This document provides a training course for medical volunteers at the Grandma's Marathon. It summarizes the most common medical conditions volunteers will treat, including exercise associated collapse, heat-related illness, exertional hyponatremia, cardiac arrest, and stress fractures. For each condition, it describes signs and symptoms, risk factors, definitions of severity, and appropriate on-site treatment protocols. The document emphasizes that early recognition and treatment are critical for time-sensitive conditions like heat stroke and hyponatremia in order to avoid complications.
The musculoskeletal system Anatomy and physiologykajal chandel
The musculoskeletal system is made up of bones, cartilage, ligaments, tendons and muscles, which form a framework for the body. Tendons, ligaments and fibrous tissue bind the structures together to create stability, with ligaments connecting bone to bone, and tendons connecting muscle to bone.
The musculoskeletal system Anatomy and physiologykajal chandel
The musculoskeletal system is made up of bones, cartilage, ligaments, tendons and muscles, which form a framework for the body. Tendons, ligaments and fibrous tissue bind the structures together to create stability, with ligaments connecting bone to bone, and tendons connecting muscle to bone.
This presentation was made by various histology slides of cartilages (taken from web pages) as a pretest for the exams. Not for any other commercial purposes.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
An overview of the most commonly encountered emergencies in endurance athletes. The Baker to Vegas Law Enforcement Relay Race is the Largest of its kind in the world. This Year over 7000 runners will be competing in the 120 mile race.
A brief yet comprehensive description of a very common problem faced in KSA especially during hajj season. It is meant to enhance the awareness among ER and ICU physicians.
This presentation was made by various histology slides of cartilages (taken from web pages) as a pretest for the exams. Not for any other commercial purposes.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
An overview of the most commonly encountered emergencies in endurance athletes. The Baker to Vegas Law Enforcement Relay Race is the Largest of its kind in the world. This Year over 7000 runners will be competing in the 120 mile race.
A brief yet comprehensive description of a very common problem faced in KSA especially during hajj season. It is meant to enhance the awareness among ER and ICU physicians.
Syncope is a temporary loss of consciousness usually related to insufficient blood flow to the brain. It's also called fainting or "passing out." It most often occurs when blood pressure is too low (hypotension) and the heart doesn't pump enough oxygen to the brain.
For more information, you can book an appointment at
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
David Hryvniak, an experienced trail and road runner who also happens to be a doctor and assistant professor at UVA’s Department of Physical Medicine and Rehabilitation (He works with Dr. Wilder). David will talk about common overuse injuries and how to prevent those injuries.
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
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
2. Introduction
• Thank you very much for volunteering to provide
medical coverage at Grandma’s Marathon.
• This course is designed to introduce you to the
most common and most important conditions
you’ll be treating in the medical tent.
• These issues include:
– Exercise Associated Collapse
– Heat-Related Illness
– Exertional Hyponatremia
– Cardiac Arrest
– Stress Fracture
3. Exercise Associated Collapse
• This is the most common medical problem
encountered after marathons
• 59-85% of all post-marathon medical visits
– Br J Sports Med. 2011 Nov;45(14):1157-62.
• EAC is caused by a postural drop in systolic
blood pressure
– Inactivation of the calf muscle pump upon cessation
of prolonged exercise
– Results in lower extremity venous blood pooling,
reduced atrial filling pressure, and subsequent
syncope
5. Exercise Associated Collapse
Treatment
• Evaluate in supine position with legs elevated
• Oral rehydration
• Cooling
• Rest
• Most patients will recover in 30 min
• Monitor for MENTAL STATUS CHANGES or
failure to progress – which might suggest
– Exertional Hyponatremia
– Hyperthermia
– Cardiac Arrest
– Hypothermia
– Hypoglycemia
6. True or False?
• A patient with suspected exercise
associated collapse is not improving
despite 30 minutes of rest with her legs
elevated, gentle cooling and oral fluids.
You should give her a liter of IV normal
saline.
7. False
• It would be appropriate to check her core
temperature (rectal thermometer) and
serum electrolytes.
• IV fluids are rarely necessary. Oral
rehydration is safer and less expensive.
• If the patient is too nauseated to tolerate
oral fluids antiemetic medications are
available.
8. Exertional Hyponatremia
• Dilutional decrease in serum sodium
concentration during physical activity caused by:
– Over hydration
– Salt losses in sweat
– Fluid retention enhanced by increased ADH secretion
during running
• Incidence
– 12.5% of marathon runners.
• London Marathon
• Br J Sports Med. 2011 Jan;45(1):14-9. Epub 2009 Jul 20.
9. Exertional Hyponatremia
• Risk factors
– Finishing time over 4 hours
– Marathon running inexperience
– Small stature
– Female gender
– NSAID use
– Unusually hot conditions
10. Exertional Hyponatremia
• Mild EH
Defined by Na+ less
than 135mmol/L with
headache,
paresthesias,
nausea,
bloated/swollen
sensation
• Severe EH
Defined by Na+ less
than 135mmol/L with
decreased mental
status, confusion,
disorientation,
agitation, delirium,
seizures, respiratory
distress
11. Exertional Hyponatremia
Treatment
• Mild EH
• No IV fluids
• Consider oral fluid restriction
• Pt may drink salty oral fluids
like V8, Coke, or chicken broth
(4 bouillon cubes in 4oz
water).
