This document discusses acute respiratory distress syndrome (ARDS), fat embolism syndrome (FES), and thromboembolic disease which are common complications in orthopaedic trauma patients. It defines each condition and covers their etiology, pathophysiology, diagnosis, treatment, prevention and outcomes. ARDS is an acute respiratory failure caused by lung inflammation from trauma or other insults. FES occurs after long bone fractures and causes hypoxia, confusion and rash. Thromboembolic disease risks include immobility and hypercoagulability from injury. The document outlines ways to prevent these conditions through early fracture fixation, prophylactic measures and screening protocols.
Acute pulmonary embolism and its management.Puja Gupta
Critical Care Nursing (CCN).Respiratory disorders. Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).
A pulmonary embolism (PE) is a blood clot that develops in a blood vessel in the body (often in the leg). It then travels to a lung artery where it suddenly blocks blood flow.
Deep Vein Thrombosis and Pulmonary Embolism, by Prof. Minnu M. PanditraoMinnu Panditrao
Dr. Mrs. Minnu Panditrao, goes in depth with the very important topic of Deep Vein Thrombosis, Pulmonary embolism, aetio patheogenesis, clinical features, management etc.
Deep vein thrombosis (DVT) and Pulmonary embolism (PE)Aminul Haque
Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE), constitute a major global burden of disease.
Venous thromboembolism (VTE) is a disorder that includes deep vein thrombosis and pulmonary embolism. A deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, usually in the lower leg, thigh, or pelvis.
Acute pulmonary embolism and its management.Puja Gupta
Critical Care Nursing (CCN).Respiratory disorders. Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).
A pulmonary embolism (PE) is a blood clot that develops in a blood vessel in the body (often in the leg). It then travels to a lung artery where it suddenly blocks blood flow.
Deep Vein Thrombosis and Pulmonary Embolism, by Prof. Minnu M. PanditraoMinnu Panditrao
Dr. Mrs. Minnu Panditrao, goes in depth with the very important topic of Deep Vein Thrombosis, Pulmonary embolism, aetio patheogenesis, clinical features, management etc.
Deep vein thrombosis (DVT) and Pulmonary embolism (PE)Aminul Haque
Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE), constitute a major global burden of disease.
Venous thromboembolism (VTE) is a disorder that includes deep vein thrombosis and pulmonary embolism. A deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, usually in the lower leg, thigh, or pelvis.
This Presentation focuses on answering the questions the surgical residents face while treating the patients of Deep Venous Thrombosis on surgical floor as per latest (2012) American College of Chest Physician Guidelines
It is estimated that 20% of American women and 7% of American men suffer from venous disease. Venous disease results in symptoms such as aching, fatigue, swelling, and pain in the legs which can interfere with daily living.Cosmetic issues may affect quality of life.
At least 20% of patients with venous disease will develop leg ulcers. This presentation outlines the normal anatomy and physiology of venous drainage of the extremities as well as the common venous disorders such as varicose veins and deep vein thrombosis.
Deep vein thrombosis (DVT) & pulmonary embolism (PE). Life-threatening complications following trauma. Incidence of 5 to 63%. Risk factors: Pelvic and lower extremity fractures,Head injury and Prolonged immobilization. DVT prophylaxis is essential in the management of trauma patients.
Professor Panditrao expresses his views about the day to day challenge, faced in clinical practice. Considered to be a simple surgery, but the anesthetic management is very challenging because of the primary pathology, co-morbidities and repeated surgeries involved.
Educative power-point presentation for students in paediatrics, paediatric critical care, neonatology, And trainees or fellows in paediatric critical care
To provide quick, painless & safe recovery from surgery as soon as possible.
Learning Objectives:
1.The need for immediate post-op care
2. Common post-operative problems
3. Anticipation & prevention of common complications
4. Identification & Treatment
5. Enhancement of recovery
6. Systematic discharge
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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
NYSORA Guideline
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
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).
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.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
3. ARDS
• Acute respiratory failure in the post
traumatic period characterized by a
decreased PaO2 and a diffuse and often
massive extravasation of fluid from the
pulmonary vasculature to the interstitial
space of the lungs.
11. ARDS
Outcome
• Significant Cause of Mortality
• Major Cause of Death in Patients with the
Lowest ISS scores
• 40% - 50% Mortality Rate
– Mortality Rate Slowly Decreasing with
Changing & Improving Therapy
12. Fat Embolism Syndrome
(FES)
• A Causative Factor In ARDS
• Occurs Following A Long Bone Fracture
• Characterized by:
– Hypoxia
– Mental Confusion
– Petechial Rash
13. FES
• Unanticipated Respiratory Distress
• Diagnosis of Exclusion
• Often Placed in The Category of ARDS
• R/O other Causes of Hypoxia
– Pulmonary Contusion
– ARDS
– Pneumonia
17. Biochemical Etiology
• Chemical Mediators Released @ time of
Fracture
• Fat Released at Time of Fracture
• Fat Metabolism by Lipase releases Free
Fatty Acids
• Free Fatty Acids Result in Endothelial Lung
Damage
18. Gurd et al
FES Diagnosis
• Major Criteria
– Hypoxemia
– CNS Depression
– Petechial Rash
– Pulmonary Edema
• Minor Criteria
– Tachycardia
– Pyrexia
– Retinal Emboli
– Fat in Urine
– Fat in Sputum
– Thrombocytopenia
– Decreased Hematocrit
19. Gurd et al
FES Diagnosis
• 1 Major Criteria
• 4 Minor Criteria
25. Type of Fracture Fixation
-Controversial-
• IM Nail - Reamed vs Un-Reamed
– Increased Pulmonary Dysfunction With Reamed
technique
– Decreased with Unreamed Technique
– Pape et al
• IM Nail Reamed vs Plate Osteosynthesis
– No Difference In Pulmonary Dysfunction
• Bosse et al
26. Effect of IM Nailing
• Canal Opening
• Reaming
• Nail Insertion
• Unreamed Nail Insertion
• All Cause Increased IM Pressure
• All Cause Embolic Showers On
Echocardiograms
27. Systemic Effects of Trauma
Injury
12 hours 24 hours
Postinjury
Inflammatory
Response
Second Insult
MOF
IM Nailing As A cause of Secondary Systemic Injury
28. DVT Incidence
• DVT occurance
60% if ISS >9.
