIDS ARE DISTRIBUTED AMONG VARIOUS COMPARTMENTS
ADVERSE EFFECTS
Arterial line analysis
1) An arterial line allows continuous monitoring of a patient's blood pressure by connecting an arterial catheter to a pressure transducer. The transducer converts pressure oscillations into an electrical waveform displayed on a monitor.
2) The arterial waveform provides information about cardiovascular physiology and hemodynamics. An accurate waveform depends on proper catheter placement, monitoring equipment setup, and avoiding issues like dampening or resonance.
3) Key portions of the arterial waveform include the anacrotic limb, representing ventricular ejection; the dicrotic notch, indicating aortic and pulmonary valve closure; and stroke volume variance seen with respiration. Proper waveform analysis guides fluid and pressor management.
Fluid and electrolyte management
Fluid and electrolyte management is important for perioperative care. Key points include:
1. Body water is divided into intracellular fluid and extracellular fluid. Common IV fluids contain different electrolyte concentrations and osmolarities.
2. Crystalloids expand plasma volume but leave the intravascular space quickly, while colloids remain intravascular longer but do not correct electrolyte deficiencies.
3. Perioperative fluid management aims to replace pre-existing deficits, normal maintenance needs, and abnormal surgical losses like blood loss, third spacing, and insensible losses. Close monitoring of fluid status is important.
Hypernatremia
Hypernatremia is a serum sodium level over 145 mEq/L, occurring in 1% of hospitalized patients with high mortality regardless of acute or chronic onset. It can be caused by hypovolemia due to fluid losses exceeding intake, euvolemia from excess skin and lung losses, or hypervolemia from concentrated saline or mineralocorticoid excess. Symptoms include GI issues, dry skin and mucosa, neurologic changes like restlessness and seizures, and cardiovascular abnormalities depending on volume status. Treatment involves gradually decreasing sodium levels with hypotonic fluids and restricting dietary sodium intake.
Diabetes ketoacidosis
The document discusses diabetic ketoacidosis (DKA), providing definitions, pathophysiology, precipitating events, symptoms, diagnosis, and treatment. DKA is defined as hyperglycemia, ketosis, and acidemia. It results from insulin deficiency leading to lipolysis, ketogenesis, and hyperglycemia. Common causes include infection, inadequate insulin, drugs like cocaine, and pregnancy. Treatment involves fluid resuscitation, insulin therapy to lower glucose levels to 140-180 mg/dL, electrolyte replacement, and treating the underlying precipitant once the patient is stabilized. Potassium levels require close monitoring during treatment.
Fluid & Electrolyte balance by Dr Nesar
This document discusses fluid balance and fluid therapy. It begins by defining fluid balance as when water intake equals water loss each day. It then discusses total body water content and its compartments. Key points include that intravenous fluids can be classified as crystalloids or colloids. Common crystalloid fluids discussed include normal saline, Ringer's lactate, dextrose 5%, and Isolyte solutions. Albumin and dextran are presented as examples of colloid fluids. Indications, contraindications, and complications of various intravenous fluids are provided.
Cvp
The document discusses central venous pressure (CVP) monitoring. It aims to explain what CVP is, the purposes and indications for monitoring it, the equipment needed, nursing roles and responsibilities, potential complications, and how to interpret CVP readings. Specifically, CVP refers to the blood pressure in the right atrium and is monitored using a catheter placed in the jugular or subclavian vein. CVP provides information about a patient's fluid balance, circulating blood volume, and right heart function. Nurses must understand how to set up monitoring equipment properly and know that abnormal CVP readings should be considered in the full clinical context of the patient.
Management of sepsis
The document provides an overview of the management of sepsis and septic shock. It discusses that early goal-directed therapy within the first 6 hours including antibiotics, fluids, vasopressors and inotropes if needed can significantly improve outcomes. Other key points covered include the definitions and diagnostic criteria for sepsis; appropriate antibiotic therapy and vasopressor use; importance of lung-protective ventilation; role for activated protein C, steroids, tight glucose control and renal replacement therapy. Prognosis depends on early recognition and treatment as mortality increases significantly with delayed or inadequate care.
Iv fluid therapy (types, indications, doses calculation)
Intravenous fluid therapy is essential for maintaining normal body functioning and hydration. There are three main types of intravenous fluids - colloids, crystalloids, and blood products. Crystalloids include isotonic fluids like 0.9% sodium chloride and lactated Ringer's solution, hypotonic fluids, and hypertonic fluids. Isotonic fluids maintain intravascular volume while hypotonic and hypertonic fluids shift fluid between intravascular and intracellular spaces. Close monitoring is needed with intravenous fluid therapy to avoid complications of overhydration or dehydration.
Intravenous fluid therapy
IV fluid therapy
introduction
body physiology
history
types of ivf
iv fluids in detail
ivf in critical care
NICE guidelines
Fluid therapy
This document discusses pediatric fluid therapy and body fluid compartments. It begins by describing the different fluid compartments in the body, including total body water, extracellular fluid, and intracellular fluid. It then focuses on neonatal fluid management, noting that extracellular fluid is initially greater than intracellular fluid at birth, and describing appropriate intravenous fluid volumes for neonates. The document also discusses fluid requirements in children, evaluation of intravascular volume, choice of fluid types including crystalloids, colloids, and blood products, and provides guidelines for fluid resuscitation in dehydrated children.
Iv fluids
This document provides an overview of intravenous (IV) infusion, including definitions, purposes, types of solutions, equipment used, flow rate calculation, factors affecting flow rate, nursing considerations, and potential complications. Specifically, it defines IV infusion as administering medication or solution into a patient's vein using gravity. It describes various solutions like normal saline, Ringer's lactate, and dextrose that can be used and factors like viscosity and tubing length that influence flow rate. The document emphasizes the importance of assessing patients, maintaining sterile technique, and monitoring for signs of infection, air embolism, or fluid overload during IV therapy.
