Lactate: How Sick Is Your Patient
•Download as PPT, PDF•
15 likes•8,555 views
The document discusses lactate levels and their use in identifying occult hypoperfusion and sepsis in pre-hospital patients. It describes a pilot study that uses pre-hospital lactate measurement and notification of "Sepsis Alert" to initiate early goal directed therapy for sepsis patients in the field. The study aims to determine if this approach can improve outcomes by earlier treatment of hypoperfusion and sepsis.
Report
Share
Report
Share
![Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
Recommended
Understanding Lactate - Paul Marik
Lactate has been viewed as a byproduct of anaerobic metabolism and an indicator of tissue hypoperfusion since the 1900s. This theory is still widely believed. Paul busts the myths surrounding lactic acidosis, anaerobic metabolism, tissue hypoxia and the role of lactate in sepsis.
Key take-away facts include:
- The production of lactate actually consumes hydrogen ions. Lactic acidosis is really lactic alkalosis.
- Lactate is produced physiologically and is a precursor for gluconeogenesis.
- During exercise, skeletal muscle exports lactate as the primary fuel for the heart and brain.
- At VO2max, intracellular oxygen stays the same. Anaerobic metabolism in cells only occur as a pre-terminal event. The exception is in complete arterial occlusion.
- Adrenaline promotes lactate production
- Lactate infusion has been shown to increase cardiac output in septic and cardiogenic shock
- Lactate is a survival advantage!
Lactate Overview
The document discusses lactate production and metabolism. It challenges the traditional view that high lactate levels always indicate tissue hypoxia or anaerobic metabolism. Lactate can be produced through many mechanisms including accelerated aerobic glycolysis stimulated by factors like catecholamines. The liver, kidneys, and muscle all play roles in lactate metabolism, with the majority being used for gluconeogenesis or oxidation rather than indicating hypoxia. High lactate is a marker of physiological stress but the source does not necessarily mean malperfusion, and treatment should focus on the underlying condition rather than just the lactate level alone.
Lactate by jack.
Dr. Jakeer Hussain discusses lactic acidosis, which occurs when blood lactate levels are elevated above 5 mmol/L along with metabolic acidosis. Lactic acidosis can be type A, due to tissue hypoperfusion, or type B, which has no evidence of hypoperfusion. Common causes of lactic acidosis include shock, metformin use, mesenteric ischemia, sepsis, lung injury, and certain drugs. The presentation depends on the underlying condition, but resolving lactic acidosis generally indicates successful resuscitation in shock.
Diabetic ketoacidosis
Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria.
Fluid therapy in medical disorders
- Fluid therapy requires selecting the appropriate intravenous fluid based on the patient's condition, including their electrolyte and acid-base disorders.
- In hypovolemic shock, isotonic saline is preferred, while colloids are most effective but costly. Ringer's lactate is preferred if larger volumes are needed.
- In diarrhea, Ringer's lactate is preferred. In vomiting, isotonic saline with potassium is used. For combined losses, isotonic saline with potassium works best.
- In hepatic encephalopathy and stroke, maintenance of euvolemia is key, avoiding hypotonic fluids and electrolyte imbalances that could worsen the conditions.
Diabetic ketoacidosis by dr. noman
Diabetic ketoacidosis is a life-threatening complication of diabetes that occurs when there is not enough insulin in the body. It is characterized by high blood sugars, high ketones, and metabolic acidosis. The main treatment involves fluid replacement, insulin therapy to lower blood sugars and ketones, correcting electrolyte imbalances like potassium, and treating any underlying infections. Complications can include hypokalemia, hypoglycemia, cerebral edema, and pulmonary edema. Patient education focuses on medication adherence, sick-day management, and seeking medical care if symptoms worsen.
Metabolic acidosis by Dr. Neha Singh
This document discusses acid-base imbalance and metabolic acidosis. It defines metabolic acidosis as a pH imbalance where the body has too much acid due to metabolism and not enough bicarbonate to neutralize acid effects. Metabolic acidosis is characterized by reduced serum bicarbonate, decreased arterial carbon dioxide partial pressure, and reduced blood pH below 7.35. The document outlines the pathophysiology of metabolic acidosis and discusses compensation mechanisms, arterial blood gas components, and case examples of acid-base imbalances.
Acute Respiratory Failure
Acute respiratory failure is a life-threatening condition caused by the failure of oxygen and carbon dioxide exchange in the lungs. Prompt recognition and initiation of supportive treatments like oxygen supplementation are crucial for successful outcomes. Blood gas analysis helps differentiate between pulmonary and extra-pulmonary causes of hypoxemia and hypercapnia, with an increased alveolar-arterial oxygen difference being a sensitive indicator of respiratory diseases interfering with gas exchange. Management involves treating the underlying etiology, providing oxygen, and considering intubation and mechanical ventilation for persistent hypoxemia, progressive acidosis, or altered mental status.
Recommended
Understanding Lactate - Paul Marik
Lactate has been viewed as a byproduct of anaerobic metabolism and an indicator of tissue hypoperfusion since the 1900s. This theory is still widely believed. Paul busts the myths surrounding lactic acidosis, anaerobic metabolism, tissue hypoxia and the role of lactate in sepsis.
Key take-away facts include:
- The production of lactate actually consumes hydrogen ions. Lactic acidosis is really lactic alkalosis.
- Lactate is produced physiologically and is a precursor for gluconeogenesis.
- During exercise, skeletal muscle exports lactate as the primary fuel for the heart and brain.
- At VO2max, intracellular oxygen stays the same. Anaerobic metabolism in cells only occur as a pre-terminal event. The exception is in complete arterial occlusion.
- Adrenaline promotes lactate production
- Lactate infusion has been shown to increase cardiac output in septic and cardiogenic shock
- Lactate is a survival advantage!
Lactate Overview
The document discusses lactate production and metabolism. It challenges the traditional view that high lactate levels always indicate tissue hypoxia or anaerobic metabolism. Lactate can be produced through many mechanisms including accelerated aerobic glycolysis stimulated by factors like catecholamines. The liver, kidneys, and muscle all play roles in lactate metabolism, with the majority being used for gluconeogenesis or oxidation rather than indicating hypoxia. High lactate is a marker of physiological stress but the source does not necessarily mean malperfusion, and treatment should focus on the underlying condition rather than just the lactate level alone.
Lactate by jack.
Dr. Jakeer Hussain discusses lactic acidosis, which occurs when blood lactate levels are elevated above 5 mmol/L along with metabolic acidosis. Lactic acidosis can be type A, due to tissue hypoperfusion, or type B, which has no evidence of hypoperfusion. Common causes of lactic acidosis include shock, metformin use, mesenteric ischemia, sepsis, lung injury, and certain drugs. The presentation depends on the underlying condition, but resolving lactic acidosis generally indicates successful resuscitation in shock.
Diabetic ketoacidosis
Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that mainly occurs in patients with type 1 diabetes, but it is not uncommon in some patients with type 2 diabetes. This condition is a complex disordered metabolic state characterized by hyperglycemia, ketoacidosis, and ketonuria.
