In cases of environmental hypothermia, the common sense approach of “Warm them up!” may be the worst thing that you can do for your patient. In this presentation we learn the deadly effects of immersion, after-drop and cold induced vasodilation and how to properly differentiate between mild, moderate and severe hypothermia. We will discuss wilderness EMT and extreme environment treatment algorithms and how they apply to your service area.
Detailed information on assessing the trauma patients with time dependent principle management and selection between early total care and damage control surgery.
INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
Detailed information on assessing the trauma patients with time dependent principle management and selection between early total care and damage control surgery.
INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
Provides reasons for restoring urban streams in Euclid OH, an inner ring suburb of Cleveland OH. Describes plans to create the Green Creek Escarpment Ravine Preserve on Green Creek, asmall Lake Erie tributary east of Cleveland. Green Creek is an "Escarpment Run" that drains the face of the Portage Escarpment. Describes the Euclid Railroad Trail within the preserve. Links with other Bluestone Heights slideshare presentations on urban stream restoration in Euclid, OH.
Research guru and PI for the ARISE study, college examiner and semi-professional forrest-based carpenter, Anthony always gives a fascinating talk. This time he gives an intelligent and considered breakdown on the nebulous topic of cerebral protection.
Fluid and electrolyte management in surgical patients.KETAN VAGHOLKAR
Fluid and electrolyte management has to be aggressive. It is pivitol in speedy recovery in GI surgery. Changes should be anticipated and treated promptly. A detailed knowledge of this is essential for optimum management especially in the ICU.
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
Provides reasons for restoring urban streams in Euclid OH, an inner ring suburb of Cleveland OH. Describes plans to create the Green Creek Escarpment Ravine Preserve on Green Creek, asmall Lake Erie tributary east of Cleveland. Green Creek is an "Escarpment Run" that drains the face of the Portage Escarpment. Describes the Euclid Railroad Trail within the preserve. Links with other Bluestone Heights slideshare presentations on urban stream restoration in Euclid, OH.
Research guru and PI for the ARISE study, college examiner and semi-professional forrest-based carpenter, Anthony always gives a fascinating talk. This time he gives an intelligent and considered breakdown on the nebulous topic of cerebral protection.
Fluid and electrolyte management in surgical patients.KETAN VAGHOLKAR
Fluid and electrolyte management has to be aggressive. It is pivitol in speedy recovery in GI surgery. Changes should be anticipated and treated promptly. A detailed knowledge of this is essential for optimum management especially in the ICU.
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
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Environmental emergencies include
COLD-INDUCED INJURIES
Heat-induced injuries
altitude pulmonary edema
For Nursing students i hope it would be usefull, wish you best of luck, dont forget to join me on twitter acount Suliman_alatwi
The drawbacks of climate change are so overt. The Disturbance of Great Ocean Conveyor currents led to the extreme changes in temperature around the globe in the form of a cooler northern, warmer tropical and cooler snowy winter, warmer summer. Many deaths from hypothermia were reported especially in refugee camps as it is not well equipped. Hypothermia is a medical emergency that occurs when the body loses heat faster than it can produce heat, causing a dangerously low body temperature. Normal body temperature is around 98.6 F (37 C). Hypothermia occurs as the body temperature falls below 95 F (35 C). When body temperature drops, heart, nervous system and other organs can't work normally. Left untreated, hypothermia can eventually lead to complete failure of heart and respiratory system and eventually to death.
Good vehicle extrication demands a unique collaboration between rescue and emergency medical personnel. Incorporating key victim assessment information in the extrication size-up will improve your strategic and tactical plans. To save a patient (not just chop up a vehicle) rescue and EMS must understand each other’s’ jobs and work together effectively. This program uses a real-world approach to incorporate EMS care considerations in the extrication strategy and shows how most critical trauma encountered in vehicle collisions can be managed quickly and effectively by first re-sponders. This program will help you make better strategic extrication decisions and more safely deliver immediate life-saving treatment, reducing time from patient contact to patient removal to pa-tient surgery.
Prehospital Sepsis Research Update 2024 Rom DuckworthRommie Duckworth
Recently published papers have given us new insights into the next steps for prehospital care for sepsis patients. By looking at both macro and micro views of patient management this program presents our new understanding of the role of antibiotics, fluid administration, and coordination of clinical care as well as future tools, including advanced biomarkers and the application of antimicrobial nanotechnology. Arm yourself with indispensable knowledge to elevate your prehospital practice and make a real difference in patient outcomes.