• 35%-60% DVT in
pelvic fracture
• PE-Most common
preventable cause of
death in trauma.
31. Endothelial Injury
• Direct Trauma to Vein @ time of Injury
• Compression of the Vein Secondary to
Fracture Position
• Vein Manipulation @ Time of Fracture
Fixation
37. IVC Filter Indications
• Anticoagulation
Prohibited
• High Risk Patients
• DVT Prior to
Necessary Surgery
• PE Despite
Anticoagulation
38. IVC Filter
• Prevents Major PE
• Low Morbidity
– 96% Patent
– 8% Migration
– 4% PE
• Filter insertion in the
ICU
• Expensive
• Invasive
• Does not treat DVT
• Venous Insufficiency
• Filter Occlusion
• Permanent
Advantages Disadvantage
39. Heparin
• Heparin Potentiates Anti-Thrombin III
Activity
• Complex Inhibits
– Thrombin (IIa), IXa, Xa
• Heparin effect relative short duration
– Reversed with Protamine Sulfate
• Significant hemorrhage risk
40. SQ Heparin
• Low Cost
• No Monitoring
• Convenient
• Relatively Low
Incidence of
Bleeding
• Insufficient
Efficacy in High
Risk Patients
• Unpredictable
Responses
• Heparin Induced
Thrombocytopenia
Advantages Disadvantage
41. Low Molecular Weight Heparin
(LMWH)
• Potentiates Antithrombin III
• Specific for Factor Xa
• Minimal effects on other Factors
42. LMWH
• No Monitoring
• Increased Efficacy
• Longer 1/2 life
• Predictable
Response
• Lower risk of
thrombocytopenia
• Parenteral
Administration
• Cost
Advantages Disadvantage
43. Aspirin
• Inhibits cyclooxygenase
• Decreases Platelet Adherence
• ? Effectiveness in Musculoskeletal Trauma
– Venous clots not typically found to have
Platelet aggregates
44. Aspirin
• Oral Administration
• Tolerated well
• In-expensive
• No Monitoring
• ? Efficacy when used
alone
• GI Intolerance
• Prolonged anti-platelet
effect
Advantages Disadvantage
45. Warfarin
• Blocks Vit K conversion in Liver
• Effects Vit K Dependent Factors
• Effects the Extrinsic Clotting System
• Factor VII Effected first, Short Half Life
• Monitored with Pro-Time
– INR 2.0-2.5
• Reversed With Vitamin K or FFP
49. Ascending Contrast Venography
• Sensitive for detection
• Invasive
• Dye Problems
(allergies, renal)
• Injection Site Irritation
• Poor Pelvic Vein
Evaluation
• Gold Standard
*Invasiveness,expense make ACV a poor screening tool
50. Doppler/Duplex Ultrasound
• Comparable to Venogram
• Non Invasive
• No Morbidity
• Poor Axial (i.e Pelvic)
Vein Evaluation
• Operator Dependent
• Good Screening Tool
– Noninvasive, reproducible
51. Magnetic Resonance Venography
• Non Invasive
• Good Visualization of
Pelvic Veins
• Difficult in Polytrauma
Patient
• Excellent specificity and
sensitivity for suspected
DVT
• Controversial for screening
53. Ventilation Perfusion Scan
• Ventilation Perfusion mismatch
• Results
– Low probabiltity
• 15% False Negative
– Medium
• Need Angiogram
– High probability
• 15% False Positive
• Screening Tool
54. Pulmonary Angiogram
• Angiographic Evaluation of
pulmonary vascular tree
• Allows Placement of IVC
Filter in same setting if
indicated
• Sensitive - Standard in PE
Detection. Diagnostic
55. Treatment PE
• Anticoagulation
• Filter for recurrent
event despite
anticoagulation
• Thrombectomy
– Serious Acute PE
– Patient in extremous
– Large identifiable PE
56. Treatment DVT/PE
• Heparin
– Bolus 10-15K units
– Continuous Infusion
• 1000Units/Hr
– Goal → PTT 2x Control
• Prevent Clot
propagation and
recurrent PE
– Discontinue when
Therapeutic on Wafarin
• Warfarin
– INR 2.0-3.0
– 3-6 Month Duration
– Contraindicated in:
• Pregnancy
• Liver insufficieny
• Poor Compliance
– Prolonged Therapy may
decrease recurrence
rates (6 mos)
57. DVT/PE Outcome
• No Diagnosis and Treatment
– 30% Mortality
• Correct Diagnosis and Therapy
– 11% Mortality in First Hour
– 8% Mortality After First Hour
58. DVT/PE Outcome
• Post Thrombotic Syndrome
– Valvular Incompetence
– Venous Stasis
– Edema
– Cutaneous Atrophy
• Recurrent DVT
– 20% of Patients
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