Fluid therapy in medical disorders
- Fluid therapy requires selecting the appropriate intravenous fluid based on the patient's condition, including their electrolyte and acid-base disorders.
- In hypovolemic shock, isotonic saline is preferred, while colloids are most effective but costly. Ringer's lactate is preferred if larger volumes are needed.
- In diarrhea, Ringer's lactate is preferred. In vomiting, isotonic saline with potassium is used. For combined losses, isotonic saline with potassium works best.
- In hepatic encephalopathy and stroke, maintenance of euvolemia is key, avoiding hypotonic fluids and electrolyte imbalances that could worsen the conditions.
Diabetic ketoacidosis by dr. noman
Diabetic ketoacidosis is a life-threatening complication of diabetes that occurs when there is not enough insulin in the body. It is characterized by high blood sugars, high ketones, and metabolic acidosis. The main treatment involves fluid replacement, insulin therapy to lower blood sugars and ketones, correcting electrolyte imbalances like potassium, and treating any underlying infections. Complications can include hypokalemia, hypoglycemia, cerebral edema, and pulmonary edema. Patient education focuses on medication adherence, sick-day management, and seeking medical care if symptoms worsen.
Metabolic acidosis by Dr. Neha Singh
This document discusses acid-base imbalance and metabolic acidosis. It defines metabolic acidosis as a pH imbalance where the body has too much acid due to metabolism and not enough bicarbonate to neutralize acid effects. Metabolic acidosis is characterized by reduced serum bicarbonate, decreased arterial carbon dioxide partial pressure, and reduced blood pH below 7.35. The document outlines the pathophysiology of metabolic acidosis and discusses compensation mechanisms, arterial blood gas components, and case examples of acid-base imbalances.
Acute Respiratory Failure
Acute respiratory failure is a life-threatening condition caused by the failure of oxygen and carbon dioxide exchange in the lungs. Prompt recognition and initiation of supportive treatments like oxygen supplementation are crucial for successful outcomes. Blood gas analysis helps differentiate between pulmonary and extra-pulmonary causes of hypoxemia and hypercapnia, with an increased alveolar-arterial oxygen difference being a sensitive indicator of respiratory diseases interfering with gas exchange. Management involves treating the underlying etiology, providing oxygen, and considering intubation and mechanical ventilation for persistent hypoxemia, progressive acidosis, or altered mental status.
Hypokalemia & Hyperkalemia PPT (2)
This document discusses potassium levels in the blood and factors that can cause hypokalemia (low potassium) or hyperkalemia (high potassium). It begins by stating the normal range for potassium in blood is 3.5-5 mEq/L. It then provides multiple potential causes for abnormal potassium levels including medications, diet, vomiting/diarrhea, kidney disease, and cellular shifts of potassium between extracellular and intracellular fluid. Mnemonics are also presented to help remember key points. Assessment findings and complications associated with hypo- and hyperkalemia like arrhythmias and muscle weakness are described.
Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) is characterized by acute lung injury and hypoxemia caused by a profound inflammatory response and diffuse alveolar damage. ARDS has an incidence of 5-71 per 100,000 people and costs $5 billion annually to treat in the US. Standard treatment focuses on treating the underlying cause, maintaining adequate oxygen levels through ventilator support using lung-protective strategies, and considering approaches like prone positioning to improve oxygenation. While mortality was historically high, outcomes have improved with application of evidence-based protocols, though ARDS still carries significant morbidity and risk of long-term complications.
Arterial Blood Gases
This document provides an overview of arterial blood gas interpretation. It discusses normal values for pH, PaCO2, HCO3, PaO2 and SaO2. It explains acid-base balance and the respiratory and metabolic mechanisms that control pH. A 3-step process is outlined for interpreting ABG results: 1) determine if acidosis or alkalosis based on pH, 2) evaluate the respiratory mechanism using PaCO2, and 3) evaluate the metabolic mechanism using HCO3. Compensation and combined disturbances are also addressed. Case examples are provided to demonstrate interpreting ABG results and diagnosing respiratory vs. metabolic causes of acid-base imbalances.
Electrolyte imbalance
This document discusses electrolyte imbalances, specifically hypokalemia, hyperkalemia, and magnesium imbalance. It outlines the causes, clinical manifestations, and treatment considerations for anesthesia for each condition. Key points include decreased cardiac contractility and arrhythmias with hypokalemia, skeletal muscle weakness and cardiac effects with hyperkalemia, and uses of magnesium for conditions like preeclampsia and tetanus. Treatment involves oral or IV potassium replacement, calcium or sodium bicarbonate for hyperkalemia, and magnesium supplementation. Anesthetic implications are also addressed.
Basics In Arterial Blood Gas Interpretation
This document provides guidelines for interpreting arterial blood gas results, including:
1. It describes how to summarize the acid-base and oxygenation status based on pH, PCO2, HCO3, PO2, and other values.
2. It outlines the steps to determine if a disturbance is respiratory or metabolic in nature, and whether it is acute or chronic.
3. Causes and compensation mechanisms for various acid-base imbalances like respiratory acidosis/alkalosis and metabolic acidosis/alkalosis are reviewed.
Fluid management in Pediatrics
This document discusses fluid management in pediatric patients. It covers the following key points:
- Body fluids are composed of intracellular and extracellular fluid compartments. Total body water varies with age.
- Intravenous fluids aim to maintain hydration and electrolyte balance. Common IV fluids include normal saline, Ringer's lactate, and dextrose solutions.
- Maintenance fluid rates are calculated based on weight and age to replace insensible water losses and electrolytes. Fluid deficits from conditions like diarrhea are replaced in addition to maintenance needs.
Potassium Management
This document discusses potassium management and provides key details about hypokalemia and hyperkalemia. It covers:
- Causes of hypokalemia including redistribution, extrarenal loss, and renal loss. Redistribution can be caused by alkalosis, medications, or increased sympathetic tone. Extrarenal losses include diarrhea, laxative abuse, and sweating. Renal losses are associated with metabolic acidosis or alkalosis.
- Treatment of hypokalemia focuses on replacing deficits orally or intravenously, while also treating underlying causes.
- Causes of hyperkalemia include increased intake, pseudohyperkalemia, transcellular shifts during conditions like tumor l
ARDS - Diagnosis and Management
This document provides an overview of the diagnosis and management of Acute Respiratory Distress Syndrome (ARDS). It begins with defining ARDS and discussing the Berlin definition. It then covers risk factors, etiology, clinical course, pathophysiology, differential diagnosis, and management approaches. The management section emphasizes the importance of lung-protective ventilation with low tidal volumes to prevent ventilator-induced lung injury in ARDS patients.
Acute Lung Injury & ARDS
This document summarizes acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), including definitions, epidemiology, clinical presentation, predictors of outcome, mortality rates, and ventilator-based management strategies. Key points include:
- The 1994 consensus definitions of ALI and ARDS focus on timing, radiographic findings, and impaired oxygenation.
- Common causes are direct lung injury from aspiration/pneumonia or indirect injury from sepsis/shock.
- Mortality ranges from 31-74% depending on study. Non-respiratory organ failure is a major cause of death.