IV Fluid Therapy
This document discusses intravenous (IV) fluid therapy. It begins by introducing the components of solutions like water and solutes, and the functions of water in the body including transport, waste elimination, and temperature regulation. It then discusses fluid balance, the thirst mechanism, and fluid gains and losses. The document outlines the purposes of IV fluid regulation including rehydration and medication administration. It describes identifying dehydration and types of IV fluids available like crystalloids and colloids. It concludes with nursing considerations for different fluid types and complications of IV fluid treatment.
Propofol
Propofol is an intravenous sedative used for inducing and maintaining general anesthesia. It works by enhancing the effect of the inhibitory neurotransmitter GABA in the brain. Propofol is formulated as a 1% aqueous solution containing soybean oil, glycerol, and egg lecithin. It has a rapid onset of 15-30 seconds, short duration of 5-10 minutes, and is metabolized in the liver. Common uses include anesthesia induction, sedation, and ventilation in ICU patients. Side effects include nausea, cough, and confusion.
Iv Fluid Therapy by Faisal Azmi
The document discusses the history and uses of intravenous (IV) fluids, describing how IV fluids are used to maintain adequate fluid volume and electrolyte balance in the body. It also explains the concepts of osmosis, tonicity, and body fluid compartments as they relate to IV fluid administration and the goals of IV fluid therapy. Specific types of IV fluids, such as crystalloids and colloids, are categorized and their indications, contraindications, and potential complications are outlined.
Fluid and electrolytes
intravenous fluid and electrolytes are important topics in medical science. potassium is one of the vital electrolytes of the human body. this presentation has a discussion on several iv fluids and potassium balance and also how to manage the potassium imbalance.
Sedation analgesia in icu
The document discusses sedation, analgesia, and paralysis in the ICU. It describes the goals of sedation as patient comfort while allowing interaction. The challenges include assessing sedation and altered drug pharmacology. An ideal sedation agent would have rapid onset and offset and lack respiratory depression. Monitoring scales like the Richmond Agitation Scale are used to standardize treatment. Dexmedetomidine, propofol, opioids and paralytics may be used. The optimal sedation approach balances adequate treatment while avoiding oversedation risks.
Care of patient on ventilator
1. The document provides guidelines for the care of patients requiring mechanical ventilation including indications for ventilation, modes of ventilation, troubleshooting alarms, weaning criteria and processes, and complications.
2. Mechanical ventilation is used to support breathing for those unable to maintain adequate oxygen or CO2 levels spontaneously, including those with respiratory failure, neuromuscular diseases, or trauma/illnesses affecting breathing.
3. Modes of ventilation include controlled, assisted, intermittent mandatory, and pressure support modes. Nurses must monitor for alarms related to pressures, volumes, and apnea and address causes such as tubing issues or secretions.
Levetiracetam
Levetiracetam is a white powder that is wholly soluble in water. It is the S-enantiomer form which has anticonvulsant properties, while the R-enantiomer does not. It inhibits calcium channels and prevents the release of calcium from intracellular stores. It is rapidly absorbed after oral administration, has a high bioavailability, and is excreted unchanged in the urine. Common side effects include somnolence, asthenia, and nausea. It is indicated as an adjunctive treatment for partial onset seizures, myoclonus, and primary generalized tonic-clonic seizures in adults and children.
Central line
This document provides information on central venous catheters (CVCs). It defines a CVC as a catheter placed in a large vein, with regular sites being the neck, chest, groin, or peripherally. CVCs are used to administer medications, fluids, obtain blood tests, and measure central venous pressure. The document describes CVC lumen types, catheter types including tunneled and non-tunneled, insertion techniques using the Seldinger method, complications, and care/maintenance of CVCs.
status epilepticus presentation
A 31-year-old male presented with a fever for one week and seizures and altered sensorium for three days. He experienced generalized tonic-clonic seizures that were initially uncontrolled. Imaging showed findings suggestive of viral or autoimmune encephalitis. Refractory status epilepticus was diagnosed and treated with high doses of multiple antiepileptic drugs, including lacosamide, which eventually controlled the seizures. Status epilepticus is defined as a seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur. The pathophysiology involves reductions in inhibitory GABA receptors and increases in excitatory glutamate receptors over time.
management of foreign body inhalation and bronchoscopy in children
This document discusses anesthesia considerations for bronchoscopy procedures to remove foreign body inhalation. It notes that foreign body inhalation is most common in children ages 6 months to 3 years and presents highest risk in that age group due to exploring objects orally and lack of coordination. Rigid bronchoscopy is the standard approach for removal, requiring careful anesthesia to control breathing while the scope is inserted and foreign body extracted. Key goals are maintaining oxygenation and minimizing risks like pulmonary aspiration or dislodging the object during ventilation changes.
Intravenous fluids crystalloids and colloids
Dr. Omar Kamal Ansari from the department of anaesthesiology discusses intravenous fluid therapy. He describes various types of intravenous fluids including crystalloids like normal saline and Ringer's lactate, colloids like albumin and hetastarch, and discusses their indications, contraindications, and complications. He also discusses fluid requirements, osmolality, electrolyte balances, and principles of intravenous fluid administration.
Intravenous fluids
Physical exam findings of hypovolemia include decreased skin turgor, dry mucous membranes, orthostatic hypotension, and decreased jugular venous pressure. Signs of fluid overload include shortness of breath, edema, elevated jugular venous pressure, and crackles. Intravenous fluids are used for hydration, shock, and as vehicles for medications. Crystalloids like normal saline and lactated ringer's are used for initial resuscitation while colloids like albumin and hetastarch provide greater volume expansion over longer periods. Maintenance fluid rates are calculated based on weight and ongoing losses.
More Related Content
What's hot
Fluid and electrolyte management
Fluid and electrolyte management is important for perioperative care. Key points include:
1. Body water is divided into intracellular fluid and extracellular fluid. Common IV fluids contain different electrolyte concentrations and osmolarities.
2. Crystalloids expand plasma volume but leave the intravascular space quickly, while colloids remain intravascular longer but do not correct electrolyte deficiencies.
