The presentation deals with the basics of hemorrhage i.e. classification, etiology. It also covers the mechanism of hemostasis and the various methods to achieve hemostasis.
Hope you like it! Suggestions and feedback will always be well appreciated. :)
Subject: Medical Surgical Nursing / Adult Health Nursing
Title: Shock
Prepared by: Misfa Khatun, Nursing tutor
Content:
- Introduction
- Definition of Shock
- Classify Shock
- Stages of Shock
- Enumerate the Causes of shock
- Pathophysiology of Shock
- Identify the Signs and symptoms of Shock
- First ais management of Shock
- Treatment of Shock
- Management of Shock
- Nursing management of Shock
The presentation deals with the basics of hemorrhage i.e. classification, etiology. It also covers the mechanism of hemostasis and the various methods to achieve hemostasis.
Hope you like it! Suggestions and feedback will always be well appreciated. :)
Subject: Medical Surgical Nursing / Adult Health Nursing
Title: Shock
Prepared by: Misfa Khatun, Nursing tutor
Content:
- Introduction
- Definition of Shock
- Classify Shock
- Stages of Shock
- Enumerate the Causes of shock
- Pathophysiology of Shock
- Identify the Signs and symptoms of Shock
- First ais management of Shock
- Treatment of Shock
- Management of Shock
- Nursing management of Shock
Disseminated intravascular coagulation (DIC) is a syndrome in which either the extrinsic or intrinsic or both pathways are activated to produce multiple fibrin clots in small blood vessels.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Disseminated intravascular coagulation (DIC) is a syndrome in which either the extrinsic or intrinsic or both pathways are activated to produce multiple fibrin clots in small blood vessels.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
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Blood transfusion is the process through which blood and blood products are transferred to circulation intravenously. Early transfusions used whole blood but modern medical practice commonly used components of blood.It helps to replace blood lost during injury or surgery. It is a life saving procedure. before transfusion of blood it is necessary to know your blood group type. As blood group o is considered as universal donor and blood group AB considered as universal accepter.
Blood transfusion are relatively safe but can be fatal if incorrectly administered. Donated blood can be processed into components such as PCV, FFP, Platelets, Cryoprecipitate. Doctors and nurses plays a major role in blood transfusion. They should follows all safety precautions throughout all steps of administrating procedure.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
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This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
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Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
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2. TYPES OF BLEEDING
DEPNDING ON THE SOURSE OF
BLEEDING
1- ARTERIAL– BRIGHT RED AND COMES IN JETS
WITH THE PULSE OF THE PATIENT
2- VENOUS – DARK RED BLOOD , STEADY AND
COPIOUS
3- CAPILLARY– BRIGHT RED RAPID OOZE
( ABRASIONS )
2 29/02/1429
3. DEPENDING ON THE TIME OF
OCCURANCE
1- PRIMARY BLEEDING – OCCURS AT THE TIME OF
INJURY OR OPERATION
2- REACTIONARY BLEEDING – USUALLY OCCURS IN
4-6 HOURS OR WITH IN THE 24 HOURS THAT
FOLLOW THE PRIMARY BLEEDING, DUE TO
EITHER SLIPPING OF LIGATURE , DISLOGEMENT
OF A CLOT OR CESSATION OF THE REFLEX
VASOSPASM.
