This document summarizes guidelines for treating hypertensive emergencies and urgencies. It defines hypertensive crisis as a severe elevation in blood pressure (>180/120 mmHg) and differentiates between emergencies and urgencies based on whether there is evidence of impending or progressive target organ dysfunction. The goal in treating hypertensive urgencies is to reduce mean arterial pressure by 10-15% within hours using oral medications. Hypertensive emergencies require more rapid blood pressure reduction, typically using intravenous medications, to prevent or limit end-organ damage. Lifestyle modifications and initial drug choices are outlined based on blood pressure levels and patient risk factors.
This document provides an outline and overview of hypertension and hypertensive emergencies. It discusses the definition, pathophysiology, evaluation, treatment and management of hypertension as well as specific topics like pediatric, renal and pregnancy-related hypertension. Evaluation involves assessing for secondary causes and end-organ damage to the brain, eyes, heart and kidneys. Treatment goals are to lower blood pressure in a controlled manner to prevent adverse events while preserving organ function. Both oral and intravenous antihypertensive medications are discussed.
Management of hypertensive condition in 2020 according to AHA/ASA guidelines. We will discuss the presentation, clinical assessment, investigations, and management of hypertension along with major randomized controlled trials and guidelines.
Hypertensive emergencies require immediate blood pressure reduction to prevent end organ damage. They are characterized by severely elevated blood pressure and signs of acute target organ injury. The goal is to lower mean arterial pressure by 20-25% within minutes to hours using intravenous antihypertensive drugs like sodium nitroprusside. Hypertensive urgencies also involve severely high blood pressure but without acute organ injury, allowing for oral drugs to safely lower blood pressure within 24 hours. Rapid blood pressure reduction is avoided to prevent hypotension in both conditions.
This document discusses hypertensive urgency and emergency. Hypertensive urgency is defined as systolic BP >200 mm Hg or diastolic BP >120 mm Hg without end organ damage. Hypertensive emergency is diastolic BP >140 mm Hg with evidence of acute end organ damage. Immediate interventions for patients include assessing BP, elevating the head of bed, administering oxygen, notifying physicians, and documenting status changes. Patients may experience symptoms like headache, confusion, chest pain, or nausea.
Severe hypertension that is a potentially life-threatening condition refers to a hypertensive crisis.
Severe hypertension is further classified into hypertensive emergencies or hypertensive urgencies.
Hypertensive emergency refers to a severe hypertension that is associated with new or progressive end-organ damage. In these clinical situations, blood pressure should be reduced immediately to prevent or minimize organ dysfunction.
Hypertensive urgency refers to severe hypertension without evidence of new or worsening end-organ injury.
A hypertensive emergency is hypertension with acute impairment of one or more
organ systems that can result in irreversible organ damage. Especially:-
Central nervous system
Cardiovascular system
Renal system.
The term hypertensive emergency is primarily used as a specific term for a hypertensive crisis with a diastolic blood pressure greater than or equal to 120mmHg and/or systolic blood pressure greater than or equal to 180mmHg.
Hypertensive emergency differs from hypertensive crisis in that, in the former, there is evidence of acute organ damage.
The presentation covers definitions, identification, Treatment goals, Special situations, Practice points, and cardinal pharmacotherapy. Session presented in NBE learning session
This document discusses hypertensive emergencies, which are severe cases of high blood pressure that result in acute organ damage. It defines categories of hypertensive states and provides details on etiology, pathophysiology, presentation, workup, and treatment of hypertensive emergencies. Treatment involves identifying the affected organ system and gradually lowering blood pressure over hours to days to prevent further organ injury, using intravenous medications like nitroprusside, labetalol, or nicardipine depending on the situation. Specific guidance is provided for rapidly lowering blood pressure in conditions like hypertensive encephalopathy, intracerebral hemorrhage, and ischemic stroke.
This document discusses hypertensive urgency and emergency. Hypertensive urgency is severely elevated blood pressure without target organ damage, with symptoms like headache and dizziness. Treatment involves slowly lowering blood pressure over hours to days. Hypertensive emergency is elevated blood pressure that results in organ damage to the brain, heart, or kidneys, requiring immediate treatment to lower blood pressure within minutes to hours to prevent further damage. Specific treatments depend on the affected organ and may include drugs like labetalol, nicardipine, and sodium nitroprusside. The main difference between urgency and emergency is that emergency involves organ damage while urgency does not.
This document provides an outline and overview of hypertension and hypertensive emergencies. It discusses the definition, pathophysiology, evaluation, treatment and management of hypertension as well as specific topics like pediatric, renal and pregnancy-related hypertension. Evaluation involves assessing for secondary causes and end-organ damage to the brain, eyes, heart and kidneys. Treatment goals are to lower blood pressure in a controlled manner to prevent adverse events while preserving organ function. Both oral and intravenous antihypertensive medications are discussed.
Management of hypertensive condition in 2020 according to AHA/ASA guidelines. We will discuss the presentation, clinical assessment, investigations, and management of hypertension along with major randomized controlled trials and guidelines.
Hypertensive emergencies require immediate blood pressure reduction to prevent end organ damage. They are characterized by severely elevated blood pressure and signs of acute target organ injury. The goal is to lower mean arterial pressure by 20-25% within minutes to hours using intravenous antihypertensive drugs like sodium nitroprusside. Hypertensive urgencies also involve severely high blood pressure but without acute organ injury, allowing for oral drugs to safely lower blood pressure within 24 hours. Rapid blood pressure reduction is avoided to prevent hypotension in both conditions.
This document discusses hypertensive urgency and emergency. Hypertensive urgency is defined as systolic BP >200 mm Hg or diastolic BP >120 mm Hg without end organ damage. Hypertensive emergency is diastolic BP >140 mm Hg with evidence of acute end organ damage. Immediate interventions for patients include assessing BP, elevating the head of bed, administering oxygen, notifying physicians, and documenting status changes. Patients may experience symptoms like headache, confusion, chest pain, or nausea.
Severe hypertension that is a potentially life-threatening condition refers to a hypertensive crisis.
Severe hypertension is further classified into hypertensive emergencies or hypertensive urgencies.
Hypertensive emergency refers to a severe hypertension that is associated with new or progressive end-organ damage. In these clinical situations, blood pressure should be reduced immediately to prevent or minimize organ dysfunction.
Hypertensive urgency refers to severe hypertension without evidence of new or worsening end-organ injury.
A hypertensive emergency is hypertension with acute impairment of one or more
organ systems that can result in irreversible organ damage. Especially:-
Central nervous system
Cardiovascular system
Renal system.
The term hypertensive emergency is primarily used as a specific term for a hypertensive crisis with a diastolic blood pressure greater than or equal to 120mmHg and/or systolic blood pressure greater than or equal to 180mmHg.