3. Perioperative fluid management aims to replace pre-existing deficits, normal maintenance needs, and abnormal surgical losses like blood loss, third spacing, and insensible losses. Close monitoring of fluid status is important.
Hypernatremia
Hypernatremia is a serum sodium level over 145 mEq/L, occurring in 1% of hospitalized patients with high mortality regardless of acute or chronic onset. It can be caused by hypovolemia due to fluid losses exceeding intake, euvolemia from excess skin and lung losses, or hypervolemia from concentrated saline or mineralocorticoid excess. Symptoms include GI issues, dry skin and mucosa, neurologic changes like restlessness and seizures, and cardiovascular abnormalities depending on volume status. Treatment involves gradually decreasing sodium levels with hypotonic fluids and restricting dietary sodium intake.
Diabetes ketoacidosis
The document discusses diabetic ketoacidosis (DKA), providing definitions, pathophysiology, precipitating events, symptoms, diagnosis, and treatment. DKA is defined as hyperglycemia, ketosis, and acidemia. It results from insulin deficiency leading to lipolysis, ketogenesis, and hyperglycemia. Common causes include infection, inadequate insulin, drugs like cocaine, and pregnancy. Treatment involves fluid resuscitation, insulin therapy to lower glucose levels to 140-180 mg/dL, electrolyte replacement, and treating the underlying precipitant once the patient is stabilized. Potassium levels require close monitoring during treatment.
Fluid & Electrolyte balance by Dr Nesar
This document discusses fluid balance and fluid therapy. It begins by defining fluid balance as when water intake equals water loss each day. It then discusses total body water content and its compartments. Key points include that intravenous fluids can be classified as crystalloids or colloids. Common crystalloid fluids discussed include normal saline, Ringer's lactate, dextrose 5%, and Isolyte solutions. Albumin and dextran are presented as examples of colloid fluids. Indications, contraindications, and complications of various intravenous fluids are provided.
Cvp
The document discusses central venous pressure (CVP) monitoring. It aims to explain what CVP is, the purposes and indications for monitoring it, the equipment needed, nursing roles and responsibilities, potential complications, and how to interpret CVP readings. Specifically, CVP refers to the blood pressure in the right atrium and is monitored using a catheter placed in the jugular or subclavian vein. CVP provides information about a patient's fluid balance, circulating blood volume, and right heart function. Nurses must understand how to set up monitoring equipment properly and know that abnormal CVP readings should be considered in the full clinical context of the patient.
Management of sepsis
The document provides an overview of the management of sepsis and septic shock. It discusses that early goal-directed therapy within the first 6 hours including antibiotics, fluids, vasopressors and inotropes if needed can significantly improve outcomes. Other key points covered include the definitions and diagnostic criteria for sepsis; appropriate antibiotic therapy and vasopressor use; importance of lung-protective ventilation; role for activated protein C, steroids, tight glucose control and renal replacement therapy. Prognosis depends on early recognition and treatment as mortality increases significantly with delayed or inadequate care.
Iv fluid therapy (types, indications, doses calculation)
Intravenous fluid therapy is essential for maintaining normal body functioning and hydration. There are three main types of intravenous fluids - colloids, crystalloids, and blood products. Crystalloids include isotonic fluids like 0.9% sodium chloride and lactated Ringer's solution, hypotonic fluids, and hypertonic fluids. Isotonic fluids maintain intravascular volume while hypotonic and hypertonic fluids shift fluid between intravascular and intracellular spaces. Close monitoring is needed with intravenous fluid therapy to avoid complications of overhydration or dehydration.
Intravenous fluid therapy
IV fluid therapy
introduction
body physiology
history
types of ivf
iv fluids in detail
ivf in critical care
NICE guidelines
Fluid therapy
This document discusses pediatric fluid therapy and body fluid compartments. It begins by describing the different fluid compartments in the body, including total body water, extracellular fluid, and intracellular fluid. It then focuses on neonatal fluid management, noting that extracellular fluid is initially greater than intracellular fluid at birth, and describing appropriate intravenous fluid volumes for neonates. The document also discusses fluid requirements in children, evaluation of intravascular volume, choice of fluid types including crystalloids, colloids, and blood products, and provides guidelines for fluid resuscitation in dehydrated children.
Iv fluids
This document provides an overview of intravenous (IV) infusion, including definitions, purposes, types of solutions, equipment used, flow rate calculation, factors affecting flow rate, nursing considerations, and potential complications. Specifically, it defines IV infusion as administering medication or solution into a patient's vein using gravity. It describes various solutions like normal saline, Ringer's lactate, and dextrose that can be used and factors like viscosity and tubing length that influence flow rate. The document emphasizes the importance of assessing patients, maintaining sterile technique, and monitoring for signs of infection, air embolism, or fluid overload during IV therapy.
IV Fluid Therapy
This document discusses intravenous (IV) fluid therapy. It begins by introducing the components of solutions like water and solutes, and the functions of water in the body including transport, waste elimination, and temperature regulation. It then discusses fluid balance, the thirst mechanism, and fluid gains and losses. The document outlines the purposes of IV fluid regulation including rehydration and medication administration. It describes identifying dehydration and types of IV fluids available like crystalloids and colloids. It concludes with nursing considerations for different fluid types and complications of IV fluid treatment.
Propofol
Propofol is an intravenous sedative used for inducing and maintaining general anesthesia. It works by enhancing the effect of the inhibitory neurotransmitter GABA in the brain. Propofol is formulated as a 1% aqueous solution containing soybean oil, glycerol, and egg lecithin. It has a rapid onset of 15-30 seconds, short duration of 5-10 minutes, and is metabolized in the liver. Common uses include anesthesia induction, sedation, and ventilation in ICU patients. Side effects include nausea, cough, and confusion.
