This document discusses pulmonary embolism (PE), a potentially lethal condition caused by blood clots in the lungs. PE is often missed due to nonspecific symptoms but can lead to death if untreated. Risk factors include immobilization, surgery, cancer, pregnancy, and oral contraceptives. Symptoms range from nonspecific chest pain to circulatory collapse. Diagnosis involves tests like CT scans, VQ scans, echocardiograms and D-dimer levels. Treatment involves oxygen, anticoagulants like blood thinners, and potentially thrombolytics for severe cases. Outcomes depend on early detection and treatment, but PE can still lead to complications like pulmonary hypertension if not addressed.
Pulmonary embolism (PE) is a blockage in the lungs caused by blood clots that travel from deep veins, usually in the legs. It is the third most common cause of death in hospitalized patients, with over 650,000 cases occurring per year in the US. Risk factors include immobilization, hypercoagulability, and recent surgery or trauma. Symptoms can include chest pain, shortness of breath, cough, or fainting. Diagnosis is confirmed through imaging tests like CT angiography or ventilation-perfusion scans. Treatment involves blood thinners like heparin, warfarin, or newer oral anticoagulants to prevent further clotting. Thrombolytic drugs
Pneumonia is an infection of the lungs caused by bacteria, viruses or other pathogens. It is commonly transmitted when germs are inhaled into the lungs. Risk factors include impaired immunity, smoking, neurological conditions that impact swallowing, and chronic lung diseases. Diagnosis involves chest x-ray, sputum culture, blood tests and assessment of severity using CURB65 score. Treatment focuses on antibiotics, oxygen supplementation, hydration and symptom relief. Complications can include respiratory failure and sepsis.
Down syndrome is a genetic condition caused by trisomy of chromosome 21. It occurs in about 1 in 660 births. Key features in newborns include slanted eyes, small ears, loose skin on the back of the neck, and poor muscle tone. Individuals with Down syndrome often have health issues such as heart defects, hearing or vision problems, gastrointestinal abnormalities, thyroid disorders, and psychiatric conditions. Lifelong healthcare involves screening and management of associated medical problems with a focus on development, education, independence, and quality of life.
Diphtheria is an acute and highly contagious disease caused by Corynebacterium diphtheriae that causes inflammation of the mucous membranes and formation of a false membrane in the throat. It is usually spread through direct contact or contact with contaminated articles. Symptoms can range from mild to severe and include fever, sore throat, difficulty breathing and swallowing. Diphtheria is treated with antibiotics like penicillin or erythromycin and a diphtheria antitoxin for severe cases. Vaccination with Quinvaxem is recommended to protect children from the disease.
This document discusses the etiopathogenesis and management of preeclampsia. It begins by outlining recommendations for blood pressure measurement in pregnancy. It then covers the classification of hypertension in pregnancy and risk factors for preeclampsia. The document discusses the etiology of preeclampsia involving poor placentation leading to placental oxidative stress and endothelial dysfunction. Predictors of preeclampsia and the role of ultrasound are described. Management involves termination of pregnancy, with timing based on gestational age and severity of symptoms. Antihypertensive therapy aims to control blood pressure without dropping it too low.
This document discusses pulmonary embolism (PE), a potentially lethal condition caused by blood clots in the lungs. PE is often missed due to nonspecific symptoms but can lead to death if untreated. Risk factors include immobilization, surgery, cancer, pregnancy, and oral contraceptives. Symptoms range from nonspecific chest pain to circulatory collapse. Diagnosis involves tests like CT scans, VQ scans, echocardiograms and D-dimer levels. Treatment involves oxygen, anticoagulants like blood thinners, and potentially thrombolytics for severe cases. Outcomes depend on early detection and treatment, but PE can still lead to complications like pulmonary hypertension if not addressed.
Pulmonary embolism (PE) is a blockage in the lungs caused by blood clots that travel from deep veins, usually in the legs. It is the third most common cause of death in hospitalized patients, with over 650,000 cases occurring per year in the US. Risk factors include immobilization, hypercoagulability, and recent surgery or trauma. Symptoms can include chest pain, shortness of breath, cough, or fainting. Diagnosis is confirmed through imaging tests like CT angiography or ventilation-perfusion scans. Treatment involves blood thinners like heparin, warfarin, or newer oral anticoagulants to prevent further clotting. Thrombolytic drugs
Pneumonia is an infection of the lungs caused by bacteria, viruses or other pathogens. It is commonly transmitted when germs are inhaled into the lungs. Risk factors include impaired immunity, smoking, neurological conditions that impact swallowing, and chronic lung diseases. Diagnosis involves chest x-ray, sputum culture, blood tests and assessment of severity using CURB65 score. Treatment focuses on antibiotics, oxygen supplementation, hydration and symptom relief. Complications can include respiratory failure and sepsis.
