Clinical Practice Guidelines for Traumatic Brain Injury 2556Utai Sukviwatsirikul
Clinical Practice Guidelines for Traumatic Brain Injury 2556
แนวทางเวชปฏิบัติกรณีสมองบาดเจ็บ (Clinical Practice Guidelines for Traumatic Brain Injury) พิมพ์ครั้งที่ 1 2556
http://pni.go.th/pnigoth/wp-content/uploads//2013/10/Clinical-Practice-Guidelines-for-Traumatic-Brain-Injury.pdf
Haemorrhagic septicemia is an acute disease caused by two serotypes of Pasteurella multocida bacteria that mainly affects cattle and water buffalo. It is characterized by a sudden, often fatal sepsis. The disease has a high mortality rate, especially during monsoon seasons or when introduced to new regions. Transmission occurs through ingestion or inhalation of bacteria from direct contact, fomites, feed, or water. Vaccination is the primary prevention method, with oil-adjuvant bacterins providing the most effective long-term protection of 9-12 months.
Viral haemorrhagic fevers (vhf) plus questions.Shaikhani.
Viral haemorrhagic fevers are caused by several viruses and occur mostly in rural parts of Africa. Lassa fever is widespread in West Africa with an overall mortality of around 15% for hospitalized cases. Ebola outbreaks occur about once per year in countries like Congo, Uganda, and Sudan. While most have mild symptoms, all can present with fever, body aches, and bleeding. Transmission is through contact with infected individuals, animals, or insect bites. Treatment involves isolation and supportive care, with ribavirin used for Lassa fever and South American haemorrhagic fevers.
Clinical Practice Guidelines for Traumatic Brain Injury 2556Utai Sukviwatsirikul
Clinical Practice Guidelines for Traumatic Brain Injury 2556
แนวทางเวชปฏิบัติกรณีสมองบาดเจ็บ (Clinical Practice Guidelines for Traumatic Brain Injury) พิมพ์ครั้งที่ 1 2556
http://pni.go.th/pnigoth/wp-content/uploads//2013/10/Clinical-Practice-Guidelines-for-Traumatic-Brain-Injury.pdf
Haemorrhagic septicemia is an acute disease caused by two serotypes of Pasteurella multocida bacteria that mainly affects cattle and water buffalo. It is characterized by a sudden, often fatal sepsis. The disease has a high mortality rate, especially during monsoon seasons or when introduced to new regions. Transmission occurs through ingestion or inhalation of bacteria from direct contact, fomites, feed, or water. Vaccination is the primary prevention method, with oil-adjuvant bacterins providing the most effective long-term protection of 9-12 months.
Viral haemorrhagic fevers (vhf) plus questions.Shaikhani.
Viral haemorrhagic fevers are caused by several viruses and occur mostly in rural parts of Africa. Lassa fever is widespread in West Africa with an overall mortality of around 15% for hospitalized cases. Ebola outbreaks occur about once per year in countries like Congo, Uganda, and Sudan. While most have mild symptoms, all can present with fever, body aches, and bleeding. Transmission is through contact with infected individuals, animals, or insect bites. Treatment involves isolation and supportive care, with ribavirin used for Lassa fever and South American haemorrhagic fevers.
This document provides an outline for a lecture on gall bladder and biliary tree diseases. It begins with an overview of the anatomy and physiology of the gallbladder and biliary ducts. It then discusses the clinical presentation of patients with biliary diseases and specific disease entities such as cholelithiasis, acute cholecystitis, obstructive jaundice, and gallbladder cancer. For each disease, it covers epidemiology, risk factors, pathophysiology, clinical features, diagnostic workup, and management. The document concludes with references.
The document describes a scenario of being on call on the pediatric wards. It introduces two patients, Luis and Ryan, who are exhibiting signs of shock such as pallor, tachypnea, and diaphoresis. The document then provides an overview of shock, its signs and symptoms, and the initial steps of fluid resuscitation and obtaining additional help.
The document summarizes information about Ebola virus hemorrhagic fever and Lassa virus hemorrhagic fever. It describes the etiology, epidemiology, signs and symptoms, diagnosis, treatment and prevention of the two viral hemorrhagic fevers. Ebola virus causes a severe multisystem disease in humans characterized by fever, headache and bleeding. Lassa fever is endemic in West Africa and transmitted from rodents to humans, causing fever, bleeding and organ dysfunction. Treatment involves supportive care and the antiviral drug ribavirin.
Viral Hemorrhagic Fevers (VHFs) are caused by four families of viruses that can cause bleeding and damage the vascular system. Symptoms include bleeding under the skin, in organs and orifices. The viruses are transmitted through contact with infected hosts like rodents, mosquitoes and ticks. Treatment focuses on supportive care, with some viruses treated with ribavirin. Prevention involves controlling host populations and avoiding contact with their bodily fluids.
Neonatal bilious vomiting is due to congenital obstruction in GI tract. This will present in early neonatal life. Exact diagnosis should be made quickly and appropriate surgical intervention should be done immediately to save these unfortunate children.
