Hemodynamic monitoring involves measuring and monitoring the factors that influence blood flow and pressure in the body. It is concerned with five main areas: the right heart, lungs, left heart, fluid status, and blood pressures. Normal hemodynamic values include a central venous pressure of 2-6 mmHg, pulmonary artery pressure of 6-15 mmHg, pulmonary capillary wedge pressure of 6-12 mmHg, and a cardiac output of 4-8 L/min. Treatment for different types of shock depends on the underlying cause but may include inotropes, vasopressors, antibiotics, and fluid resuscitation.
Workshop of Low Cardiac Output Management, 2018Isman Firdaus
Low cardiac output or shock or circulatory failure was the terminal state of any disease including cardiovascular problem. It is consist distributive, volume, obstructive and cardiogenic circulatory failure leading multi organ failure and mortality. Hemodynamic monitoring is important evaluation to guide the medication and treatment.
Anaesthesia in Cardiac Patients for Non-cardiac SurgeryRashad Siddiqi
The reader should be able to:
(1) identify factors which will lead to increased cardiovascular risk for patients undergoing non-cardiac surgery
(2) decide which patients require further cardiovascular testing
(3) make optimization plan for such patients
(4) understand the principles of anaesthesia for patients with cardiac disease
This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
Workshop of Low Cardiac Output Management, 2018Isman Firdaus
Low cardiac output or shock or circulatory failure was the terminal state of any disease including cardiovascular problem. It is consist distributive, volume, obstructive and cardiogenic circulatory failure leading multi organ failure and mortality. Hemodynamic monitoring is important evaluation to guide the medication and treatment.
Anaesthesia in Cardiac Patients for Non-cardiac SurgeryRashad Siddiqi
The reader should be able to:
(1) identify factors which will lead to increased cardiovascular risk for patients undergoing non-cardiac surgery
(2) decide which patients require further cardiovascular testing
(3) make optimization plan for such patients
(4) understand the principles of anaesthesia for patients with cardiac disease
This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
The CVP in patient with hypovolemic shock
case :
Mostafa 22years old
Agitated and compleaning of abdominal pain
Airway is patent
Respiratory rate 32 per min.
BP 90/60 mmHg.
Pulse 130 bpm.
Temp 36C.
Abdominal distension.
Cold skin
Nsogastric tube rvealed green liqued
Urinary cathetar revealed dark urine
Hemoglobin is 7.
FAST is postive.
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CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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.
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.
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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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
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.
2. Objectives
Learner will be able to state the definition
of basic hemodynamic terms.
• The definition of hemodynamics.
• The factors determining hemodynamics.
• The definition of cardiac output.
• Factors that determine cardiac output.
• The definitions for preload, afterload,
contractility.
• Define cardiogenic shock, septic shock,
hypovolemic shock and treatments.
3. WHAT IS
HEMODYNAMIC MONITORING
Simply stated hemodynamics is about pressure.
Involves movement of blood.
The measurement and monitoring factors that influence
the force and flow of blood.
Universal law, all matter seeks its lowest possible energy
state
For blood it means trying to be at lowest pressure
gradient. Hence going from highest to lowest pressure.
4. Gases also obey this
pressure gradient
• The reason carbon
dioxide jumps off the
blood stream,
through alveolar
capillary membrane
and into alveoli is
because there is less
CO2 there.
5. Circulatory System
Circulatory system divided into two major parts:
Pulmonary System Systemic System
Pulmonary system made up of the
right side of the heart right (right Systemic is made up of left side of
atrium & right ventricle), the heart (left atrium and left
pulmonary arteries, & pulmonary ventricle), the arteries and veins.
veins.
Carry oxygenated blood from the
Arteries direct blood from the right
left heart to different organ
ventricle to the lungs. Veins
systems. Veins partially return the
conduct oxygenated blood from
deoxygenated blood back to right
lungs to left side of the heart.
side of the heart.
7. IN THE
CIRCULATORY SYSTEM
Heart is the pump that provides power
to move blood throughout the blood
vessels (perfusion)
Blood vessels direct blood from the
heart to tissues through arteries and
capillaries (circulatory system) and
back to the right heart through the
veins
Blood is the medium in which oxygen
and other nutrients are carried to the
tissues.
8. Blood moves
downstream
• When leaving left
ventricle pressure is
about 120/80 mmgh
• In capillaries pressure is
about 20 mmHg
• From capillaries , back to the
right heart where pressure is
about 4mmHg
9. WHAT IS CARDIAC OUTPUT
Cardiac output is the quantity of blood pumped out by the
left ventricle in each minute. Normal 4 - 8 L/min*
Cardiac output is the product of heart rate and stroke
volume (the vol. of blood ejected by the ventricle w/ each
contraction.)
Stroke volume is the volume of blood ejected by the
ventricles by a single heart beat. Normal 60 -120ml/beat
Cardiac output divided by body surface area is known
as Cardiac Index. Normal 2.5 - to 4.0 L/min/m2*
10. What determines cardiac output?
Heart Rate and Stroke Volume!!
Stroke volume is a function of three important factors.
Stroke volume is the volume of blood ejected by the ventricle by a single heart beat.
Normal for adults 60 to 130 ml/beat.