Down syndrome is a genetic condition caused by trisomy of chromosome 21. It occurs in about 1 in 660 births. Key features in newborns include slanted eyes, small ears, loose skin on the back of the neck, and poor muscle tone. Individuals with Down syndrome often have health issues such as heart defects, hearing or vision problems, gastrointestinal abnormalities, thyroid disorders, and psychiatric conditions. Lifelong healthcare involves screening and management of associated medical problems with a focus on development, education, independence, and quality of life.
Diphtheria is an acute and highly contagious disease caused by Corynebacterium diphtheriae that causes inflammation of the mucous membranes and formation of a false membrane in the throat. It is usually spread through direct contact or contact with contaminated articles. Symptoms can range from mild to severe and include fever, sore throat, difficulty breathing and swallowing. Diphtheria is treated with antibiotics like penicillin or erythromycin and a diphtheria antitoxin for severe cases. Vaccination with Quinvaxem is recommended to protect children from the disease.
This document discusses the etiopathogenesis and management of preeclampsia. It begins by outlining recommendations for blood pressure measurement in pregnancy. It then covers the classification of hypertension in pregnancy and risk factors for preeclampsia. The document discusses the etiology of preeclampsia involving poor placentation leading to placental oxidative stress and endothelial dysfunction. Predictors of preeclampsia and the role of ultrasound are described. Management involves termination of pregnancy, with timing based on gestational age and severity of symptoms. Antihypertensive therapy aims to control blood pressure without dropping it too low.
This document discusses the management of preterm labor in cases of placenta previa and abruption placentae. It describes placenta previa as when the placenta is located over or near the internal os, and notes four degrees. For placenta previa, the expectant approach aims to continue the pregnancy for lung maturity using bed rest and monitoring. For abruption placentae, which is premature separation of a normally situated placenta, the active approach is indicated due to risks of further separation and fetal death, with immediate delivery by vaginal or cesarean delivery for severe cases.
Hypocalcemia occurs when serum calcium levels fall below 8.5 mg/dl. It can be caused by low or high parathyroid hormone levels. Low PTH levels are due to parathyroid agenesis, destruction, or reduced function. High PTH levels are caused by vitamin D deficiency, renal insufficiency, drugs, or miscellaneous conditions. Hypocalcemia symptoms vary based on severity and chronicity and include muscle spasms, paresthesia, and seizures. Treatment involves calcium and vitamin D supplementation.
Respiratory failure can occur due to hypoxemic failure, hypercapnic (ventilatory) failure, or impaired airway function. Noninvasive ventilation (NIV) delivers ventilatory support without an artificial airway and can effectively treat respiratory failure caused by conditions like COPD exacerbation and cardiogenic pulmonary edema. The first 30 minutes of NIV require intensive monitoring and support, but it can help improve gas exchange, respiratory effort, and outcomes when criteria for use are met and close monitoring of response is provided. NIV should be discontinued if the patient cannot tolerate the interface, respiratory status fails to improve, or intubation is needed.
Hyperkalemia is defined as a plasma potassium level above 5.5 mEq/L. It can be caused by a shift of potassium from intracellular to extracellular space due to acidosis or tissue damage. Other causes include reduced renal excretion due to medications like ACE inhibitors or renal failure. Symptoms range from none to muscle weakness to cardiac arrhythmias. Treatment involves calcium to antagonize cardiac effects, insulin or beta-agonists to shift potassium intracellularly, and cation exchange resins or dialysis to remove excess potassium.
1. The document discusses pulmonary embolism, including its definition, risk factors, signs and symptoms, diagnostic tests, and treatment options.
2. Common diagnostic tests mentioned are CT scans, ventilation-perfusion scans, pulmonary angiograms, and MRAs. Treatment involves respiratory support, hemodynamic support like thrombolysis, and anticoagulation typically with heparin or warfarin.
3. Complications of anticoagulation therapy discussed include bleeding, heparin-induced thrombocytopenia, and osteoporosis from prolonged use. Monitoring of anticoagulation levels and potential drug interactions is also addressed.
