This document discusses the intra-aortic balloon pump (IABP), including its history, principles of function, indications, anatomy, techniques of insertion and removal, and key contributors. The IABP provides temporary left ventricular support by mechanically displacing blood within the aorta. It was first developed in the 1950s and used successfully in 1967. The document outlines the physiology effects of IABP therapy in increasing myocardial oxygen supply and decreasing demand. Common indications for IABP include cardiogenic shock and high-risk coronary interventions. The document reviews IABP device components, insertion techniques, optimal catheter positioning, and complications.
Go through the cybercrimes which are occuring recently
Hacking devices are a new method of killing people.
Technologies have been so much advanced.
How to be safe from this?
Go through my works then. :)
Be aware.. Your parents are being treated with devices while treatment.. be sure to know the cybersecurity features of it.
Portable devices (Insulin pumps etc) are also in threat.
Go through the cybercrimes which are occuring recently
Hacking devices are a new method of killing people.
Technologies have been so much advanced.
How to be safe from this?
Go through my works then. :)
Be aware.. Your parents are being treated with devices while treatment.. be sure to know the cybersecurity features of it.
Portable devices (Insulin pumps etc) are also in threat.
central venous pressure and intra-arterial blood pressure monitoring. invasiv...prateek gupta
central venous pressure and intra-arterial blood pressure monitoring. various sites for cvp and Ibp insertion. working principle for cvp and ibp. indication and complication. various waveform of cvp and ibp
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Points for discussion :
1. History
2. Principles of IABP function
3. Physiology and Pathophysiology of IABP
4. Indications and Contraindications
5. Anatomy of device
6. Techniques of insertion, complications
and removal
7. References
8. Video presentation.
3. ADRIAN
KANTROVITZ
Started experiments
on DIASTOLIC
AUGMENTATION at
Western Reserve
University as a
research fellow
(1952) in the
Department of
Cardiovascular
Physiology under
Dr.Carl Wiggers.
4. In 1958, Harken :
“Removal of some of
the blood volume via
the femoral artery
during systole and
replacing it rapidly in
diastole, so called
diastolic augmentation
as a treatment for left
ventricular failure.
5. S.MOULOPOULOS
& team (1962)
At Cleveland clinic , conducted
preliminary studies with latex
tubing tied around the end of
polyethylene catheter with
multiple side holes.
The tubing,catheter and balloon
formed a closed system that was
filled with CO2.
Stroke was triggered with the aid
of ECG.
6. Moulopoulos and colleagues developed a
prototype in which IABP inflation and deflation
were timed to the cardiac cycle.
7. In 1967 Adrian Kantrowitz after gaining enough experience in
animal experiments, He identified that the use of helium as the
shuttle gas gave sufficient transit speed to assure appropriate
timing.
“ On June 29, 1967, 45-year-old woman who was comatose,
anuric, cold, and cyanotic , her blood pressure was
unobtainable. The patient was clearly near death.“
They inserted the balloon pump and she was pumped for about
7 hours, her condition stabilized, and the pump was removed.
The patient recovered and was subsequently discharged from
the hospital.
8. Contibutors
BUKLEY et al- Balloon inflation in diastole
augments coronary perfusion and deflation just
before systole markedly reduces resistance to the
left ventricular ejection and thereby reduces cardiac
work and myocardial o2 consumption.
In 1973 two different groups headed by
Buckley.M.J & Housman LB, reported the
successful utilization of IABP in patients who
were unable to be weaned from
cardiopulmonary bypass.
9. MUNDTH & coworkers:Reported a patient who sustained
cardiogenic shock following myocardial infarction and was
stabilised with IABP and subsequently underwent coronary
revascularisation with the support of the balloon pump and
had an uneventful recovery. This was the first report where
the application of the IABP extended successfully to
support heart failure post coronary artery surgery.
10. Percutaneous insertion (1980)
Bregman D, Casarella WJ.
First Percutaneous insertion of intra-aortic balloon pump:
Initial clinical experience. Ann Thorac Surg
Subramanian VA et al.
