Updated global adult sepsis guidelines, released in October 2021 by the Surviving Sepsis Campaign (SSC), place an increased emphasis on improving the care of sepsis patients after they are discharged from the intensive care unit (ICU) and represent greater geographic and gender diversity than previous versions.
The new guidelines specifically address the challenges of treating patients experiencing the long-term effects of sepsis. Patients often experience lengthy ICU stays and then face a long, complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families are often uncertain how to coordinate care that promotes recovery and matches their goals of care.
Updated global adult sepsis guidelines, released in October 2021 by the Surviving Sepsis Campaign (SSC), place an increased emphasis on improving the care of sepsis patients after they are discharged from the intensive care unit (ICU) and represent greater geographic and gender diversity than previous versions.
The new guidelines specifically address the challenges of treating patients experiencing the long-term effects of sepsis. Patients often experience lengthy ICU stays and then face a long, complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families are often uncertain how to coordinate care that promotes recovery and matches their goals of care.
SEPSIS AND SEPTIC SHOCKDELIVER TARGETED RESUSCITATIONSandro Zorzi
WHO Critical Care Severe Acute Respiratory Infection Training
At the end of this lecture, you will be able to:•Describe how to deliver early, targeted resuscitation in patients (adults and children) with sepsis-induced tissue hypoperfusion and shock.•Understand the special considerations when resuscitating paediatricpatients in resource-limited settings.
fluid optimization concept based on dynamic parameters of hemodynamic monitoringSurendra Patel
Recent advances in hemodynamic monitoring to assess fluid responsiveness of patients in acute circulatory failure is based on dynamic parameters like SPV, PPV, SVV and PVI. These parameters are more accurate than static but needs advanced and sensitive monitoring tools.
Novel hemodynamic monitoring tool for major surgery and ICU patients. With minimally invasive doppler probe insertable through regular central line, Nilus is adding right side perspective back into hemodynamic monitoring.
Bronchial Thermoplasty (BT) Novel Treatment for Patients with Severe AsthmaBassel Ericsoussi, MD
Do our Asthma Patients Know What They Are Missing?Now, A Revolutionary Procedure Can Help Them Lead A Fuller Life.
Bronchial Thermoplasty (BT) Novel Treatment For Patients With Severe Asthma
HEMODYNAMICS MONITORING IN CRITICALLY ILL PATIENTS: ASSESSMENT OF FLUID STATU...Bassel Ericsoussi, MD
Invasive methods are well accepted, but there is increasing evidence that these methods are neither accurate nor effective in guiding therapy
An accurate and non-invasive measurement of CO is the best method of cardiovascular assessment
Endobronchial Ultrasound Guidance of TBNA. Current Approach To Lung Cancer St...Bassel Ericsoussi, MD
EBUS-TBNA, EUS-FNA or their combination have finally gained acceptance as the tests of first choice in mediastinal staging. In suspected non-small cell lung cancer, endobronchial ultrasound may be preferred in the histologic sampling of paratracheal and subcarinal mediastinal adenopathy because the diagnostic yield can surpass mediastinoscopy
THE VENTILATOR CIRCUIT AND VENTILATOR-ASSOCIATED PNEUMONIA (VAP) Bassel Ericsoussi, MD
THE VENTILATOR CIRCUIT APPEARS TO HAVE ONLY A SMALL EFFECT ON THE DEVELOPMENT OF VAP. This contradicts the widely held belief that the ventilator circuit is an important contributor to the development of VAP
New technology called Electromagnetic Navigation Bronchoscopy® (ENB) that uses virtual bronchoscopy and real time 3-dimensional CT images that enable me to localize these peripheral lung nodules for diagnosis and treatment. This outpatient procedure is minimally invasive and therefore has a small risk of pneumothorax (2-3%) and its published diagnostic yield rates range from 67% - 86%
The Role Of Corticosteroids In The Perioperative Management Of Endobronchial ...Bassel Ericsoussi, MD
FBs, particularly those with high oil content may cause severe mucosal inflammation with formation of bulky granulation tissue. When a FB is completely encased in bulky and bleeding granulation tissue, extraction can be very difficult or impossible. A short course of corticosteroids may reduce the inflammatory process and enhance recovery pre or post extraction and in some cases may facilitate removal of the FB.
