Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
Introduction of organ donation .
Introduction of brain death and pathophysiology following it.
Perioperative problems in organ retrieval .
Goals of management of these patients .
Anesthetic management of the cadaver during organ harvesting.
Pain assessment in ED an evidence-based updatekellyam18
This presentation delivered at the International Conference on Emergency Medicine in Dublin describes different approaches to assessing pain in emergency department patients. It summarises the evidence supporting the various approaches and makes recommendations for practice.
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
Introduction of organ donation .
Introduction of brain death and pathophysiology following it.
Perioperative problems in organ retrieval .
Goals of management of these patients .
Anesthetic management of the cadaver during organ harvesting.
Pain assessment in ED an evidence-based updatekellyam18
This presentation delivered at the International Conference on Emergency Medicine in Dublin describes different approaches to assessing pain in emergency department patients. It summarises the evidence supporting the various approaches and makes recommendations for practice.
this topic explains the nature of pain, signs and symptoms of pain, different types of pain, factors influencing pain, assessment of pain and pharmacological and non pharmacological management of pain.
Acute neuropathic pain - Stephan Schug - SSAI2017scanFOAM
A talk by Stephan Schug at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
Brief Synopsis of Analgesics used in Dentistry for Pain Control & Management with Dosage Information & Severity Encountered during Drug Metabolism & Administration.
Management of Heart Failure in the ED Setting:
An Evidence-Based Review of the Literature
J Emerg Med, 2018 Sep 26.
doi: 10.1016/j.jemermed.2018.08.002
Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake up and late presenting strokes undergoing neurointervention with Trevo (DAWN) trial methods
Int J Stroke. 2017 Aug;12(6):641-652.
Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct
N Engl J Med. 2018 Jan 4;378(1):11-21.
A multicenter randomized controlled trial of endovascular therapy following imaging evaluation for ischemic stroke (DEFUSE 3)
Int J Stroke. 2017 Oct;12(8):896-905.
Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging
N Engl J Med. 2018 Feb 22;378(8):708-718.
The European Guideline on Management of Major Bleeding and Coagulopathy Follo...Sun Yai-Cheng
The European Guideline on Management of Major Bleeding and Coagulopathy Following Trauma: Fourth Edition
Rossaint et al. Critical Care (2016) 20:100
DOI 10.1186/s13054-016-1265-x
ACEP Policy for Fever Infants and Children Younger than 2 Years of Age in EDSun Yai-Cheng
Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever
Ann Emerg Med. 2016;67:625-639
2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment
Stroke. 2015;46:3020-3035.
With the Proliferation of Mobile Medical Apps, Which Ones Work Best in the Emergency Department?
Annals of Emergency Medicine, August 2015 Vol. 66, Issue 2, A13–15
Use of tPA for the Management of Acute Ischemic Stroke in the ED: ACEP PolicySun Yai-Cheng
ACEP Clinical Policy
Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department
Ann Emerg Med. 2015;66:322-333
Evaluation and Management of Acute Aortic Dissection: ACEP PolicySun Yai-Cheng
ACEP Clinical Policy
Evaluation and Management of Adult Patients With Suspected Acute Nontraumatic Thoracic Aortic Dissection
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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.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Management of Pain in the ICU
1. Clinical Practice Guidelines
for the Management of Pain
in Adult Patients in the ICU
Crit Care Med 2013; 41:263–306
I want you to feel pain, to think about
pain, to accept pain, to know pain.
“
”
3. Level of
Evidence
Quality of
Evidence
Type of
Evidence
Definition
A High High quality
randomized
controlled trial
(RCT)
Further research is unlikely to
change our confidence in the
estimate of effect.
B Moderate RCT with
significant
limitations
(downgraded),
or high-quality
OS (upgraded)
Further research is likely to have
an important impact on our
confidence in the estimate of
effect and may change the
estimate.
C Low Observational
study (OS)
Further research is very likely to
have an important impact on our
confidence in the estimate of
effect and is likely to change the
estimate.
Factors That Affect the Quality of Evidence
5. We recommend that pain be routinely
monitored in all adult ICU patients (+1B).
6. The Behavioral Pain Scale (BPS) and the
Critical-Care Pain Observation Tool
(CPOT) are the most valid and reliable
behavioral pain scales for monitoring pain
in medical, postoperative, or trauma
(except for brain injury) adult ICU
patients who are unable to
self-report and in whom motor
function is intact and
behaviors are observable.