Preliminary clinical experience with percutaneous intra-aortic
balloon pumping.
The first prefolded IAB was developed in 1986.
11. 2
IABP
Temporary support for the left ventricle by mechanically
displacing blood within the aorta
Most common and widely available methods of mechanical
circulatory support
Concepts:
- Systolic unloading
- Diastolic augmentation
Traditionally used in surgical and non surgical patients
with cardiogenic shock
12. Physiologicaleffects of IABPtherapy
• The primary goal of IABP treatment is to improve the
ventricular performance of the failing heart by
facilitating an increase in myocardial oxygen supply
and a decrease in myocardial oxygen demand.
13. • IABP inflates at the onset of diastole, thereby
increasing diastolic pressure and deflates just before
systole, thus reducing LV afterload. Increases coronary
perfusion
14. Primary effect of IABP
1) Increase myocardial oxygen supply
2) Decrease myocardial oxygen demand
Secondary effect of IABP
1) Increase in cardiac output
2) Increasing in MAP that will lead to
improvement of perfusion to all organ
3) Increases LV ejection
15. Effects on other systems
Renal = increases renal perfusion and urine
output
Neurological= increasing cerebral perfusion
and enhancing neurological state
Vascular- increases peripheral perfusion
16. Basicprinciples of counterpulsation
• Counterpulsation (augmentation) is a term that
describes balloon inflation in diastole and deflation
in early systole.
• Balloon inflation causes ‘volume displacement’ of blood
within the aorta, both proximally and distally. This
leads to a potential increase in coronary blood flow
and potential improvements in systemic perfusion by
augmentation of the intrinsic ‘Windkessel effect
17.
18.
19. 3
Indications for IABP
1. Cardiogenic shock:
- Associated with acute MI
VSR, Ischaemic MR
2. In association with CABG :
Preoperative insertion
- Patients with severe LV dysfunction
- Patients with intractable ischemic arrhythmias
Postoperative insertion
- Postcardiotomy cardiogenic shock
3. In association with nonsurgical revascularization:
-Hemodynamically unstable infarct patients
-High risk coronary interventions
- severe LV dysfunction, LMCA, complex coronary artery disease
4. Stabilization of cardiac transplant recipient before insertion of VAD
Post infarction angina
Ventricular arrhythmias relathed to ischemia
23. Working principles of IABP
• Balloon pump device
• Insertion of IABP
• Position of balloon
• Effects of IABP
• Management of IABP
• Troubleshooting
• Weaning & Removal
34. IABP catheter:
10-20 cm long polyurethane bladder
25cc to 50cc capacity
Optimal 85% of aorta occluded (not 100%)
The shaft of the balloon catheter contains 2 lumens:
- one allows for gas exchange from console
to balloon
- second lumen
- for catheter delivery over a guide wire
- for monitoring of central aortic
pressure after installation.
37. 15
Balloon sizing
Sizing based on patients
height
Four common balloon
sizes
Balloon length and
diameter increases with
each larger size
40 cm³ balloon is most
commonly used
Paediatric balloons also
available : sizes 2.5, 5.0,
12.0 and 20 cm³
Balloon size Height
50 cm³ > 6 feet
40 cm³ 5 feet 4 inch
to 6 feet
34 cm³ 5 feet to 5
feet 4 inch
25 cm³ < 5 feet
38.
39. Insertion
1) Percutaneous insertion
via trans Femoral, Axillary, Brachial and Radial
approach
2) Femoral artery cutdown insertion
3) Intraoperatively insertion through Ascending
aorta (Transthoracic insertion)
40. Insertion
Majority by femoral artery
by Seldinger technique
Alternatively
•Ascending aorta
•Axillary artery
•Brachial artery
•Radial artery
41.
42.
43. 18
Connect ECG
Set up pressure lines
Femoral access – followed by insertion of the supplied
sheath
IABP insertion
44. 19
Take the entire catheter and T handle as one unit
(DO NOT disconnect one-way
valve when removing the
extracorporeal tubing from the
tray.)
Pull out the T- handle only as shown
45.