Rommie L. Duckworth is a dedicated emergency responder, author, and educator from the United States with more than thirty years of experience working in fire departments, hospital healthcare systems, and private emergency medical services. Rom is a career fire captain and paramedic EMS Coordinator for Ridgefield (CT) Fire Department and director of the New England Center for Rescue and Emergency Medicine. Rom holds a master’s degree in public administration, is a graduate of the US National Fire Academy’s Executive Fire Officer program, and is the recipient of the NAEMT Presidential Award, American Red Cross Hero Award, Sepsis Alliance Sepsis Hero Award, and the EMS 10 Innovators Award for Sepsis Education. Rom is the author of "Duckworth on Education," as well as chapters in more than a dozen EMS, fire, rescue, and medical textbooks and over 100 published articles in fire and EMS magazines. A member of the NAEMT Board of Directors and the Sepsis Alliance Advisory Board Rom continues to work for the advancement of emergency services.
www.RomDuck.com
While the popular myth is that everyone learns from experience, we all know people who can pass through experience without ever learning a thing. We now know that real learning comes from ef-fective reflection on real-life and simulated experiences. This session will provide you with the tools to use for effective reflection and enhanced learning from any situation. These include the learning models that lead to successful debriefing as well as the modified Plus Delta debrief format. These tools are crucial for any emergency services leader, educator, or provider for continuous per-formance improvement.
www.romduck.com
The Steps to Succession Planning Emergency ServicesRommie Duckworth
Identifying and preparing the next generation of leaders for your department is a critical responsi-bility. What will happen to all of the hard work you’ve put into your organization when it comes time for you to leave? Who will take your organization to the next level? Will they be ready to face the challenges that await them? Will they know how? Training your replacement takes work. Mak-ing a plan, finding a candidate, helping them develop, and handing off the reins isn’t just a good strategy; it is the only choice for your organization to survive. It can take time, money, and work and may seem counterintuitive to train people for a job they aren’t currently doing, but the “Train Your Replacement” mindset, and the four steps it requires, will help your organization get ready for the next set of challenges. This intensively participative workshop helps attendees evaluate their organization and themselves with the goal of “deepening the bench” of future emergency services leaders.
Teaching Formats:
-Lecture
-Question and Answer
Learning Objectives: At the conclusion of this program students will be able to:
- Utilize the “first steps-next steps-step up-step out” format of successful succession planning.
- Ask the key questions necessary to frame a succession plan or program.
- Outline the job requirements as they exist now and as they may exist 5 to 15 years into the leader-ship development process.
- Apply NFPA 1020 or NEMSMA 7 Pillars to leadership development in their organization.
- Link job performance requirements to knowledge, skills, and attitude requirements for positions that will need to be filled.
Title: Designer Drug Evolution: Managing Uncontrolled Patients On Controlled Substances
Description: Emergency services are confronted by horrific events caused by a surge in the use of new types of designer drugs. In this program we'll use real world case studies to discuss the up-surge in mephedrone based drugs (“bath salts” and more), synthetic marijuana, salvia divinorum, datura weed, molly and more; what these drugs are, where they've come from, and what form they may take in the future. We'll also discuss what regulators and law enforcement are doing to stop them, and what field providers can do to manage the fallout from this new wave of designer drugs.
Teaching Formats:
-Lecture
-Discussion
-Case Studies
-Question and Answer
Learning Objectives: Students will be able to:
- Identify, assess and manage designer drug abusers in acute crises and overdose situations.
- Coordinate response and scene management across emergency services for designer drug emergencies.
- Provide both basic and advanced emergency medical care for designer drug abuse and ex-cited delirium.
- Understand past, present and future development of designer drugs presented through his-torical and contemporary case studies.