7.
8.
9. We do not suggest that vital signs (or
observational pain scales that include vital
signs) be used alone for pain assessment
in adult ICU patients (–2C).
We suggest that vital signs
may be used as a cue to
begin further assessment of
pain in these patients,
however (+2C).
11. Opiates Equi-
Analgesic
Dose (mg)
IV PO
Onset (IV) Eliminat
ion Half-
Life
Intermittent
Dosing
Side Effects and
Other Information
Fentanyl 0.1 N/A 1-2 min 2-4 hr 0.35–0.5
μg/kg IV
q0.5–1 hr
Less hypotension
than with morphine.
Accumulation with
hepatic impairment.
Hydro-
morphon
e
1.5 7.5 5-15 min 2-3 hr 0.2–0.6 mg
IV q1–2 hr
Therapeutic option
in patients tolerant
to
morphine/fentanyl.
Accumulation with
hepatic/renal
impairment.
Morphine 10 30 5-10 min 3-4 hr 2–4 mg IV
q1–2 hr
Accumulation with
hepatic/renal
impairment.
Histamine release.
Pharmacology of Opiate Analgesics
12. Nonopiates
(Route)
Onset Eliminati
on Half-
Life
Dosing Side Effects and Other Information
Ketamine (IV) 30-40
sec
2-3 hr Loading dose 0.1–0.5
mg/kg IV followed by 0.05–
0.4 mg/kg/hr
Attenuates the development of acute tolerance to
opioids. May cause hallucinations and other
psychological disturbances.
Acetaminophen
(PO)
Acetaminophen
(PR)
30-60
min
2-4 hr 325–1000 mg every 4–6 hr;
max dose ≤ 4 g/day)
May be contraindicated in patients with significant
hepatic dysfunction.
Acetaminophen
(IV)
5-10 min 2 hr 650 mg IV every 4 hrs –
1000 mg IV every 6 hr; max
dose ≤ 4 g/day
Ketorolac
(IM/IV)
10 min 2.4-8.6 hr 30 mg IM/IV, then 15–30
mg IM/IV every 6 hr up to 5
days; max dose = 120
mg/day × 5 days
Avoid NSAID in following conditions: renal dysfunction;
GI bleeding; platelet abnormality; concomitant ACEI
therapy, CHF, cirrhosis, asthma. Contraindicated for
the treatment of perioperative pain in CABG surgery
Ibuprofen (PO) 25 min 1.8-25. hr 400 mg PO every 4 hrs;
max dose = 2.4 g/day
Gabapentin
(PO)
N/A 5-7 hr Starting dose = 100 mg PO
three times daily;
maintenance dose = 900–
3600 mg/day in 3 divided
doses
Side effects: (common) sedation, confusion, dizziness,
ataxia. Adjust dosing in renal failure pts. Abrupt
discontinuation associated with drug withdrawl
syndrome, seizures.
Carbamazepine
immediate
release (PO)
4-5 hr 25-65 hrs
initially,
then 12-
17 hr
Starting dose = 50–100 mg
PO bid; maintenance dose
= 100–200 mg every 4–6 hr;
max dose = 1200 mg/day
Side effects: (common) nystagmus, dizziness, diplopia,
lightheadedness, lethargy; (rare) aplastic anemia, and
agranulocytosis; Stevens–Johnson syndrome or toxic
epidermal necrolysis with HLA-B1502 gene. Multiple
drug interactions due to hepatic enzyme induction.
Pharmacology of Nonopiate Analgesics
13. We recommend that preemptive analgesia
and/or non-pharmacologic interventions
(e.g., relaxation) be administered to
alleviate pain in adult ICU patients prior to
invasive and potentially painful procedures
(+2C).
14. We recommend that intravenous (IV)
opioids be considered as the first-line
drug class of choice to treat non-
neuropathic pain in critically ill patients
(+1C).
15. All available IV opioids, when titrated to
similar pain intensity endpoints, are
equally effective (C).
16. We suggest that non-opioid analgesics be
considered to decrease the amount of
opioids administered (or to eliminate the
need for IV opioids altogether) and to
decrease opioid-related side effects (+2C).
17. We recommend that either enterally
administered gabapentin or
carbamazepine, in addition to IV opioids,
be considered for treatment of neuropathic
pain (+1A).