The document outlines admission and discharge criteria for intensive care units (ICU). It states that ICUs should only admit patients with reversible medical conditions and a reasonable chance of substantial recovery. It provides examples of conditions that would qualify for ICU admission in various body systems. Discharge criteria include stabilized vital signs and lessened care needs. The document notes triage may be necessary due to limited ICU beds, and that factors like severity, prognosis, treatment response and quality of life will be considered.
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
FAST HUGS BID principle followed for care of critically ill patients, as checklist is a simple strategy which is used for identifying and checking the significant aspects in the general care of ICU patients.
In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
FAST HUGS BID principle followed for care of critically ill patients, as checklist is a simple strategy which is used for identifying and checking the significant aspects in the general care of ICU patients.
In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
The presentation deals with the basics of pre anesthetic checkups, its only for the educations purpose!
Any kind of replication, modifications and republication is strictly prohibited.
All Rights reserved to the Author. 2016
Preparation of patient before arrival to icu 13.11.22.pptxanjalatchi
Preparation of the patient includes the preoperative assessment, review of preoperative tests, optimisation of medical conditions, adequate preoperative fasting, appropriate premedication, and the explanation of anaesthetic risk to patients.
Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking small blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems moving parts of the body.
A condition affecting the blood's ability to clot and stop bleeding.
In disseminated intravascular coagulation, abnormal clumps of thickened blood (clots) form inside blood vessels. These abnormal clots use up the blood's clotting factors, which can lead to massive bleeding in other places. Causes include inflammation, infection and cancer.
shock is the state of insufficient blood flow to the tissues of the body .it contains introduction, definition, stages of shock, types of shock, diagnostic evaluation, prognosis ,prevention, care for each stage.
Preparation of patient before arrival to icu 13.11.22.pptxanjalatchi
Preparation of the patient includes the preoperative assessment, review of preoperative tests, optimisation of medical conditions, adequate preoperative fasting, appropriate premedication, and the explanation of anaesthetic risk to patients.
Similar to Icu admission, discharge criteria and triage (20)
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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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
3. ADMISSION CRITERIA
• The Intensive Care Unit is an expensive resource area
and should be reserved for patients with reversible
medical conditions with a reasonable prospect of
substantial recovery.
• Patients with the following conditions are candidates for
admission to the General Intensive Care Unit:
4. A. Respiratory
1. Acute respiratory failure requiring ventilatory support
2. Acute pulmonary embolism with haemodynamic instability
3. Massive haemoptysis
4. Upper airway obstruction
5. B. Cardiovascular
1. Shock states
2. Life-threatening dysrhythmias
3. Dissecting aortic aneurysms
4. Hypertensive emergencies
5. Need for continuous invasive monitoring of cardiovascular
system (arterial pressure, central venous pressure, cardiac output)
6. C. Neurological
1. Severe head trauma
2. Status epilepticus
3. Meningitis with altered mental status or respiratory compromise
4. Acutely altered sensorium with the potential for airway compromise
5. Progressive neuromuscular dysfunction requiring respiratory
support and / or cardiovascular monitoring (myasthenia gravis,
Gullain-Barre syndrome)
6. Brain dead or potentially brain dead patients who are being
aggressively managed while determining organ donation status
7. D. Renal
1. Requirement for acute renal replacement therapies in an
unstable patient
2. Acute rhabdomyolysis with renal insufficiency
8. E. Endocrine
1. Diabetic ketoacidosis complicated by haemodynamic instability, altered mental
status
2. Severe metabolic acidotic states