As seen in Fire Engineering Magazine’s Fire/EMS Column
Revised for 2024
To think of stroke as a life or death situation is to over-simplify. The concept of “Time Is Brain” doesn’t refer to inanimate neurons that die as a stroke progresses. Each moment of delay in stroke care can destroy not only a patient’s ability to perform activities to get through the day can also lose cells that contain personality and memories. Even patients who survive may lose part of their life. As hospitals are developing new methods of treatment for stroke victims, what role is there for EMS? This program will examine new in-hospital treatments like site-specific thrombolytics, clot corkscrews, cranial hypothermia, and the critical role of EMS in each phase of Stroke Systems of Care. These systems rely on both ALS and BLS providers to not simply save patients’ lives. This lively, pertinent, and through-provoking lecture shows how the actions of EMS providers are critical to every step of saving stroke patients’ life’s.
www.ROMDUCK.com
This program can help you answer the following ques-tions about UAVs and fire department operations
• How can sUAS be used to enhance emergency and non-emergency fire department operations?
• How do federal, state, and local laws and regulations impact fire de-partment use of sUAS?
• What are the potential costs of using SUASs in fire department opera-tions?
• What are the political, social, and other non-regulatory considerations of using sUAS in fire department operations?
Presented by Capt. Rommie L. Duckworth, MPA, LP, EFO
Ridgefield (CT) Fire Department
What they didn't tell you about Anaphylaxis 2023.pptxRommie Duckworth
What’s the difference between anaphylactic and anaphylactoid, and should I care? Can a patient have a life-threatening reaction on a first exposure? What are the most important ALS medications for anaphylaxis after epinephrine? How bad is it to give epinephrine for a panic attack? What the heck is Kounis syndrome? Why didn't they teach me this in class? The past ten years have seen a dramatic increase in the number of cases of anaphylaxis across the United States. In response, the American College of Emergency Physicians and the World Allergy Organization have issued im-portant updates on initial emergency treatment for patients suffering from anaphylaxis. While epi-nephrine remains the front-line drug for all levels of care, recent studies show that in-hospital and pre-hospital providers alike aren’t giving it as often or as early as they should. This interactive case-study and pub-quiz style presentation answers these questions and many more with a focus on a rapid differential of anaphylaxis and effective initial and secondary treatments to manage these immediately life-threatening emergencies.
Regular medical and recreational use of cannabis is on the rise among all age groups. In most cases, this is associated with few side effects, but some regular users experience a wildly paradoxical reaction. While cannabis will normally suppress nausea and pain and stimulate appetite, weekly cannabis use can sometimes produce severe cramping, abdominal pain, vomiting, and nausea, known as cannabinoid hyperemesis syndrome (CHS). In this program, we explore the pathophysiology of CHS, discuss presentations that EMS may encounter, and review the current diagnostic and treatment criteria. Current estimates of cannabinoid hyperemesis syndrome affecting potentially 2.7 million people in the US annually, with significant increases in states with legalization. With complica-tions of CHS including kidney failure, electrolyte imbalance and skin burns on patient seeking self-treatment, can EMS providers afford to be unprepared?
Teaching Formats:
-Lecture
-Discussion
-Case Studies
-Question and Answer
Learning Objectives: Students will be able to:
- Appreciate the acute and chronic hazards presented by cannabinoid hyperemesis syndrome
- Describe the three phases of cannabinoid hyperemesis syndrome
- Identify prehospital presentation signs and symptoms of cannabinoid hyperemesis syndrome with a focus on differential diagnosis
- Debate current theories of the pathogenesis of cannabinoid hyperemesis syndrome
- Describe immediate EMS as well as long-term treatment for cannabinoid hyperemesis syndrome
Catch Them and Keep Them: Recruiting and retaining top employees and volunteersRommie Duckworth
Work in any organization, large or small, paid or volunteer, involves transactions of value where the member gets value from the organization and gives value back. Volunteer and employment ex-changes have traditionally focused on the perspective of the organization and what they could get from members. Today, leaders must flip that perspective and consider what the member is looking to gain rather than just what the organization is willing to give to the employee or volunteer. Getting this "employee value proposition" right can help organizations attract high-quality candidates, engage current members to boost performance, and improve the customer experience and business operations. With quality EMS candidates and providers at a premium, organizations that can provide good employee value propositions will thrive, and those that do not will fail to survive.
The Top 10 Resuscitation Headlines and Controversies: And How To Read Past Th...Rommie Duckworth
We’ve all heard controversies about cardiac resuscitation. “Use the right medications.”, “Medications don’t matter.”, “Airway first!”, “Don’t worry about the airway!” It is confusing for EMS professionals to sort out exactly what they’re supposed to do. Taking a look at the Top Ten Headlines for cardiac resuscitation, this program evaluates the strength of the science behind each recommendation as well as how they might be implemented in different EMS systems. Getting past the “Headlines,” attendees will return home well-equipped to open up discussions about optimizing EMS cardiac arrest resuscitation in their systems beyond “I read this study once” or “This is what the algorithms say now.”