- A landmark 2000 trial showed that a "lung-protective strategy" using lower tidal volumes
Neonatal Emergency and Common Problems in Emergency Department
A 5-day-old boy presented with poor feeding and lethargy. On examination, he was difficult to arouse and slightly jaundiced with mottled skin. His vital signs showed hypothermia, tachycardia, and prolonged capillary refill time. Intravenous access was obtained and fluids, antibiotics, and tests were initiated to evaluate for possible sepsis given his concerning symptoms. Further history revealed worsening feeding over the past day.
Metabolic acidosis
This document provides information on metabolic acidosis, including:
- Metabolic acidosis occurs when there is an excess of fixed or exogenous acids in the blood, accompanied by a drop in plasma bicarbonate concentration.
- It is classified based on calculations of anion gap, delta ratio, and osmolar gap. An increased anion gap suggests retained fixed acids while a normal anion gap acidosis involves bicarbonate loss.
- Causes include lactic acidosis, ketoacidosis, and renal tubular acidosis. Treatment involves identifying and treating the underlying cause while monitoring the patient and correcting fluid, electrolyte and pH imbalances.
Ventilator Management In Different Disease Entities
The document discusses ventilator management in different disease entities. It covers indications for mechanical ventilation in conditions like respiratory failure, ARDS, COPD, chest trauma, and head injury. For ARDS specifically, it summarizes the key findings of the NIH ARDS Network trial which demonstrated that a lower tidal volume strategy of 6 ml/kg predicted body weight reduced mortality compared to the traditional higher tidal volume approach.
Cardiac Arrest in the Pediatric OR
This document discusses cardiac arrest in pediatric patients undergoing anesthesia. It notes that the rate of cardiac arrest attributable to anesthesia has decreased but mortality remains high. Common causes of arrest include hypoxia, cardiovascular issues like hypovolemia and hyperkalemia, and certain medications. The document then outlines recommendations from pediatric basic life support guidelines and discusses various causes of arrest like hypoxia, hypovolemia, hyperkalemia, and issues related to succinylcholine and bupivacaine administration. It emphasizes strategies for maintaining the airway, adequate fluid resuscitation, risks of rapid blood transfusion, and treatments for hyperkalemia and local anesthetic toxicity.
Arterial Blood Gases Talk
This document provides information about arterial blood gases (ABGs), including how to perform an ABG, normal ranges for ABG values, and how to interpret ABG results. It discusses how to determine if a patient has a respiratory or metabolic acidosis or alkalosis based on ABG values such as pH, pCO2, and HCO3-. It also covers oxygenation status, compensation, mixed acid-base disturbances, and causes of hypoxemia, respiratory acidosis/alkalosis, and metabolic acidosis/alkalosis.
ACUTE MANAGEMENT OF Hyperkalemia
This document discusses hyperkalemia, or high levels of potassium in the blood. It begins by listing the normal potassium range and then describes some common causes of hyperkalemia, including the release of potassium from cells due to conditions like rhabdomyolysis or tumor lysis syndrome, and decreased renal excretion of potassium due to renal failure or medications. Clinical manifestations of hyperkalemia are then outlined, such as weakness, paralysis, arrhythmias, and ECG changes including peaked T waves. The document concludes by presenting two case histories of patients with hyperkalemia and CKD and recommends treatment approaches starting with calcium gluconate for cardiac instability and then other options to increase potassium excretion or remove it through dialysis if
Hyperkalemia
This document discusses potassium homeostasis and hyperkalemia. It notes that potassium is mainly intracellular and its levels are regulated by the kidneys, sodium-potassium pump, and aldosterone. Causes of hyperkalemia include intracellular shifts, decreased excretion, and excess intake. Clinical features range from asymptomatic to muscle weakness to arrhythmias. ECG changes correlate with potassium levels and include peaked T waves, PR prolongation, and eventually a sine wave pattern. Treatment focuses on antagonizing cardiac effects with calcium, driving potassium intracellularly with insulin/beta-agonists, and removing it through cation exchange resins, diuretics, or hemodialysis.
Lactic Acidosis-An update
This document provides an overview of lactic acidosis, including its pathophysiology, causes, diagnosis, and treatment. It discusses how lactic acid is normally produced and eliminated in the body, and how an imbalance between production and elimination can lead to hyperlactatemia and lactic acidosis. The document covers two main types of lactic acidosis - type A associated with tissue hypoxia, and type B which occurs in the absence of hypoxia. Treatment focuses on supporting circulation and ventilation, improving microcirculation, treating underlying causes, and considering sodium bicarbonate or other buffer administration in severe cases. Monitoring blood lactate levels is important for assessing patients and guiding therapy.
ABG, step by step approach (Updated)
Provides a simple organized way for ABG analysis with special emphasis on Acid-base balance interpretation & its crucial rule in clinical toxicology practice.
High Altitude Illness
1) High altitude illness includes acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). AMS causes headache, nausea, fatigue, and dizziness. HACE is a neurological deterioration in someone with AMS. HAPE causes cough, dyspnea, and chest tightness. (2) Risk factors for these illnesses include rapid ascent, exertion, prior history, age under 50, and underlying lung/heart conditions. (3) Treatment depends on the illness but may include descent, oxygen, medications like dexamethasone or nifedipine, and hyperbaric bags that simulate lower altitudes.
Hypokalemia
Hypokalemia, or low potassium levels, can have significant effects on muscles, the cardiovascular and nervous systems. It is defined as a potassium level below 3.5 mEq/L. The majority of potassium is found inside cells and is essential for various cellular functions through membrane pumps and channels. Causes of hypokalemia include reduced intake, redistribution into cells, and increased losses through the kidneys or gastrointestinal tract. Treatment focuses on replacing potassium stores through oral or intravenous supplementation, addressing the underlying cause, and preventing further losses and complications like cardiac arrhythmias.
Lactic Acidosis
Lactic acidosis occurs when there is an imbalance between the production and use of lactic acid in the body. It can be caused by tissue hypoxia (type A) or other non-hypoxic factors like malignancy, liver disease, or drugs (type B). The document discusses the pathophysiology of lactic acidosis including lactate metabolism, cytokine effects, and the Warburg effect seen in cancer. Treatment focuses on resolving the underlying cause, with sodium bicarbonate used cautiously and alternatives like hemodialysis considered to correct acidosis and remove lactate when needed.
Rob Mac Sweeney vs Paul Marik - Predicting Fluid Responsiveness is a Waste of...
Rob Mac Sweeney and Paul Marik battle it out at SMACCForce in Chicago. Pro and Con is Predicting Fluid Responsiveness a waste of time?
More Related Content
What's hot
Hypokalemia & Hyperkalemia PPT (2)
This document discusses potassium levels in the blood and factors that can cause hypokalemia (low potassium) or hyperkalemia (high potassium). It begins by stating the normal range for potassium in blood is 3.5-5 mEq/L. It then provides multiple potential causes for abnormal potassium levels including medications, diet, vomiting/diarrhea, kidney disease, and cellular shifts of potassium between extracellular and intracellular fluid. Mnemonics are also presented to help remember key points. Assessment findings and complications associated with hypo- and hyperkalemia like arrhythmias and muscle weakness are described.
Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) is characterized by acute lung injury and hypoxemia caused by a profound inflammatory response and diffuse alveolar damage. ARDS has an incidence of 5-71 per 100,000 people and costs $5 billion annually to treat in the US. Standard treatment focuses on treating the underlying cause, maintaining adequate oxygen levels through ventilator support using lung-protective strategies, and considering approaches like prone positioning to improve oxygenation. While mortality was historically high, outcomes have improved with application of evidence-based protocols, though ARDS still carries significant morbidity and risk of long-term complications.
Arterial Blood Gases
This document provides an overview of arterial blood gas interpretation. It discusses normal values for pH, PaCO2, HCO3, PaO2 and SaO2. It explains acid-base balance and the respiratory and metabolic mechanisms that control pH. A 3-step process is outlined for interpreting ABG results: 1) determine if acidosis or alkalosis based on pH, 2) evaluate the respiratory mechanism using PaCO2, and 3) evaluate the metabolic mechanism using HCO3. Compensation and combined disturbances are also addressed. Case examples are provided to demonstrate interpreting ABG results and diagnosing respiratory vs. metabolic causes of acid-base imbalances.
Electrolyte imbalance
This document discusses electrolyte imbalances, specifically hypokalemia, hyperkalemia, and magnesium imbalance. It outlines the causes, clinical manifestations, and treatment considerations for anesthesia for each condition. Key points include decreased cardiac contractility and arrhythmias with hypokalemia, skeletal muscle weakness and cardiac effects with hyperkalemia, and uses of magnesium for conditions like preeclampsia and tetanus. Treatment involves oral or IV potassium replacement, calcium or sodium bicarbonate for hyperkalemia, and magnesium supplementation. Anesthetic implications are also addressed.
Basics In Arterial Blood Gas Interpretation
This document provides guidelines for interpreting arterial blood gas results, including:
1. It describes how to summarize the acid-base and oxygenation status based on pH, PCO2, HCO3, PO2, and other values.
2. It outlines the steps to determine if a disturbance is respiratory or metabolic in nature, and whether it is acute or chronic.
3. Causes and compensation mechanisms for various acid-base imbalances like respiratory acidosis/alkalosis and metabolic acidosis/alkalosis are reviewed.
Fluid management in Pediatrics
This document discusses fluid management in pediatric patients. It covers the following key points:
- Body fluids are composed of intracellular and extracellular fluid compartments. Total body water varies with age.
- Intravenous fluids aim to maintain hydration and electrolyte balance. Common IV fluids include normal saline, Ringer's lactate, and dextrose solutions.
- Maintenance fluid rates are calculated based on weight and age to replace insensible water losses and electrolytes. Fluid deficits from conditions like diarrhea are replaced in addition to maintenance needs.
Potassium Management
This document discusses potassium management and provides key details about hypokalemia and hyperkalemia. It covers:
- Causes of hypokalemia including redistribution, extrarenal loss, and renal loss. Redistribution can be caused by alkalosis, medications, or increased sympathetic tone. Extrarenal losses include diarrhea, laxative abuse, and sweating. Renal losses are associated with metabolic acidosis or alkalosis.
- Treatment of hypokalemia focuses on replacing deficits orally or intravenously, while also treating underlying causes.
- Causes of hyperkalemia include increased intake, pseudohyperkalemia, transcellular shifts during conditions like tumor l
ARDS - Diagnosis and Management
This document provides an overview of the diagnosis and management of Acute Respiratory Distress Syndrome (ARDS). It begins with defining ARDS and discussing the Berlin definition. It then covers risk factors, etiology, clinical course, pathophysiology, differential diagnosis, and management approaches. The management section emphasizes the importance of lung-protective ventilation with low tidal volumes to prevent ventilator-induced lung injury in ARDS patients.
Acute Lung Injury & ARDS
This document summarizes acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), including definitions, epidemiology, clinical presentation, predictors of outcome, mortality rates, and ventilator-based management strategies. Key points include:
- The 1994 consensus definitions of ALI and ARDS focus on timing, radiographic findings, and impaired oxygenation.
- Common causes are direct lung injury from aspiration/pneumonia or indirect injury from sepsis/shock.
- Mortality ranges from 31-74% depending on study. Non-respiratory organ failure is a major cause of death.
- A landmark 2000 trial showed that a "lung-protective strategy" using lower tidal volumes
Neonatal Emergency and Common Problems in Emergency Department
A 5-day-old boy presented with poor feeding and lethargy. On examination, he was difficult to arouse and slightly jaundiced with mottled skin. His vital signs showed hypothermia, tachycardia, and prolonged capillary refill time. Intravenous access was obtained and fluids, antibiotics, and tests were initiated to evaluate for possible sepsis given his concerning symptoms. Further history revealed worsening feeding over the past day.
Metabolic acidosis
This document provides information on metabolic acidosis, including:
- Metabolic acidosis occurs when there is an excess of fixed or exogenous acids in the blood, accompanied by a drop in plasma bicarbonate concentration.
- It is classified based on calculations of anion gap, delta ratio, and osmolar gap. An increased anion gap suggests retained fixed acids while a normal anion gap acidosis involves bicarbonate loss.
- Causes include lactic acidosis, ketoacidosis, and renal tubular acidosis. Treatment involves identifying and treating the underlying cause while monitoring the patient and correcting fluid, electrolyte and pH imbalances.
Ventilator Management In Different Disease Entities
The document discusses ventilator management in different disease entities. It covers indications for mechanical ventilation in conditions like respiratory failure, ARDS, COPD, chest trauma, and head injury. For ARDS specifically, it summarizes the key findings of the NIH ARDS Network trial which demonstrated that a lower tidal volume strategy of 6 ml/kg predicted body weight reduced mortality compared to the traditional higher tidal volume approach.
Cardiac Arrest in the Pediatric OR
This document discusses cardiac arrest in pediatric patients undergoing anesthesia. It notes that the rate of cardiac arrest attributable to anesthesia has decreased but mortality remains high. Common causes of arrest include hypoxia, cardiovascular issues like hypovolemia and hyperkalemia, and certain medications. The document then outlines recommendations from pediatric basic life support guidelines and discusses various causes of arrest like hypoxia, hypovolemia, hyperkalemia, and issues related to succinylcholine and bupivacaine administration. It emphasizes strategies for maintaining the airway, adequate fluid resuscitation, risks of rapid blood transfusion, and treatments for hyperkalemia and local anesthetic toxicity.
Arterial Blood Gases Talk
This document provides information about arterial blood gases (ABGs), including how to perform an ABG, normal ranges for ABG values, and how to interpret ABG results. It discusses how to determine if a patient has a respiratory or metabolic acidosis or alkalosis based on ABG values such as pH, pCO2, and HCO3-. It also covers oxygenation status, compensation, mixed acid-base disturbances, and causes of hypoxemia, respiratory acidosis/alkalosis, and metabolic acidosis/alkalosis.