THE PRESIPITATING FACTOR ARE
A- THE INCREASE IN THE BLOOD PRESSURE AFTER
RECOVERY FROM SHOCK OR ANASTHESIA
3 29/02/1429
4. B- RESTLESSNESS OF THE PATIENT
C- COUGHING AND VOMITING THAT INCREASE
THE VENOUS PRESSURE
3- SECONDARY BLEEDING – OCCUR WITHIN 7-
14 DAYS AFTER THE PRIMARY TRAUMA OR
OPERATION AND THE CAUSE IS ALWAYS
INFECTION WHICH LEADS TO SLOUGHIN OF
AN ARTERY IN AN AREA BY PRESSURE OF A
DRAIN TUBE OR A BONE FRAGMENT OR BY
SLIPPING OF A LIGATURE IN AN INFECTED
AREA OR MALIGNANT TISSUE
4 29/02/1429
5. DEPENDING ON THE VISIBILITY
A- EXTERNAL ( REVEALED ) BLEEDING
B- INTERNAL ( CONCAELED ) BLEEDING LIKE
INTRA-ABDOMINAL OR INTRACRANIAL
BLEEDING
THE INTERNAL BLEEDING MAY BECOME
EXTENAL AS IN HEMATEMESIS DUE TO A
BLEEDING PEPTC ULCER OR HEMATURIA
AFTER RENAL INJURY OR AN INTRUTERINE
BLEEDING TURNS INTO BLEEDING PER
VAGINA
5 29/02/1429
6. HOW TO MEASURE ACUTE BLOOD
LOSS ?
A NORMAL BLOOD VOLUME IS 80-85 ML / KG IN INFANTS AND
ABOUT 65-75 ML / KG IN ADULTS
1- BLOOD CLOT SIZE – A CLENCHED FIST SIZE CLOT ROUGHLY EQUALS
500 ML
2 - SITE OF A CLOSED # SWELLING -- A MODERATE SWELLING IN A #
TIBIA EQUALS TO 500- 1500 ML OF BLOOD, WHILE A MODERATE
SWELLING IN A # FEMUR EQUALS TO 500-2000 ML OF BLOOD LOSS
3- SWAB WEIGHING – BY SUBSTRACTING THE WEIGHT OF SOACKED
SWABS FROM THEIR WEIGHT WHEN THEY WERE DRY AND THE
BLOOD LOSS IS 1 ML FOR EVERY 1 GM DIFFERENCE
4- HEMOGLOBIN LEVEL ESTIMATION – THERE IS NO IMMEDIATE
DECREASE IN Hg LEVEL AFTER BLEEDING BUT AFTER 8 HOURS IT
WILL DROP BECAUSE OF THE INFLUX OF THE INTERSITIAL FLUID
INTO THE VASCULAR COMPARTEMENT ( DILUTION )
6 29/02/1429
7. TREATMENT
1- PRESSURE ON THE SITE OF BLEEDING –BY
PACKING OR DIGITS OR BALOONS INFLATED AT
THE SITE OF BLEEDING ( ESOPHAGEAL VARICES)
2- REST AND POSITION – BY ELEVATION OF THE
INJURED LIMB TO DECREASE BLOOD RETURN TO
THE HEART
3- OPERATIVE PROCEDURES – BY USING
HEMOSTATS, CLIPS, DIATHERMY, LIGATURES,
GELATIN SPONGES, AND ADRENALIN SOACKED
GAUZE ( 1: 1000 )
4- BLOOD TRANSFUTION
7 29/02/1429
8. INDICATION OF BLOOD TRANSFUSION
1- ANEMIA-- RECENT STUDY SHOWED THAT A
TRANSFUSION THRESHOLD OF 70 G/L WAS
AS SAFE AND POSSIBLY SUPERIOR TO ONE OF
100 G/L IN CRITICAL CARE PATIENTS. A
MINIMUM PREOPERATIVE HAEMOGLOBIN
OF 100 G/L IS NO LONGER REGARDED AS
ESSENTIAL, AS MANY PATIENTS WITH A
LOWER HAEMOGLOBIN TOLERATE SURGERY
AND SEEM TO RECOVER JUST AS WELL.
8 29/02/1429
9. 2- BLOOD LOSS – IF GREATER THAN 30 PER
CENT OF ESTIMATED BLOOD VOLUME,
PATIENTS WITH MASSIVE BLOOD LOSS,
DEFINED AS THOSE REQUIRING
TRANSFUSION OF A VOLUME OF BLOOD
GREATER THAN THEIR BLOOD VOLUME
WITHIN 24 H
DEPLETION OF COAGULATION FACTORS IS
UNUSUAL, BECAUSE STORED BLOOD
CONTAINS ADEQUATE AMOUNTS OF ALL
EXCEPT FOR FACTORS V AND VIII, WHICH
FALL DURING STORAGE.