• Monitor until urination.
• Discharge home with
instructions to monitor for EH
symptoms and to seek urgent
medical attention if any
symptoms develop
• Severe EH
• Check core temp – treat
hyperthermia if present
• 100mL 3%
hypertonic saline
bolus
• Up to two additional 100ml 3%
hypertonic saline boluses may
be given at 10 min intervals
with Na+ recheck and no
improvement in symptoms
• Transfer to ER for ongoing
treatment/monitoring/recovery
12. True or False?
• A runner with headache, nausea, and
tingling feet has a Na+ 125. She has no
confusion. She could receive 1L of IV
normal saline.
13. False
• No exercise-associated hyponatremic
patient should receive IV normal saline.
– Mild hyponatremics (those without mental
status changes) can use saltly oral fluids until
they urinate.
– Severe hyponatremics (those with mental
status changes) should receive the hypertonic
saline boluses.
– Please involve Dr. Nelson or Dr. Pipho in the
care of any hyponatremic patients.
14. Heat-Related Illness
• On a cool, dry day we’ll care for around
200 ill runners. On a hot, humid day the
race could generate over 600 patients in
the medical tent.
• Heat-Related Illness can cause a mass-
casualty event in hot or humid marathons
• Heat-Related Illness can be life-
threatening and must be identified and
treated promptly
15. Heat-Related Illness
Definitions – Continuum of disease
– Hyperthermia – core temp > 40°C or 104°F
– Heat Cramps – cramping assoc with
dehydration, muscle fatigue, and electrolyte
depletion.
– Heat Exhaustion – Inability to exercise due
to heat intolerance
– Heat Stroke – Hyperthermia with central
nervous system changes (Mental Status
Changes) and possibly multiple organ
system failure
17. Treatment of Heat-Related Illness
• Early recognition and treatment is key
• Rectal Temp is the only accurate measure
of core temperature
• Emperical treatment if suspicion is high
• Remove excess clothing
• Place in supine position with legs elevated
• Oral fluid replacement
• Cooling therapy
– Must be done on-site prior to transfer
– Time is tissue!!!
18. Treatment of Heat-Related Illness
On-Site Cooling Methods
• Ice Bags
– Place bags in groin, axilla, and behind neck
– Least efficient but most convenient cooling method
– Appropriate for low-grade cases
• Iced Towels
– Cover exposed skin with iced towels
– Place fan on pt for improved convection
– Proven as a rapid method for core temp reduction
– Less invasive than Ice Water Submersion
• Ice Water Submersion
– Continuous rectal temperature must be monitored
– Pt is lowered into ice water
– Remove pt when temp is below 40C
19. True or False?
• A hyperthermic runner with delirious
behavior should be emergently transferred
to the hospital for cooling.
20. False
• Heat stroke needs to be treated
immediately with on-site cooling in the
medical tent.
• Ice water submersion has the fastest core
temp cooling rate, followed by iced towel
rotation.
21. Cardiac Arrest
• Incidence of SCA
– 1 in 57,000 marathon runners
• Retrospective survey of marathon medical directors
• Med Sci Sports Exerc. 2012 Apr 19.
– 1 per 100,00 full marathon runners
• Race Associated Cardiac Arrest Event Registery
• N Engl J Med. 2012 Jan 12;366(2):130-40
– 1 per 50,000 marathon runners
• TCM and Marine Corp marathons 1976-1994
• J Am Coll Cardiol. 1996 Aug;28(2):428-31
22. Location of Cardiac Arrest According to Race Quartile.
Cardiac Arrest Can Happen Anywhere on the Course.
23. Time to defibrillation affects survival
Survival rate decreases by 10% every 3 minutes in VF
24. Myocardial Infarction
• Most common in middle-aged male runners
• May have vague or atypical presentation
mimicking other conditions like GERD or MSK
pain
• A normal EKG in the medical tent is not
reassuring as ischemic changes may have not
yet developed
• All angina should be considered unstable.
Emergency cardiac meds and rapid hospital
transfer should be initiated.
25. Stress Fractures
• Atraumatic bone injury caused by
repetitive, excessive stress.
• Continued stress can progress to
complete fractures.
• Stress fractures comprise 5-10% of sports
medicine visits in the US.
• Running is the most common sport
associated with stress fractures.
26. Stress Fractures
• History: Focal bone pain worsened with
walking, running or weight bearing.
Pain may persist into rest periods.
• Physical exam: Reproducible focal point
tenderness. Pain with ROM if joint
involved (ie femoral neck)
• Urgency of treatment depends on low or
high-risk stratification
27. High Risk Stress Fractures
• High Risk Stress
Fractures should be
made non-wt bearing
and sent for urgent
imaging
• Increased risk
complications
including:
– Malunion
– Nonunion
– Avascular necrosis
– Arthritic change
– Occult fractures.
• High Risk Locations
– Femoral Neck
– Tibial Diaphysis
– Navicular
– 5th Metatarsal
28. True or False
• A runner has severe groin pain. You
suspect a femoral neck stress fracture.
This patient can be placed on crutches
and follow-up with an orthopedists in 2 or
3 days.
29. False
• Xrays should be done immediately to
evaluate for a completed femoral neck
stress fracture. This is urgent because of
the risk of femoral head avascular
necrosis and developing hip arthritis.