ACUTE MANAGEMENT OF Hyperkalemia
This document discusses hyperkalemia, or high levels of potassium in the blood. It begins by listing the normal potassium range and then describes some common causes of hyperkalemia, including the release of potassium from cells due to conditions like rhabdomyolysis or tumor lysis syndrome, and decreased renal excretion of potassium due to renal failure or medications. Clinical manifestations of hyperkalemia are then outlined, such as weakness, paralysis, arrhythmias, and ECG changes including peaked T waves. The document concludes by presenting two case histories of patients with hyperkalemia and CKD and recommends treatment approaches starting with calcium gluconate for cardiac instability and then other options to increase potassium excretion or remove it through dialysis if
Hyperkalemia
This document discusses potassium homeostasis and hyperkalemia. It notes that potassium is mainly intracellular and its levels are regulated by the kidneys, sodium-potassium pump, and aldosterone. Causes of hyperkalemia include intracellular shifts, decreased excretion, and excess intake. Clinical features range from asymptomatic to muscle weakness to arrhythmias. ECG changes correlate with potassium levels and include peaked T waves, PR prolongation, and eventually a sine wave pattern. Treatment focuses on antagonizing cardiac effects with calcium, driving potassium intracellularly with insulin/beta-agonists, and removing it through cation exchange resins, diuretics, or hemodialysis.
Lactic Acidosis-An update
This document provides an overview of lactic acidosis, including its pathophysiology, causes, diagnosis, and treatment. It discusses how lactic acid is normally produced and eliminated in the body, and how an imbalance between production and elimination can lead to hyperlactatemia and lactic acidosis. The document covers two main types of lactic acidosis - type A associated with tissue hypoxia, and type B which occurs in the absence of hypoxia. Treatment focuses on supporting circulation and ventilation, improving microcirculation, treating underlying causes, and considering sodium bicarbonate or other buffer administration in severe cases. Monitoring blood lactate levels is important for assessing patients and guiding therapy.
ABG, step by step approach (Updated)
Provides a simple organized way for ABG analysis with special emphasis on Acid-base balance interpretation & its crucial rule in clinical toxicology practice.
High Altitude Illness
1) High altitude illness includes acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high altitude pulmonary edema (HAPE). AMS causes headache, nausea, fatigue, and dizziness. HACE is a neurological deterioration in someone with AMS. HAPE causes cough, dyspnea, and chest tightness. (2) Risk factors for these illnesses include rapid ascent, exertion, prior history, age under 50, and underlying lung/heart conditions. (3) Treatment depends on the illness but may include descent, oxygen, medications like dexamethasone or nifedipine, and hyperbaric bags that simulate lower altitudes.
Hypokalemia
Hypokalemia, or low potassium levels, can have significant effects on muscles, the cardiovascular and nervous systems. It is defined as a potassium level below 3.5 mEq/L. The majority of potassium is found inside cells and is essential for various cellular functions through membrane pumps and channels. Causes of hypokalemia include reduced intake, redistribution into cells, and increased losses through the kidneys or gastrointestinal tract. Treatment focuses on replacing potassium stores through oral or intravenous supplementation, addressing the underlying cause, and preventing further losses and complications like cardiac arrhythmias.
What's hot (20)
Neonatal Emergency and Common Problems in Emergency Department
Neonatal Emergency and Common Problems in Emergency Department
Ventilator Management In Different Disease Entities
Ventilator Management In Different Disease Entities
Viewers also liked
Lactic Acidosis
Lactic acidosis occurs when there is an imbalance between the production and use of lactic acid in the body. It can be caused by tissue hypoxia (type A) or other non-hypoxic factors like malignancy, liver disease, or drugs (type B). The document discusses the pathophysiology of lactic acidosis including lactate metabolism, cytokine effects, and the Warburg effect seen in cancer. Treatment focuses on resolving the underlying cause, with sodium bicarbonate used cautiously and alternatives like hemodialysis considered to correct acidosis and remove lactate when needed.
Rob Mac Sweeney vs Paul Marik - Predicting Fluid Responsiveness is a Waste of...
Rob Mac Sweeney and Paul Marik battle it out at SMACCForce in Chicago. Pro and Con is Predicting Fluid Responsiveness a waste of time?
Myburgh on Fluids ICN NSW 2015
This document summarizes the history and evidence around fluid management and the use of colloids like albumin and hydroxyethyl starch (HES). It discusses several large randomized controlled trials that compared albumin and HES to crystalloids in critically ill patients. The SAFE study found increased mortality with albumin compared to saline in ICU patients. Subsequent trials found increased mortality and renal failure with HES compared to crystalloids in sepsis patients. This led regulatory agencies around the world to restrict or withdraw approval for HES use in high-risk patients like those with sepsis or renal impairment. The evidence suggests colloids like HES may increase mortality and renal failure compared to crystalloid fluids in critically ill patients.
Hinds - Crack the Chest, Get Crucified
Resuscitation legend John Hinds talks about the consequences of our actions in resuscitation.
He discusses resuscitative emergency thoracotomies and the philosophy and mindset required by the practitioner rather than the technicalities of how to perform it.
As John says, trying to find the fault in a wiring loom of a ZX10 is difficult. Opening a chest is not. But it has been built up to be such a heroic procedure that we're stopping people doing it.
John discusses a case and the way it was discussed in the ensuing mortality meeting. He breaks down the personalities you see in these meetings - the sycophants, supporters, the skeptics and coins the phrase #resuswankers.
The hardest part of a resuscitative thoracotomy is not making the first cut - it's dealing with the #resuswankers.
Using simulation, optimising logistics and training the team effectively John managed to change the culture in an institution. This translated into an incredible save.
Take home points include:
Prepare. Know the evidence.
Make your intentions honourable.
Do it.
Seek out the skeptics.
Never allow a wanker to bring you down.
He does this with his usual dry wit, genuine passion and refreshing modesty that have made him so popular.
To see how mating hippos and batman are of relevance, you'll have to watch the talk.
John will be dearly missed by our community and this talk shows you why.
When to STOP Resuscitation by Roger Harris
When to stop resuscitation in probably the biggest question challenging Critical Care and it's a challenge that many of us face virtually every clinical shift. The main problem is that there is little good data to guide us, leaving us to navigate this situation with few coordinates to plot a path forward. When to stop resuscitation explores this problem and suggests some landmarks we can use to navigate by. It examines the inter-relationship between the pillars of our medical ethics Autonomy, Beneficence, Non-Maleficence and Justice. To better understand the clinical challenges we face, the talk also uses a framework provided by modern physics and the 'Space Time Continuum' theorem. Hence the title might more appropriately be – “The will to Live – The courage to die and the space-time continuum”.
If the thought of how Einstein’s theorem on ‘General Relativity’ can help us answer the question of, when to stop resuscitation interests you then don’t miss this.
Toxicology For EMS
Three EMS and ED-related toxicology case reviews; some of the references are dated but the information is still helpful to know
Group Capstone Project
This is the presentation for a group capstone project that I helped to create as a member of the team.
Todora_marc-Lactate-update
The study examined the effects of three recovery methods - cold water immersion (CWI), active recovery (AR), and passive recovery (CON) - on blood lactate levels, heart rate, and repeated sprint performance. There were no significant differences found between the recovery methods for lactate clearance, heart rate, or 200m sprint times. While not statistically significant, CWI and AR resulted in slightly lower lactate levels than CON after recovery. The results suggest that the recovery methods did not differentially impact repeated sprint performance in recreationally active males.