11. Stroke volume is a function of three important factors.
Preload After-load Contractility
Arterial resistance to flow
Filling volume of the Forcefulness of myocardial
out of the ventricles during
ventricles (diastole). contraction
contraction (aortic bp)
SVR indicates afterload for If the ventricle is adequately
the L. ventricle. PVR indicates filled & resistance to outflow
The filling volume of the afterload for the R. ventricle. optimal, cardiac output will
ventricles prior to not be adequate if contractility
Appropriate level of afterload
contraction is one to the is poor. Factors that reduce
for the L. ventricle is essential
most important factors cardiac contractility are called
to maintain adequate
determining the negative inotropes & include
perfusion pressure to the
subsequent volume of hypoxemia, acidosis, &
body. in afterload
blood ejected during medications such as beta
(peripheral vasodilation) will
systole. Too little filling blockers.
cause BP to drop. in BP will
or too much filling leads Factors that increase
stimulate the heart to C.O.
to a reduced stroke contractility are called positive
to maintain circulation.
volume. inotropes and include certain
The interaction between C.O. beta-adrenergics and
& after-load determines BP. parasympatholytics.
12. Five factors we look at to
determine hemodynamics
• Right heart
• Lungs
• Left Heart
• Too much fluid
• Not enough fluid
13. Hemodynamics is all
about pressures
• CVP: Central Venous Pressure (before the R. heart)
• PAP: Pulmonary Artery Pressure (after the R. heart)
• PCWP: Pulmonary Wedge Pressure (after the lungs)
• C.O Cardiac Output: although not a pressure but a
volume it also relates to pressure (after the L. heart)
• We are concerned about the functions that lies
between these pressure values (i.e. right heart, lungs,
left heart, and the systemic vascular system.)
14. Normal
Values
Also called right atrial pressure, right side
preload, right ventricular end diastolic
Measurement taken at the
pressure... they all use right as description
R. atrium or vena cava.
CVP 2-6 mmHg
Looks at function of right Low values may be High values
heart in general dehydration or relates to fluid
vasodilation - fluids or overload -
vasoconstriction drugs. diurese the pt.
Measurement taken w/
6 - 15
transducer at tip of
PAP mmHg
catheter placed in
Also called Right ventricular after- load.
(mean 14) pulmonary artery.
Measurement taken w/ Also called left atrial
6-12 Relates to
balloon-tipped catheter pressure, left ventricular
PCWP Normal 8 inflated and wedge in filling pressure, left
function of Left
mmHg heart.
pulmonary artery. ventricular preload
If CO is , usu.
Expressed as volume Generally relates to Left treat w/ cardiac
C.O 4 - 8 L/min
ventricle inotropics or
rather than pressure.
chronotropics.
15. Pressure after Relates to function
the right heart of left heart
PAP = 6 - 15 PCWP = 6 - 12
C.O. = 4 - 8
CVP = 2 - 6 Pulmonary L/min
Pressure vascular
before the system Generally
right heart relates to
condition of
left ventricle
Right heart Left Heart
16. QUICK QUESTIONS TO ASK YOURSELF
WHEN LOOKING AT THESE PRESSURES.
What two pressure would you look
at for right heart function?
CVP and PAP CVP Before R. heart
PAP After R. heart
What two pressures would look at PWCP After lungs
for blood flow to the lungs? C.O. After L. heart
PAP and PCWP
What about left heart?
PCWP and then volume C.O.
17. Etiology
Results form inadequate cardiac contractility. Most common in
the United states and most often seen in patients experiencing a
Cardiogenic shock: myocardial infarction. Approximately 6 to 7% of patients
having an M.I. develop cardiogenic shock.
Failure of vascular tone most often seen in the septic patient.
Septic shock causes complex problems with maldistribution of
flow resulting in severe vasodilation and a very low afterload.
Distributive shock: Cardiac output is often increased, but flow to vital organs is
often inadequate owing to low perfusion pressures and
persistent hypotension.
Hypovolemic Inadequate or decrease circulating blood volume. Can be a
shock: result of bleeding from trauma, surgery, or dehydration.
18. Treatment
Positive inotropes and vasopressors are the primary approach.
Inotropics, chronotropes, and vasocontrictors, such as
dopamines and norepinephrine, may be needed to improve
Cardiogenic shock:
blood pressure. Inotropics should NOT be used if patient is
suspected of having acute myocardial infarction given that in
can further stress the heart and extend infarctions.
Antibiotics and volume expansion are essential for patients in
septic shock. Volume expansion improves BP by filling the void
created by the peripheral vasodilation associated with sepsis.
Distributive shock: Vasopressors such as dopamine and norepinephrine improve
hypotension by partially reversing the vasodilation caused by
sepsis and by stimulating contractility therefore improving
cardiac output..
Rapid replacement of circulating blood volume is crucial. As a
rule, fluid resuscitation is needed whenever the systolic blood
pressure is below 90mm Hg and there are no signs of vital
Hypovolemic
organ disfunction (abnormal sensorium). If patient had large
shock: amount of blood loss, it is ideal to use blood as a replacement.
If hypovolemic shock is not caused by bleeding, saline
solutions are effective in aiding circulating blood.
19. Treatment Conclusion
• Oxygen!!
• Mechanical ventilation is most often needed in the
patient with the type of shock that does not resolve
quickly. Those with septic shock or sever
cardiogenic shock most often need mechanical
ventilation given that it aids in reducing oxygen
consumption of the respiratory muscles.
• Close monitoring of all patients diagnosed with
shock in the ICU is important.