This document provides an overview of mechanical ventilation settings, modes, advantages and disadvantages of different modes, guidelines for initiation, and examples of troubleshooting. It discusses settings like trigger sensitivity, tidal volume, PEEP, and rates. Modes covered include assist-control, pressure support, and SIMV. Guidelines recommend starting with low tidal volumes and optimizing PEEP and FiO2. Troubleshooting examines causes of high pressures, coping with COPD patients, improving synchrony, and managing ARDS.
An excellent tool to treat refractory hypoxia. Target audience are ICU junior physicians and Respiratory Therapists. It will take away the fear of "What is APRV?" from your hearts and you will feel ready to give it a try.
An excellent tool to treat refractory hypoxia. Target audience are ICU junior physicians and Respiratory Therapists. It will take away the fear of "What is APRV?" from your hearts and you will feel ready to give it a try.
Mechanical Ventilation (MV) is almost always a challenging topic for ICU nurses and practitioners. In this presentation we are going to review and relearn basics of MV together.
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
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
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.
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
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
2. Overview of topics
1. Settings
2. Modes
3. Advantages and disadvantages between modes
4. Guidelines in the initiation of mechanical
ventilation
5. Common trouble shooting examples with
mechanical ventilation
3. Settings
1. Trigger mode and sensitivity
2. Respiratory rate
3. Tidal Volume
4. Positive end-expiratory pressure (PEEP)
5. Flow rate
6. Inspiratory time
7. Fraction of inspired oxygen
4. Trigger
There are two ways to initiate a ventilator-delivered
breath: pressure triggering or flow-by triggering
When pressure triggering is used, a ventilator-delivered
breath is initiated if the demand valve senses a negative
airway pressure deflection (generated by the patient
trying to initiate a breath) greater than the trigger
sensitivity.
When flow-by triggering is used, a continuous flow of
gas through the ventilator circuit is monitored. A
ventilator-delivered breath is initiated when the return
flow is less than the delivered flow, a consequence of
the patient's effort to initiate a breath
5. Tidal Volume
The tidal volume is the amount of air delivered with
each breath. The appropriate initial tidal volume
depends on numerous factors, most notably the
disease for which the patient requires mechanical
ventilation.
6. Respiratory Rate
An optimal method for setting the respiratory rate
has not been established. For most patients, an initial
respiratory rate between 12 and 16 breaths per minute
is reasonable
7. Positive End-Expiratory Pressure
(PEEP)
Applied PEEP is generally added to mitigate end-
expiratory alveolar collapse. A typical initial applied
PEEP is 5 cmH2O. However, up to 20 cmH2O may be
used in patients undergoing low tidal volume
ventilation for acute respiratory distress syndrome
(ARDS)
8. Flow Rate
The peak flow rate is the maximum flow delivered by
the ventilator during inspiration. Peak flow rates of 60
L per minute may be sufficient, although higher rates
are frequently necessary. An insufficient peak flow
rate is characterized by dyspnea, spuriously low peak
inspiratory pressures, and scalloping of the
inspiratory pressure tracing
9. Inspiratory Time: Expiratory Time
Relationship (I:E Ratio)
During spontaneous breathing, the normal I:E ratio is
1:2, indicating that for normal patients the exhalation
time is about twice as long as inhalation time.
If exhalation time is too short “breath stacking”
occurs resulting in an increase in end-expiratory
pressure also called auto-PEEP.
Depending on the disease process, such as in ARDS,
the I:E ratio can be changed to improve ventilation
10. Fraction of Inspired Oxygen
The lowest possible fraction of inspired oxygen
(FiO2) necessary to meet oxygenation goals should be
used. This will decrease the likelihood that adverse
consequences of supplemental oxygen will develop,
such as absorption atelectasis, accentuation of
hypercapnia, airway injury, and parenchymal injury
11. Modes of Ventilation: The Basics
Assist-Control Ventilation Volume Control
Assist-Control Ventilation Pressure Control
Pressure Support Ventilation
Synchronized Intermittent Mandatory Ventilation
Volume Control
Synchronized Intermittent Mandatory Ventilation
Pressure Control
12. Assist Control Ventilation
A set tidal volume (if set to volume control) or a set
pressure and time (if set to pressure control) is
delivered at a minimum rate
Additional ventilator breaths are given if triggered by
the patient
13. Pressure Support Ventilation
The patient controls the respiratory rate and exerts a
major influence on the duration of inspiration,
inspiratory flow rate and tidal volume
The model provides pressure support to overcome
the increased work of breathing imposed by the
disease process, the endotracheal tube, the
inspiratory valves and other mechanical aspects of
ventilatory support.