Endocrine
The document discusses endocrine issues in critical illness, including the stress response and its effects on glucose levels and insulin resistance. It presents evidence that tight glycemic control with intensive insulin therapy reduces mortality in critically ill patients. The text also examines glucocorticoid physiology and biosynthesis, noting that adrenal insufficiency is common in sepsis and ICU patients. Studies demonstrate improved outcomes with hydrocortisone replacement in patients with septic shock or adrenal insufficiency.
Diphtheria - Prac. Microbiology
This document discusses Gram positive bacilli including Corynebacterium and Listeria. It focuses on Corynebacterium diphtheriae, providing details on its morphology, culture characteristics, virulence factors causing diphtheria, clinical manifestations of disease, diagnosis and prevention through vaccination. It also briefly discusses Listeria monocytogenes and its ability to cause neonatal meningitis through contaminated food consumption by the mother.
Sepsis
This document discusses sepsis, septicemia, and multiple organ dysfunction syndrome (MODS). It defines related terms like bacteremia, systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock. It discusses the magnitude of the problem globally and in India. It covers the pathophysiology and most common sources of infection. It also summarizes the Surviving Sepsis Campaign guidelines for management of sepsis and septic shock. Finally, it provides an overview of recent advances and controversies in the field and lists various biomarkers that can be used for diagnosis, prognosis, and stratification of sepsis severity.
Lt what does it really mean
LT refers to the exercise intensity at which lactate production exceeds removal and begins to accumulate. It is an important determinant of endurance performance and provides a measure of metabolic fitness compared to VO2max as a measure of cardiovascular fitness. LT can be measured in various ways that are closely related. Factors like muscle mitochondria, fiber type, exercise mode determine LT. Training, especially continuous training around threshold, can significantly improve LT over a season in athletes. Interval training may also effectively raise LT.
Lec04 pyruvate met
The document outlines the fates of pyruvate and the energy yields from glycolysis. It discusses:
1) Pyruvate can be reduced to lactate by lactate dehydrogenase under anaerobic conditions, oxidatively decarboxylated to acetyl-CoA by pyruvate dehydrogenase in aerobic conditions, or carboxylated to oxaloacetate.
2) Glycolysis yields 2 ATP under anaerobic conditions from the conversion of glucose to lactate, and yields 2 additional ATP under aerobic conditions when NADH is reoxidized by the electron transport chain.
3) Other monosaccharides like fructose and galactose can enter glycolysis after
Management of lactic acidosis
Lactic acidosis is defined as a serum lactate level greater than 5mmol/L accompanied by acidosis and a low serum pH. It occurs when lactate production exceeds utilization, commonly due to tissue hypoxia or impaired liver/kidney function. Management involves treating the underlying cause to restore oxygen delivery and lactate clearance. Bicarbonate therapy can raise the pH but risks hypercapnia and is not recommended in some cases. New therapies like dichloroacetate aim to increase lactate utilization but have not reduced mortality in clinical trials.
Catheter Associated Urinary Tract Infection (CAUTI)
Catheter Associated Urinary Tract Infection (CAUTI)Philippine Hospital Infection Contol Nurses Associaton (PHICNA) Inc.
(1) The document summarizes guidelines for diagnosis, prevention and treatment of catheter-associated urinary tract infections in adults from the Infectious Diseases Society of America.
(2) It defines catheter-associated UTI and asymptomatic bacteriuria, and discusses epidemiology, microbiology, risk factors, complications of short and long-term catheterization, and recommendations for diagnosis and management.
(3) The document provides treatment guidelines including first-line and alternative antibiotic options for catheter-associated UTIs based on risk of specific organisms.Hacking medical education 20150604
This document discusses 7 hacks for medical education and lifelong learning. It recommends learning from masters like Osler, discovering the hidden curriculum, and applying cognitive science techniques like retrieval practice and spaced repetition. It also suggests joining the FOAM (Free Open Access Meducation) movement, being a critical thinker by evaluating sources, and working smarter through time management. The overall message is that learning is difficult but must be embraced in order to continually improve, master knowledge, and have a positive impact.
Advanced Airway Management
The document outlines steps for intubation including preparing, anticipating challenges, ensuring oxygenation and ventilation through various means including initially placing an endotracheal tube, addressing a failed intubation by continuing oxygenation and ventilation, planning for a surgical airway if intubation and ventilation cannot be achieved, and successfully performing a surgical airway with the bottom line being oxygenation and ventilation were maintained.
Critical Care Haematology
Deirdre talks ‘bad blood’ – the complex world of critical care haematology.
Critically ill patients frequently have activation of inflammatory and clotting pathways. These are likely adaptive responses in the human.
When they run riot, or the fine balance between pro- and anti-inflammatory states is shifted, there can be significant morbidity and mortality.
Deirdre presents three patients to highlight these issues and what you can do about it. This acronym-busting talk will focus on some acquired haematological disorders in critically ill patients.
Platelets make up a tiny percentage of blood – just 0.01%. However, they have a crucial role to play. A low platelet count can be due to reduced production or increased destruction.
Disseminated Intravascular Coagulation (DIC) is a clinical and laboratory diagnosis that affects about 1% of hospitalised patients. At the most severe end it is associated with bleeding and/or thrombotic complications. Disorders such as thrombotic thrombocytopenia purpura (TTP) and other forms of micro-angiopathic haemolytic anaemia (MAHA) will also be described including the role of ADAMST13.
The knowledge of what is what, is critical, as it will dictate treatment. Heparin-Induced Thrombocytopaenia (HIT) is an uncommon but important condition which is difficult to diagnose in a critically ill patient. It is a heparin dependent pro-thrombotic disorder. There is no good test for HIT.
Have you always wondered about NETs (neutrophil extracellular traps) and their importance? If so this whistle-stop tour of non-malignant hematology in the ICU is for you!
Deirdre drives home the message that low platelets are common in the critically ill and the causes are multifactorial.
Finally, for more like this head to our podcast page. #CodaPodcast
Integrating In Situ Simulation
A presentation given by Luke Wainwright and myself about some of the trials and tribulations and eventual successes with integrating simulation into hospital education programs.
Anyone Can Intubate, or Not: Teaching airway skills the antifragile way
Becoming competent in airway management requires good decision making and and technical skills. Ultimately what matters is how your clinical performance impacts patient outcomes. For this we need to have a clear understanding of what defines success ensuring that its more than just 'getting the tube'. Come to this talk and you'll experience a Canadian take on Guinness, adventure sports, flying a plane and how other factors including failure influence airway management outcomes.
Viewers also liked (20)
Rob Mac Sweeney vs Paul Marik - Predicting Fluid Responsiveness is a Waste of...
Rob Mac Sweeney vs Paul Marik - Predicting Fluid Responsiveness is a Waste of...