Hypertensive emergency differs from hypertensive crisis in that, in the former, there is evidence of acute organ damage.
The presentation covers definitions, identification, Treatment goals, Special situations, Practice points, and cardinal pharmacotherapy. Session presented in NBE learning session
This document discusses hypertensive emergencies, which are severe cases of high blood pressure that result in acute organ damage. It defines categories of hypertensive states and provides details on etiology, pathophysiology, presentation, workup, and treatment of hypertensive emergencies. Treatment involves identifying the affected organ system and gradually lowering blood pressure over hours to days to prevent further organ injury, using intravenous medications like nitroprusside, labetalol, or nicardipine depending on the situation. Specific guidance is provided for rapidly lowering blood pressure in conditions like hypertensive encephalopathy, intracerebral hemorrhage, and ischemic stroke.
This document discusses hypertensive urgency and emergency. Hypertensive urgency is severely elevated blood pressure without target organ damage, with symptoms like headache and dizziness. Treatment involves slowly lowering blood pressure over hours to days. Hypertensive emergency is elevated blood pressure that results in organ damage to the brain, heart, or kidneys, requiring immediate treatment to lower blood pressure within minutes to hours to prevent further damage. Specific treatments depend on the affected organ and may include drugs like labetalol, nicardipine, and sodium nitroprusside. The main difference between urgency and emergency is that emergency involves organ damage while urgency does not.
This document provides information on hypertensive emergencies and urgencies, including their classification, evaluation, and management. It defines hypertensive emergencies as severe hypertension with evidence of acute target organ damage, while urgencies involve severe hypertension without organ damage. For emergencies, rapid parenteral treatment is needed to stop organ damage progression while avoiding hypoperfusion. Several parenteral agents are discussed for specific conditions along with their dosing and side effects. The goal is to lower blood pressure gradually to avoid complications. Hypertensive urgencies can often be treated orally as outpatients after initial control.
This document defines hypertensive emergencies and discusses their management. It begins by classifying hypertension and defining hypertensive crises. Hypertensive emergencies are acute severe hypertension with signs of target organ damage, while hypertensive urgencies have severe hypertension without organ damage. The document then covers the epidemiology, etiology, pathophysiology, presentation, investigations, and management of hypertensive emergencies. It discusses treating different organ-specific emergencies like stroke, heart failure, and kidney injury. The management involves rapid blood pressure reduction while monitoring for complications. Various intravenous medications are outlined to treat specific emergencies. Careful titration is needed due to the risk of overtreatment.
1. The document discusses hypertensive emergencies and urgencies, their causes, manifestations, evaluation, and management.
2. Initial evaluation involves assessing for target organ damage by examining cardiovascular, neurological, and renal systems. Laboratory tests and imaging help identify secondary causes and end-organ effects.
3. Intravenous antihypertensives like sodium nitroprusside, nicardipine, and labetalol are used to lower blood pressure in hypertensive emergencies to prevent further organ damage, while oral medications are preferred for urgencies.
This document discusses hypertensive crisis, which can manifest as either an emergency or urgency depending on the presence of acute or progressive end-organ damage. Hypertensive emergencies require immediate treatment to reduce blood pressure to prevent irreversible organ damage and death. Examples include accelerated or malignant hypertension and hypertensive encephalopathy. Hypertensive urgencies involve elevated blood pressure without symptoms or organ damage, allowing more gradual blood pressure reduction. Proper classification and treatment can improve outcomes for patients experiencing hypertensive crisis.
- Hypertensive emergencies are severe hypertension with acute end-organ damage. Common causes include essential hypertension, preeclampsia, renal disease, pheochromocytoma.
- The brain, heart, kidneys are most vulnerable to damage. Symptoms include headache, confusion, chest pain, dyspnea.
- Treatment involves rapid blood pressure reduction, usually over hours, to prevent further injury. Antihypertensives like nicardipine, labetalol, nitroprusside are used. Blood pressure goals depend on specific end-organ involved.
- Stroke requires more cautious reduction to avoid worsening ischemia or hemorrhage. Heart failure is treated with diuretics
The document outlines a presentation on hypertension and hypertensive disorders for allied health workers. It begins with an introduction and outline covering hypertension and hypertensive disorders of pregnancy. The outline discusses risk factors and diagnosis of hypertension, as well as management of hypertensive crisis. Guidelines for diagnosing and treating hypertension from sources like the 2020 Philippine CPG are also summarized.
This document discusses hypertensive crisis, including its definition, clinical presentation, management, and targets of organ damage. It presents a case study of a patient with chest tightness and shortness of breath who is found to have severely high blood pressure and signs of organ damage. The diagnosis is hypertensive emergency. Treatment involves rapid intravenous blood pressure reduction in the hospital. Guidelines recommend lowering mean arterial pressure no more than 25% within the first hour for hypertensive emergencies. Exceptions are made for certain conditions like ischemic stroke and aortic dissection that require more aggressive blood pressure control.
The document discusses hypertensive emergencies, which are severe elevations in blood pressure over 180/120 mmHg that require immediate reduction to prevent target organ damage, as well as various treatment approaches depending on the specific organ involved such as gradual reduction for stroke, rapid control for aortic dissection, and moderate control for intracerebral hemorrhage. Drugs that can be used for acute blood pressure reduction include sodium nitroprusside, nicardipine, labetalol, and hydralazine.
This document defines hypertensive crises and hypertensive encephalopathy. It distinguishes between hypertensive urgency, which is elevated blood pressure without end organ damage, and hypertensive emergency, which is elevated blood pressure with end organ damage. Hypertensive encephalopathy is specifically defined as abrupt elevated blood pressure exceeding cerebral autoregulation limits, causing headaches, confusion, and other neurological symptoms. The pathophysiology involves failure of cerebral blood flow regulation and damage to blood vessels from very high blood pressure. Treatment of hypertensive urgency can be done with oral antihypertensives over 1-2 days, while hypertensive emergency requires rapid parenteral treatment to lower diastolic blood pressure by 25%
The document discusses the differences between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), noting that DKA involves hyperglycemia, ketosis and acidosis while HHS involves severe hyperglycemia and hyperosmolarity without acidosis. It provides details on the pathophysiology, clinical presentation, diagnostic evaluation and treatment approaches for DKA and HHS, emphasizing the goals of treatment as improving circulation, gradually reducing glucose and correcting electrolyte imbalances.
This document discusses the management of hypertensive emergencies and urgencies. It defines hypertensive emergencies as marked blood pressure elevation with acute life-threatening organ damage, requiring rapid BP reduction in an ICU. Hypertensive urgencies involve significant but not life-threatening BP elevation without acute organ dysfunction, allowing gradual oral medication-based BP reduction over hours. The document reviews ideal intravenous antihypertensive agents, special considerations for neurological, cardiovascular and other emergencies, and the treatment of hypertensive urgencies.
