This document discusses massive transfusion protocols (MTPs) which provide rapid blood replacement for severe hemorrhage. MTPs aim to transfuse blood products in a 1:1:1 ratio of fresh frozen plasma, platelets, and red blood cells. Early transfusion according to MTPs is essential to sustain organ function. Complications of massive transfusion include hypothermia, acidosis, coagulopathy, and electrolyte abnormalities which can further impair coagulation. Regular monitoring of coagulation factors and viscoelastic tests can guide targeted treatment to correct deficiencies. Hospitals should establish standardized MTPs and train personnel to optimize outcomes for massively bleeding patients.
I missed the Critical Care Congress at Pune. Couldn't make it because of certain personal reasons. However, I was to deliver a talk on ROLE OF BLOOD COMPONENTS & rFVIIa IN OBSTETRICS on 21 Jul 13 at 11 am. Feel duty bound to share the presentation with all who wanted to hear it there. I have uploaded it at Slideshare and queries, if any, may be addressed to navneetmagon@gmail.com.
Blood products Transfusion and related complications,
Types of cell salvage, blood warming and autologous blood,
With intraoperative blood lots monitoring and transfusion
I missed the Critical Care Congress at Pune. Couldn't make it because of certain personal reasons. However, I was to deliver a talk on ROLE OF BLOOD COMPONENTS & rFVIIa IN OBSTETRICS on 21 Jul 13 at 11 am. Feel duty bound to share the presentation with all who wanted to hear it there. I have uploaded it at Slideshare and queries, if any, may be addressed to navneetmagon@gmail.com.
Blood products Transfusion and related complications,
Types of cell salvage, blood warming and autologous blood,
With intraoperative blood lots monitoring and transfusion
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Massive transfusion protocol (MTPs)
• Established to provide rapid blood replacement in a
setting of severe hemorrhage
• Early optimal blood transfusion is essential to sustain
organ perfusion and oxygenation
3. What is Massive transfusion?
10 units of red cells in 24 hours
Total blood volume is replaced within 24 hours
Three units over one hour
50% of total blood volume is replaced within 3
hours
4. Massive Transfusion-Clinical Settings
• Trauma
• Surgery (e.g. Liver, Cardiovascular)
• Less frequent
• abdominal aortic aneurysm
• liver transplant
• obstetric catastrophes
• GI bleeding
5. • Cardiac surgery — Most common cause of massive transfusion
• Obstetric hemorrhage — Gravid and parturient women are
hypercoagulable with compensatory hyperfibrinolysis.
• Liver disease —
• leads to the reduced production of normal coagulation factors
• production of abnormal factors
9. Emergency blood issue
Immediate Within an hour
Minutes
Group O Rh neg
Packed RBCs
ABO & Rh D type
Group specific blood
(5-10 min)
ABO & Rh D type
Complete crossmatch
If units are issued without X match – written consent of physician to be taken,
-complete X match protocols followed after issue
Immediate spin
crossmatch
( 15-20) min)
10. Emergency Release Blood - Universal Donor
• O, RhD neg/pos RBCs – 5 min
• AB or A Plasma/Platelets
11. Recommendations
• “Damage control” approach
• Improved survival when the ratio of transfused Fresh Frozen Plasma
(FFP, in units) to platelets (in units) to red blood cells (RBCs, in units)
approaches 1:1:1
Holcomb JB, Jenkins D, Rhee P, et al. Damage control resuscitation: directly addressing
the early coagulopathy of trauma. J Trauma 2007; 62:307.
12. Important
If uncorrected, concurrent hypothermia and acidosis can further
exacerbate coagulopathy and lead to irreversible multiorgan failure
(MOF).
Untimely or incomplete control of massive bleeding- systemic
consumptive coagulopathy with hemodilution and endothelial damage
At the onset - aggressive fluid replacement and bleeding control can
reduce the tissue injury, inflammation, and hypoperfusion
13. • Borgman MA, Spinella PC, Perkins JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J
Trauma 2007; 63:805.
• Holcomb JB, Wade CE, Michalek JE, et al. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg
2008; 248:447.
• Cotton BA, Au BK, Nunez TC, et al. Predefined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications. J Trauma 2009; 66:41.
• Shaz BH, Dente CJ, Nicholas J, et al. Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients.
Transfusion 2010; 50:493.
• Inaba K, Lustenberger T, Rhee P, et al. The impact of platelet transfusion in massively transfused trauma patients. J Am Coll Surg 2010; 211:573.
