This document discusses various inotropes and vasoactive agents used to support hemodynamics. It describes the classification of agents as inotropes, chronotropes, vasopressors, or vasodilators. Key agents covered include dopamine, dobutamine, adrenaline, noradrenaline, milrinone, vasopressin, nitroglycerine, and sodium nitroprusside. For each agent, the document discusses receptor physiology, hemodynamic effects, indications, dosing, side effects, and monitoring considerations. It concludes with describing a vasoactive inotrope score used to quantify cardiovascular support.
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
Rational choice of inotropes and vasopressors in intensive care unitSaneesh P J
The presentation introduces commonly used interpose and vasopressors; their classification; and how to choose the drug in ICU. Clinical scenarios - cariogenic shock; neurocritical care; septic shock and anaphylactic shock are elaborated.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
A Practical Approach to Ionotropes and vasopressors Aneesh Bhandary
Vasopressors are a powerful class of drugs that induce vasoconstriction and Inotropes increase cardiac contractility. Choice of an agent should be based upon the suspected underlying etiology of shock.
This presentation deals with the practical issues and controversies surrounding the use of these agents
Rational choice of inotropes and vasopressors in intensive care unitSaneesh P J
The presentation introduces commonly used interpose and vasopressors; their classification; and how to choose the drug in ICU. Clinical scenarios - cariogenic shock; neurocritical care; septic shock and anaphylactic shock are elaborated.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
A Practical Approach to Ionotropes and vasopressors Aneesh Bhandary
Vasopressors are a powerful class of drugs that induce vasoconstriction and Inotropes increase cardiac contractility. Choice of an agent should be based upon the suspected underlying etiology of shock.
This presentation deals with the practical issues and controversies surrounding the use of these agents
Thyroid and its pathology (Hypothyroidism).Vikas Reddy
GREEK :- THYREOS – SHIELD ; EIDOS – FORM
1.LOCATION:- Anterior to trachea in between the cricoid cartilage and the suprasternal notch.
2.SHAPE:- It has 2 lobes connected with an isthmus, each lobe in turn has two poles.
3.Weighs around 10-20 gm, highly vascular and soft in consistency.
4. 4 Parathyroid glands which secrete PTH are located posterior to each pole of thyroid
The RLN traverse the lateral border of thyroid gland and must be identified during thyroid surgery to avoid injury and vocal cord paralysis.
Develops from the floor of primitive pharynx during the 3rd week of gestation.
Fetal cells in which developmental transcription factors TTF-1,TTF-2 & PAX-8 are expressed selectively form the thyroid gland ,secondly they result in induction of thyroid specific genes
Tg,TPO,NIS,TSH-R.
Mutations-THYROID AGENESIS & DYSHORMONOGENESIS(CONG. HYPOTHYROIDISM).
The developing gland migrates along the thyroglossal duct to reach its final location in the neck.
LINGUAL THYROID AND THYROGLOSSAL DUCT CYST.
Thyroid hormone synthesis begins at about 11 weeks of gestation.
Until 11 week of gestation and even later, it is the maternal thyroid hormones which cross the placenta to reach the fetus and aid its development.
Therefore a child born to a hypothyroid mother would suffer from features of congenital hypothyroidism.
Secondly if the mother has TSH-R blocking antibodies or has received anti thyroid therapy during pregnancy, might lead to transient congenital hypothyroidism.
About pharmacological classification of sympathetic nervus system both sympathomimetics and sympatholytics drug and all about his pharmacokinetics and pharmacodynamics action on body
Vk gmailcomcom and care Educate the ‘at the hell is not known meaning in 12 hindi meaning of the positive thought ke liye liye mana kiya hai maine us se baat karunga to delay ho gya h kya mere se baat
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
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
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
7. Dobutamine
• Hemodynamic effects:
Improves cardiac output by improving stroke volume &
decreasing afterload with minimal tachycardia.
• Indications :
- Cardiogenic shock with normal BP
- Fluid refractory septic shock with normal BP and
impaired extremity perfusion
8. Side effects
• Increases myocardial oxygen consumption
leading to supply-demand mismatch.
• Tachycardia & arrhythmias.
10. NOTE
• At rates > 0.5, bp can ↑ but CO and organ
perfusion can worsen with a potential for
vulnerable organ ( gut, kidneys) iscemia
and failure. ( Numbers look better but
patients perfusion may be worse)
11. Indication
• Cardiogenic shock with decompensated shock
{ Improves diastolic BP, resulting in better coronary
perfusion & improved myocardial function }
• Myocardial dysfunction after cardiac arrest
• Cold septic shock refractory to fluids &
dobutamine/dopamine.
• Severe shock of any etiology
12. How to start and titrate
• Start infusion @0.1-0.3 mcg/kg/min.
• If BP improves but perfusion worsens add
inodilators
• Doses > 0.6 mics/kg/min are rarely useful as
ensuing organ ischemia may lead to MODS
15. Side effects
• ↑ Afterload { not appropriate in cardiogenic
shock}
• Worsens perfusion leading to multi organ
failure.
16. Vasopressin
• Potent pressor.
• Indication :
- Catecolamine resistant , vasodilatory
septic shock - after maximum NA(0.5-
1mcg/kg/min)
- Central DI
17. PDE inhibitors
• Results in increased cellular concentrations of
cAMP by inhibiting its destruction.
• Inotropy, lusitropy, vasodilatory with no
chronotropy resulting in improved
contractility,decreased preload & afterload.
• Synergestic effects with catecholamines
21. Sodium Nitroprusside(SNP)
• Produces arterial vasodilation resulting in
preload and afterload.
• Hemodynamics:
↓ SVR, ↓ PVR
Rapid half life of 2 mins
23. Levosimendan
• Calcium Sensitizer : New class of agent that
increases sensitivity of cardiac myofilament to
calcium .
• Inotropic and vasodilatory properties.
• Most extensively studied in acute heart
failure, but given the potential role for
abnormal calcium handling in sepsis-induced
myocardial depression, its use also has been
proposed in sepsis.
24.
25. Care & Monitoring
• Tailored to desired hemodynamics response
• Cardiorespiratory monitoring in ICU
• Sideeffects if patient is hypovolumic or normal
cardiac function
• Rapid purge
• Freshly prepared solution
26. Vasoactive inotrope score
• Wernovsky et al and modified by
• Skippen and Krahn.
• 1 X dopamine (mics/kg per minute) + 1 X
dobutamine +15 X milrinone + 100 X
epinephrine +100 X norepinephrine +1000
X vasopressin (expressed as U/kg/per
minute).