Catheter Associated Urinary Tract Infection (CAUTI)
Catheter Associated Urinary Tract Infection (CAUTI)
Anyone Can Intubate, or Not: Teaching airway skills the antifragile way
Anyone Can Intubate, or Not: Teaching airway skills the antifragile way
Similar to Lactate: How Sick Is Your Patient
Behcations
The document discusses various metabolic complications associated with HIV infection and antiretroviral therapy (HAART), including lactic acidemia, lipodystrophy, dyslipidemia, and insulin resistance. Lactic acidemia is proposed to result from mitochondrial toxicity of nucleoside reverse transcriptase inhibitors (NRTIs) and can range from asymptomatic to potentially fatal lactic acidosis. Lipodystrophy involves abnormal fat redistribution including central lipohypertrophy and peripheral lipoatrophy, which are associated with prolonged HAART use and protease inhibitor therapy. Management of these conditions involves treatment interruption or switching antiretrovirals to limit toxicity.
Fwd: Bambury tutorial on preop assessment
---------- Forwarded message ----------
From: Henning L. Stokmo <helangen@gmail.com>
Date: 2009/2/12
Subject: Bambury tutorial on preop assessment
To: ucdgrad09@gmail.com
ICU Topics for the Final FRCA
This document provides guidance on intensive care medicine topics that may be covered in the FRCA exam, with a focus on acute liver failure and cardiogenic shock. It discusses 20 specific ICU questions that may appear in the MCQ section and advises candidates to focus on structure in their answers. Example cases are presented on acute liver failure and a postoperative patient with cardiogenic shock, with discussion points provided for each. Key topics in the management of these conditions like encephalopathy, fluid balance and inotropes are reviewed. Candidates are encouraged to answer just the question asked and not provide irrelevant extra details.
Heat stress txolan 2012
This is the slides from a lecture delivered by Dr. Ben Buchanan at the 2012 TXOLAN Alpaca Spectacular Show.
Shock Comprehensive
This document provides an overview of neonatal shock and hypotension. It defines shock, discusses the pathophysiology including factors that influence cardiac output and blood flow to tissues. It describes the stages of shock, risk factors, clinical manifestations, evaluation and treatment including volume expanders and vasoactive drugs. Specific types of shock like hypovolemic, cardiogenic, distributive and their treatments are explained. Intractable shock and further care are also summarized.
Rhabdomyolysis Im Morning
This document summarizes a case of rhabdomyolysis likely caused by a drug interaction between simvastatin 80mg and gemfibrozil. The patient presented with progressive weakness and muscle pain. Labs showed a CPK over 20,000 and acute kidney injury. Rhabdomyolysis was diagnosed. The document then provides background on rhabdomyolysis including causes, pathogenesis involving calcium dysregulation and cell injury, systemic effects especially risk of acute kidney injury, diagnosis, and treatment options including IV fluids and bicarbonate to prevent pigment nephropathy. Close monitoring is needed due to risk of complications.
Nephrology Board Review
The document discusses several nephrology cases and questions. It includes a case of a 64-year-old man with alcoholic cirrhosis and hyponatremia admitted for confusion and lethargy. Labs show hyponatremia and the cause is determined to be hepatorenal syndrome. Another case discusses a 72-year-old man who developed acute renal failure after cardiac catheterization, with findings suggesting cholesterol embolization. The document also reviews acid-base disorders and provides mnemonics for differential diagnoses of anion gap and non-gap acidosis.
paediatric-septic-shock. Is caused by staphylococcus bacteria.
Septic shock is a very serious and emergency situation... In which need to special care to the child
ITTABV1
The document discusses the initial assessment and management of trauma and burn patients. It covers the primary and secondary surveys, with a focus on airway, breathing, circulation, and exposure. Key steps in trauma resuscitation include rapid sequence intubation, needle decompression for tension pneumothorax, and fluid resuscitation. The document also discusses hemorrhagic shock evaluation and algorithms, as well as burn depth, extent, and resuscitation guidelines such as the Parkland formula.
paediatric-septic-shock is a very sever and dangerous for pediatric
The document discusses paediatric septic shock, including definitions, risk factors, clinical manifestations, investigations, and management. It defines the progression from systemic inflammatory response syndrome to sepsis to severe sepsis to septic shock. It emphasizes early recognition and goal-directed resuscitation including fluid boluses, antibiotics, and vasoactive drugs. Controversies around hydrocortisone and activated protein C are discussed. Studies supporting goal-directed therapy and extracorporeal membrane oxygenation for refractory shock are summarized.
Hypotension management in ICU, volume vessel or pump?
This document discusses the management of hypotension and hypoperfusion. It begins with an overview of fluid, vasopressor, and inotropic therapy and the importance of matching oxygen delivery to demand. It then presents a case of a patient with peritonitis and hypotension and discusses the pathophysiology of hypoperfusion, including situations where blood pressure may be normal but microcirculation is impaired. The document emphasizes optimizing both the macrocirculation and microcirculation in management. It discusses various fluid resuscitation endpoints and techniques to assess fluid responsiveness to guide fluid administration. Finally, it addresses the use of vasopressors and inotropes in the context of sepsis.
Nutrition
This document discusses nutritional support for patients in the intensive care unit (ICU). It covers reasons for nutritional support like limiting catabolism and increasing survival. It describes assessing patients and calculating calorie and protein needs using formulas like Harris-Benedict and Ireton-Jones. Enteral nutrition is preferred over total parenteral nutrition when possible due to lower infection risks. Early enteral nutrition within 24-48 hours is associated with better outcomes. Overfeeding can cause complications so goals are tailored to patient stress level and condition.
Septic cardiomyopathy colour
1) Sepsis can cause cardiomyopathy known as sepsis-induced cardiomyopathy (SCM), characterized by left ventricular dilatation and decreased ejection fraction despite normal or low filling pressures.
2) Two proposed mechanisms for SCM are myocardial ischemia/hypoperfusion and the direct effects of inflammatory mediators on cardiomyocytes.
3) While SCM is usually reversible within 7-10 days, non-survivors tend to have greater ventricular dilatation and worse systolic function compared to survivors. Dobutamine and other inotropes are not consistently beneficial and may have adverse effects. Levosimendan shows potential as an alternative based on its inotropic and vasodilatory effects
ANTIHYPERTENSIVE THERAPY-market review 2013
Basics of hypertension and available treatment.
Overview of mechanism of action, risks/benefits of various classes of drugs.
Prevalent prescription trends and future market review.
paediatric-septic-shock very rare condition to the baby
Pediatric septic shock is a infectious condition when client not taken proper treatment at previously so ut lead to septic shock.
ICU topics for Final FRCA
This patient is a 25 year old female admitted to the ICU for respiratory failure and hypotension following a 6 day prodromal illness. She is intubated and receiving vasopressors. The differential diagnosis includes sepsis, severe sepsis, or septic shock from an unknown source. Principles of management include identifying the source, administering appropriate antibiotics, optimizing hemodynamics and organ function, and providing lung protective ventilation for her acute respiratory distress syndrome. Early enteral nutrition is important to support her systemic immune response and prevent further organ dysfunction from a cumulative energy deficit.
