This is a topic from cardiovascular system which includes definition, risk factors, pathophysiology, clinical menifestation, diagnostic evaluation and management
continuous or intermittent monitoring of heart activity, generally by electrocardiography, with assessment of the patient's condition relative to their cardiac rhythm.
This is a topic from cardiovascular system which includes definition, risk factors, pathophysiology, clinical menifestation, diagnostic evaluation and management
continuous or intermittent monitoring of heart activity, generally by electrocardiography, with assessment of the patient's condition relative to their cardiac rhythm.
It describes how to check blood pressure effectively. Indications to checking and contriandications. Role of continuous blood pressure measurement. Preparation before checking blood pressure and precautions.
Pulmonary Arterial Hypertension: The Other High Blood Pressure and its association with scleroderma is presented by
Micheal J. Cuttica MD, MS, Assistant Professor of Medicine, Director; Northwestern Pulmonary Hypertension Program, Northwestern University
This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
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The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
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Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
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The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
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Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
2. INTRODUCTION
• "Repeated or continuous observations or measurements of
the patient, his or her physiological function, and the
function of life support equipment, for the purpose of
guiding management decisions, including when to make
therapeutic interventions, and assessment of those
interventions".
• A patient monitor may not only alert caregivers to
potentially life-threatening events; many provide
physiologic input data used to control directly connected
life-support devices.
3. CATEGORIES OF PATIENTS WHO NEED
MONITORING
• There are at least four categories of patients who need
physiologic monitoring:
• Patients with unstable physiologic regulatory systems; for
example, a patient whose
• Patients with a suspected life-threatening condition; for
example, a patient who has findings indicating an acute
myocardial infarction (heart attack).
• Patients at high risk of developing a life-threatening condition;
for example, patients immediately post open-heart surgery, or a
premature infant whose heart and lungs are not fully
developed.
• Patients in a critical physiological state; for example, patients
with multiple trauma or septic shock.
4. SYSTEMS TO BE MONITORED
• CARDIOVASCULAR MONITORING
• RESPIRATORY MONITORING
• CENTAL NERVOUS SYSTEM MONITORING
• RENAL SYSTEM MONITORING
• HEPATIC SYSTEM MONITORING
• HEMATOLOGICAL MONITORING
6. Continuous cardiac monitoring
• Continuous cardiac monitoring allows for rapid assessment
and constant evaluation.
• It is now common practice for five leads.
• The monitoring lead of choice is determined by the patient's
clinical situation.
7. 12-Lead ECG
• ECG Interpretation
• Heart rate: Count the R waves on a 6 sec strip and multiply by
10 to calculate the rate.
• Rhythm (regularity): To assess regularity, The R-R interval
should not differ by more than 0.12 sec.
• Atrial activity: Observe for the presence or absence of P
waves.
• AV node activity: The duration of the P-R interval
• Ventricular activity: Measure the QRS interval And Q wave (if
present) = less than 0.04 sec.
8. • Heart Rate
– Heart rate is a nonspecific parameter. It is usually measured by auscultation of
the heart and palpation of an artery, automatically taken from an ECG or arterial
pulse pressure wave.
– Increase in heart rate (tachycardia) may be caused by hypovolemia (the
tachycardia is a compensatory mechanism), fever, excitement, exercise and pain.
– Decrease in heart rate (bradycardia) may be caused by high vagal tone, severe
electrolyte disturbances and atrioventricular conduction blocks.
• Heart Rhythm
– When irregularities in heart sounds are heard, the heart rate should be compared
to pulse rate and the difference in rates are called pulse deficits. Pulse deficits
are indicative of arrhythmias. Hypoxia, myocardial contusions and metabolic or
acid base imbalance may cause arrhythmias.
– Some examples of cardiac arrhythmias include- premature atrial contraction
(PAC), atrial fibrillation, premature ventricular contraction (PVC) and
ventricular tachycardia. All pulse abnormalities should be confirmed by a
electrocardiogram (ECG).
9. Some other parameters that are observed in
cardiovascular monitoring include-
• Mucous membrane color :
• The normal mucous membrane color is pink. In diseased state
the mucous membrane color may be yellow,pale,white,brick
red or blue.
• Capillary refill time(CRT) :
• It is an indication of peripheral perfusion. CRT is the rate at
which blood returns to the capillary bed after it has been
compressed digitally.
• Normal CRT is 1-2 seconds.
• Prolonged CRT is due to vasoconstriction.
10. HAEMODYNAMIC MONITORING
• The reasons for haemodynamic monitoring are -
– To establish a precise health-related diagnosis;
– To determine appropriate therapy; and
– To monitor the response to that therapy.
• Hemodynamic monitoring can be –
– Non-Invasive
– Invasive
11. Non-invasive Monitoring
Non-invasive monitoring does not require any device to be
inserted into the body and therefore does not breach the skin.
• Directly measured non-invasive variables include –
– Body Temperature,
– Heart Rate,
– Blood Pressure,
– Respiratory Rate,
– Urine Output,
– Trans cutaneous pulse oximetry
– Expired carbon monoxide monitors.