The document provides an overview of asthma, including its history, symptoms, pathophysiology, diagnosis, and treatment. It defines asthma as a chronic inflammatory airway disease characterized by bronchial hyperresponsiveness. The symptoms of asthma include coughing, shortness of breath, wheezing, chest tightness, and inability to take in enough air. Diagnostic tests include peak flow testing, spirometry, allergy skin tests, and chest X-rays. Treatment involves education, avoidance of triggers, and medications like bronchodilators, corticosteroids, leukotriene antagonists, and mast cell stabilizers.
Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by airflow limitation that is usually progressive. It is the third leading cause of death in the United States. The two main conditions that make up COPD are chronic bronchitis and emphysema. Cigarette smoking is the leading risk factor. Symptoms include dyspnea, chronic cough, and sputum production. Diagnosis is confirmed by spirometry showing airflow limitation. Management focuses on smoking cessation, bronchodilators, glucocorticoids, pulmonary rehabilitation, oxygen therapy, and managing exacerbations and comorbidities.
Pulmonary embolism is a blockage in one of the pulmonary arteries in the lungs. It can be life-threatening and cause symptoms like shortness of breath, chest pain, and coughing up blood. The document discusses the pathophysiology, risk factors, clinical presentation, diagnostic workup and imaging for pulmonary embolism. It notes that imaging tests like CT scans, ultrasound of the heart and lungs, and ventilation-perfusion scans are used to diagnose pulmonary embolism, and that electrocardiograms and blood tests are also part of the evaluation. Assessment tools like the PESI score are used to determine the severity and risk.
This document discusses abdominal aortic aneurysms (AAA). It defines AAA as a focal dilation of the abdominal aorta that is 1.5 times greater than normal diameter. AAA most commonly involves the infrarenal abdominal aorta and risk factors include smoking, hypertension, and family history. Left untreated, AAA can progressively enlarge and rupture, causing exsanguination and death. Elective repair has a low mortality rate compared to 90% mortality with ruptured AAA. As such, early diagnosis through screening high risk populations and elective repair can reduce AAA-related mortality. Endovascular aneurysm repair is a less invasive alternative to open repair, particularly for high risk patients, but may be less durable long-term.
Abdominal aortic aneurysms (AAAs) and thoracic aortic aneurysms are abnormal dilations of the aorta that can rupture if left untreated. AAAs are most common in men over 65 who smoke. Screening for AAAs is recommended for at-risk men to detect aneurysms before rupture. Treatment options include open surgical repair or endovascular aneurysm repair (EVAR) where a stent graft is placed via catheter to exclude the aneurysm from blood flow. EVAR has lower risks than open repair but requires lifelong surveillance due to risks of complications like endoleaks.
The Emerson Hospital Stroke Awareness 2020 program aims to educate staff about recognizing the signs and symptoms of acute stroke, the importance of early intervention, and stroke prevention. As a designated Primary Stroke Center, the hospital is required to have stroke protocols and collect data to maintain this status. Stroke is a leading cause of death in the US, with someone having a stroke every 40 seconds. Recognizing symptoms quickly and getting treatment, such as clot-busting drugs within 3-4.5 hours or clot removal within 24 hours, is critical to limiting brain damage from stroke.
This document provides an overview of haemostasis, thrombosis, and embolism. It begins by defining haemostasis and describing the key components involved - blood vessels, platelets, coagulation system, and fibrinolytic system. It then defines thrombosis and lists some common predisposing factors. The outcomes of thrombosis are described as lysis, propagation, organisation, recanalization, or embolism. Embolism is defined as the blockage of a blood vessel by solid, liquid or gas at a distant site from its origin. Deep vein thrombosis and pulmonary embolism are discussed in more detail, including risk factors, effects, prevention and treatment options.
This document discusses the management of preterm labor in cases of placenta previa and abruption placentae. It describes placenta previa as when the placenta is located over or near the internal os, and notes four degrees. For placenta previa, the expectant approach aims to continue the pregnancy for lung maturity using bed rest and monitoring. For abruption placentae, which is premature separation of a normally situated placenta, the active approach is indicated due to risks of further separation and fetal death, with immediate delivery by vaginal or cesarean delivery for severe cases.
Hypocalcemia occurs when serum calcium levels fall below 8.5 mg/dl. It can be caused by low or high parathyroid hormone levels. Low PTH levels are due to parathyroid agenesis, destruction, or reduced function. High PTH levels are caused by vitamin D deficiency, renal insufficiency, drugs, or miscellaneous conditions. Hypocalcemia symptoms vary based on severity and chronicity and include muscle spasms, paresthesia, and seizures. Treatment involves calcium and vitamin D supplementation.
