Evaluation of the adult chest pain in emergency departmentfereshteh setva
Evaluation of the adult with chest pain in the emergency department is a big challenge and this presentation is very useful to know the major cause of chest pain and approach them
Evaluation of the adult chest pain in emergency departmentfereshteh setva
Evaluation of the adult with chest pain in the emergency department is a big challenge and this presentation is very useful to know the major cause of chest pain and approach them
Chest pain cardiac or not Dr Yasser DiabYasser Diab
Chest pain cardiac or not with common pitfalls in diagnosis focusing into life threatening causes and quick glance at emergency management. auditorium at Farwaniya hospital ED ,State Of Kuwait.
Any discomfort or pain in the chest region is referred to as chest pain. It might travel to other parts of your upper body, such as your neck, jaw, or down your arms. Pain in the chest may be subtle or acute. You can have achiness or tightness. Or your chest could feel as though something is pressing down on it.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. Chest pain—broadly defined as any discomfort in the
anterior thorax occurring above the epigastrium and
below the mandible—can be one of the most
challenging problem managed by the physicians.
The typical patients’ concern with the first bout of
chest pain is their apprehension of the onset of
cardiac pathology, such as ischemic heart disease
(IHD).
Chest discomfort is among the most common reasons
for which patients present for medical attention at
either an emergency department (ED) or an
outpatient clinic.
5. Any adult male (more than 30 years), or
postmenopausal female, complaining of
retrosternal pain should be suspected to be
having myocardial ischemia, until proved
otherwise.
5
8. History taking
Ask the patient the following 10 points about chest pain:
1. Onset
2. Site of pain
3. Character (Quality)
4. Duration
5. Radiation
6. Aggravating factor
7. Relieving factor
8. Local tenderness
9. Associated symptoms
10. Severity.
8
18. • Chest pain due to ischemic heart disease (IHD) may manifest as:
Angina pectoris :2-10 min., relieved by rest , not associated with
vomiting
Myocardial infarction :>30 min., not relieved by rest , associated
with vomiting
19. Characteristics of cardiac pain
• Onset. The pain of MI typically takes several minutes
or even longer to develop; similarly, angina builds up
gradually in proportion to the intensity of exertion.
19
20.
21.
22. • Associated features. The pain of MI, massive
pulmonary embolism or aortic dissection is often
accompanied by autonomic disturbance, including
sweating, nausea and vomiting.
Breathlessness, due to pulmonary congestion arising
from transient ischemic left ventricular dysfunction, is
often a prominent and occasionally the dominant
feature of MI or angina (angina equivalent).
Breathlessness may also accompany any of the
respiratory causes of chest pain and can be associated
with cough, wheeze or other respiratory symptoms.
26. DIFFERENTIAL DIAGNOSIS
• Acute, sudden and severe chest pain described as tearing that
is maximal at onset and radiates to interscapular area raises
the possibility of aortic dissection.
Important diagnostic feature is the inequality in the pulses, e.g.
carotid, radial and femoral, and a blood pressure differential of
greater than 20 mm Hg
31
27. • Severe chest pain, retrosternal, accompanied by dyspnea,
cough, and hemoptysis developing in a patient who has been
immobilized or bedridden is suggestive of pulmonary embolism
• Chest discomfort due to pericarditis is typically retrosternal,
aggravated by coughing, deep respiration, or change in
position; worse in supine, and relieved in sitting upright and
leaning forward
• The pain of esophageal spasm is commonly an intense,
squeezing discomfort that is retrosternal in location and, like
angina, may be relieved by nitroglycerin
32
28. • Pain in a dermatomal distribution can also be caused by herpes
zoster
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29. PULMONARY50%
EXCLUDE75%
34
95% CAUSES
• Stable angina NON ischemic chest pain
ECG CXR
DIAGNOSTIC CAUSES
TREADMILL TEST ECHO
DIAGNOSTIC VALVE LESION
CORONARY ABDOMINAL U S
ANGIOGRAPHY , OGD
DIAGNOSTIC ABDOMINAL