Iv Fluid Therapy by Faisal Azmi
The document discusses the history and uses of intravenous (IV) fluids, describing how IV fluids are used to maintain adequate fluid volume and electrolyte balance in the body. It also explains the concepts of osmosis, tonicity, and body fluid compartments as they relate to IV fluid administration and the goals of IV fluid therapy. Specific types of IV fluids, such as crystalloids and colloids, are categorized and their indications, contraindications, and potential complications are outlined.
Fluid and electrolytes
intravenous fluid and electrolytes are important topics in medical science. potassium is one of the vital electrolytes of the human body. this presentation has a discussion on several iv fluids and potassium balance and also how to manage the potassium imbalance.
Sedation analgesia in icu
The document discusses sedation, analgesia, and paralysis in the ICU. It describes the goals of sedation as patient comfort while allowing interaction. The challenges include assessing sedation and altered drug pharmacology. An ideal sedation agent would have rapid onset and offset and lack respiratory depression. Monitoring scales like the Richmond Agitation Scale are used to standardize treatment. Dexmedetomidine, propofol, opioids and paralytics may be used. The optimal sedation approach balances adequate treatment while avoiding oversedation risks.
Care of patient on ventilator
1. The document provides guidelines for the care of patients requiring mechanical ventilation including indications for ventilation, modes of ventilation, troubleshooting alarms, weaning criteria and processes, and complications.
2. Mechanical ventilation is used to support breathing for those unable to maintain adequate oxygen or CO2 levels spontaneously, including those with respiratory failure, neuromuscular diseases, or trauma/illnesses affecting breathing.
3. Modes of ventilation include controlled, assisted, intermittent mandatory, and pressure support modes. Nurses must monitor for alarms related to pressures, volumes, and apnea and address causes such as tubing issues or secretions.
Levetiracetam
Levetiracetam is a white powder that is wholly soluble in water. It is the S-enantiomer form which has anticonvulsant properties, while the R-enantiomer does not. It inhibits calcium channels and prevents the release of calcium from intracellular stores. It is rapidly absorbed after oral administration, has a high bioavailability, and is excreted unchanged in the urine. Common side effects include somnolence, asthenia, and nausea. It is indicated as an adjunctive treatment for partial onset seizures, myoclonus, and primary generalized tonic-clonic seizures in adults and children.
Central line
This document provides information on central venous catheters (CVCs). It defines a CVC as a catheter placed in a large vein, with regular sites being the neck, chest, groin, or peripherally. CVCs are used to administer medications, fluids, obtain blood tests, and measure central venous pressure. The document describes CVC lumen types, catheter types including tunneled and non-tunneled, insertion techniques using the Seldinger method, complications, and care/maintenance of CVCs.
status epilepticus presentation
A 31-year-old male presented with a fever for one week and seizures and altered sensorium for three days. He experienced generalized tonic-clonic seizures that were initially uncontrolled. Imaging showed findings suggestive of viral or autoimmune encephalitis. Refractory status epilepticus was diagnosed and treated with high doses of multiple antiepileptic drugs, including lacosamide, which eventually controlled the seizures. Status epilepticus is defined as a seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur. The pathophysiology involves reductions in inhibitory GABA receptors and increases in excitatory glutamate receptors over time.
management of foreign body inhalation and bronchoscopy in children
This document discusses anesthesia considerations for bronchoscopy procedures to remove foreign body inhalation. It notes that foreign body inhalation is most common in children ages 6 months to 3 years and presents highest risk in that age group due to exploring objects orally and lack of coordination. Rigid bronchoscopy is the standard approach for removal, requiring careful anesthesia to control breathing while the scope is inserted and foreign body extracted. Key goals are maintaining oxygenation and minimizing risks like pulmonary aspiration or dislodging the object during ventilation changes.
What's hot (20)
Iv fluid therapy (types, indications, doses calculation)
Iv fluid therapy (types, indications, doses calculation)
management of foreign body inhalation and bronchoscopy in children
management of foreign body inhalation and bronchoscopy in children
Similar to FLUID THERAPY AND ELECTROLYTE MANAGEMENT final.pptx
Intravenous fluids crystalloids and colloids
Dr. Omar Kamal Ansari from the department of anaesthesiology discusses intravenous fluid therapy. He describes various types of intravenous fluids including crystalloids like normal saline and Ringer's lactate, colloids like albumin and hetastarch, and discusses their indications, contraindications, and complications. He also discusses fluid requirements, osmolality, electrolyte balances, and principles of intravenous fluid administration.
Intravenous fluids
Physical exam findings of hypovolemia include decreased skin turgor, dry mucous membranes, orthostatic hypotension, and decreased jugular venous pressure. Signs of fluid overload include shortness of breath, edema, elevated jugular venous pressure, and crackles. Intravenous fluids are used for hydration, shock, and as vehicles for medications. Crystalloids like normal saline and lactated ringer's are used for initial resuscitation while colloids like albumin and hetastarch provide greater volume expansion over longer periods. Maintenance fluid rates are calculated based on weight and ongoing losses.
Fluids
This document summarizes a presentation on fluids and electrolytes given by Dr. Ankit Kaura. It discusses various intravenous fluids including crystalloids like normal saline, Ringer's lactate, and dextrose saline as well as colloids like albumin, dextran, gelatin, and hydroxyethyl starch. For each fluid, the document outlines their composition, pharmacological properties, indications, contraindications, and administration details. The effects of large volume crystalloid infusion and differences between colloids are also summarized.
Medication and fluid therapy.pptx
This document discusses various types of intravenous fluids used in medication and fluid therapy. It describes crystalloid fluids like normal saline and Ringer's lactate, which contain electrolytes and provide intravascular volume expansion. It also discusses dextrose solutions like 5% dextrose and Dextrose saline, which provide calories in addition to fluid. The document outlines the composition, pharmacological effects, indications, and contraindications of these intravenous fluids.