The Top 10 Trauma Myths and Legends: Seeking the science beyond the textbooksRommie Duckworth
We’ve all heard the legends of trauma care. “ABCs vs. CABs!”, “Mechanism of Injury Matters!”, “Never remove a dressing!”, “Hyperventilate that head injury!” But what happens when what you were taught no longer matches what science says? Taking a look at the Top Ten Trauma Myths and Legends, this program evaluates the strength of the science behind each recommendation as well as how they might be implemented in different EMS systems. Getting past “we’ve always done it this way,” attendees will return home well-equipped to open up discussions about trauma care in their systems beyond, “This is what I was taught in class.” and “I read this study once.”
Vince Lombardi said, “The quality of a person’s life is in direct proportion to their commitment to excellence.” In our work, the quality of the lives of others is also in direct proportion to our commitment to excellence. So, if we have all agreed to work in the service of others in their time of need, why do some people in emergency services only go as far as “good enough”? How do people slide from doing what’s right to doing what’s “good enough,” and how do we reconnect them to a commitment to excellence? Inspiring and informative, Rom Duckworth shows how easy it can be for organizations and individuals to stray from the path of excellence and reminds us of the importance of what we do and why, in our unique profession, good enough is simply not good enough.
www.RomDuck.com
Prehospital traumatic cardiac arrest is relatively rare and highly complex event that will challenge even the most skilled providers and resuscitation teams. This is further complicated by a shortfall of clear consensus guidelines to help EMS providers rapidly identify, assess, prioritize and care for underlying life-threats as they simultaneously work to resuscitate the patient. What is the best bal-ance between simple algorithms that focus on core priorities versus critical think-ing recommendations that address issues more specifically? This session looks at the latest research and guidelines from key organizations such as the National Association of EMS Physicians, American College of Surgeons Committee on Trauma, and the American Heart Association as well as similar organizations from around the world to help us make the best decisions and take rapid action to give our patients the best hope of survival. Find more at www.RomDuck.com
Sepsis is an emergent medical condition that kills more people annually than prostate cancer, breast cancer, and AIDS combined. For every two heart attack patients cared for by EMS, five patients are hospitalized by sepsis. EMS transports 60% of patients with severe sepsis arriving at the ED and yet EMS providers are often unaware of its presence or what they should do if they find it. This presentation discusses new sepsis criteria along with expert commentary as to how they can be applied in the field. This program includes real-world, practical methods for EMS identification, assessment and field treatment of life-threatening sepsis and looks at the current state of sepsis critical care as well as what we can anticipate in the coming months and years.
In the United States each year approximately 75,00 children develop severe sepsis, ap-proximately 6,800 of whom will die. Many of these cases may include missed or delayed diagnosis. As an EMS provider you play a decisive role in the identification and early treatment of these critically ill children. This program will show EMS providers how to identify, assess, and begin treatment for pediatric patients with sepsis as well as how to coordinate care with emergency department and critical care staff. This program is in-tended for both advanced and basic providers whether working or not your EMS system currently has formal sepsis alert protocols. Learn the latest updates and take home the knowledge of how you can make the biggest difference for our littlest patients.
For more information go to www.RomDuck.com
The Top 10 Resuscitation Headlines and Controversies: And How To Read Past Th...Rommie Duckworth
We’ve all heard the controversies for cardiac resuscitation. “Use the right medications.”, “Medications don’t matter.”, “Airway first!”, “Don’t worry about the airway!” It is confus-ing for EMS professionals to sort out exactly what they’re supposed to do. Taking a look at the Top Ten Headlines for cardiac resuscitation this program evaluates the strength of the science behind each recommendation as well as how they might be implemented in dif-ferent EMS systems. Getting past the “Headlines”, attendees will return home well-equipped to open up discussions about optimizing EMS cardiac arrest resuscitation in their systems beyond “I read this study once” or “This is what the algorithms say now.”