This document discusses hypertensive crises, including definitions, epidemiology, pathophysiology, assessment, diagnosis, and management. It defines hypertensive emergencies as elevated blood pressure with acute end-organ damage, while hypertensive urgencies involve impending end-organ damage. The typical patient presenting with crisis is middle-aged, noncompliant with medications, and may use substances. Treatment of emergencies requires immediate blood pressure reduction in the ICU to prevent further damage, while urgencies can be treated gradually as uncontrolled hypertension. Nitroprusside is very effective but has limitations like toxicity risks with prolonged use.
This document provides an overview of the management of hypertensive crisis. It begins with definitions of hypertensive urgency and emergency. It then covers etiology, pathophysiology, clinical evaluation, workup, and management. The goals of management are to lower blood pressure gradually in hypertensive urgencies, and more rapidly in emergencies to prevent end organ damage, while avoiding too rapid a drop in pressure. Drugs discussed for acute treatment include sodium nitroprusside, nicardipine, clevidipine, labetalol, and esmolol. Special scenarios like myocardial ischemia and aortic dissection are also addressed.
This document provides an overview of ischaemic stroke, including its definition, risk factors, pathophysiology, clinical presentation, diagnosis and management. Key points include:
- Ischaemic stroke accounts for 80% of strokes and results from focal brain infarction due to obstruction of cerebral blood flow.
- Major risk factors include hypertension, atrial fibrillation, diabetes, hyperlipidemia and previous stroke or TIA.
- Clinical syndromes depend on the location of brain infarction and can include motor/sensory deficits, aphasia and visual field cuts.
- Diagnosis involves neuroimaging such as CT, MRI and vascular imaging to identify the cause.
- Acute
This document discusses hypertensive emergencies. It defines hypertensive emergency as acute end-organ damage from severely high blood pressure that requires rapid control. Over 500,000 Americans experience this each year. Treatment involves quickly starting intravenous drugs to lower blood pressure 20% within 60 minutes to prevent further damage, while oral medications are initiated. Conditions like stroke, aortic dissection and eclampsia may require specific approaches. Rapid diagnosis and management of hypertensive emergencies is critical to reducing mortality rates that can be as high as 90%.
This document discusses chronic kidney disease (CKD), including its definition, stages, causes, complications, screening, diagnosis, treatment, and management. CKD is defined as irreversible kidney damage or reduced glomerular filtration rate lasting over 3 months. The leading causes are diabetes and hypertension. As CKD progresses, complications arise affecting multiple body systems. Treatment aims to slow progression, manage complications, and prepare for kidney replacement if needed.
Acute kidney injury (AKI) is a potentially life-threatening
syndrome that occurs primarily in hospitalized patients
and frequently complicates the course of critically ill
patient.
Acute Kidney Injury is is (abrupt) reduction in kidney functions as evidence by changed in laboratory values; serum creatinine, blood urea nitrogen(BUN)and urine output
This document discusses the management of hypertensive emergencies in children. It defines hypertension and hypertensive crises, and outlines the urgency vs emergency distinction. It describes the prevalence of hypertension in children, potential causes, pathophysiology, and complications involving end organ damage if left untreated. Initial diagnostic approach involves assessing for end organ injury and its severity, with the immediate goal of therapy being to decrease blood pressure quickly in emergency situations.
The document discusses hypertensive emergencies and urgencies. It defines hypertensive emergencies as severe high blood pressure with impending or progressive organ damage, while urgencies involve severe elevation in BP without organ damage. Various intravenous antihypertensive medications are reviewed for treating emergencies, including vasodilators like sodium nitroprusside, nicardipine, and nitroglycerin, as well as adrenergic inhibitors like labetalol, esmolol, and phentolamine. The ideal drug lowers blood pressure without compromising organ blood flow and has a rapid onset and offset of action with minimal side effects. Treatment goals and medication choices depend on the underlying cause and end organ
This document provides information on hypertensive emergencies and urgencies, including their classification, evaluation, and management. It defines hypertensive emergencies as severe hypertension with evidence of acute target organ damage, while urgencies involve severe hypertension without organ damage. For emergencies, rapid parenteral treatment is needed to stop organ damage progression while avoiding hypoperfusion. Several parenteral agents are discussed for specific conditions along with their dosing and side effects. The goal is to lower blood pressure gradually to avoid complications. Hypertensive urgencies can often be treated orally as outpatients after initial control.
This document defines hypertensive emergencies and discusses their management. It begins by classifying hypertension and defining hypertensive crises. Hypertensive emergencies are acute severe hypertension with signs of target organ damage, while hypertensive urgencies have severe hypertension without organ damage. The document then covers the epidemiology, etiology, pathophysiology, presentation, investigations, and management of hypertensive emergencies. It discusses treating different organ-specific emergencies like stroke, heart failure, and kidney injury. The management involves rapid blood pressure reduction while monitoring for complications. Various intravenous medications are outlined to treat specific emergencies. Careful titration is needed due to the risk of overtreatment.
1. The document discusses hypertensive emergencies and urgencies, their causes, manifestations, evaluation, and management.
2. Initial evaluation involves assessing for target organ damage by examining cardiovascular, neurological, and renal systems. Laboratory tests and imaging help identify secondary causes and end-organ effects.
3. Intravenous antihypertensives like sodium nitroprusside, nicardipine, and labetalol are used to lower blood pressure in hypertensive emergencies to prevent further organ damage, while oral medications are preferred for urgencies.
This document discusses hypertensive crisis, which can manifest as either an emergency or urgency depending on the presence of acute or progressive end-organ damage. Hypertensive emergencies require immediate treatment to reduce blood pressure to prevent irreversible organ damage and death. Examples include accelerated or malignant hypertension and hypertensive encephalopathy. Hypertensive urgencies involve elevated blood pressure without symptoms or organ damage, allowing more gradual blood pressure reduction. Proper classification and treatment can improve outcomes for patients experiencing hypertensive crisis.
- Hypertensive emergencies are severe hypertension with acute end-organ damage. Common causes include essential hypertension, preeclampsia, renal disease, pheochromocytoma.
- The brain, heart, kidneys are most vulnerable to damage. Symptoms include headache, confusion, chest pain, dyspnea.
- Treatment involves rapid blood pressure reduction, usually over hours, to prevent further injury. Antihypertensives like nicardipine, labetalol, nitroprusside are used. Blood pressure goals depend on specific end-organ involved.
- Stroke requires more cautious reduction to avoid worsening ischemia or hemorrhage. Heart failure is treated with diuretics
The document outlines a presentation on hypertension and hypertensive disorders for allied health workers. It begins with an introduction and outline covering hypertension and hypertensive disorders of pregnancy. The outline discusses risk factors and diagnosis of hypertension, as well as management of hypertensive crisis. Guidelines for diagnosing and treating hypertension from sources like the 2020 Philippine CPG are also summarized.