Fluid therapy in canines
This document discusses fluid therapy in canines. It describes the reasons for fluid administration including correcting dehydration, acid-base abnormalities, and electrolyte imbalances. Ringer's lactate solution is preferred for correcting dehydration from diarrhea as the lactate is converted to bicarbonate, while isotonic saline is better for vomiting-induced dehydration to prevent further potassium loss. The document also covers fluid types, calculating fluid deficits, monitoring parameters, and guidelines for fluid administration.
Plasma expanders.pptx
This document discusses different types of volume expanders used to increase blood volume, including crystalloids like normal saline and Ringer's lactate, as well as colloids like albumin, dextrans, gelatin polymers, and hydroxyethyl starch. It provides details on the composition and uses of various fluids, as well as their advantages and disadvantages. The ideal properties of volume expanders are described. Crystalloids expand extracellular volume while colloids are better at expanding plasma volume due to their larger size, though some colloids can interfere with coagulation or cause allergic reactions.
Alcohol metabolism and alcoholism & Fatty liver.pptx
1) Alcohol is metabolized in the liver, where it is oxidized and can cause fatty liver disease if consumed in excess over long periods of time.
2) Both short and long term effects of alcohol consumption are outlined, with short term effects including intoxication and long term effects including liver damage, increased cancer risk, and neurological effects.
3) The biochemical alterations caused by alcohol in the liver are described, including increased acetaldehyde and NADH levels inhibiting the Krebs cycle and causing fatty liver.
Balance fluid therapy.pptx
1. The document discusses balanced fluid therapy and compares various intravenous fluid solutions. It outlines the evolution of infusion solutions from saline to more balanced solutions like Ringer's lactate, Plasmalyte, and Sterofundin.
2. Unbalanced solutions like saline have limitations as they do not contain all essential electrolytes, have electrolyte concentrations different than plasma, are not always isotonic, and lack buffered base. This can lead to issues like hyperchloremic acidosis, dilutional acidosis and disturbances in acid-base balance.
3. More balanced solutions mimic the electrolyte composition of plasma, are isotonic, and contain metabolizable buffers. Studies have found that restrictive use of chloride-lib
Renal replacement therapy
- Renal replacement therapies are important in critical care for managing complications of renal failure such as fluid, electrolyte and acid-base imbalances. There are many questions around optimal therapy including timing, dose and modality.
- Acute kidney injury is common in the ICU and associated with worse outcomes. Continuous renal replacement therapies may provide more stable volume and chemistry control compared to intermittent therapies.
- High volume hemofiltration shows promise for removing inflammatory mediators in sepsis but optimal dose is still unclear. Renal replacement therapies have an important role beyond renal support as blood purification techniques.
Pharmacology of Plasma expanders
This document summarizes different types of plasma expanders used to treat conditions involving fluid loss such as hemorrhage and shock. There are two main types of volume expanders: crystalloids like saline and colloids made from large insoluble molecules such as dextran, albumin, and gelatin. Common colloid plasma expanders discussed include albumin from human plasma, gelatins produced from collagen, hydroxyethyl starches, dextrans made by bacteria, and hypertonic saline solutions. The document compares the characteristics, mechanisms, and side effects of these different plasma expander options.
Alcohol
This document discusses the effects of ethanol (alcohol) on various body systems. It begins by classifying alcoholic beverages and describing alcohol metabolism in the liver. It then summarizes ethanol's effects on the central nervous system, including its actions on various neurotransmitter systems. The document goes on to discuss ethanol's cardiovascular, gastrointestinal, and other organ-specific effects. It concludes by covering topics like alcohol tolerance, dependence and withdrawal, as well as pharmacological treatments for alcoholism.
Hypolipidemic drugs.ppt
- Statins are the most potent cholesterol-lowering drugs that work by inhibiting HMG-CoA reductase in the liver. They can lower LDL cholesterol by 20-60% and are first-line treatment for hyperlipidemia. Common side effects include elevated liver enzymes and muscle pain.
- Bile acid sequestrants work by binding bile acids in the gut, increasing their removal from the body. This lowers cholesterol by upregulating LDL receptors. They are less potent than statins and have poor tolerability.
- Other drug classes for treating hyperlipidemia include fibrates, niacin, and drugs that inhibit cholesterol absorption but statins are usually the preferred first-line
Diuretics
Diuretics are drugs that promote increased production of urine. The main classes of diuretics are loop diuretics, thiazide diuretics, carbonic anhydrase inhibitors, osmotic diuretics, and aldosterone antagonists. Loop diuretics such as furosemide act on the loop of Henle and are highly effective. Thiazide diuretics such as hydrochlorothiazide are commonly used to treat hypertension and edema. Carbonic anhydrase inhibitors reduce fluid production in various tissues. Osmotic diuretics work by increasing osmotic pressure in the kidney tubules. Aldosterone antagonists such as spironolactone counteract sodium retention caused by
Mgs seminar fluid final
This document discusses fluid and electrolytes in surgical patients. It covers the composition of body fluids, total body water, fluid intake and losses, types of fluids including colloids and crystalloids, and important electrolytes like sodium. Preoperative, intraoperative, and postoperative fluid management is explained. The importance of correcting hypovolemia, anemia, and other factors preoperatively is emphasized. Intraoperative fluid losses are estimated based on surgery type and trauma. Postoperative fluid goals and common electrolyte abnormalities are also outlined.
Lipid metabolism and hypolipedemic drugs
This document discusses lipid metabolism and hypolipidemic drugs. It defines different types of lipids including triglycerides, cholesterol, and lipoproteins. It describes the normal metabolism of lipids and how elevated LDL and triglycerides can lead to conditions like atherosclerosis. The document then summarizes several classes of drugs used to treat hyperlipidemia including statins, bile acid sequestrants, cholesterol absorption inhibitors, and fibrates. It provides examples of drugs in each class and their effects on lipid levels as well as common adverse effects.