It is a tremendous challenge to deliver quality emergency services education. The hurdles that have to be overcome by program directors and individual educators to meet objectives and help students achieve competencies can be discouraging at best. That's why we have to stick together. Here is a treasure-trove of top-tips for educators.
It is a tremendous challenge to deliver quality emergency services education. The hurdles that have to be overcome by program directors and individual educators to meet objectives and help students achieve competencies can be discouraging at best. That's why we have to stick together. Here is a treasure-trove of top-tips for educators.
Putting hands on teamwork back in your classroom ssRommie Duckworth
As a profession, emergency services is nearly unique in it’s demands for providers to be able to act as both coordinated team members and independent operators. Critical concepts such as group dynamics, teambuilding, leadership, followership, and interpersonal communications can be difficult to introduce in cognitive and affective domains, let alone practice as psychomotor skills. While there are plenty of “Get out of your seat” activities out there, many of them entertain and fill time, but few focus on teaching and evaluating team-based competencies. Featuring fifteen exercises that you can bring back to your EMS classroom today this program will help you help your students work together better both in the classroom and on the street.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
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.
Evaluation of antidepressant activity of clitoris ternatea in animals
Ice rescue and immersion hypothermia slide share
1. Ice Rescue & Hypothermia
Training in Ice Rescue and
Treatment of Immersion
Hypothermia
Rommie L. Duckworth, LP
Tuesday, February 21, 2012
2. Introduction
It‟s 10 O‟clock in the morning on a Saturday in
February and the tones go off for a man
through the ice. You arrive as first on scene
with the engine to find a 2 ft. hole in the ice
surrounded by fishing gear. Inside that hole
is a man desperately holding on to the edge
of the ice crying out weakly for help. As a
Police officer on the scene pulls a rescue
suit off the engine and hands it to you and
says „Get out there and save him!‟ you ask
yourself, „Do I know what to do?‟”
4. Objectives:
The Rescuer will demonstrate the ability to
initiate appropriate field treatment for
drowning and immersion hypothermia.
The Rescuer will understand the proper
techniques and equipment to be used to
prevent injury to emergency personnel
operating in cold temperature
environments.
The Rescuer will demonstrate the ability to
correctly perform ice rescue techniques
under realistic environmental conditions.
5.
6. Course Outline:
4 Introduction
4 Objectives
n Recognition and Treatment: Drowning
& Immersion Hypothermia
n Rescuer Safety
n Incident Size Up
n Ice conditions
n Available resources
7. Course Outline:
n Course Equipment
n Set up and donning
n Hand signals / Tender‟s duties
n Live Rescue
n Extrication Techniques
n Conclusion
n FOOD!!!
8. Recognition & Treatment
In order to understand any rescue techniques,
one must understand the injury to the victim
and the treatment necessary as well as
prevention of the same injury to the rescuer.
In a bad car wreck, why don‟t
we jump in without protective
gear and yank the victim out
by the head?
9. Definition of Hypothermia
Clinically defined as body core temp of
<95 deg. F (<35 deg. C)
Simply defined as the body ‟ s
temperature lowering below the normal
functioning temperature range.
11. Cooling
Types of Cooling (heat loss)
Conduction
Direct Contact
Convection
Water / Air Movement
Radiation
Surface area vs temp.
Evaporation
Sweating & Breathing
12. Cooling
Environmental Factors Accelerating Cold
Wind Chill
More convection increases RATE of heat loss.
Objects do NOT cool to Wind Chill Temp.
Immersion
Heat loss in water is 10-25x loss in air of same
temp.
Cooling rates vary greatly with changes in...
13. Cooling
Cooling rates vary greatly with change in
Water temperature and circulation
Time and degree of immersion
Thermal protection - Clothing
Muscle Mass vs Body Fat
Physical Activity
Age of the victim
Aerobic fitness vs Illness
Last oral intake
ETOH
14. Frostbite
Frostbite, trench foot and
Chilblains: Cold injury
localized to an extremity,
usually associated with
chilled, humid environ-
ment and poor circulation.
16. Frostbite
Degrees
1deg.=numbness and erythemia
2deg.=blisters / clear or milky fluid
3deg.=purple or bloody blisters
4deg.=almost solid ice
17. Frostbite
Prevention for Rescuers!
Stay dry
Dress warm but…
Do NOT overdress
Do NOT induce sweating (antiperspirant)
(Eskimo Saying:You sweat, you die!)