46.
47. 22
Connecting to console:
- The central lumen of the catheter is flushed and connected to pressure
tubing with 3 way and then to a pressure transducer to allow for
monitoring of central aortic pressure.
- Zero the transducer
Initial set-up:
- Once connected properly the console would show ECG and pressure
waveforms.
- Check mean pressure
- Make sure the setting is at “auto”
- Usually IABP started at 1:1 or 1:2 augmentation
- Usually Augmentation is kept at maxim
49. POSITION OF IABP
The tip should be
situated distal to left
subclavian artery
take off.
On chest radiography
optimal position will be
level of the carina or
b/w the 2nd and 3rd
intercostal spaces.
Too far— subclavian &
vertebral occlusion
Too low— mesenteric
& renal ischemia
50.
51. 1) ECG signal – most
common
• Inflation
- middle of T wave
• Deflation
– peak of R wave
63. How to check waveform is acceptable ?
First change from 1:1 to 1:2 augmentation
64. How to check waveform is acceptable ?
Check the dicrotic notch
See if augmentation starts at that point
This should produce a sharp “V” at inflation.
and diastolic augmented wave > Systolic
wave.
76. Variation in balloon pressure wave forms
Increased duration of
plateau due to longer
diastolic phase
Decreased duration
of plateau due to
shortened diastolic
phase
79. Never leave in standby by mode for more than 20 minutes >
thrombus formation
Patient Management During IABP
support
80. Complications
• Limb ischemia
• Bleeding at insertion site
• Infection
• Aortic dissection – tearing aorta during ballon
insertion
• Thromboembolism
81. • Reducing urine output
• Balloon catheter rupture and gas loss
• Hemolysis
• Thrombocytopenia
82.
83. Weaning of IABP
Timing of weaning:
- Patient should be stable for 12 – 24 hours
- Decrease inotropic support
- Decrease pump ratio
– From 1:1 to 1:2 or 1:3
- Decrease augmentation
- Monitor patient closely
-ABG,Urine output, blood
pressure should be good
– If patient becomes unstable, weaning should be
immediately discontinued
85. Controversies
There has been different schools of thought
regarding weaning methods
Volume vrs Ratio .. Which is better ?
Ratio – reduction in augmention from 1:1 to
1:2 for 4 hours then 1:3 for one hour then
removal
Volume – 10% of volume reduction every hour
for 5 hours then removal.
86. Few papers have published regarding weaning
which is better includes
1. Onarati et al (2013) Italy sample size -30
2. Tokita et.all (2014) USA, sample size- 30
3. Hsin et al. (2013) Taiwan sample size -85
4. Bigmani et al. (2012) Italy
5. Lewis et al. (2006) Australia – says Volume
weaning is better
6. Manohar et al (2012) USA sample size 429
87. The inference from all above mentioned
papers is There has been no clear evidence
regarding which method is superior in weaning
from IABP still inconclusive.
88.
89. Impella Vrs IABP
1) Impella vrs IABP in acute MI . Brunilda
Alushi et.all Germany
2) Impella vrs IABP in acute MI. Abdelmoniem
Moustafa et.all USA
Impella is asssociated with higher incidence of
bleeding, limb compliocations, hemolysis.
91. References
Cardiopulmonary bypass priciples and techniques- Amman Jordan
Manual of perioperative care in cardiac surgery- Robert M.Bojar
Oxford handbook of cardiac surgery
Sabiston Spencer book of cardiac surgery
IABP: history-evolution pathophysiology indications:what we need
to know H. Parissis, V. Graham*et al.
A prospective randomized study comparing surgical and
percutaneous removal of intraaortic balloon pump Michael J. Rohrer
et al.
Percutaneous Intraaortic Balloon pumping: Initial Clinical
Experience.. David Bregman, M.D., and William J. Casarella, M.D.
Intra-aortic balloon pump postcardiac surgery: A literature review
Mansour Jannati et al.
Intra-aortic balloon pump in CABG – Factors affecting outcome Okonta KE,
*Kanagarajan N, Anbarasu M.