This document discusses birth asphyxia, including its definition, causes, pathophysiology, clinical manifestations, assessment, effects, classification, management, investigations and prognosis. Some key points:
- Birth asphyxia is defined as reduction of oxygen delivery and accumulation of carbon dioxide around birth, leading to respiratory failure in newborns. It is assessed using Apgar scores and fetal monitoring.
- Causes include maternal, delivery and fetal factors that interfere with maternal-fetal circulation such as prematurity, cord problems and placental issues.
- Effects depend on severity and can involve multiple organs, particularly the brain, heart and lungs. Management focuses on stabilizing vital functions and preventing further injury through temperature control
The document discusses the care of common pediatric emergencies including asthma, bronchiolitis, pneumonia, croup, and foreign body obstruction. It covers the pathophysiology, assessment, history, physical exam findings, and management considerations for each condition. The care of the normal newborn is also summarized, outlining the immediate attention, transition care, attention in the postpartum period, and follow up consultations needed after birth and during early childhood.
This document provides guidelines for the management of severe sepsis and septic shock according to the Surviving Sepsis Campaign. It outlines the initial resuscitation goals of fluid resuscitation, antibiotic administration, lactate clearance, and maintaining a central venous oxygen saturation of greater than 70% through fluid administration, vasopressors if needed, and dobutamine. The use of stress-dose steroids and recombinant human activated protein C for certain high-risk patients is also recommended.
Dear Viewers,
Greetings from “ Surgical Educator”
Today I have uploaded a video on one of the congenital causes for obstructive jaundice- Biliary Atresia. In this episode, I am discussing about the etiology, types, clinical features, investigations, treatment and surgical outcome of Biliary Atresia. I hope you will enjoy the video. You can watch all my surgical teaching video casts in the following link: surgicaleducator.blogspot.com.
Perinatal asphyxia, also known as asphyxia neonatorum, is defined as impaired respiratory gas exchange accompanied by metabolic acidosis in newborns. It occurs due to interruption of umbilical cord blood flow or failure of placental gas exchange. Clinical features include apnea, bradycardia, cyanosis, and hypotonia. Multiple organs can be affected, especially the brain, kidneys, heart, and lungs. Brain damage ranges from mild to severe based on duration and severity of asphyxia. Management involves supportive care, treatment of complications, and in severe cases hypothermia therapy or anticonvulsants for seizures may be used. Outcomes depend on the stage of hypo
Disseminated intravascular coagulation (DIC) is a syndrome characterized by widespread activation of coagulation that can occur as a result of various underlying conditions. It results from an imbalance between coagulation and anticoagulation processes in the body. DIC can be acute, with bleeding and shock being dominant symptoms, or chronic, where thrombosis and clotting may predominate. The most common triggers of DIC are infectious diseases, cancer, obstetric complications, and severe tissue injury. Diagnosis involves identifying symptoms of bleeding and thrombosis, abnormal laboratory coagulation test results, and ruling out other conditions. Treatment focuses on treating the underlying cause, replacing coagulation factors, platelets, and fibrinogen, and
A presentation about DIC (Disseminated Intravascular Coagulopathy).
Done by 4th year medical students at the University of Science and Technology, Sana'a, Republic of Yemen, in October 2010.
This document discusses the diagnosis and management of shock. It defines shock as impaired tissue oxygenation and perfusion that can lead to organ dysfunction and death if left untreated. The document classifies shock into 4 main categories: hypovolemic, cardiogenic, distributive, and obstructive. It then describes the key clinical features, causes, and goals of treatment for each type of shock. The general principles of shock management are also summarized, which include treating the underlying cause, restoring adequate perfusion and tissue oxygen delivery, and reducing oxygen demand through supportive care.
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
The document summarizes neonatal sepsis, including its definition, epidemiology, causes, symptoms, diagnosis, and treatment. It discusses the pathophysiology of neonatal immune deficiency that predisposes infants to sepsis. Early and late onset sepsis are described, along with common pathogens for each. Risk factors like prematurity, maternal infections, and invasive procedures are outlined. The clinical presentation of sepsis is generally non-specific. Evaluation includes blood tests and cultures. Treatment involves initial broad-spectrum antibiotics tailored based on results and infant risk factors. Prevention strategies like vaccines and hand washing are mentioned.
The document discusses concepts related to sepsis, severe sepsis, and septic shock. It provides statistics on the incidence and mortality of these conditions. It also describes the pathophysiology of sepsis, including the roles of inflammation, coagulation abnormalities, and hemodynamic changes. Potential mediators such as cytokines, nitric oxide, and endotoxin are examined in the development of septic shock.
The document describes the anatomy and physiology of the biliary tree. It details the structures of the gallbladder, bile ducts, and their variations. Bile aids in digesting lipids and eliminating waste. The liver produces bile which is stored in the gallbladder and released in response to cholecystokinin after eating to help break down fats in the small intestine.