This document discusses hypertensive crisis, including its definition, clinical presentation, management, and targets of organ damage. It presents a case study of a patient with chest tightness and shortness of breath who is found to have severely high blood pressure and signs of organ damage. The diagnosis is hypertensive emergency. Treatment involves rapid intravenous blood pressure reduction in the hospital. Guidelines recommend lowering mean arterial pressure no more than 25% within the first hour for hypertensive emergencies. Exceptions are made for certain conditions like ischemic stroke and aortic dissection that require more aggressive blood pressure control.
The document discusses hypertensive emergencies, which are severe elevations in blood pressure over 180/120 mmHg that require immediate reduction to prevent target organ damage, as well as various treatment approaches depending on the specific organ involved such as gradual reduction for stroke, rapid control for aortic dissection, and moderate control for intracerebral hemorrhage. Drugs that can be used for acute blood pressure reduction include sodium nitroprusside, nicardipine, labetalol, and hydralazine.
This document defines hypertensive crises and hypertensive encephalopathy. It distinguishes between hypertensive urgency, which is elevated blood pressure without end organ damage, and hypertensive emergency, which is elevated blood pressure with end organ damage. Hypertensive encephalopathy is specifically defined as abrupt elevated blood pressure exceeding cerebral autoregulation limits, causing headaches, confusion, and other neurological symptoms. The pathophysiology involves failure of cerebral blood flow regulation and damage to blood vessels from very high blood pressure. Treatment of hypertensive urgency can be done with oral antihypertensives over 1-2 days, while hypertensive emergency requires rapid parenteral treatment to lower diastolic blood pressure by 25%
The document discusses the differences between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), noting that DKA involves hyperglycemia, ketosis and acidosis while HHS involves severe hyperglycemia and hyperosmolarity without acidosis. It provides details on the pathophysiology, clinical presentation, diagnostic evaluation and treatment approaches for DKA and HHS, emphasizing the goals of treatment as improving circulation, gradually reducing glucose and correcting electrolyte imbalances.
This document discusses the management of hypertensive emergencies and urgencies. It defines hypertensive emergencies as marked blood pressure elevation with acute life-threatening organ damage, requiring rapid BP reduction in an ICU. Hypertensive urgencies involve significant but not life-threatening BP elevation without acute organ dysfunction, allowing gradual oral medication-based BP reduction over hours. The document reviews ideal intravenous antihypertensive agents, special considerations for neurological, cardiovascular and other emergencies, and the treatment of hypertensive urgencies.
This document discusses hypertensive crises, including definitions, epidemiology, pathophysiology, assessment, diagnosis, and management. It defines hypertensive emergencies as elevated blood pressure with acute end-organ damage, while hypertensive urgencies involve impending end-organ damage. The typical patient presenting with crisis is middle-aged, noncompliant with medications, and may use substances. Treatment of emergencies requires immediate blood pressure reduction in the ICU to prevent further damage, while urgencies can be treated gradually as uncontrolled hypertension. Nitroprusside is very effective but has limitations like toxicity risks with prolonged use.
This document provides an overview of the management of hypertensive crisis. It begins with definitions of hypertensive urgency and emergency. It then covers etiology, pathophysiology, clinical evaluation, workup, and management. The goals of management are to lower blood pressure gradually in hypertensive urgencies, and more rapidly in emergencies to prevent end organ damage, while avoiding too rapid a drop in pressure. Drugs discussed for acute treatment include sodium nitroprusside, nicardipine, clevidipine, labetalol, and esmolol. Special scenarios like myocardial ischemia and aortic dissection are also addressed.
This document provides an overview of ischaemic stroke, including its definition, risk factors, pathophysiology, clinical presentation, diagnosis and management. Key points include:
- Ischaemic stroke accounts for 80% of strokes and results from focal brain infarction due to obstruction of cerebral blood flow.
- Major risk factors include hypertension, atrial fibrillation, diabetes, hyperlipidemia and previous stroke or TIA.
- Clinical syndromes depend on the location of brain infarction and can include motor/sensory deficits, aphasia and visual field cuts.
- Diagnosis involves neuroimaging such as CT, MRI and vascular imaging to identify the cause.
- Acute
This document discusses hypertensive emergencies. It defines hypertensive emergency as acute end-organ damage from severely high blood pressure that requires rapid control. Over 500,000 Americans experience this each year. Treatment involves quickly starting intravenous drugs to lower blood pressure 20% within 60 minutes to prevent further damage, while oral medications are initiated. Conditions like stroke, aortic dissection and eclampsia may require specific approaches. Rapid diagnosis and management of hypertensive emergencies is critical to reducing mortality rates that can be as high as 90%.
This document discusses chronic kidney disease (CKD), including its definition, stages, causes, complications, screening, diagnosis, treatment, and management. CKD is defined as irreversible kidney damage or reduced glomerular filtration rate lasting over 3 months. The leading causes are diabetes and hypertension. As CKD progresses, complications arise affecting multiple body systems. Treatment aims to slow progression, manage complications, and prepare for kidney replacement if needed.
Acute kidney injury (AKI) is a potentially life-threatening
syndrome that occurs primarily in hospitalized patients
and frequently complicates the course of critically ill
patient.
Acute Kidney Injury is is (abrupt) reduction in kidney functions as evidence by changed in laboratory values; serum creatinine, blood urea nitrogen(BUN)and urine output
This document discusses the management of hypertensive emergencies in children. It defines hypertension and hypertensive crises, and outlines the urgency vs emergency distinction. It describes the prevalence of hypertension in children, potential causes, pathophysiology, and complications involving end organ damage if left untreated. Initial diagnostic approach involves assessing for end organ injury and its severity, with the immediate goal of therapy being to decrease blood pressure quickly in emergency situations.
The document discusses hypertensive emergencies and urgencies. It defines hypertensive emergencies as severe high blood pressure with impending or progressive organ damage, while urgencies involve severe elevation in BP without organ damage. Various intravenous antihypertensive medications are reviewed for treating emergencies, including vasodilators like sodium nitroprusside, nicardipine, and nitroglycerin, as well as adrenergic inhibitors like labetalol, esmolol, and phentolamine. The ideal drug lowers blood pressure without compromising organ blood flow and has a rapid onset and offset of action with minimal side effects. Treatment goals and medication choices depend on the underlying cause and end organ
Effect of Blood Pressure Lowering in Early Ischemic Stroke, Time to Change Pr...Ersifa Fatimah
Seorang rekan residen neuro sampai mengirim (via e-mail) sebuah jurnal yang baru ditelaahnya di larut malam. Kepada si cip, dia menyatakan bagaimana jurnal ini membuat pikirannya bergejolak, “Seperti dipaksa untuk menerima sebuah pemikiran baru yang melawan apa yang telah kita yakini bersama dalam proses belajar kita selama 5 tahun terakhir ini!”