9 29/02/1429
10. 3- REPLACEMENT OF BLOOD COMPONENTS –
RED & WHITE BLOOD CELLS, COAGULATION FACTORS,
PLASMA
PROCEDURE FOR BLOOD TRANSFUSION
1- PRETRANSFUSION COMPATIBILITY TESTING -- A.
BLOOD GROUPING ,THE ABO AND RHD GROUPS OF
THE PATIENT ARE DETERMINED.
B Donor blood of the same ABO and RhD group as the
patient is selected.
D. Cross-matching-- The full cross-match involves
testing the patient's plasma against a sample of the
red cells from the donor unit in a direct
agglutination test.
10 29/02/1429
11. 2- BLOOD ORDERING – A. ELECTIVE
SURGERY-- SUFFICIENT TIME SHOULD
BE ALLOWED FOR THE LABORATORY TO
CARRY OUT PRETRANSFUSION TESTING.
B. EMERGENCIES--
THERE MAY BE INSUFFICIENT TIME FOR
FULL PRETRANSFUSION TESTING.—USE
2 UNITS OF O RHD-NEGATIVE BLOOD
('EMERGENCY STOCK') , TO ALLOW
ADDITIONAL TIME FOR THE
LABORATORY TO GROUP THE PATIENT.
11 29/02/1429
12. 3-Blood, blood components, and blood products--
Blood collected from donors is processed into:
A- Blood components, such as red cell and
platelet concentrates, fresh frozen plasma and
cryoprecipitate, which are prepared from a
single donation of blood by simple separation
methods such as centrifugation, and transfused
without further processing.
B- Blood products, such as coagulation factor
concentrates and albumin and immunoglobulin
solutions, which are prepared by complex
processes using the plasma from many donors
as the starting material.
12 29/02/1429
13. Strategies for avoiding or reducing
the use of blood tranfusion
By discontinuing antiplatelet and anticoagulant drugs, if
possible, several days before surgery.
Anaemia, if present, should be investigated and treated
appropriately in advance of elective surgery.
Intraoperative measures include the use of meticulous surgical
and anaesthetic techniques, a cautious use of anticoagulants
during surgery, and the use of drugs to enhance haemostasis
AND THE USE OF AUTOLOGOUS TRANSFUSION.
13 29/02/1429
14. Autologous transfusion
THERE ARE THREE TYPES OF AUTOLOGOUS
TRANSFUSION:
1-PREDEPOSIT. THE PATIENT DONATES 2–5 UNITS OF BLOOD
AT APPROXIMATELY WEEKLY INTERVALS BEFORE ELECTIVE
SURGERY.
2-PREOPERATIVE HAEMODILUTION. ONE OR TWO UNITS OF
BLOOD ARE REMOVED FROM THE PATIENT IMMEDIATELY
BEFORE SURGERY AND RETRANSFUSED TO REPLACE
OPERATIVE LOSSES.
3-BLOOD SALVAGE. BLOOD LOST DURING OR AFTER SURGERY
MAY BE COLLECTED AND RETRANSFUSED. SEVERAL
TECHNIQUES OF VARYING LEVELS OF SOPHISTICATION ARE
AVAILABLE. OPERATIVE SITE MUST BE FREE OF BACTERIA,
BOWEL CONTENTS, AND TUMOUR CELLS.
14 29/02/1429
15. Complications of blood transfusion
1-- Immediate haemolytic transfusion reactions
This is the most serious complication of blood
transfusion and is usually due to ABO incompatibility.