12. Invasive Monitoring
• Invasive monitoring requires the vascular system to be
cannulated and pressure or flow within the circulation
interpreted.
• Invasive haemodynamic monitoring technology includes:
– Systemic arterial pressure monitoring
– Central venous pressure
– Pulmonary artery pressure
– Cardiac output (Thermodilution).
13. Blood Pressure Monitoring
• Blood Pressure
– Normal B.P. (18 + age) = 100-120/60-80 mm Hg,
– Prehypertension = 120-139 /80- 90 mm Hg
– Hypertension = >140/90 mm Hg
– Hypotension = < 90/60 mm Hg
• Systemic arterial blood pressure can be measured by-
– Indirectly or non-invasive
– Directly or invasive
14. • Non-Invasive Blood Pressure Monitoring –
NIBP monitoring by the use of manual or electronic sphygmomanometer.
• Invasive Intra-Arterial Pressure Monitoring –
– Arterial pressure recording is indicated when precise and continuous
monitoring is required, such as in periods of instability of cardiac output and
blood pressure.
– Arterial cannula is placed in the artery. Most common site Radial Artery and
other sites are The Brachial, Femoral, Dorsalis Pedis and Axillary Arteries.
– Three main factors are monitored –
• Preload
• Afterload
• Contractility
15. Central venous pressure
Preload in the right ventricle is generally measured as CVP.
• Normal value of CVP is – 0 to +8 mm of Hg 'OR' 0 to +10 Cm H2O.
• A CVP less than 0 may be due to vasodilatation (increased volume
capacitance) or hypovolemia. A CVP in a normal range but in the face of
signs consistent with vasoconstriction may be due to hypovolemia.
• A CVP greater than 10 may be due to the heart's inability to function as a
pump or fluid over-load, vasoconstriction (decreased volume capacitance),
pericardial effusion and positive pressure ventilation.
• Locations used for central venous access:
– The commonest sites in critically ill patients are –
• Subclavian Vein Approaches
• Internal Jugular Vein Approaches
16. Pulmonary Artery Pressure (PAP)
• PAP monitoring is indicated for adults in severe hypovolaemic or
cardiogenic shock, where there may be diagnostic uncertainty, or where the
patient is unresponsive to initial therapy.
• The PAP is used to guide administration of fluid, inotropes and
vasopressors.
• PAP monitoring may also be utilised in other cases of haemodynamic
instability when diagnosis is unclear.
• It may be helpful when clinicians want to differentiate hypovolaemic from
cardiogenic shock or, in cases of pulmonary oedema, to differentiate
cardiogenic from non-cardiogenic origins.
• It has been used to guide haemodynamic support in a number of disease
states such as shock, and to assist in assessing the effects of fluid
management therapy.
17. Pulmonary Capillary Wedge Pressure
• Also known as Pulmonary artery occlusion pressure (PAOP).
• Measured by the pulmonary artery catheter balloon.
• Normally the PAOP varies between 8-12 mmHg.
• Patients with poor left ventricular function have a PAOP
exceeding 18mmHg.
18. Left Atrial Pressure Monitoring
• Left atrial pressure monitoring directly estimates left heart
preload.
• It requires an open thorax to enable direct cannulation of the
atrium
• It is used only in the postoperative cardiac surgical setting
19. RESPIRATORY MONITORING
• Respiratory insufficiency is one of the main reasons for
admission to a critical care unit, as either a potential or actual
problem, so comprehensive respiratory monitoring is
essential.
• The respiratory monitoring include –
– Pulse oximetry
– Arterial Blood Gases Analysis
– Ventilation monitoring
20. Pulse oximetry
• Normal SpO2 is greater than 97%.
• It is important that when SpO2 appears to be abnormal, the
arterial blood is sampled and gases are checked. Therefore,
arterial blood gases are also needed periodically to assess other
parameters.
21. Arterial Blood Gases Analysis
• Arterial blood gases (ABGs) are one of the most commonly
performed laboratory tests in ICUs and other critical care
areas.
• ABG measurements are essential for assessing
oxygenation/gas exchange and ventilation.
• ABGs are measured to determine the status of the acid–base
balance and oxygenation, and include measurement of the
PaO2, PaCO2, acidity (pH) and bicarbonate (HCO3
-).
• Continuous blood gas monitoring is possible if a fibreoptic
sensor or an oxygen electrode is inserted into the arterial
catheter system. The advantage of the arterial catheter is that it
facilitates ABG sampling without repeated arterial punctures.
22. Ventilation Monitoring
Measurements Description Normal Value
Temperature (T) Default setting is 37°C. No consensus on
analysis according to patient temperature.
Consistency of greater importance.
37°C
Haemoglobin (Hb) Samples need to be fully mixed so should
be constantly agitated until analysed.
