High altitudes are frequented by ardent mountaineers or tough soldiers. The medical problems faced at these uninhabitable conditions are discussed only when some catastrophe strikes them like Everest avalanche or Siachen avalanche. The presentation classifies high altitude, the medical problems faced there and management of same.
Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs.
DYSPNOEA IS DEFINED AS THE UNDUE AWARENESS OF UNPLEASANT BREATHING.WHEN THERE IS AMIS MATCH BETWEEN THE AFFERENT VENTILATORY SIGNALS AND THE EFFERENT RESPIRATORY SIGNALS IN THE BRAIN WE MAY GET AN UNIGNORABLE FEELING FOR NEED OF MORE AND MORE OXYGEN.
Acute respiratory distress syndrome (ARDS) is a sudden and progressive form of acute respiratory failure in which the alveolar capillary membrane becomes damaged and more permeable to intravascular fluid resulting in severe dyspnoea, hypoxemia and diffuse pulmonary infiltrates.
GEMC: Electrical and Lightening Injuries: Resident TrainingOpen.Michigan
This is a lecture by Dr. Rashmi Kothari from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Pulmonary edema is often caused by congestive heart failure. When the heart is not able to pump efficiently, blood can back up into the veins that take blood through the lungs. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs.
DYSPNOEA IS DEFINED AS THE UNDUE AWARENESS OF UNPLEASANT BREATHING.WHEN THERE IS AMIS MATCH BETWEEN THE AFFERENT VENTILATORY SIGNALS AND THE EFFERENT RESPIRATORY SIGNALS IN THE BRAIN WE MAY GET AN UNIGNORABLE FEELING FOR NEED OF MORE AND MORE OXYGEN.
Acute respiratory distress syndrome (ARDS) is a sudden and progressive form of acute respiratory failure in which the alveolar capillary membrane becomes damaged and more permeable to intravascular fluid resulting in severe dyspnoea, hypoxemia and diffuse pulmonary infiltrates.
GEMC: Electrical and Lightening Injuries: Resident TrainingOpen.Michigan
This is a lecture by Dr. Rashmi Kothari from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Ok Computer - What Lies Beyond 3D Printing and How it will Save Your Lifeimec
A SuperMinds 2014 Talk by Matthieu De Beule (iMinds - Medisip – Ugent).“Surgeons use a 3D-printed heart to save a child’s life”. This is truly a fantastic application of 3D printing that really helped doctors prepare for life-saving surgery And while this is impressive in an of itself, the question is what’s next? Wouldn’t it be cool if the surgeon could actually try out different treatment options to pre-operatively evaluate what would be the best for that specific patient? Applications such as this are no longer science fiction, the good news … it’s possible!
Start-ups are major engines of economic development, yet they often lack research capacity to solve their key technical innovation challenges. Discover how iMinds arms digital start-ups with the “R” in the R&D equation.
Are your presentations naughty or nice?Gavin McMahon
You've created your slides,
And checked them all twice.
But will the points you're portraying
Seem naughty or nice?
Holiday Themed Presentation Tips from @powerfulpoint
The standardization of medical 3D technology is urgent needs for designing medical devices that use 3D models and printings, for evaluating the stability of medical instruments that use the 3D printing, or for evaluation of hardware and software producing or using medical 3D models and printed material. Therefore, our working group sponsored by the IEEE Computer Society, Practical Applications of 3D Medical Modeling, investigates technical standards for medical 3D images, which include medical 3D modeling, visualization, simulation, data management, 3D printing.
Barometric pressure falls with increasing altitude, but composition of air remain same.
Study is important for:Mountaineering
Aviation & Space flight
Permanent human settlement at highlands
It discusses various effects of high altitude on human body in detail, acute mountain sickness, chronic mountain sickness, high altitude pulmonary edema, high altitude cerebral edema, acclimatization
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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
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
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
28. A combination of air
temperature and
wind speed that
affects the freezing
rate of exposed
skin.
29. Wind Chill/Frostbite Chart
As this chart indicates, if the actual temperature is -200 F and the wind is blowing 15
mph, the cold effect on your bared skin is -450 F. At this temperature, frostbite can
begin in as little as 10 minutes.
34. Air Lungs Blood Tissue
•Delivery of atmospheric O2 to the tissues normally involve 3
stages---with a drop in PO2 at each stage.
•When the starting PO2 is lower than normal, body
undergoes acclimatization so as to—
(i)↓ pressure drop during transfer
(ii)↑ oxygen carrying capacity of blood
(iii) ↑ ability of tissues to utilize O2
35. • Starts within 10- 15 min of exposure 1500m
• Mechanism
VENTILATORY ACCLIMATIZATION
Ascent to altitude
Hypoxia
Carotid body stimulation
Respiratory centres stimulation
Increased ventilation
Improved hypoxia
Decreased PCO2
CO2 + H2O H2CO3 HCO3
- + H+
36. 1.Ventilation & perfusion matching
IncreasedVentilation = Increased cardiac output
Increased Pulmonary Perfusion
Alveolar hypoxia triggers Hypoxic Pulmonary
vasoconstriction
-redistribution of blood flow to areas less
perfused at sea level
- improved gas exchange
37. LUNG DIFFUSION
Major rate limiting step
• High altitude O2 diffusion, because of
– a lower driving pressure for O2 from the air to the
blood ( low Po2)
– and inadequate time for equilibration ( decreased
transit Time)
– Long term adaptation – diffusing capacity increases
40. Increase in Hb conc in 1-2 days
initially – hemoconcentration ( diuresis)
later – increased RBC production due to
increased erythropoietin
Hypoxia is the primary stimulus for
erythropoietin secretion
Se erythropoietin levels increase in 24-48 hrs
decline within 3 weeks
41.