14. Synchronized Intermittent
Mandatory Ventilation
Breaths are given are given at a set minimal rate, however
if the patient chooses to breath over the set rate no
additional support is given
One advantage of SIMV is that it allows patients to
assume a portion of their ventilatory drive
SIMV is usually associated with greater work of breathing
than AC ventilation and therefore is less frequently used
as the initial ventilator mode
Like AC, SIMV can deliver set tidal volumes (volume
control) or a set pressure and time (pressure control)
Negative inspiratory pressure generated by spontaneous
breathing leads to increased venous return, which
theoretically may help cardiac output and function
15. Advantages of Each Mode
Mode Advantages
Assist Control Ventilation (AC) Reduced work of breathing compared
to spontaneous breathing
AC Volume Ventilation Guarantees delivery of set tidal volume
AC Pressure Control Ventilation Allows limitation of peak inspiratory
pressures
Pressure Support Ventilation (PSV) Patient comfort, improved patient
ventilator interaction
Synchronized Intermittent Mandatory
Ventilation (SIMV)
Less interference with normal
cardiovascular function
16. Disadvantages of Each Mode
Mode Disadvantages
Assist Control Ventilation (AC) Potential adverse hemodynamic effects,
may lead to inappropriate
hyperventilation
AC Volume Ventilation May lead to excessive inspiratory
pressures
AC Pressure Control Ventilation Potential hyper- or hypoventilation
with lung resistance/compliance
changes
Pressure Support Ventilation (PSV) Apnea alarm is only back-up, variable
patient tolerance
Synchronized Intermittent Mandatory
Ventilation (SIMV)
Increased work of breathing compared
to AC
17. Guidelines in the Initiation of
Mechanical Ventilation
Primary goals of mechanical ventilation are adequate
oxygenation/ventilation, reduced work of breathing,
synchrony of vent and patient, and avoidance of high
peak pressures
Set initial FIO2 on the high side, you can always
titrate down
Initial tidal volumes should be 8-10ml/kg, depending
on patient’s body habitus. If patient is in ARDS
consider tidal volumes between 5-8ml/kg with
increase in PEEP
18. Guidelines in the Initiation of
Mechanical Ventilation
Use PEEP in diffuse lung injury and ARDS to support
oxygenation and reduce FIO2
Avoid choosing ventilator settings that limit
expiratory time and cause or worsen auto PEEP
When facing poor oxygenation, inadequate
ventilation, or high peak pressures due to intolerance
of ventilator settings consider sedation, analgesia or
neuromuscular blockage
19. Trouble Shooting the Vent
Common problems
High peak pressures
Patient with COPD
Ventilator synchrony
ARDS
20. Trouble Shooting the Vent
If peak pressures are increasing:
Check plateau pressures by allowing for an inspiratory
pause (this gives you the pressure in the lung itself
without the addition of resistance)
If peak pressures are high and plateau pressures are low
then you have an obstruction
If both peak pressures and plateau pressures are high
then you have a lung compliance issue
21. Trouble Shooting the Vent
High peak pressure differential:
High Peak Pressures
Low Plateau Pressures
High Peak Pressures
High Plateau Pressures
Mucus Plug ARDS
Bronchospasm Pulmonary Edema
ET tube blockage Pneumothorax
Biting ET tube migration to a
single bronchus
Effusion
22. Trouble Shooting the Vent
If you have a patient with history of COPD/asthma
with worsening oxygen saturation and increasing
hypercapnia differential includes:
Given the nature of the disease process, patients have difficultly
with expiration (blowing off all the tidal volume)
Must be concern with breath stacking or auto- PEEP
Management options include:
Decrease respiratory rate Decrease tidal volume
Adjust flow rate for quicker
inspiratory rate
Increase sedation
Adjust I:E ratio
23. Trouble Shooting the Vent
Increase in patient agitation and dis-synchrony on
the ventilator:
Could be secondary to overall discomfort
Increase sedation
Could be secondary to feelings of air hunger
Options include increasing tidal volume, increasing flow rate,
adjusting I:E ratio, increasing sedation
24. Trouble shooting the vent
If you are concern for acute respiratory distress
syndrome (ARDS)
Correlate clinically with HPI and radiologic findings of
diffuse patchy infiltrate on CXR
Obtain a PaO2/FiO2 ratio (if < 200 likely ARDS)
Begin ARDSnet protocol:
Low tidal volumes
Increase PEEP rather than FiO2
Consider increasing sedation to promote synchrony with
ventilator