Respiratory failure can occur due to hypoxemic failure, hypercapnic (ventilatory) failure, or impaired airway function. Noninvasive ventilation (NIV) delivers ventilatory support without an artificial airway and can effectively treat respiratory failure caused by conditions like COPD exacerbation and cardiogenic pulmonary edema. The first 30 minutes of NIV require intensive monitoring and support, but it can help improve gas exchange, respiratory effort, and outcomes when criteria for use are met and close monitoring of response is provided. NIV should be discontinued if the patient cannot tolerate the interface, respiratory status fails to improve, or intubation is needed.
Hyperkalemia is defined as a plasma potassium level above 5.5 mEq/L. It can be caused by a shift of potassium from intracellular to extracellular space due to acidosis or tissue damage. Other causes include reduced renal excretion due to medications like ACE inhibitors or renal failure. Symptoms range from none to muscle weakness to cardiac arrhythmias. Treatment involves calcium to antagonize cardiac effects, insulin or beta-agonists to shift potassium intracellularly, and cation exchange resins or dialysis to remove excess potassium.
1. The document discusses pulmonary embolism, including its definition, risk factors, signs and symptoms, diagnostic tests, and treatment options.
2. Common diagnostic tests mentioned are CT scans, ventilation-perfusion scans, pulmonary angiograms, and MRAs. Treatment involves respiratory support, hemodynamic support like thrombolysis, and anticoagulation typically with heparin or warfarin.
3. Complications of anticoagulation therapy discussed include bleeding, heparin-induced thrombocytopenia, and osteoporosis from prolonged use. Monitoring of anticoagulation levels and potential drug interactions is also addressed.
The document provides an overview of asthma, including its history, symptoms, pathophysiology, diagnosis, and treatment. It defines asthma as a chronic inflammatory airway disease characterized by bronchial hyperresponsiveness. The symptoms of asthma include coughing, shortness of breath, wheezing, chest tightness, and inability to take in enough air. Diagnostic tests include peak flow testing, spirometry, allergy skin tests, and chest X-rays. Treatment involves education, avoidance of triggers, and medications like bronchodilators, corticosteroids, leukotriene antagonists, and mast cell stabilizers.
Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by airflow limitation that is usually progressive. It is the third leading cause of death in the United States. The two main conditions that make up COPD are chronic bronchitis and emphysema. Cigarette smoking is the leading risk factor. Symptoms include dyspnea, chronic cough, and sputum production. Diagnosis is confirmed by spirometry showing airflow limitation. Management focuses on smoking cessation, bronchodilators, glucocorticoids, pulmonary rehabilitation, oxygen therapy, and managing exacerbations and comorbidities.
Pulmonary embolism is a blockage in one of the pulmonary arteries in the lungs. It can be life-threatening and cause symptoms like shortness of breath, chest pain, and coughing up blood. The document discusses the pathophysiology, risk factors, clinical presentation, diagnostic workup and imaging for pulmonary embolism. It notes that imaging tests like CT scans, ultrasound of the heart and lungs, and ventilation-perfusion scans are used to diagnose pulmonary embolism, and that electrocardiograms and blood tests are also part of the evaluation. Assessment tools like the PESI score are used to determine the severity and risk.
This document discusses abdominal aortic aneurysms (AAA). It defines AAA as a focal dilation of the abdominal aorta that is 1.5 times greater than normal diameter. AAA most commonly involves the infrarenal abdominal aorta and risk factors include smoking, hypertension, and family history. Left untreated, AAA can progressively enlarge and rupture, causing exsanguination and death. Elective repair has a low mortality rate compared to 90% mortality with ruptured AAA. As such, early diagnosis through screening high risk populations and elective repair can reduce AAA-related mortality. Endovascular aneurysm repair is a less invasive alternative to open repair, particularly for high risk patients, but may be less durable long-term.
Abdominal aortic aneurysms (AAAs) and thoracic aortic aneurysms are abnormal dilations of the aorta that can rupture if left untreated. AAAs are most common in men over 65 who smoke. Screening for AAAs is recommended for at-risk men to detect aneurysms before rupture. Treatment options include open surgical repair or endovascular aneurysm repair (EVAR) where a stent graft is placed via catheter to exclude the aneurysm from blood flow. EVAR has lower risks than open repair but requires lifelong surveillance due to risks of complications like endoleaks.
The Emerson Hospital Stroke Awareness 2020 program aims to educate staff about recognizing the signs and symptoms of acute stroke, the importance of early intervention, and stroke prevention. As a designated Primary Stroke Center, the hospital is required to have stroke protocols and collect data to maintain this status. Stroke is a leading cause of death in the US, with someone having a stroke every 40 seconds. Recognizing symptoms quickly and getting treatment, such as clot-busting drugs within 3-4.5 hours or clot removal within 24 hours, is critical to limiting brain damage from stroke.