Artikel itu berjudul Effect of Blood Pressure Lowering in Early Ischemic Stroke: Meta-Analysis oleh Lee et al., dan dipublikasi dalam jurnal Stroke Juli 2015.
This document provides guidance on evaluating a child presenting with a limp. It discusses various possible differential diagnoses to consider, including septic arthritis, developmental dysplasia of the hip, Perthes disease, slipped femoral epiphysis, and more. Key aspects of history to obtain include age, presence of pain, associated symptoms, and past medical/family history. The examination should evaluate gait, limb length, range of motion, and tenderness. Initial investigations may include blood tests, x-rays of the hip and/or knee, ultrasound if effusion is suspected, and bone scan or MRI if further imaging is needed. The goal is to identify serious conditions like infections while considering more benign possibilities.
This document discusses the classification, evaluation, and management of hypertensive crises. It defines hypertensive emergency as severe hypertension with acute end-organ damage requiring immediate treatment to lower blood pressure, while hypertensive urgency involves severe hypertension without end-organ damage that usually allows for gradual blood pressure reduction over 24-48 hours. It provides guidelines for initial evaluation, laboratory testing, goals of therapy, recommended antihypertensive agents, and dosing for treating different types of hypertensive crises.
1. Hypertensive emergencies involve severe, symptomatic elevation in blood pressure that causes end organ damage to organs like the brain, kidneys, eyes, and heart. Hypertensive urgencies involve severe elevation in blood pressure without symptoms or end organ damage.
2. Hypertensive encephalopathy is the most common hypertensive emergency and involves severe blood pressure elevation that causes cerebral edema and neurological symptoms like lethargy and seizures.
3. Etiologies of hypertensive emergencies in children include renovascular diseases, congenital renal anomalies, preeclampsia, drugs like cocaine and amphetamines, and endocrine diseases.
This document provides an outline about hypertension in children. It defines hypertension and classifies it into different stages. It discusses hypertensive crisis, risk factors, pathophysiology, clinical presentations, diagnostic approach, and treatment. It notes that approximately 30% of children with a BMI over the 95th percentile have hypertension. It also outlines diagnostic testing, treatment considerations including medication options and goals, and provides algorithms for treating hypertensive urgency and emergencies. The treatment involves gradually lowering blood pressure over 24-48 hours while monitoring for side effects and end organ damage.
This document discusses the classification, clinical manifestations, investigations, and management of hypertensive crises. It distinguishes between hypertensive urgency, which involves severe but asymptomatic elevations in blood pressure, and emergency, which involves elevations with associated end-organ damage. Common symptoms include headache, fatigue, confusion, and chest pain. Investigations include blood tests, electrocardiograms, urinalysis, and imaging. Treatment depends on the situation but generally aims to lower blood pressure by 10-15% within the first hour using intravenous medications such as nitroglycerin, nitroprusside, or labetolol. Oral agents like captopril may also be used but reductions should be more gradual. The
Management of hypertension and hypertensive emergencies.pptxIvan Luyimbazi
The document discusses the management of hypertension and hypertensive emergencies. It defines uncontrolled hypertension and outlines classifications based on JNC 7 and 8 guidelines. It summarizes epidemiological data on hypertension prevalence in Uganda. It describes hypertensive crises and emergencies, complications, risk factors, pathophysiology, diagnosis, lifestyle modifications, and pharmacotherapy recommendations for treatment. The objective of treatment is to reduce complications and improve survival through lowering blood pressure via medications and lifestyle changes.
This document discusses blood pressure control in neurocritical care. It provides classifications for blood pressure levels, examines patient outcomes related to hypertension, and explores treatment options. Some key points:
- Blood pressure is classified as normal, prehypertension, stage 1 hypertension, or stage 2 hypertension based on systolic and diastolic levels.
- Analysis of patient data found risks of new organ damage, in-hospital death, admission to death, and readmission associated with hypertension.
- Acute hypertensive crises like emergencies require rapid blood pressure control to prevent end-organ damage to organs like the brain, heart, kidneys, and retina.
- Traditionally used IV antihypert
A 52-year-old man presented with worsening occipital headache, confusion over 12 hours, numbness and weakness on his right side, and blurry vision. His blood pressure was extremely high at 213/134 mm Hg. Tests found low potassium, high blood urea nitrogen and creatinine, and changes on CT scan consistent with hypertensive encephalopathy. He was admitted to the ICU and given intravenous nitroprusside, lowering his blood pressure over 3 hours and resolving his neurological symptoms within 5 hours. He was discharged on oral medications 5 days later with controlled blood pressure.
Losocor co training south africa Dr Saurav dekaassam1
Losacar co contain losartan and hydrochlorothiazide . This presentation give you brief about basics of hypertension and its treatment with losartan hydrochlorothiazide .
The document discusses hypertensive emergencies, which are severe hypertension with acute impairment of an organ system. It defines different categories of hypertension and provides case examples. It covers the etiology, pathophysiology, symptoms, workup, and treatment of hypertensive emergencies. Treatment involves rapidly lowering blood pressure over minutes to hours for patients with end-organ damage, while those without can have blood pressure controlled over days to weeks. Intravenous medications like nitroprusside, labetalol, and nicardipine are used for rapid blood pressure reduction in emergencies.
This document defines hypertensive emergencies and discusses their management. It begins by classifying hypertension and defining hypertensive crises. Hypertensive emergencies are acute severe hypertension with signs of target organ damage, while hypertensive urgencies have severe hypertension without organ damage. The document then covers the epidemiology, etiology, pathophysiology, presentation, investigations, and management of hypertensive emergencies. It discusses treating different organ-specific emergencies like stroke, heart failure, and kidney injury. The management involves rapid blood pressure reduction while monitoring for complications. Various intravenous medications are outlined for treating hypertensive emergencies based on the target organ involved.
This document summarizes guidelines for the treatment of hypertension based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. It defines hypertension and stages of high blood pressure. Lifestyle modifications and drug therapies are recommended, with treatment guided by blood pressure level and risk factors. Initial drug choices include thiazide diuretics, with addition of ACE inhibitors, ARBs, beta blockers, or calcium channel blockers as needed to control blood pressure. Special patient groups benefit from specific drug classes due to compelling indications.
This document summarizes hypertensive urgency and emergency. It defines hypertensive emergency as severe hypertension (blood pressure over 180/120 mmHg) accompanied by evidence of impending or progressive organ damage. Hypertensive urgency is severe hypertension without organ damage. The case study describes a 52-year-old man presenting with hypertensive emergency, evidenced by symptoms of organ damage including confusion, weakness, vision issues, and abnormal exam findings. He was admitted to the ICU and treated with intravenous medications, showing improvement within hours. Proper diagnosis and management of hypertensive urgencies and emergencies is important to prevent target organ damage and mortality.