Intravenous fluid resuscitation and blood transfusion.ppt
This document provides an overview of perioperative fluid therapy. It discusses physiology related to fluid balance and regulation. It outlines factors to consider in estimating perioperative fluid requirements, including maintenance needs, deficits from fasting or drainage, third spacing of fluids, blood loss replacement, and additional losses. It describes various intravenous fluid options like crystalloids, colloids, and blood products. It provides guidance on fluid resuscitation and indications for blood transfusion to support tissue oxygen delivery. The overall aim is to maintain adequate intravascular volume and oxygen delivery during the perioperative period.
chronic kidney disease.ppt
This document discusses chronic kidney disease (CKD), including its definition, stages, causes, complications, screening, diagnosis, treatment, and management. CKD is defined as irreversible kidney damage or reduced glomerular filtration rate lasting over 3 months. The leading causes are diabetes and hypertension. As CKD progresses, complications arise affecting multiple body systems. Treatment aims to slow progression, manage complications, and prepare for kidney replacement if needed.
iv fluids NEW.pptx
This document discusses various types of intravenous fluids and their uses. It begins by outlining the basic indications for IV fluid therapy, including treatment of fluid and electrolyte deficits as well as associated illnesses. It then describes different types of IV fluids in more detail, including crystalloids like saline and dextrose solutions, as well as colloid solutions like albumin, dextrans, gelatins, and hydroxyethyl starch. For each fluid, the document discusses properties, indications, contraindications, and complications. It also addresses principles of fluid management like redistribution, maintenance fluids, and fluid rates for different levels of surgical trauma.
Fluid and electrolytes
This document provides guidelines for intravenous fluid therapy for adult surgical patients. It discusses fluid management before, during, and after surgery. Key recommendations include using balanced crystalloid or colloid solutions to treat volume deficits, assessing volume status and response to fluid boluses, achieving euvolemia and minimizing sodium and fluid overload postoperatively, and providing nutrition support while mitigating risks like refeeding syndrome. The guidelines emphasize tailored fluid management based on individual patient factors, goals of fluid resuscitation, and monitoring for fluid balance and adequacy of resuscitation.
Hemodialysis treatment in patients with severe electrolyte disorders manageme...
This document discusses strategies for managing severe electrolyte disorders like hyperkalemia and hyponatremia in patients undergoing hemodialysis. It outlines approaches for correcting sodium and potassium levels in both acute and chronic settings. For sodium, the key strategies are using a dialysate concentration slightly below serum levels and lowering blood flow rate to slowly correct chronic hyponatremia. For potassium, dialysate concentration is selected based on pre-dialysis levels, with lower concentrations used to rapidly reduce high potassium levels. Close monitoring is important with any aggressive electrolyte corrections.
Similar to FLUID THERAPY AND ELECTROLYTE MANAGEMENT final.pptx (20)
Alcohol metabolism and alcoholism & Fatty liver.pptx
Alcohol metabolism and alcoholism & Fatty liver.pptx
Intravenous fluid resuscitation and blood transfusion.ppt
Intravenous fluid resuscitation and blood transfusion.ppt
Hemodialysis treatment in patients with severe electrolyte disorders manageme...
Hemodialysis treatment in patients with severe electrolyte disorders manageme...
More from Ankit Gajjar
MALARIA.pptx
Dr. Ankit Gajjar is a critical care physician at Asutosh Hospital. The document discusses malaria, including what causes it, the species that cause malaria in humans, epidemiology in India, pathophysiology, clinical features, diagnosis, treatment for uncomplicated and severe cases of P. falciparum and other species, treatment in specific populations, monitoring and follow up, relapse vs recrudescence, and various artemisinin-based combination therapies.
CLOSTRIDIUM DIIFFICICLE.ppt
C. difficile remains a common cause of diarrhea in the ICU. A multistep approach should be used, including identifying high-risk patients, testing only symptomatic patients, and treating based on severity. Strict adherence to infection control practices like hand washing and contact precautions is important to prevent transmission. Treatment involves stopping precipitating antibiotics and using metronidazole or vancomycin based on severity, with vancomycin preferred for severe or recurrent cases. Fecal microbiota transplantation is emerging as a treatment for recurrent CDI.
ORGANOPHOSPHORUS POISIONING.pptx
This document discusses organophosphorus poisoning. It covers the types and uses of organophosphates, their metabolism and mechanism of action by inhibiting acetylcholinesterase, and the resulting clinical features. Diagnosis involves looking for a history of exposure and measuring plasma butyrylcholinesterase and red blood cell acetylcholinesterase levels. Treatment consists of atropine to block muscarinic receptors, pralidoxime as a cholinesterase reactivator, and supportive care.
OCCUPATIONAL HEALTH ISSUES RELATED TO GASTROINTESTINAL TRACT.pptx
Occupational health hazards. Occupational gastrointestinal hazards. Risk factors, prevention & treatment
Lifestyle diseases
Lifestyle diseases such as obesity, hypertension, diabetes, stroke, high cholesterol, cancer, depression and infertility are on the rise. These non-communicable diseases have long courses and late diagnoses that can lead to more complications. Incidence of these diseases is higher in urban areas due to changes in diet, increased smoking, alcohol, physical inactivity, pollution and stress. Prevention of lifestyle diseases focuses on maintaining a healthy diet low in carbohydrates and sugar but high in proteins, fruits and vegetables. It also emphasizes the importance of exercise, stress management, avoiding tobacco and limited alcohol.
Calcium metabolism hypercalcemia
This document discusses calcium metabolism and hypercalcemia. It covers normal calcium values, calcium types, metabolism, regulation by hormones like PTH and vitamin D, and the calcium sensing receptor. The main causes of hypercalcemia are primary hyperparathyroidism, malignancy-associated hypercalcemia, and granulomatous diseases. Symptoms range from none in mild cases to multi-organ involvement in severe cases. Diagnosis involves measuring corrected calcium and PTH levels. Treatment aims to lower calcium through hydration, calcitonin, bisphosphonates, glucocorticoids, calcimimetics, or dialysis depending on severity. Surgery in the form of parathyroidectomy may be indicated in
TB MENINGITIS and anti tuberculous drugs
1. Tuberculous meningitis is caused by primary infection or reactivation of tuberculosis in the brain and meninges. It presents with nonspecific symptoms like fever, headache, vomiting, and altered mental status.