The document discusses various trauma scoring systems used to assess injury severity and predict patient outcomes. It describes anatomical indices like the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) which evaluate individual injuries and overall trauma burden. It also outlines physiological scores such as the Trauma Score, Revised Trauma Score, and CRAMS scale that assess vital signs and neurological status. Combination scores like TRISS use both anatomical and physiological factors to determine survival probabilities for trauma patients. Early warning scores evaluate pre-hospital and emergency department patients to guide triage and care.
The document discusses various trauma scoring systems used to assess injury severity, predict survival chances, and guide triage and treatment of trauma patients. It describes anatomical indices like the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) which evaluate individual injuries and overall injury burden. It also covers physiological scales like the Trauma Score, Revised Trauma Score, and CRAMS scale. Multiple organ dysfunction scores like SOFA are presented, along with mass casualty triage algorithms like START and SALT.
This document provides information on the management of traumatic brain injury (TBI). It defines TBI as an alteration in brain function caused by a blow or jolt to the head. The primary survey for a TBI patient involves assessing the airway, breathing, circulation, disability or neurological status, and exposure. Disability is evaluated using the Glasgow Coma Scale. Mild TBI is defined as a brief alteration in mental status or consciousness with a Glasgow Coma Scale score between 13-15. The document also discusses complications, guidelines for CT scans, and classifications of mild versus severe TBI.
This document provides guidance on the management of multiple trauma patients. It outlines the ABCDE approach and trauma concept, which emphasizes rapidly assessing and treating the most life-threatening injuries first before making definitive diagnoses.
The primary survey involves simultaneously assessing the patient's airway, breathing, circulation, disability, and exposure. Adjuncts like monitoring, catheters and imaging may be used but not delayed transfer. The secondary survey obtains a more detailed history and physical exam.
Special considerations for pediatric, geriatric, and pregnant trauma patients are discussed. Key physiological differences and injury patterns are highlighted. The document also reviews complications like tension pneumothorax, cardiac tamponade and hemorrhagic shock and their
- Shocks occur when there is inadequate tissue perfusion and oxygenation due to problems like blood loss, fluid loss, tension pneumothorax, cardiac tamponade, etc.
- Clinical signs of shock include anxiety, tachycardia, tachypnea, decreased urine output, pale and cool skin.
- Treatment of shock involves rapid identification of the cause, stopping any ongoing bleeding, and fluid resuscitation. Blood transfusion may be needed for more severe cases. Care must be taken to avoid complications like hypothermia, acidosis, and coagulopathy during resuscitation.
14. HEMORRHAGIC SHOCK
“GRADE”
Category Blood loss Findings
Compensated Shock < 20% BV Heart, Brain OK,
Mean arterial pressure OK
(Vasoconstriction)
Uncompensated Shock 20-40% BV Mean arterial pressureUncompensated Shock 20-40% BV
(1-2Liter)
Mean arterial pressure
Low cardiac output
Anaerobic glycolysis
Exsanguinated Shock > 40% BV Profound BP
GCS
15. ESTIMATION OF BLOOD LOSS
BLOOD LOSS BP
<25% Blood volume BP > 110 mmHg
25-33% Blood volume BP ~ 100 mmHg
> 33% Blood volume BP < 100 mmHg> 33% Blood volume BP < 100 mmHg
16. PRINCIPLE OF RESUSCITATION
“HEMORRHGIC SHOCK”
1.Physiologic replacement
-Balanced salt solution-Balanced salt solution
-RBC (Hb < 7 q/L)
2. Pharmacologic treatment
-Vasoactive drugs
3. Control external blood loss
4. Major operation
17. TIMING OF FLUID RESUSCITATION
1. Delayed fluid replacement
-Control hemorrhge first
2. Immediate fluid replacement
-2-4 Litre Acetar-2-4 Litre Acetar
-20 ml/kg in children
-PRC to maintain BP
3. Hypotensive resuscitation
-ไม่ควรใช้กรณี Blunt และ Brain Injuries
-ใช้กรณีบาดแผลทะลวงทีลําตัว
38. EMERGENCY DEPARTMENT
SURGERY
Long bone fracture
“Femoral fracture can bleed significantly”“Femoral fracture can bleed significantly”
1. Traction splint
2. Vascular injuries
52. EMERGENCY DEPARTMENT
SURGERY
Abdominal Trauma
“Significant intraabdominal or retroperitoneal hemorrhage“Significant intraabdominal or retroperitoneal hemorrhage
can be a reason to go to rapidly to the OR”
1. DPL
2. Ultrasonography
3. CT scan
73. EMERGENCY DEPARTMENT
SURGERY
Pelvic Trauma
“In is essential to return the pelvis to its original
configuration as swiftly as possible”
1. นอนนิง ๆ ห้ามทํา PCT
configuration as swiftly as possible”
1. นอนนิง ๆ ห้ามทํา PCT
2. Pelvic binding
3. PASG
4. C-clamp
5. Other form of external fixation
90. OBSTRUCTIVE SHOCK
• Decrease breath sounds
• Hyper-resonance of the affected side
• Displacement of trachea• Displacement of trachea
• Distended neck veins