No use of ETOH or tobacco
Proper fitting clothes & equipment
Be aware of respiratory heat loss
Beware of touching metals or liquids
18. Frostbite
Signs and Symptoms
Numbness
Tingling - Electric shock feeling
Decreased motor function
Pain
Necrosis
Burning Sensation
19. Frostbite
Treatment
Remove from cold
Stabilize temperature
Protect the skin
DO NOT RUB
DO NOT initiate rewarming if there is any
likelihood of re-freezing.
Leave blisters intact
NO ETOH ingestion!
20. General Hypothermia
The body‟s reaction to heat loss
and the cold environment.
21. THE BODY‟S REACTION
Heat senses (primarily through the skin)
are connected to the hypothalamus.
The body attempts to increase heat
production and decrease heat loss.
The body primarily increases heat
production by increasing two things:
Activity (metabolism)
Food digestion (chemical reaction)
22. THE BODY‟S REACTION
The body reduces heat loss by...
Peripheral Vasoconstriction
Blood shunting from extremities to core
Reducing Respirations.
For protection the body also uses...
Cold Induced VasoDilation (C.I.V.D.)
Due to vascular smooth muscle paralysis
Constriction relaxes momentarily
Cycles in 5-10 minute cycles
Theory as to amount of protection is in doubt
23. Assessment
Reading temperatures in the field are
usually NOT practical.
Field temp. instruments must be both
calibrated and capable of reading to <20C,
68F.
Preferred rectal or esophageal NOT
tympanic or oral!
What do we use for assessment?
Physical Observations
Signs and Symptoms
BRAINS!
26. Assessment
Severe Hypothermia (Below 90 f)
Intermittent or No Shivering
Inability to move
Unconsciousness
Muscle Rigidity
Internally Cold
Depressed Vitals
27. The Body‟s Reaction
Nervous System
Depression
Impaired memory
Impaired Judgment
Excessive Radio Use
Loss of reflexes
Sluggish to Fixed Pupils
28. The Body‟s Reaction
Metabolism
Increased Catecholamine Production
Major Muscle Groups increase rate 2-5X
Increased digestion
Changes in O2 Consumption
Disseminated Intravascular Coagulation
Systemic blood coagulation
Initiated by blood chemicals
Process poorly understood
29. The Body‟s Reaction
Renal System
Decreased ADH
Increase in urinary output 200-350%
Increased pressure on system (Immersion)
Relative hypotension after hydrostatic squeeze
is like rapid deflation of MAST
Further increase in blood viscosity
Change in blood pH-acidosis
30. The Body‟s Reaction
Cardiac
Initial Tachycardia
Progressive Bradycardia
Conduction irregularities due to many
mechanisms
Acidosis
Electrolyte imbalance
Hypoxia
More on this in the ACLS section
31. The Body‟s Reaction
Respiratory System
Increased viscosity of surfactant
Decreased elasticity
Decreased muscle energy (reserves)
32. Afterdrop
BEFORE we start to treat, understand…
How the watermelon freezes, or
PATHOPHYSIOLOGY OF AFTER DROP
Shivering
Peripheral Vasoconstriction
Extremities numb and useless
Wastes build up in extremities
Core remains warm (for now)
Influx of fluid causes more diuresis
33. Afterdrop continued
Blood begins to “sludge”
Skin senses warming resulting in
peripheral vasodilation
Pressure Drops (relative hypotension)
Frigid Wastes flush back to warm core
Pt. Feels warmer but core organs
temperature drop.
Cardiac complications, renal failure, etc.
34. Treatment - Mild - Mod.
Stop the cooling!
Stabilize temperature
Application of Blankets / Coverings
Application of heat to heat points
Tx of signs / symptoms as they present
Tx of other illness / injuries as needed
ACLS Hypothermia Algorithm
35. Treatment - Severe
Stop the cooling!
Stabilize temperature
Heat from inside out
Heated humidified O2
Warmed IV fluids
Direct skin application of heat to skin is
discouraged (possible burns)
May need to check pulse >1 minute
Tx of signs / symptoms as they present
ACLS Hypothermia Algorithm
38. Drowning Definitions
DROWNING: Death by asphyxiation
following submersion.
NEAR-DROWNING: NEAR-death by
asphyxiation following submersion.