42. Plasma to cytoplasm – 10mmHg
Cytoplasm to mitochondria – 1-2mmHg
Diminished ms fibre
Increased myoglobin conc
Increased levels of enzymes involved in
oxidative phosphorylation
43. Cerebral Blood flow
Cerebral bld flow increases initially due to hypoxia
Hypocapnia cerebral vasoconstriction bld flow
decreases
13% greater than sea level
Improved O2 delivery
44. Motor, sensory & cognitive abilities impair
New tasks are learned with difficulty at
3048m
Short term memory impaired
Arterial So2 85% - impair concentration and
fine motor coordination
Arterial So2 75% - poor judgement and
irritability
45.
46. Diuresis & natriuresis
Peripheral venous constriction →
increased central volume →
decreased ADH and aldosterone →
diuresis →
decreased plasma volume and hyperosmolality.
47. Cheyne-Stokes Respirations
Above 10,000 ft (3,000 m) most people experience a periodic
breathing during sleep.The pattern begins with a few shallow
breaths increases to deep sighing respirations falls off
rapidly.
During period of breathing-arrest, person often becomes
restless & may wake with a sudden feeling of suffocation.
Can disturb sleeping patterns exhausting the climber.
O2 & acetazolamide help
48. At high altitude air is thin. To make up for it, the
blood gets thick, respiration ↑ & circulation
improves, provided adequate time is given &
body functions properly still some limitations
remain as implied!!!
49. • Process by which people gradually adjust to high altitude
• Determines survival and performance at high altitude
• Series of physiological changes
O2 delivery
hypoxic tolerance +++
• Acclimatization depends on
• severity of the high-altitude hypoxic stress
• rate of onset of the hypoxia
• individual’s physiological response to hypoxia
Acclimatisation
51. FIRST STAGE ACCLIMAZATION(Above 2700 m and up to
3600 m):The acclimatization period will be for 6 days as
under:
(i) First and second day: Rest except for short walks in the
unit lines only, not involving any climbs.
(ii) Third and fourth day: walk at slow pace for 1.5 -3Km
avoid steep climbs.
(iii) Fifth and sixth day: walk upto 5 Km and climb upto 300
m at a slow pace.
6April 2016 51
52. SECOND STAGE ACCLIMATIZATION(Above 3600 m and
up to 4500 m):This is carried out for 4 days as under:
(i ) First & Second day: Slow walk for a distance for 1.5 -3 Km avoid
steep climbs.
(ii) Third day: slow walk and climb upto 300 m.
(iii) Fourth day: Climb 300 m without equipment.
THIRD STAGE ACCLIMATIZATION:(Above 4500 m):This
also lasts for 4 days and is on the same lines as second stage
acclimatization.
6April 2016 52
63. Progression of Acute Mountain
Sickness
If ascent is continued or accelerated
by a patient with untreated AMS, HAPE
or HACE may occur and death may
result
64. Usually get AMS before HACE
Mental status changes +/ ataxia
Confusion, ataxia, stupor
focal neurologic signs
May lead to coma, irreversible neurological
damage or death
Incidence 0.53% - 1.25%
65. Other causes of encephalopathy
CO poisoning
Hypertensive crisis
Hypoxia
Meningitis
Hypoglycemia
Hypothermia
67. IMMEDIATE DESCENT
Do NOT wait until morning if HACE occurs at
night
Oxygen
Hyperbaric bag (to facilitate descent if
necessary NOT replace it)
Dexamethasone
68.
69. Commonest cause (54%)of Hospital admission due
to HAA related illnesses
Most common cause of death from high altitude
illness.
• Until 1960 – Pneumonia
• 1960 - Pulmonary edema (Houston)
6April 2016 69
70. Non cardiogenic pulmonary edema
Manifests within 2-4 days of ascent >2400m
(8000 feet)
2nd night
71. Pulmonary hypertension
Exaggerated Hypoxic Pulmonary vasoconstriction
High levels of ET1
Increased sympathetic tone
Lower levels of NO
Uneven hypoxic vasoconstriction
Pulmonary Endothelium Fragility
Abnormal alveolar fluid resorption
81. Avalanche
50 to 100 miles per hour
Can be as fast as 200 miles per
hour
Can generate impact pressures
> 150 lbs/square inch
(can destroy even concrete
structures)
Occur with greatest frequency
on slopes of 30 to 45 degrees
82. Causes of death in avalanche
Direct impact trauma of snow blocks or ice
Indirect trauma of hitting against objects
such as trees or rocks
Hypoxia from encasement in snow
Hypothermia
Restrictive chest compression
83. Radiation Exposure
High altitude retinopathy
UV keratitis
pain, photophobia, tearing,
erythema, chemosis, eyelid
swelling
24 h to heal, analgesics and cold
comp.
Wear sunglasses
UV dermatitis
84. Miscellaneous Altitude Related
Medical Problems
Immune suppression
–probably related to tissue hypoxia
–wounds slower to heal & more likely to get infected
–wound infections can show antibiotic resistance
Prothrombotic state leading to various Thrombosis
High altitude peripheral edema
85. Khumbu cough
Purulent bronchitis and painful throat near
universal at very high altitude
respiratory heat loss, bronchospasm and mucosal
cracking (dry and cold effects)
coughing can lead to rib #s
Antibiotics no use
wear your balaclava – there are face masks that
act as HME
86. 1. Chronic mountain sickness- due to
excessive erythrocytosis
Described in 1928 Monge’s disease
Young and middle aged men
Low Landers who ascend to HA
High Landers with / without respiratory disease
Increased blood volume, PAH, haematocrit >60%
CNS symptoms dominate
Plethoric florid faces, dark red conjunctiva, haemorrage below nail
2. High altitude pulmonary hypertension
Without polycythemia