There is complement activation by the antigen-
antibody reaction, usually due to IgM antibodies,
leading to rigors, lumbar pain, dyspnoea, hypotension,
haemoglobinuria, and renal failure. At the first
suspicion of any serious transfusion reaction, the
transfusion should always be stopped and the donor
units returned to the blood transfusion laboratory with
a new blood sample from the patient to exclude a
haemolytic transfusion reaction.
15 29/02/1429
16. 2--DELAYED HAEMOLYTIC TRANSFUSION
REACTIONS
THESE MAY OCCUR IN PATIENTS ALLOIMMUNIZED
BY PREVIOUS TRANSFUSIONS OR PREGNANCIES.
THE ANTIBODY TITRE IS TOO LOW TO BE
DETECTED BY PRETRANSFUSION COMPATIBILITY
TESTING, BUT A SECONDARY IMMUNE
RESPONSE OCCURS AFTER TRANSFUSION,
RESULTING IN DESTRUCTION OF THE
TRANSFUSED CELLS, USUALLY BY IGG
ANTIBODIES. THE PATIENT MAY DEVELOP
ANAEMIA AND JAUNDICE ABOUT A WEEK AFTER
THE TRANSFUSION, ALTHOUGH MANY ARE
CLINICALLY SILENT.
16 29/02/1429
17. 3--NON-HAEMOLYTIC (FEBRILE) TRANSFUSION
REACTIONS
FEBRILE REACTIONS ARE A COMMON
COMPLICATION OF BLOOD TRANSFUSION IN
PATIENTS WHO HAVE PREVIOUSLY BEEN
TRANSFUSED OR PREGNANT. THE USUAL CAUSE
IS THE PRESENCE OF LEUCOCYTE ANTIBODIES IN
THE RECIPIENT ACTING AGAINST TRANSFUSED
LEUCOCYTES, LEADING TO RELEASE OF
PYROGENS. TYPICAL SIGNS ARE FLUSHING AND
TACHYCARDIA, FEVER (>38°C), CHILLS, AND
RIGORS. PARACETAMOL MAY BE USED TO
REDUCE THE FEVER.
17 29/02/1429
18. 4--Urticaria And Anaphylaxis
Urticarial Reactions Are Often Attributed To Plasma
Protein Incompatibility But, In Most Cases, They
Are Unexplained. They Are Common But Rarely
Severe; Stopping Or Slowing The Transfusion, And
Intravenous Chlorpheniramine 10 Mg (Adult
Dose), Are Usually Sufficient Treatment.
Anaphylactic Reactions Occasionally Occur; Severe
Reactions Are Seen In Patients Lacking IgA Who
Produce Anti-IgA That Reacts With IgA In The
Transfused Blood. The Transfusion Should Be
Stopped And Adrenaline 0.5 Mg Intramuscular
And Chlorpheniramine 10 Mg Intravenous Should
Be Given Immediately; Endotracheal Intubation
May Be Required.
18 29/02/1429
19. 5– TRANSMISSION OF INFECTION
HEPATITIS, HUMAN IMMUNODEFICIENCY VIRUS
OTHER VIRUSES: CYTOMEGALOVIRUS, EPSTEIN–
BARR VIRUS, HUMAN T-CELL
LEUKAEMIA/LYMPHOMA VIRUS TYPE 1 (HTLV-1)
PARASITES: MALARIA, TRYPANOSOMIASIS,
TOXOPLASMOSIS SYPHILIS AND TRANSFUSION OF
BLOOD CONTAMINATED WITH BACTERIA
6--CIRCULATORY FAILURE DUE TO VOLUME
OVERLOAD.7-- IRON OVERLOAD DUE TO MULTIPLE
TRANSFUSIONS. 8-- MASSIVE TRANSFUSION OF
STORED BLOOD MAY CAUSE BLEEDING AND
ELECTROLYTE CHANGES. 9-- THROMBOPHLEBITIS
10-- AIR EMBOLISM
19 29/02/1429