SUBMERSION INCIDENT: Refers to any
in-water drowning-type event,
regardless of eventual outcome.
39. Drowning Statistics
As of 1986 drowning was second only to
motor vehicle accidents as a cause of
accidental death in America for ages < 44.
It ranks third for all age groups, just
behind automobile accidents and falls, but
well above alien abductions.
Many experts suggest that the numbers of
drownings are actually much higher due to
the fact that many incidents (as with alien
abductions) go unreported.
40. Ice Rescue Victims
Typical Victims of Ice Related Accidents
-Animals
-Children
-Ice fishermen
-Ice Skaters
-Snomobilers (4-wheelers, etc)
41. Common Factors:
Unprepared for immersion: Two thirds of
all drowning victims could not swim
and did not intend to be in the water.
Non Use Of A PFD (life jacket)
Alcohol / Drug Use: Several studies have
shown that as many as fifty percent of
drowning victims were legally drunk.
42. Common Factors:
Underlying Disease: Hypoglycemia, MI,
cardiac arrythmias, syncope, seizures,
stroke and many other disease states
Trauma: As previously discussed.
Hypothermia: As previously discussed.
43. Pathophysiology
Wet Drownings. In 85% of all drownings
the victim immediately aspirates water
upon submersion. This is termed a “Wet”
drowning.
Dry Drownings. In the remaining cases,
cold water stimulates laryngospasm, an
uncontrolled shutting off of the trachea by
the epiglottis. Because of this
laryngospasm, no water enters the lungs.
44. PATHOPHYSIOLOGY
Salt vs. Fresh: Regardless of submersion
in Salt or any variation of fresh water,
the end result is the washing out
surfactant and causing atelectasis,
decreased ventilatory compliance and
again inducing massive shunting.
45. PATHOPHYSIOLOGY
Contaminants, whether they be from
sand, vomit, chemicals, bacteria or
suspended particles, are also of
concern. While there are no direct
treatments in the field for contaminants
in the lungs of a drowning other than
suctioning it is important to notify the
hospital of what contaminates are
suspected.
46. Cold Water Reflex:
This is an involuntary reflex of the
diaphragm stimulated by cold water. When
the victim is splashed in the face with cold
water the diaphragm spasms causing a
sharp inhalation gasp. Unfortunately,
because the victim’s airway is often
partially or fully submerged during this
gasp, the victim will simply suck in water
leading to increased panic. RESCUERS…
-COVER YOUR MOUTH!!!
47. Mammalian Diving Reflex:
Marine mammals’ physiological response
when stimulated by cold water submersion
is the shunting blood from their peripheral
tissues to their body’s core. The increased
blood volume in the core then stimulates a
vagal response which produces profound
bradycardia. This shunting of blood from
non-essential organs and lowered oxygen
demand allows the diving mammal to
remain underwater for a prolonged period.
48. Mammalian Diving Reflex:
Mammalian Dive Reflex theory purports that
some humans, notably children under 5,
may also use this reflex to survive
prolonged submersion. The mammalian
diving reflex theory was developed in the
1960’s as an explanation for the well
publicized survival of exceptional
submersion times of some near drowning
victims.
49. Post Immersion Synd.
This term describes the occurrence of Adult
Respiratory Distress Syndrome (ARDS) in
near drowning victims after an
asymptomatic post submersion interval
from several hours to several days. This
syndrome occurs through different means
depending on what type of fluid the victim
was immersed in (salt vs. fresh water)
although the end result is the same.
50. Treatment for Drowning
Asymptomatic: The asymptomatic
patient will most often wish to go home
and forget the incident. Because of the
threat of Post Immersion Syndrome it is
important that all patients be observed
in a hospital for four to six hours. At a
minimum, patients should be
convinced to have a follow up visit with
a physician within twenty four hours.
51. Treatment for Drowning
Symptomatic: “No one is dead until they
are warm and dead”
Always consider C-Spine Precautions
Airway:Tube and suction
Breathing: Ventilate
Circulation: CPR (in water, like on stairs
do it if you can, if not, MOVE!)
Disability
52. Treatment for Drowning
History to note for drowning victims
Age
PMHx
Medications
Trauma
H2O temp
Depth of submersion
Length of time in water vs. submerged
Breathing off compressed air source
Contaminates aspirated
59. Ice Rescue & Safety
“Well its about freakin‟ time!”