2. Diagnosis involves examination of cerebrospinal fluid which may show presence of tuberculosis bacteria, inflammatory cells, or elevated proteins. Imaging can reveal hydrocephalus, basal exudates, or tuberculomas.
3. Treatment consists of a combination of antitubercular medications like isoniazid, rifampin, pyrazinamide, and steroids administered for at least 6-9 months. Drug resistant tuberculosis requires alternative, more toxic drug regimens for
Basic ventilatory parameters
This ppt is about how to set basic ventilatory parameters. Tidal volume, RR, Peak flow, IE ratio etc... Must learn for a working in ICU
AHA BLS
This document provides information on basic life support (BLS). It begins by defining cardiac arrest as the cessation of normal blood circulation due to heart failure. It describes reversible causes of cardiac arrest including pulmonary embolism, tension pneumothorax, and various toxins or electrolyte imbalances. The basics of BLS are then outlined, including chest compressions, opening the airway, rescue breathing, and defibrillation. Steps of BLS like assessing the scene, checking for breathing and pulse are explained. Chest compression techniques, rescue breathing methods like mouth-to-mouth and bag valve mask, and use of an automated external defibrillator are described. Finally, drugs commonly used in cardiac arrest like epinephrine
Abg interpretation copy
The document provides guidance on interpreting arterial blood gas (ABG) results through a step-by-step process. It begins by outlining proper techniques for collecting an ABG sample. It then describes the variables provided in an ABG report and how to assess for acid-base disorders by analyzing the pH, PCO2, HCO3, and other values. The document outlines the steps to determine if an acid-base imbalance is respiratory or metabolic in nature and how to evaluate for compensation. It also reviews how to interpret values in specific conditions like respiratory acidosis, alkalosis, and different types of metabolic acidosis.
Trouble shooting of mechanical ventilator
Troubleshooting on mechanical ventilator
Alarm settings n mechanical ventilator
High peak pressure alarm on ventilator
mechanical ventilator basic
ACUTE MANAGEMENT OF Hyperkalemia
This document discusses hyperkalemia, or high levels of potassium in the blood. It begins by listing the normal potassium range and then describes some common causes of hyperkalemia, including the release of potassium from cells due to conditions like rhabdomyolysis or tumor lysis syndrome, and decreased renal excretion of potassium due to renal failure or medications. Clinical manifestations of hyperkalemia are then outlined, such as weakness, paralysis, arrhythmias, and ECG changes including peaked T waves. The document concludes by presenting two case histories of patients with hyperkalemia and CKD and recommends treatment approaches starting with calcium gluconate for cardiac instability and then other options to increase potassium excretion or remove it through dialysis if
diagnosis and management of mdr iai role of carbapenems and tigecycli.._
INTRAABDOMINAL INFECTION, COMPLICATED INTRAABDOMINAL INFECTION,
MULTI DRUG RESISTANCE, TIIGYCYCLINE AND COLISTIN,
TIGECYCLINE CARBAPENEM COLISTIN
Role of vitamin c and thiamine in sepsis
Advance treatment of sepsis and septic shock to improve outcome.
vitamin C, thiamine and hydrocortisone combination is studied well and prooven to beneficial
NUTRITION IN CRITICAL CARE
This document provides national guidelines and protocols for critical care nutrition practice in India. It discusses why adequate nutrition is important for critically ill patients, when to start enteral or parenteral nutrition, how to determine caloric and protein needs based on patient characteristics, appropriate routes of administration, contraindications, complications, and disease-specific nutrition protocols. The key recommendations are to start early enteral nutrition within 48 hours when possible, provide 1.2-2 g/kg protein and 20-35 kcal/kg calories based on weight status, and use enteral over parenteral nutrition when GI function allows.
Aspiration pneumonia
Aspiration pneumonia is caused by bacteria from the mouth or stomach entering the lungs. It can develop hours to days after aspiration occurs. The most common pathogens have changed from anaerobic bacteria to aerobic bacteria. Diagnosis is based on clinical history, risk factors, and chest x-ray. Treatment depends on whether it is community-acquired or hospital-acquired pneumonia. Antibiotics are used but duration depends on severity and response. Preventive measures focus on oral hygiene and early mobilization of high-risk patients like stroke patients.
A role of anticoagulation in neurocritical care jhjk
This document discusses the role of anticoagulation in neurocritical care. It notes that anticoagulation remains the mainstay for preventing and treating thrombosis. It then compares different anticoagulants and their properties. It provides dosing guidelines for prophylactic and therapeutic anticoagulation in various neurologic conditions and procedures. Finally, it discusses newer oral anticoagulants and their advantages over warfarin, though they lack reversal agents and are not useful in renal failure or pregnancy.
Ventilation in acute heart failure
This document discusses ventilation in acute heart failure. It defines key terms like classification of heart failure and diagnostic criteria. It describes the pathophysiology and goals of treatment. Non-invasive ventilation with CPAP or BiPAP is indicated for cardiogenic pulmonary edema to improve oxygenation and reduce workload. Settings, monitoring, complications and indications for invasive ventilation are reviewed. The effects of weaning and NIV for chronic heart failure are also summarized.
Ulinastatin final
This document discusses Ulinastatin, a drug used to treat sepsis. It provides background on sepsis definitions, pathophysiology, current treatment approaches and their limitations. Ulinastatin is introduced as a protease inhibitor extracted from human blood and urine that can reduce the inflammatory response in sepsis. The document outlines Ulinastatin's pharmacology, proposed mechanisms of action, indications, dosing, and evidence from clinical studies showing it significantly reduced mortality from sepsis compared to placebo with few adverse effects. A large multicenter randomized controlled trial in India found a 13% absolute reduction and 66% relative reduction in 28-day mortality among sepsis patients treated with Ulinastatin versus placebo.