Hypertensive crisis is defined as severe elevation of blood pressure (>180/120 mmHg) complicated by evidence of impending or progressive end organ damage. It requires immediate treatment to prevent end organ damage to organs like the brain, heart, kidneys, and lungs. The main goals of treatment are rapid but controlled reduction of blood pressure, usually with intravenous antihypertensive medications like labetalol, nicardipine, or sodium nitroprusside. Treatment must be tailored based on the specific cause and end organ involvement, with careful monitoring of vitals and organ function during rapid blood pressure reduction.
This document discusses hypertensive emergencies and urgencies. It defines hypertensive emergency as severe hypertension with acute end-organ damage, requiring rapid BP reduction over hours. Hypertensive urgency is severe hypertension without acute end-organ damage, allowing BP control over days to weeks. The main organs affected are the brain, heart, and kidneys. Initial treatment involves evaluating for end-organ damage and relaxing the patient before considering IV antihypertensives. Goals are to lower BP by 25% over the first hour while maintaining organ perfusion. Specific treatments depend on the damaged organ system. Follow-up after discharge assesses for ongoing hypertension management.
This document defines essential hypertension and provides a classification of blood pressure levels according to the JNC-7 report. It also outlines the causes, initial investigations, complications, and treatment of hypertension. Hypertension is classified as normal, prehypertensive, or hypertensive stage 1 or 2 based on systolic and diastolic blood pressure levels. Lifestyle modifications and drug treatments including diuretics, beta-blockers, ACE inhibitors, ARBs, and calcium channel blockers are recommended depending on the hypertension stage. Hypertensive crisis requires urgent treatment with intravenous drugs to lower blood pressure and prevent complications affecting the heart, brain, kidneys, and other organs.
The Role of Nitroglycerin in Emergency Hypertension update.pptxGestana
Hypertension remains a leading global cause of death. Guidelines provide classifications for hypertension based on office, ambulatory, and home blood pressure measurements. Hypertensive emergencies require immediate treatment to lower blood pressure and prevent end organ damage. Intravenous nitroglycerin is recommended due to its fast-acting, short duration, and safety profile, allowing for gradual blood pressure reduction without compromising organ perfusion. The goal of treatment is optimal blood pressure control without further harm by carefully lowering pressure up to 25% within the first hour.
The document provides information on the management of hypertensive crisis. It begins with outlines of topics covered which include introduction, etiology, pathophysiology, clinical evaluation, workup, and management. It then goes into further detail on these topics. The key points are:
1) Hypertensive crisis is defined as a sudden rise in blood pressure that causes end organ damage and is classified as either a hypertensive urgency or emergency.
2) Common causes include poorly controlled essential hypertension and renal disease.
3) Rapid evaluation is needed to identify end organ damage to the heart, kidneys, brain, or vasculature.
4) Treatment involves slowing lowering blood pressure, usually over hours
This document discusses hypertensive crisis and provides treatment guidelines. It defines hypertensive emergency as high blood pressure in the presence of end-organ damage, which requires rapid reduction of blood pressure over 2-6 hours. Intravenous medications such as nicardipine, sodium nitroprusside, and labetalol are recommended over oral agents. Diltiazem is highlighted as an option that can reduce blood pressure while controlling heart rate and minimizing increases in intracranial pressure. The document recommends diltiazem intravenous infusion for hypertensive crisis and provides dosing charts.
This document defines various types of hypertensive crises and emergencies and provides treatment guidelines. It discusses malignant hypertension, hypertensive encephalopathy, ischemic stroke, subarachnoid hemorrhage, and other specific conditions. It also defines various intravenous antihypertensive medications and their usages, doses, and cautions. The document is intended to guide physicians in diagnosing and treating different hypertensive emergencies.
After this presentation, the reader should be able to describe features of papilledema with main causes and investigations needed in the work up and differentiate it from pseudopapilledema.
This document discusses hypertensive crisis, including definitions, classifications, management, and special considerations. Hypertensive crisis is defined as a sudden increase in blood pressure with or without end-organ damage. It is classified into hypertensive urgency, which can be treated as an outpatient with fast-acting oral antihypertensives, and hypertensive emergency requiring ICU admission and parenteral antihypertensive drugs. Treatment aims to lower blood pressure gradually over hours to days to minimize risks. Special situations like aortic dissection or stroke may require different blood pressure targets or medications. Primary care doctors can provide initial treatment with fast-acting oral antihypertensives before referral.
Hypertension is a common cardiovascular disease where blood pressure is repeatedly above normal levels and can cause organ damage if left untreated; it is usually classified as essential or secondary hypertension and is typically treated initially with lifestyle changes and monotherapy using drugs that lower blood pressure by different mechanisms such as diuretics, sympathoplegics, vasodilators, and angiotensin antagonists, with polypharmacy used if monotherapy is ineffective.
1. The document discusses various neurosurgical emergencies including brain trauma, subarachnoid hemorrhage, and intracerebral hematomas.
2. It outlines key factors that influence prognosis in brain trauma such as age, Glasgow Coma Scale score, pupillary reactivity, and CT scan findings. Secondary factors like hypotension can also worsen outcomes.
3. Management principles for neurosurgical emergencies focus on maintaining cerebral oxygenation and perfusion while controlling factors like intracranial pressure, temperature, blood pressure, and glucose.
This document provides an overview of key aspects of clinical research papers, including their typical structure and components. It outlines the main sections such as the title, abstract, introduction, methods, results, discussion, and references. It also describes important considerations for study design, including defining the study population and ensuring internal and external validity. Common study designs like randomized controlled trials and how to properly implement randomization and blinding are covered.
This document provides an overview of evidence-based medicine (EBM). It defines EBM as integrating the best available research evidence with clinical expertise and patient values. The key steps of EBM are outlined as formulating a clinical question using PICO (population, intervention, comparison, outcome), searching for evidence, appraising research studies, and applying the evidence to clinical problems. Study designs such as randomized controlled trials and systematic reviews are discussed. Methods for critically appraising studies including assessing validity and determining the clinical importance of results are also summarized.
1) The document discusses a lecture on evidence-based medicine (EBM) and critical appraisal.
2) EBM involves integrating the best available research evidence with clinical expertise and patient values. It includes formulating clinical questions, searching for evidence, appraising research, and applying the evidence to patient care.
3) The lecture reviews the principles of EBM and critical appraisal, including how to formulate answerable clinical questions using the PICO framework, search for evidence, and appraise different types of research studies.