60. Ice Rescue Safety:
According to national statistics, more rescuers
die each year trying to perform water rescues
than victims are saved from the water. Most of
these victims are firefighters.
We are part of the problem, not the solution.
Like everything else we do, “If you don’t know,
don’t go!”
You must be properly trained, equipped and
prepared.
Don’t do anything uncomfortable.
61. Safety for the Rescuer
Dangers are Drowning, Hypothermia and other
bodily injury.
Take a break when you need it so you can go
out again.
Stay warm and dry!
Ambulance standing by for rehab. and Tx.
Always wear a PFD
H.E.L.P. & Huddle
Self-Rescue / Elbow Crawl
62. Safety for the Rescuer
The turn out gear vapor barrier will trap air.
DEMO
63. Safety for the Rescuer
HAZARDS:
Physical Hazards
Rocky approach
Steep Approach
Hazardous Materials
Chemicals
Biologicals
Vehicles in the water
Swift / moving water
Large Moving Ice Blocks
64.
65. Size Up:
Begins while enroute
Weather
Time of Day / Day of week
Light Conditions (Glare / Dark)
Available Resources
Ice Conditions
Type of incident
66. Size Up:
On Scene
Spotters (For point-last-seen) Binoculars
911 Caller
Reliability
Point & Time Last Seen
Number of Victims
Access to Victims
Risk vs. Benefit
Strategy & Tactics
67. Types of Ice Rescue
-Animal rescue
Risk vs. benefit
NEVER risk human life for an animal
rescue
Civilians may go to retrieve animal
-Vehicle through the ice
Occupants in vehicle
Extrication of occupants
Haz-Mat release
Associated Trauma
68. Ice Conditions
Quality: much more important than thickness for
weight bearing
Thickness and quality can vary greatly in different
areas at different times.
69. Available Resources
General rules
Call early, can always send back
Keep it close, but not too close
Boats
Different boats for different jobs
Useful trailers & sleds
Can be deceptive hindrance
DO NOT bother trying to break ice
Either paddle or slide flat bottom
boat through H20
70. Available Resources
Dispatch : Coordinate multiple resources
Fire Engine
Personnel
Lighting
Equipment
Special Rescue Equipment
71. Available Resources
Equipment NOT to call or use
Any person not wearing PFD
Untrained persons
Human chains
If 1 fell through will 10 people?
Anything that SINKS!
87. TODAY’S EQUIPMENT
1) Suit:
a) 16 lbs. buoyant.
b) NOT Water proof
c) Secure seals as best you can
d) Be careful of zipper (bees wax)
e) Do NOT wear shoes if possible
f) Watch where you walk
2) Harness:
a) Chest Harness to keep upright & disperse weight
b) Carries additional. Equip.
c) DO NOT substitute waist harness or looped rope
88. TODAY’S EQUIPMENT FOR
NFVFD
3) Rope: Reeled or bagged. Poly preferred!
4) Rescue Tube: To reach and/or secure victim
5) Knife: Used on rope, not on Victim! Disposable!
6) Drop Marker Buoy: One hand release to mark
location
7) Cyalume: increase rescuer vis. & hand signals
8) Sled, SKED, Backboard or Boat: For sliding Victim
9) Pole: Huh, huh, he said “pole”. Reach & Grab victim
& ice
10) ICE PICKS:Home-made or Commercial
11) Whistle
98. Ice Rescue Techniques
Contact Patient
Grab them from behind
If not already done, connect harness
Remember to talk & reassure
99. Ice Rescue Techniques
Lift / Push Patient
If possible use floatation device,
harness, special rescue device, etc.
Use spec rescue devices as directed
Communicate w/tender to pull pull
Pull must be smooth and gentle
No Jostling of the patient, remember.
100. Ice Rescue Techniques
Lift / Push Patient
If necessary make direct pt. Contact
Use YOUR buoyancy to lift pt.
Use bobbing technique to lift pt.
You must get the patient UP AND
OUT OF THE HOLE!
If needed, immobilize the patient‟s
spine prior to moving to shore.
104. Ice Rescue Techniques
Don‟t forget the water / land interface!
IC should coordinate RESCUE re-
sources with EMS resources.
The ambulance should be at the
extrication point, ready to receive the
pattient (s).