• de Biasi AR, Stansbury LG, Dutton RP, et al. Blood product use in trauma resuscitation: plasma deficit versus plasma ratio as predictors of mortality in trauma (CME). Transfusion
2011; 51:1925.
Patients who have sustained severe traumatic
injuries and/or who are likely to require
massive transfusion should receive a
1:1:1 ratio of FFP to platelets to RBCs at
the outset of their resuscitation and
transfusion therapy
14. Important!
Uncrossmatched group O Rh D negative
RBCs /Whole blood
Residual plasma with both antibodies
(Anti A & B) can accumulate when large
quantities are transfused
Repeat the blood group and do antibody
titres before resuming transfusion of
RBCs of the patient’s own blood group.
15. Fibrinogen concentrate
• European guidelines recommend fibrinogen concentrate when the
level falls below 1.5g
• Cost of fibrinogen concentrate is much more than cryoprecipitate
• Availability
16. Cryoprecipitate
• Most common blood product used to replace fibrinogen
• Contains approximately 200–250 mg of fibrinogen per unit
• Standard dose of two 5-unit pools should be administered early
in major obstetric haemorrhage.
• Subsequent cryoprecipitate transfusion should be guided by
fibrinogen results, aiming to keep levels above 1.5 g/l.
17. Platelet Transfusion
• It becomes necessary after two volumes of blood loss.
• 10 to 12 units of transfused RBCs- 50 percent fall in the
platelet count
• Platelet concentrates should be transfused as 1
pack/10 kg body weight.
19. Massive Transfusion Protocol
Regional West Medical Center
• Six units RBC’s
• Four units FFP
• Deliver first “package” within 35 minutes of the initial
order.
Immediately prepare
first transfusion
“package” :
• Six units RBC’s
• Four units FFP
• One Single Donor Platelet or one “six-pack” random
platelets
Have second “package”
ready within 35
minutes of issue of first
“package”.
• Six units RBC’s
• Four units FFP
• One “ten-pack” pooled Cryoprecipitate
Have third “package”
ready within 35
minutes of issue of
second “package.”
23. Acidosis and hypothermia
Acidosis
Interferes with formation of coagulation factor complexes
Hypothermia
Reduces enzymatic activity of coagulation factors
Prevents activation of platelets
24. Hypothermia
RBCs that are stored at 4C are transfused rapidly
Lowers the recipient’s core temperature and further
impairs haemostasis.
Reduces the metabolism of citrate and lactate
Increases the likelihood of hypocalcaemia, metabolic
acidosis and cardiac arrhythmias.
Shifts the oxyhaemoglobin dissociation curve to the left,
reducing tissue oxygen delivery
10 units of cold blood
products and an hour of
surgery can lead to a 3°C
drop in core temperature
and hypothermic
coagulopathy
27. ALTERATIONS IN HEMOSTASIS
• Acute DIC
• microvascular oozing
• prolongation of the PT and aPTT in excess of that expected by dilution
• significant thrombocytopenia
• low fibrinogen levels
• increased levels of D-dimer
28. Hypocalcaemia
• Citrate binds calcium
• Results in hypotension, small pulse pressure, flat ST-segments and
prolonged QT intervals on the ECG.
• Slow i.v. injection of calcium gluconate 10%
29. Hyperkalaemia
• The potassium concentration of blood increases during storage, by as
much as 5–10 mmol u1 .
• Hyperkalaemia rarely occurs during massive transfusions unless the
patient is also hypothermic and acidotic
30. Monitoring recommendations
• PT, aPTT
• Platelet count
• Fibrinogen
• Electrolytes
• Viscoelastic test
• after the administration of every five to seven units of red cells.
32. Viscoelastic whole-blood assays
• TEG® and ROTEM®
• provide information on the coagulation process through the graphic
display of clot initiation, propagation and lysis.
• used to guide transfusion of blood components
33.
34. • Costeffective -since it reduces inappropriate transfusions, thus
improving transfusion management and patients’ clinical outcome
35. Depletion of fibrinogen and coagulation
factors
• PT prolonged – FFP in a dose of 15 ml/kg
• aPTT prolonged – factor VIII/fibrinogen concentrate
36. Summary and recommendations
• Need to define protocol triggers , an algorithm for preparation and
delivery of blood products, including continued support
• The protocol should be updated annually and practised in ‘skills drills’
to inform and train relevant personnel.