This document provides an overview of diffuse parenchymal lung disease (DPLD) and idiopathic interstitial pneumonias (IIPs). It discusses the classification of IIPs including idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), and others. It also covers the clinical presentation, diagnostic approach involving history, physical exam, pulmonary function tests, radiological findings on high-resolution CT, and role of bronchoscopy with bronchoalveolar lavage in evaluating these conditions. Key points like reduced diffusing capacity on pulmonary function tests and honeycombing on imaging in IPF
This document provides an overview of scientific writing and research proposals. It discusses types of scientific publications such as journal articles, books, and conference posters. It emphasizes using clear, precise language and proper structure for scientific papers, including titles, introductions, methods, results, and references sections. The document also outlines the key elements of a good research proposal, such as stating the problem, reviewing previous literature, describing the methodology, presenting a timeline and budget, and listing references. Researchers are advised to write proposals that are coherent, informative, and clearly structured to convince readers of the significance and merit of the proposed research.
This document discusses novel treatment options for asthma, focusing on biologic-based targeted therapies. It summarizes the four approved type-2 targeted biologic therapies that target IL-5 and IgE, as well as IL-4 and IL-13. These target key pathways involved in type-2 inflammation like eosinophil recruitment and activation. Emerging therapies also target other inflammatory pathways like IL-17. Characterization of inflammatory biomarkers and phenotypes helps identify patients that may benefit most from specific targeted therapies.
This document provides information on diffuse parenchymal lung disease (DPLD) and idiopathic interstitial pneumonias (IIPs). It begins with an overview of common IIPs including idiopathic pulmonary fibrosis (IPF), other IIPs, familial IIP, IIP with autoimmune features, and smoking-related ILDs. It then discusses diagnosing other ILDs through clinical, radiological findings and management approaches. Specific ILDs covered include CTD-associated ILDs, diffuse cystic lung diseases like lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, pulmonary alveolar proteinosis, and diffuse alveolar damage
1. The document provides an overview of evidence-based medicine (EBM) and the process of critically appraising research evidence. EBM involves integrating the best available research evidence with clinical expertise and patient values and preferences.
2. The key steps of EBM are outlined, including formulating a clear clinical question using PICO (population, intervention, comparison, outcome), searching for and appraising the evidence, and applying the results to the clinical problem.
3. Users' guides are provided for critically appraising different study designs, focusing on whether the results are valid and assessing the magnitude and precision of the treatment effect. Factors like randomization, blinding, follow-up, and equal treatment of groups
1. Transbronchial biopsy is the least invasive approach to obtain a histologic diagnosis for a 60-year-old man with shortness of breath, a history of smoking, and basilar crackles. Objective parameters like 6MWT, DLCO, FVC, and HRCT can assess progression of the disease. Lung transplantation is the best curative treatment.
2. A 50-year-old current smoker with shortness of breath and cough showing findings on HRCT and PFTs would be diagnosed with RB-ILD based on surgical lung biopsy findings.
3. A 40-year-old man with rapid deterioration and bilateral infiltrates on CXR would be diagnosed with acute eosin
Pneumonia can be categorized as community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), hospital-acquired pneumonia (HAP) including ventilator-associated pneumonia (VAP). HCAP refers to patients who received recent healthcare but did not stay overnight in the hospital. CAP occurs in people acquired in the community with an annual rate of 5.16 to 6.11 cases per 1000 persons increasing with age. Streptococcus pneumoniae is the most common worldwide cause of CAP. Pneumonia pathogens can be typical bacteria like S. pneumoniae or atypical organisms such as Legionella spp, Mycoplasma pneumoniae, and Chlamydophila pneumoniae.
This study analyzed 29 cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Saudi Arabia from March to May 2014. Most cases were male Saudi nationals over age 40. Common symptoms were fever, cough and shortness of breath. Patients had abnormal chest imaging and laboratory abnormalities including low white blood cell count. Ten patients (34%) died, generally being older, male smokers with more severe symptoms and worse laboratory and blood gas values. MERS-CoV disproportionately affected health care workers through close contact with infected patients.
Based on the information provided:
- The patient has a UIP pattern on HRCT consistent with IPF.
- His occupational exposure to asbestos 35 years ago could be contributing to the fibrosis.
- His rheumatoid arthritis is seronegative so unlikely the cause.
- A multidisciplinary discussion including review of HRCT, pulmonary function tests and clinical history is needed to determine if he meets criteria for a confident diagnosis of IPF. Given his occupational exposure, other ILDs need to be considered or excluded as well.
The CT scan shows bilateral, basal-predominant reticular opacities and honeycombing. Given the patient's history of asbestos exposure, though brief, the radiological findings are most consistent with a diagnosis of asbestosis. Asbestosis is the correct answer.
This document provides a summary of an presentation on approaches to interstitial lung disease (ILD) and updates in idiopathic pulmonary fibrosis (IPF) management. It begins with an introduction to ILDs and the pulmonary interstitium. It then covers the pathogenesis, classification, epidemiology, clinical assessment including history, exams, tests and tissue sampling, and radiological and pathological findings of ILDs. A significant portion discusses IPF specifically, including prognosis, guidelines for diagnosis, and medical therapies including pirfenidone and nintedanib which have been shown to reduce lung function decline in clinical trials. It concludes with experience using pirfenidone in Saudi Arabia.
Neuromuscular Disorders Respiratory Complications and AssessmentNahid Sherbini
This document discusses respiratory complications and management in patients with neuromuscular disorders. Key points:
- Duchenne muscular dystrophy is the most common childhood muscular dystrophy, causing progressive muscle weakness.
- Respiratory muscle weakness can occur independently of peripheral muscle weakness and should be evaluated through tests like PFTs, MIP, MEP, and cough assessment.
- Non-invasive ventilation may benefit those requiring short term or intermittent support, while invasive ventilation is preferred for acute respiratory failure due to risks of NPPV. Proper respiratory management can extend lifespans.
Hemoptysis is defined as the spitting of blood from the lungs or bronchial tubes. It can be classified based on severity from mild to massive. Common causes include infections like tuberculosis, cancers, vascular abnormalities and vasculitis. Initial management focuses on airway protection, oxygenation and circulation. Bronchoscopy helps identify the bleeding site and allows local measures like lavage, vasoconstrictors and tamponade. For persistent or massive bleeding, bronchial artery embolization or surgery may be needed. Precise localization through CT and arteriography guides definitive treatment.
The national lung screening trial /Nahid SherbiniNahid Sherbini
The National Lung Screening Trial (NLST) compared low-dose CT screening to chest x-ray (CXR) screening for lung cancer in high-risk individuals. Over 53,000 participants were randomized to receive either low-dose CT or CXR screening annually for three years. The primary endpoint was lung cancer mortality. An interim analysis found that low-dose CT screening reduced lung cancer mortality by 20% compared to CXR, with fewer advanced stage cancers detected in the CT group. However, the false positive rate was high at around 95% for both screening methods.