This document provides an overview of haemostasis, thrombosis, and embolism. It begins by defining haemostasis and describing the key components involved - blood vessels, platelets, coagulation system, and fibrinolytic system. It then defines thrombosis and lists some common predisposing factors. The outcomes of thrombosis are described as lysis, propagation, organisation, recanalization, or embolism. Embolism is defined as the blockage of a blood vessel by solid, liquid or gas at a distant site from its origin. Deep vein thrombosis and pulmonary embolism are discussed in more detail, including risk factors, effects, prevention and treatment options.
2. DEFINITION
• Lactic acidosis is a pathological state diagnosed when
the serum concentration of lactate or lactic acid is
persistently 5mmol/L or greater and there is
significant acidemia and serum pH< 7.35.
(Normal lactate concentration is 2.0 mmol/L).
3. FORMATION OF LACTIC ACID
• Red blood cells, brain and skin are major sources of
lactic acid at rest while during exercise skeletal
muscles release significant amount of lactic acid.
• Kidney and liver utilize lactic acid and convert it into
carbon dioxide and water and use it for
gluconeogenesis.
• Lactic acid and pyruvic acid are inter convertible and
the reaction is catalyzed by the enzyme lactate
dehydrogenase.
6. CLINICALLY IMPORTANT
CAUSES OF LACTIC ACIDOSIS
• Vigorous exercise
• Tissue hypoxia
• Cardio-respiratory arrest
• Carbon monoxide poisoning
• Drugs and toxins
• Terminal cirrhosis or hepato-cellular failure
• Neoplastic diseases
• Congenital deficiency of enzymes
7. SIGNS AND SYMPTOMS
• general malaise
• loss of weight and loss of appetite
• myalgia
• weakness and fatigue
• nausea, vomiting
• abdominal pains
• tachypnoea
• tachycardia
8. MANAGEMENT OF LACTIC
ACIDOSIS
• The most important therapy in management of lactic
acidosis is correction of underlying cause.
• In hypovolumic or cardiogenic shock, restoration of
perfusion and adequate tissue oxygenation will
reverse lactic acidosis.
• In septic shock, antibiotic treatment, surgical
drainage/debridement will help in reversal of lactic
acidosis.
9. • Giving intravenous thiamine in cases of total
parentral nutrition will help in resolution of lactic
acidosis.
• In status asthmaticus, high dose of beta 2 agonist
should be tapered gradually to reduce lactate levels.
• In shock, vaso constrictors should be added only after
volume replacement as they worsen the acidosis.
10. ALKALI THERAPY
• Start bicarbonate infusion to keep pH above 7.10
• The side effects of bicarbonate therapy is acute
hypercapnia, volume overload and cardiac
depression.
• When lactic acidosis is accompanying pulmonary
oedema, cardiopulmonary arrest, seizures, biguanide
therapy, ethanol ingestion, and diabetic ketoacidosis
bicarbonate therapy is not recommended.
11. HAEMODIALYSIS
• Haemodialysis is rarely indicated as a treatment for
lactic acidosis.
• It may be used in drug toxicity to speed up
elimination of drug/toxin.
• It is helpful when fluid overload and cardiac or renal
insufficiency is present.
12. RECENT ADVANCES
• Glucose, insulin infusion, nitropruside infusion,
hemodialysis, peritoneal dialysis have all been used
in order to treat lactic acidosis but their efficacy is
unproven.
• Thiamine, lipoic acid and dichloroacetate have been
used as they increase the activity of pyruvate
dehydrogenase enzyme.
13. DICHLOROACETATE
• Dichloroacetate (DCA) is an activator of pyruvate
dehydrogenase.
• It can lower concentration of lactic acid in patients by
improving the lactate utilization but when used in
large clinical trial it did not show any effect on
mortality.
• DCA, however, may be helpful in lactic acidosis in
children with severe malaria.
14. TRIS HYDROXYMETHYL
AMINOMETHANE (THAM)
• It is a weak alkali and theoretical has the advantage
over bicarbonate as it produces less carbon dioxide.
• Clinical trials do not prove THAM to be more
effective than bicarbonate.
15. CARBICARB
• Carbicarb is an equimolar combination of sodium
carbonate and sodium bicarbonate that produces less
carbon dioxide than sodium bicarbonate alone.
• It has theoretical advantage but trials have not
demonstrated any reduction in mortality or morbidity.