Whole-lung lavage is a large-volume BAL that is performed mainly in the treatment of PAP. In brief, it involves the induction of general anesthesia followed by isolation of the two lungs with a double-lumen endotracheal tube and performance of single-lung ventilation while large volume lavages are performed on the nonventilated lung. Warmed normal saline solution in 1-L aliquots (total volumes up to 20 L) is instilled into the lung, chest physiotherapy is performed, then the proteinaceous effluent is drained with the aid of postural positioning. The sequence of events is repeated until such time as the effluent, which is initially milky and opaque, becomes clear. This procedure results in significant clinical and radiographic improvement secondary to the washing out of the proteinaceous material from the alveoli. The whole-lung lavage video details all aspects of the procedure, including case selection, patient preparation and equipment, a step-by-step review of the procedure, and postoperative considerations.
Dynamic Central Airway Obstruction: Tracheomalacia, Tracheobronchomalacia, An...Bassel Ericsoussi, MD
Dynamic Central Airway Obstruction: Tracheomalacia, Tracheobronchomalacia, And Excessive Dynamic Airway Collapse: Classification, Diagnosis, and Treatment
Deep Venous Thrombosis and Pulmonary Embolism : Diagnostic Approach and Curre...Bassel Ericsoussi, MD
Acute pulmonary embolism: Overview, Diagnosis, Treatment
DVT/PE in pregnancy
Prevalence of PE in COPD exacerbations
Diagnostic vascular ultrasonography
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
CURRENT INTERNATIONAL GUIDELINES FOR MANAGEMENT OF SEVERE SEPSIS AND SEPTIC SHOCK
1. Bassel Ericsoussi, MD
Pulmonary & Critical Care Specialist
CURRENT
INTERNATIONAL
GUIDELINES
FOR
MANAGEMENT
OF
SEVERE
SEPSIS
AND
SEPTIC
SHOCK
FRANCISCAN
ALLIANCE
SEPSIS
CARE
SUMMIT
5. Ini7al
Resuscita7on
Early
Goal-‐directed
Therapy
EGDT
• Should
be
ini/ated
EARLY
as
soon
as
hypoperfusion
is
recognized
• Should
NOT
BE
DELAYED
pending
ICU
admission
• DURING
THE
FIRST
6
HOURS,
the
goals
of
ini/al
resuscita/on
should
include
all
of
the
following:
– CVP
8–12
mmHg
– MAP
>
65
mmHg
– Urine
output
>
0.5
mL/kg/hr
– SvO2
>70%
• Improved
survival
for
emergency
department
pa/ents
presen/ng
with
sep/c
shock
– 16%
absolute
reduc/on
in
28-‐day
mortality
rate.
6. CVP
AS
A
MARKER
OF
INTRAVASCULAR
VOLUME
STATUS
AND
RESPONSE
TO
FLUIDS
• CVP
is
NOT
RELIABLE
for
judging
intravascular
volume
status
• A
low
CVP
generally
can
be
relied
upon
as
suppor/ng
posi/ve
response
to
fluid
loading
• Target
CVP
8–12
mmHg
• Higher
target
CVP
of
12-‐15
mmHg
should
be
achieved
– Mechanically
ven/lated
pa/ents
– Decreased
ventricular
compliance
– Pulmonary
artery
hypertension
– Increased
abdominal
pressure
7.
8. Assessment
of
Fluid
Status
and
Measures
of
Volume
Responsiveness
IVC
Diameter
Varia7on
• Measure
proximal
IVC
AP
diameter
3
cm
from
the
RA
• Spontaneous
breathing
q
>
50%
decrease
in
the
IVC
diameter
with
inspira/on
predicts
responsiveness
to
volume
expansion
• Posi/ve
pressure
ven/la/on
q
>
12%
increase
in
the
IVC
diameter
with
inspira/on
predicts
responsiveness
to
volume
expansion
q Max
D
–
min
D
/
average
D
>
12%
q Max
D
-‐
min
D
/
min
D
>
18%
13. Assessment
of
Fluid
Status
and
Measures
of
Volume
Responsiveness
Pulse
pressure
varia7on
14. LIMITATIONS
OF
IVC
AND
PULSE
PRESSURE
VARIATIONS
• All
pa/ents
must
be:
– Passively
ven/lated
–
heavily
sedated
– Large
/dal
volume
10-‐12
ml/kg
– Off
vasopressors
– Sinus
rhythm
– Absence
of
increased
abdominal
pressure
• Good
luck
finding
these
pa/ent
Bassel
Ericsoussi,
MD
14
15. Assessment
of
Fluid
Status
and
Measures
of
Volume
Responsiveness
Passive
Leg
Raising
and
Stroke
Volume
Varia7on
• Straight
leg
raising
test:
Can
be
done
on
any
pa/ent
– Sinus
or
irregular
rhythm
– Spontaneous
breathing
or
on
ven/lator
– On
pressors
or
off
pressors
• Use
apical
5
chamber
view
and
measure
the
aor/c
blood
flow
(stroke
volume)
• Raise
legs
to
45
degree
(you
have
just
given
a
“blood
bolus”
500
ml
blood
in
legs
returned
to
the
heart)
• Wait
30-‐60-‐90
sec
(highest
values
within
90
sec)
• Recheck
the
stroke
volume
– SVV
>
12%
Bassel
Ericsoussi,
MD
15
16. Assessment
of
Fluid
Status
and
Measures
of
Volume
Responsiveness
Passive
Leg
Raising
and
Artery
Peak
Velocity
• Doppler
evalua/on
of
arterial
peak
velocity
varia/on
q In
the
responder
pa/ent,
passive
leg
raising
induced
an
increase
of
arterial
peak
velocity
by
15%
17.