3. Thyroid storm or myxedema coma with haemodynamic instability
4. Hyperosmolar state with coma and/or haemodynamic instability
5. Adrenal crises with haemodynamic instability
6. Other severe electrolyte abnormalities, such as:
o Hypo or hyperkalemia with dysrhythmias or muscular weakness
o Severe hypo or hypernatremia with seizures, altered mental status
o Severe hypercalcemia with altered mental status, requiring haemodynamic
monitoring
9. F. Gastrointestinal
1. Life threatening gastrointestinal bleeding
2. Acute hepatic failure leading to coma, haemodynamic
instability
3. Severe acute pancreatitis
10. G. Haematology
1. Severe coagulopathy and/or bleeding diasthesis
2. Severe anemia resulting in haemodynamic and/or
respiratory compromise
3. Severe complications of sickle cell crisis
4. Haematological malignancies with multi-organ failure
11. H. Obstetric
1. Medical conditions complicating pregnancy
2. Severe pregnancy induced hypertension/eclampsia
3. Obstetric haemorrhage
4. Amniotic fluid embolism
12. I. Multi-system
1. Severe sepsis or septic shock
2. Multi-organ dysfunction syndrome
3. Polytrauma
4. Dengue haemorrhagic fever/dengue shock syndrome
5. Drug overdose with potential acute decompensation of major
organ systems
6. Environmental injuries (lightning, near drowning,
hypo/hyperthermia)
7. Severe burns
13. J . Surgical
1. High risk patients in the peri-operative period
2. Post-operative patients requiring continuous haemodynamic
monitoring/ ventilatory support, usually following:
I. vascular surgery
II. thoracic surgery
III. airway surgery
IV. craniofacial surgery
V. major orthopaedic and spine surgery
VI. general surgery with major blood loss/ fluid shift
VII. neurosurgical procedures
14. Patients who are generally not appropriate for ICU
admission
1. Irreversible brain damage
2. End stage cardiac, respiratory and liver disease with no
options for transplant
3. Metastatic cancer unresponsive to chemotherapy and/or
radiotherapy
4. Brain dead non-organ donors
5. Patients with non-traumatic coma leading to a persistent
vegetative state
15. DISCHARGE CRITERIA
• The status of patients admitted to an ICU should be reviewed
continuously to identify patients who may no longer need ICU
care. This includes:
A. When a patient's physiologic status has stabilised and the need for
ICU monitoring and care is no longer necessary.
B. When a patient's physiological status has deteriorated and / or
become irreversible and active interventions are no longer
beneficial, withdrawal of therapy should be carried out in the
intensive care unit. Patient should only be discharged to the ward if
bed is required.
16. Discharge will be based on the following criteria:
1. Stable haemodynamic parameters
2. Stable respiratory status (patient extubated with stable arterial blood gases) and airway patency
3. Oxygen requirements not more than 60%
4. Intravenous inotropic/ vasopressor support and vasodilators are no longer necessary. Patients
on low dose inotropic support may be discharged earlier if ICU bed is required.
5. Cardiac dysrhythmias are controlled
6. Neurologic stability with control of seizures
7. Patients who require chronic mechanical ventilation (eg motor neuron disease,
cervical spine injuries) with any of the acute critical problems reversed or
resolved
8. Patients with tracheostomies who no longer require frequent suctioning
17. TRIAGE
Due to the limited number of ICU beds, triaging may be necessary.
The following factors will be taken into consideration in triaging:
a. Diagnosis
b. Severity of illness
c. Age and functional status
d. Co-morbid disease
e. Physiological reserve
f. Prognosis
g. Availability of suitable treatment
h. Response to treatment to date
i. Recent cardiopulmonary arrest
j. Anticipated quality of life
18. References:
1. Task Force of the American College of Critical Care Medicine, Society of Critical Care
Medicine: Guidelines for intensive care unit admission, discharge, and triage. Crit
Care Med 1999; 27(3):633-638
2. Society of Critical Care Medicine Ethics Committee: Consensus Statement on the
Triage of Critically Ill Patients. JAMA 1994; 271(15):1200-1203
3. Sprung CL, Geber D, Eidelman LA et al: Evaluation of triage decisions for intensive
care admission. Crit Care Med 1999; 27(6):1073-1079
4. Truog RD, Brook DW, Cook DJ et al: Rationing in the intensive care unit. Crit Care
Med 2006; 34(4):958-963