Thoracic anaesthesia
1) The document discusses preoperative evaluation and anesthetic considerations for thoracic surgery patients, with a focus on patients undergoing one-lung ventilation.
2) Key points of preoperative evaluation include assessing pulmonary function, cardiac status, investigating the extent of lung involvement, and optimizing patients with respiratory conditions like COPD.
3) Anesthetic management focuses on techniques for one-lung ventilation using devices like double-lumen endotracheal tubes, as well as strategies for ventilation, induction, and analgesia tailored to patient comorbidities.
More from Ankit Gajjar (20)
OCCUPATIONAL HEALTH ISSUES RELATED TO GASTROINTESTINAL TRACT.pptx
OCCUPATIONAL HEALTH ISSUES RELATED TO GASTROINTESTINAL TRACT.pptx
diagnosis and management of mdr iai role of carbapenems and tigecycli.._
diagnosis and management of mdr iai role of carbapenems and tigecycli.._
A role of anticoagulation in neurocritical care jhjk
A role of anticoagulation in neurocritical care jhjk
Recently uploaded
Identification and nursing management of congenital malformations .pptx
Identification and nursing management of congenital malformations .pptxMGM SCHOOL/COLLEGE OF NURSING
Identification and nursing management of congenital malformations Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Top 10 Best Ayurvedic Kidney Stone Syrups in India
we have mentioned the best 10 ayurvedic Kidney Stone Syrups. You can check all these products and choose the best one for yourself.
#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun W...
#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun W...chandankumarsmartiso
#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun Women Seeking Service
Top Effective Soaps for Fungal Skin Infections in India
Swisschem Dermacare has mentioned the List of The Best Antifungal Soap In India 2022. All of these soaps are trusted by various Dermatology Experts.
Best Ayurvedic medicine for Gas and Indigestion
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
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Learn about body grief and ways to cope with it. We will also explore methods to heal from this challenging experience.
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeProf. Marcus Renato de Carvalho
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Cell Therapy Expansion and Challenges in Autoimmune Disease
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Phone Us ❤8107221448❤ #ℂall #gIRLS In Dehradun By Dehradun @ℂall @Girls Hotel...
Phone Us ❤8107221448❤ #ℂall #gIRLS In Dehradun By Dehradun @ℂall @Girls Hotel...chandankumarsmartiso
Phone Us ❤8107221448❤ #ℂall #gIRLS In Dehradun By Dehradun @ℂall @Girls Hotel With 100% Satisfaction
Recently uploaded (20)
Identification and nursing management of congenital malformations .pptx
Identification and nursing management of congenital malformations .pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun W...
#cALL# #gIRLS# In Dehradun ꧁❤8107221448❤꧂#cALL# #gIRLS# Service In Dehradun W...
Top Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in India
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
Phone Us ❤8107221448❤ #ℂall #gIRLS In Dehradun By Dehradun @ℂall @Girls Hotel...
Phone Us ❤8107221448❤ #ℂall #gIRLS In Dehradun By Dehradun @ℂall @Girls Hotel...
FLUID THERAPY AND ELECTROLYTE MANAGEMENT final.pptx
- 1. FLUID THERAPY AND ELECTROLYTE MANAGEMENT DR ANKIT GAJJAR MD(Anaesthesia),IDCCM,IFCCM,EDIC Consultant Intensivist at Surat
- 3. Fluid Prescription • It should be like a prescribing drug…. • Type • Dose • Indication • Contraindication • Toxicity • Cost
- 4. Electrolytes Plasma Isotonic Saline Ringer’s lactate Plasmalyte Sterofundin Sodium 140 154 130 140 140 Potassium 5 0 5 5 4 Chloride 100 154 111 98 127 Calcium 2.2 0 2 0 2.5 Magnesium 1 0 0 1.5 1 Bicarbonate 24 0 0 0 0 Lactate 1 0 29 0 0 Acetate 0 0 0 27 24 Gluconate 0 0 0 23 0 Maleate 0 0 0 0 5 Osmolarity 280-300 308 273 294 297 SID in vivo 24-28 0 29 50 29
- 5. Problem: Chloride has multiple renal effects
- 6. Adverse effects • Hyperchloremia itself can cause worsening of renal function and metabolic acidosis • Hyperchloremic Acidosis can further - Coagulopathy - Cardiac depression - Reduce Nor-adrenaline release - Reduce GI motility
- 7. Advantage • Cheapest fluid • Suitable neurological condition • Choice of fluid in metabolic alkalosis
- 8. Balance salt solution • Ringer’s Lactate • Plasmalyte • Sterofundin
- 9. Ringer’s lactate • Cheaper than other BSS • Contain lactate as a buffer • In vivo SID of RL is 29 • Hypotonic than plasma
- 10. Ringer’s lactate Disadvantage • Can’t be use in liver failure • False positive result of hyperlactatemia in shock • Excessive fluid administration can cause metabolic alkalosis • Can’t be use in Neuro patients due to hypotonicity • Altered glucose metabolism • Can not be given with blood products • Chances of extravascular accumulation is high due to hypotonicity
- 11. Plasmalyte /Sterofundin • SID is much higher • Directly correct acidosis especially in DKA • Can be used in Neuro patients • Contains magnesium • SID?? • Sterofundin cannot be used with blood products
- 12. Plasmalyte /Sterofundin • Advantage of Acetate as a buffer • Glucose metabolism Is maintain • Acetate metabolise in extrahepatic tissue like muscles so safe in shock or liver failure • Body can metabolize 300 mmol / hr of Acetate (while lactate only 100 mmo/hr)
- 13. Plasmalyte/Sterofundin • Costly • Costly • Costly • Costly ……………. • Risk of Alkalosis • Acetone used as a buffer can be cardiotoxic • Drug dilutions compatibilities not clear
- 15. Water requirements increasewith: • Fever Sweating • Burns Tachypnea • Surgical drains Polyuria • Gastrointestinal losses through Vomiting or diarrhea Water requirements increase by 100to 150mL/day for each Cdegree of body temperature elevation.