18.
19. MIXED
VENOUS
OXYGEN
SATURATION
(SVO2)
• Target
SvO2
–
>
70%:
SVC
–
>
65%:
True
mixed
venous
in
the
RA
• If
SvO2
<
70%
despite
adequate
intravascular
volume
reple/on
and
in
the
presence
of
persis/ng
/ssue
hypoperfusion:
– Hb
<
10
and/or
Ht
<
30:
Transfuse
PRBCs
to
achieve
a
hematocrit
of
greater
than
or
equal
to
30%
– Dobutamine
infusion
(to
a
maximum
of
20
μg/kg/min)
20.
We
suggest
targe/ng
resuscita/on
to
normalize
lactate
in
pa/ents
with
elevated
lactate
levels
as
a
marker
of
/ssue
hypoperfusion
Prevalence
Of
Severe
Sepsis
Mortality
Hypotension
with
Elevated
Lac/c
Acid
16.6%
46.1%
Hypotension
49.5%
36.7%
Elevated
Lac/c
Acid
5.4%
30%
• SvO2
and
lac/c
acid
both
should
be
used
as
a
combined
end
point
• SvO2
>
70%
• Normal
lac/c
acid
21. • Rou/ne
screening
of
poten/ally
infected
seriously
ill
pa/ents
• Early
iden/fica/on
of
sepsis
• Early
implementa/on
of
evidence-‐based
therapy
• Improve
outcomes
• Decrease
sepsis-‐related
mortality
MANAGEMENT
OF
SEVERE
SEPSIS
Screening
for
Sepsis
22. • Associated
with
improved
pa/ent
outcomes
• Tradi/onal
con/nuing
medical
educa/on
efforts
• Applica/on
of
the
sepsis
bundles
-‐
associated
with
reduced
mortality
MANAGEMENT
OF
SEVERE
SEPSIS
Performance
Improvement
23.
24. • Administra/on
of
effec/ve
intravenous
an/microbials
within
the
first
hour
of
recogni/on
of
severe
sepsis
– Each
hour
delay
in
achieving
administra/on
of
effec/ve
an/bio/cs
is
associated
with
a
measurable
increase
in
mortality
• Ini/al
empiric
an/-‐infec/ve
therapy
include
one
or
more
drugs
that
have
ac/vity
against
all
likely
pathogens
and
that
penetrate
in
adequate
concentra/ons
into
the
/ssues
presumed
to
be
the
source
of
sepsis
• The
an/microbial
regimen
should
be
reassessed
daily
for
poten/al
de-‐
escala/on
to
prevent
the
development
of
resistance,
to
reduce
toxicity,
and
to
reduce
costs
• We
suggest
the
use
of
low
procalcitonin
levels
or
similar
biomarkers
to
assist
the
clinician
in
the
discon/nua/on
of
empiric
an/bio/cs
in
pa/ents
who
appeared
sep/c,
but
have
no
subsequent
evidence
of
infec/on
MANAGEMENT
OF
SEVERE
SEPSIS
An7microbial
Therapy
34. MANAGEMENT
OF
SEVERE
SEPSIS
SUPPORTIVE
THERAPY
OF
SEVERE
SEPSIS
• Glycemic
control
<
180
mg/dL
is
not
inferior
to
near-‐normal
glycemia
in
cri/cally
ill
pa/ents
and
is
clearly
safer
• BG
level
of
8.1
mmol/L
(146
mg/dL)
and
below
represents
an
op/mal
level
in
cri/cally
ill
pa/ents