Evaluation of preoperative pulmonary risk By Nahid SherbiniNahid Sherbini
- Pulmonary complications are a major cause of postoperative morbidity and mortality. The risk depends on patient-related factors like age, smoking history, COPD, asthma, obesity, sleep apnea, and heart failure as well as procedure-related factors like the surgical site and duration of anesthesia.
- A thorough preoperative evaluation involves reviewing the patient's history, performing a physical exam, and testing like arterial blood gases, chest x-ray, and pulmonary function tests to determine their risk level. Assigning a risk level helps guide risk reduction strategies in high risk patients.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UP
Hypertensive Emergencies
1.
2. Dr Nahed Sherbini ,Consultant Internist ,Head of Internal Medicine Department
2010 KFH, Medina
3. ED
Medical & Surgical Wards
MICU
SICU
OR
Varon J, Fromm RE. Postgrad Med. 1996;99:189-203.
4. Hypertensive Emergencies
Hypertensive Urgencies
An Approach to Drug Treatment of HU and HE
5.
6. Affects at least 1 BILLION individuals
worldwide.
Most current (2003) evidence basis for
chronic management— (JNC 7)—lacks
guidance for acute management of patients
presenting with severe acute elevations of BP.
JNC 7, JAMA 2003; 289:2560-2572.
7. Data are largely lacking.
In a single-center Italian study, HU or HE
HU:HE ratio of 3:1 in that study
Zampaglione et al, Hypertension 1996;27:144.
8. Hypertensive emergencies and urgencies
Account for 3% of all ED visits1
An “Internal Medicine” ED
N=14,209
1634 had a medical urgency or emergency2
▪ 27.4% of these were hypertensive crises
1. Kitiyakara C, Guzman N. J Am Soc Nephrol. 1998;9:133-142.
2. Zampaglione B, et al. Hypertension. 1996;27:144-147.
9.
10. JNC7
BP Classification SBP mmHg DBP mmHg
Normal <120 and <80
Prehypertension 120–139 or 80–89
Stage 1 Hypertension 140–159 or 90–99
Stage 2 Hypertension >160 or >100
11. Stage 3 hypertension (JNC 6):
Systolic > 180, Diastolic > 110
Functionally, this is “hypertensive urgency”
What about “crisis,” “emergency,” and
“urgency”?
JNC 7, JAMA 2003; 289:2560-2572.
12. “hypertensive crisis” is an acute, severe, stage
2 or 3 elevation BP.
Crisis is then differentiated into hypertensive
“emergencies” &“urgencies”.
JNC 7, JAMA 2003; 289:2560-2572.
13. Hypertensive Severe elevation in BP
emergency (>180/120 mmHg) Hypertensive Crisis
complicated by evidence of
impending or progressive
target organ dysfunction
Hypertensive Hypertensive Perioperative
Hypertensive Severe elevation in BP urgency emergency hypertension
urgency without progressive
target organ dysfunction
Emergency Intensive care Operating room
department unit post-anesthesia
care
Chobanian AV et al. Hypertension. 2003;42:1206-1252.
19. Four Categories of Presentation
1. Mild, uncomplicated
2. Transient
3. Emergencies
4. Urgencies
20. Mild, Uncomplicated HTN
Diastolic BP <115 mmHg without end organ
symptoms
Educate, do not treat, arrange follow up
Transient HTN
A reaction to some condition
▪ Pain, fright, epistaxis,
drug OD
Treat the condition
24. Goal in hypertensive urgency is to reduce
MAP (MAP= ( 2 Diastolic + systolic) / 3) by
10-15% and/or to a DBP of 110 . . . within
hours.
HU can generally be managed with oral
medications and requires BP lowering over
24-48 h.
JNC 7, JAMA 2003; 289:2560-2572.
25. Lifestyle Modifications
Not at Goal Blood Pressure (<140/90 mmHg)
(<130/80 mmHg for those with diabetes or chronic kidney disease)
Initial Drug Choices
Without Compelling With Compelling
Indications Indications
Stage 1 Hypertension Stage 2 Hypertension Drug(s) for the compelling
(SBP 140–159 or DBP 90–99 mmHg) (SBP >160 or DBP >100 mmHg) indications
Thiazide-type diuretics for most. 2-drug combination for most (usually Other antihypertensive drugs
May consider ACEI, ARB, BB, CCB, thiazide-type diuretic and (diuretics, ACEI, ARB, BB, CCB)
or combination. ACEI, or ARB, or BB, or CCB) as needed.
Not at Goal
Blood Pressure
Optimize dosages or add additional drugs
until goal blood pressure is achieved.
Consider consultation with hypertension specialist.
26. Compelling Indication Initial Therapy Options Clinical Trial Basis
ACC/AHA Heart Failure
Heart failure THIAZ, BB, ACEI, ARB, Guideline, MERIT-HF,
ALDO ANT COERNICUS, RALES
Post MI ACC/AHA Post-MI
BB, ACEI, ALDO ANT Guideline, BHAT,
SAVE, Capricorn,
ALLHAT, HOPE,
ANBP2, LIFE,
High CAD risk THIAZ, BB, ACE, CCB CONVINCE
28. Reduce MAP by ≤ 25% during the 1st minutes
to 1 h.
If stable, reduce BP to 160/100-110 mmHg in
next 2-6 h.
Conditions requiring special management
Aortic dissection
Stroke eligible for thrombolytic agents
Ischemic stroke
Chobanian AV et al. Hypertension. 2003;42:1206-1252.
29. Patients with chronic hypertension
Cerebral Blood Flow autoregulate cerebral blood flow
around higher set points
Patients with cerebral ischemia
Increasing risk of lose their ability to autoregulate
hypertensive Ischemia
encephalopathy Normotensive
Chronic hypertensive
Increasing risk
of ischemia
0 50 100 150 200 250
MAP (mm Hg)
Adapted with permission from Varon J, Marik PE. Chest. 2000;118:214-227.
30. NORMAL AUTOREGULATION AUTOREGULATION FAILURE
RISE IN BP RISE IN BP
ARTERIAL AND FAILURE OF
ARTERIOLAR VASOCONSTRICTION
CONSTRICTION
Normal flow.(flow=P/r) ENDOTHELIAL DAMAGE
(due to shear stress on the wall)
31. Patients with marked BP elevations and acute
target-organ damage
Admitted to an ICU for continuous monitoring of BP.
Should receive parenteral antihypertensive therapy with
an agent appropriate for the individual patient.
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure. US Dept of HHS; NIH publication No. 04-5230; 2004:54.
45. The Eighth Report of the Joint National
Committee on
Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure (JNC 8)
Update of the JNC 7 Report
Expected Availability for Public Review and
Comment: Spring 2011
Expected Release Date: Fall 2011