INTRODUCTION
The diaphragm is a curved musculo-fibrous sheet that separates the thoracic from the abdominal cavity.
It is pierced by structures that pass between these two regions of the body.
It’s the primary muscle of respiration.
Its dome shaped and consist of a peripheral muscular part and central tendinous part.
The muscular part arises from the margins of the thoracic opening and gets inserted into the central tendon.
Its attachments to the thoracic wall are low posteriorly and laterally, but high anteriorly.
It is rarely affected by intrinsic diseases
It has complex embryological development and its subject to a number of congenital anomalies
Altitude physiology typically focuses on people above 2500 m; ∼8000 ft. Altitudes above that are sometimes subdivided into very high (3500–5500 m; ∼11,500–18,000 ft) and extreme (>5500 m; >18,000 ft). An estimated 40 million people travel each year to altitudes >2500 m (∼8000 ft),1 and as many or more travel to altitude for leisure and sports, and work in mines, military or border operations, and the like. Altitude medicine considers the clinical disorders associated with acclimatization by the travelers, workers and migrants, and with adaptation by people with lifetimes or populations with millennia of residence (an estimated 83 million people).
With a hurried ascent, many (∼80%) will report a transient headache (high-altitude headache or [HAH]), and some will develop one of three forms of acute high-altitude illness: acute mountain sickness (AMS) and HAH, high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE). AMS and HAH are annoying and interfere with activity and work, however, HACE and HAPE can be fatal with mortality rates approaching 30%. Among some residents, chronic mountain sickness (CMS) and right ventricular hypertrophy develop over months to years of residence at altitude. Birth weights are generally lower and the rate of small-for-gestational-age babies and congenital heart defects are higher than that in lowland populations.
INTRODUCTION
The diaphragm is a curved musculo-fibrous sheet that separates the thoracic from the abdominal cavity.
It is pierced by structures that pass between these two regions of the body.
It’s the primary muscle of respiration.
Its dome shaped and consist of a peripheral muscular part and central tendinous part.
The muscular part arises from the margins of the thoracic opening and gets inserted into the central tendon.
Its attachments to the thoracic wall are low posteriorly and laterally, but high anteriorly.
It is rarely affected by intrinsic diseases
It has complex embryological development and its subject to a number of congenital anomalies
Altitude physiology typically focuses on people above 2500 m; ∼8000 ft. Altitudes above that are sometimes subdivided into very high (3500–5500 m; ∼11,500–18,000 ft) and extreme (>5500 m; >18,000 ft). An estimated 40 million people travel each year to altitudes >2500 m (∼8000 ft),1 and as many or more travel to altitude for leisure and sports, and work in mines, military or border operations, and the like. Altitude medicine considers the clinical disorders associated with acclimatization by the travelers, workers and migrants, and with adaptation by people with lifetimes or populations with millennia of residence (an estimated 83 million people).
With a hurried ascent, many (∼80%) will report a transient headache (high-altitude headache or [HAH]), and some will develop one of three forms of acute high-altitude illness: acute mountain sickness (AMS) and HAH, high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE). AMS and HAH are annoying and interfere with activity and work, however, HACE and HAPE can be fatal with mortality rates approaching 30%. Among some residents, chronic mountain sickness (CMS) and right ventricular hypertrophy develop over months to years of residence at altitude. Birth weights are generally lower and the rate of small-for-gestational-age babies and congenital heart defects are higher than that in lowland populations.
Hypoxia is O2 deficiency at the tissue level. A pathological condition in which the whole body as a whole or a region of the body is deprived of adequate oxygen supply. It is the decrease below normal levels of oxygen in inspired gases, arterial blood, or tissues, without reaching anoxia.
2. High altitude. Low hemoglobin level. Decreased oxygen supply to an area. Low oxygen carrying capacity. P
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Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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2. Objective
At the end of the lecture to be able to define hypoxia.
To be able to describe its causes , signs and
symptoms
Also to be able to comprehend about the treatment.
3. Definition
Reduced availability of O2 in tissues.
Usually irreversible , affects vital organs (brain, heart etc.,)
Lack of oxygen to brain tissues can be fatal
Anoxia- refers to absence of oxygen
4. cause
Low Po2 in arterial blood. (hypoxic hypoxia)
Inability of blood to carry o2. (anaemic hypoxia)
Decreased velocity of blood to tissue.(stagnant hypoxia)
Inability of tissues to utilize oxygen.(histotoxic hypoxia)
6. Signs & Symptoms
Headache
Dyspnoea
syncope
Increased in heart rate and breath rate
Sluggishness
Impaired motor coordination
Impaired visibility
7. Treatment
Oxygen therapy
1atm of o2 can be tolerated about 5-8 hrs in patients.
Not equally effective in all types
100% useful in hypoxic hypoxia
70% in anaemic
50% in stagnant
Nil in histotoxic