Females 115–165
g/L
Males: 130–180 g/L
Acid–base status
(pH)
Overall acidity or alkalinity of blood. 7.36–7.44
23. Carbon dioxide
(PaCO2)
Partial pressure of arterial CO2. 4.5–6.0 kPa
35–45 mmHg
Oxygen (PaO2) Partial pressure of arterial oxygen. 11–13.5 kPa
80–100 mmHg
(varies with age)
Bicarbonate (HCO3
)
Standard bicarbonate is usually used to assess
metabolic function; this is calculated by
removing the respiratory component from the
HCO3 .
22–32 mmol/L
Base excess (BE) The number of molecules of acid or base that
are needed to return 1 litre of blood to the
normal pH (7.4): it measures acid–base
balance. As with HCO3 , standard BE is more
useful for accurate assessment of metabolic
components.
3 to +3 mmol/L
Saturation (SaO2) Haemoglobin saturation by oxygen in arterial
blood.
>94%
24. CENTAL NERVOUS SYSTEM
MONITORING
• CNS monitoring in critical care units includes
– Neurological observation
– Cerebral function monitoring
– Intracranial pressure monitoring
26. Consciousness
• Consciousness is the most sensitive indicator of neurological change and is
usually the first to be noted in neurological signs
• There are three properties of consciousness which can be
individually affected by the disease process. These are:
– Arousal or wakefulness (i.e. eyes open to command)
– Alertness and awareness (i.e. orientation and communication)
– Appropriate voluntary motor activity (i.e. obeying commands)
• Common methods of assessing conscious level are:
– AVPU
– Glasgow Coma Scale (GCS)
27. AVPU
A – Alert
V – Verbal
P – Pain
U – Unresponsive
Responds spontaneously
Responds to voice
Responds to pain stimuli
No response to verbal or pain
stimuli
28. Glasgow Coma Scale (GCS)
• The GCS Is a simple & standardised system to detect
changes in level of consciousness. It should be quick,
easy, objective & accurate.
• Head injury classification
Severe head injury
Moderate head injury
Minor head injury
GCS score of 8 or less
GCS score of 9–12
GCS score of 13–15
29. Pupilary Assessment
• Pupil size
– Normal pupils are round and equal in size, with an average size
of 2–5 mm in diameter.
– Pupil size scale on the neurological observation chart
. Reaction to light
• Pupil Documentation
– Pupil size should be recorded before proceeding to test pupil
response to direct light.
– + is used to indicate a brisk response
– - is used to indicate no response
– SL is used to indicate a 'sluggish' response
– C is used to indicate closed eyes due to periorbital oedema.
30. Limb Movement
• In this section you are assessing all limbs as opposed to the
best response in a limb, as in the GCS section.
• It is a combination of active and active resisted movements
31. Cerebral Function Monitoring
• Use of continuous EEG monitoring to assess and monitor a
patient with brain injury or acute ischemia enables prevention
of further complications.
32. Intracranial Pressure Monitoring
• Normal ICP is between 0 and 15 mm Hg.
• Intracranial pressure (ICP) monitoring is commonly used in patients with -
– Severe traumatic brain injury
– Intracranial hemorrhage
– Cerebral edema
– Post-craniotomy
• Contraindications
– Central nervous system infection
– Coagulation defects
– Anticoagulant therapy
– Scalp infection
– Severe midline shift resulting in ventricular displacement
– Cerebral edema resulting in ventricular collapse
• Complications
– Intracranial infection
– Intracerebral hemorrhage
– CSF leakage
– Over drainage of CSF leading to ventricular collapse and herniation.
33. RENAL SYSTEM MONITORING
• Fluids monitoring (in-put & out-put):
• The normal urinary output is 1 - 2 ml/kg/hr. Ideally it is
important to quantitate the urine output.
• In addition to quantitation of urine, it is also helpful to
quantitate defecation and emesis, this can provide you with a
better picture of your total fluid balance. Weight gains and
losses should be monitored on a daily basis if not more
frequently. Acute changes in weight are usually a result of
fluid changes and not muscle mass.
34. HEPATIC SYSTEM MONITORING
• Prothrombin time is a useful guide for the monitoring of liver
function.
• Factor vii has a half life of 4-8 hours and its measurement can
be used to assess the severity of coagulopathy.
• Greatly increased serum transaminase activity are
characteristic of hepatocellular demage, while raised alkaline
phospatase activity is seen in biliary obstruction.
35. HEMATOLOGICAL MONITORING
• Blood tests:
Common blood tests include blood chemisteries, glucose ,ABGs , CBC
cardaic markers , and coagulation tests.
ICU patients typically have routine daily blood tests to help detect
problems early.generally patients need a daily set of electrolytes and a cbc.
Patients with arrythmias should also have Mg, P and Ca levels measured.
Patients receiving TPN need weekly liver enzymes and coagulation
profiles.
• Hb and Hct concentration monitoring :
Low hct tends to be assosciated with improved perepheral perfusion.
Serial decline in hct indicates bleeding.
Ideal HCT in critically ill patient is probably 35% with a hb
concentration of 12-14 g/dL.