CORONARY ARTERY DISEASE WITH HYPERTENSION
This document provides information on CAD, gastroenteritis, and hypertension. It includes sections on causes, transmission, symptoms, and standard treatment protocols for each condition. It then presents a case study of a 58-year-old male patient with complaints of vomiting, abdominal pain, and weakness. His medical history and examination results are detailed. He is assessed as having gastroenteritis, hypertension, and CAD. A 5-day treatment plan is outlined, along with discharge instructions and counseling on lifestyle modifications and medication management.
Shock In Children
The document discusses shock in children, defining it as circulatory system failure to supply oxygen and nutrients to meet cellular demands. It covers circulatory physiology, classifications of shock, evaluation, treatment including fluid resuscitation and vasoactive drugs, and specific types of shock such as hypovolemic, cardiogenic, obstructive, and distributive shock. Metabolic issues associated with shock like acid-base and electrolyte abnormalities are also reviewed.
Drowning by dr mahmoud zalam kfmc riyadh ksa
it is a ppt about drowning in kids
etiology c/p diagnosis
risk factors complication
pathophysiology
management and how to prevent !!!!!!!
Drowning
Drowning can cause hypoxic brain injury, pulmonary edema, hypothermia, and multi-organ dysfunction. Prognosis is poor if the victim was submerged for over 10 minutes, CPR lasted over 25 minutes, or their initial pH or core temperature was severely low. Prevention through supervision, CPR training, and lifejacket use is crucial to reducing drowning deaths and disabilities.
Similar to Lactate: How Sick Is Your Patient (20)
paediatric-septic-shock. Is caused by staphylococcus bacteria.
paediatric-septic-shock. Is caused by staphylococcus bacteria.
paediatric-septic-shock is a very sever and dangerous for pediatric
paediatric-septic-shock is a very sever and dangerous for pediatric
Hypotension management in ICU, volume vessel or pump?
Hypotension management in ICU, volume vessel or pump?
paediatric-septic-shock very rare condition to the baby
paediatric-septic-shock very rare condition to the baby
Recently uploaded
বাংলাদেশ অর্থনৈতিক সমীক্ষা (Economic Review) ২০২৪ UJS App.pdf
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
BBR 2024 Summer Sessions Interview Training
Qualitative research interview training by Professor Katrina Pritchard and Dr Helen Williams
Pengantar Penggunaan Flutter - Dart programming language1.pptx
Pengantar Penggunaan Flutter - Dart programming language1.pptx
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UP
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
Your Skill Boost Masterclass: Strategies for Effective Upskilling
Your Skill Boost Masterclass: Strategies for Effective UpskillingExcellence Foundation for South Sudan
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.BÀI TẬP BỔ TRỢ TIẾNG ANH 8 CẢ NĂM - GLOBAL SUCCESS - NĂM HỌC 2023-2024 (CÓ FI...
BÀI TẬP BỔ TRỢ TIẾNG ANH 8 CẢ NĂM - GLOBAL SUCCESS - NĂM HỌC 2023-2024 (CÓ FI...Nguyen Thanh Tu Collection
https://app.box.com/s/y977uz6bpd3af4qsebv7r9b7s21935vdAdvanced Java[Extra Concepts, Not Difficult].docx
This is part 2 of my Java Learning Journey. This contains Hashing, ArrayList, LinkedList, Date and Time Classes, Calendar Class and more.
How to Build a Module in Odoo 17 Using the Scaffold Method
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
How to Setup Warehouse & Location in Odoo 17 Inventory
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
South African Journal of Science: Writing with integrity workshop (2024)
South African Journal of Science: Writing with integrity workshop (2024)Academy of Science of South Africa
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.How to Make a Field Mandatory in Odoo 17
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
ANATOMY AND BIOMECHANICS OF HIP JOINT.pdf
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
-------------------------------------------------------------------------------
Find out more about ISO training and certification services
Training: ISO/IEC 27001 Information Security Management System - EN | PECB
ISO/IEC 42001 Artificial Intelligence Management System - EN | PECB
General Data Protection Regulation (GDPR) - Training Courses - EN | PECB
Webinars: https://pecb.com/webinars
Article: https://pecb.com/article
-------------------------------------------------------------------------------
For more information about PECB:
Website: https://pecb.com/
LinkedIn: https://www.linkedin.com/company/pecb/
Facebook: https://www.facebook.com/PECBInternational/
Slideshare: http://www.slideshare.net/PECBCERTIFICATION
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar KanvariaHow to Manage Your Lost Opportunities in Odoo 17 CRM
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
The History of Stoke Newington Street Names
Presented at the Stoke Newington Literary Festival on 9th June 2024
www.StokeNewingtonHistory.com
Recently uploaded (20)
বাংলাদেশ অর্থনৈতিক সমীক্ষা (Economic Review) ২০২৪ UJS App.pdf
বাংলাদেশ অর্থনৈতিক সমীক্ষা (Economic Review) ২০২৪ UJS App.pdf
Pengantar Penggunaan Flutter - Dart programming language1.pptx
Pengantar Penggunaan Flutter - Dart programming language1.pptx
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UP
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UP
Your Skill Boost Masterclass: Strategies for Effective Upskilling
Your Skill Boost Masterclass: Strategies for Effective Upskilling
BÀI TẬP BỔ TRỢ TIẾNG ANH 8 CẢ NĂM - GLOBAL SUCCESS - NĂM HỌC 2023-2024 (CÓ FI...
BÀI TẬP BỔ TRỢ TIẾNG ANH 8 CẢ NĂM - GLOBAL SUCCESS - NĂM HỌC 2023-2024 (CÓ FI...
How to Build a Module in Odoo 17 Using the Scaffold Method
How to Build a Module in Odoo 17 Using the Scaffold Method
How to Setup Warehouse & Location in Odoo 17 Inventory
How to Setup Warehouse & Location in Odoo 17 Inventory
South African Journal of Science: Writing with integrity workshop (2024)
South African Journal of Science: Writing with integrity workshop (2024)
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...
How to Manage Your Lost Opportunities in Odoo 17 CRM
How to Manage Your Lost Opportunities in Odoo 17 CRM
Lactate: How Sick Is Your Patient
- 1. Lactate: How Sick Is Your Patient? Littleton/Porter/Parker EMS Wayne Guerra, MD, MBA Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA
- 3. Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA
- 17. Lactate Production: Glycolysis Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA 2 H+ Glycolysis 2 H+ Glycolysis
- 19. Lactate Clearance: Cori Cycle Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA 2 H+ 2 H+ End Result: *Net loss 4 ATP *If unable to compensate ↑ lactate and acidosis (↑ H+)
- 37. Can Lactate Level Measurement in the Pre-Hospital Setting Identify Occult Hypoperfusion? Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA
- 38. Pre-Hospital Lactate and Mortality Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA Critical Care 2008, 12: R160
- 39. The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA Critical Care 2008, 12: R160: http://ccforum.com/content/12/6/R160
- 45. Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA
- 46. Sepsis Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA Suit against Memorial Hermann claims negligence caused man's sepsis, death Mariana Bridi da Costa
- 47. Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA Sepsis can strike, kill shockingly fast
- 50. Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA
- 54. ARDS Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA
- 79. Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA
- 80. Litteton/Porter/Parker EMS Wayne Guerra, MD, MBA