A presentation that talks about the Human Nervous System, the cranial nerves and the Neuro Assessment required to check if the nervous system is functioning properly.
BLOOD PRESSURE
BY: SAIYED FALAKAARA
ASSISTANT PROFESSOR
DEPARTMENT OF PHARMACY
SUMANDEEP VIDYAPEETH
Definition
Arterial blood pressure can be defined as the lateral pressure exerted by moving the column of blood on the walls of the arteries.
Significance
To ensure the blood flow to various organs
Plays an important role in exchange of nutrients and gases across the capillaries
Required to form urine
Required for the formation of lymph
Normal values
Normal adult range can fluctuate within a wide range and still be normal
Systolic/diastolic
100/60 – 140/80
Unit - mmHg
A presentation that talks about the Human Nervous System, the cranial nerves and the Neuro Assessment required to check if the nervous system is functioning properly.
BLOOD PRESSURE
BY: SAIYED FALAKAARA
ASSISTANT PROFESSOR
DEPARTMENT OF PHARMACY
SUMANDEEP VIDYAPEETH
Definition
Arterial blood pressure can be defined as the lateral pressure exerted by moving the column of blood on the walls of the arteries.
Significance
To ensure the blood flow to various organs
Plays an important role in exchange of nutrients and gases across the capillaries
Required to form urine
Required for the formation of lymph
Normal values
Normal adult range can fluctuate within a wide range and still be normal
Systolic/diastolic
100/60 – 140/80
Unit - mmHg
Goodbye GCS!
Summary by: Mark Wilson
Consciousness comprises “wakefulness” (that’s the brain stem, opening your eyes component) and “content” (that’s the supratentorial, thinking, “someone’s home” component). You can have wakefulness without content (e.g. persistent vegetative state) but not content without wakefulness.
Describing a “level” of consciousness, converting this multifaceted human brain ability into a linear scale was possibly the biggest neuroscience break through of the 20th Century. The 1974 Lancet paper in which Brian Jennet and Sir Graham Teasdale proposed the Glasgow Coma Scale (GCS) is certainly the most cited neuroscience paper. We had even put a man on the moon before this had been created. It’s relative simplicity and repeatability meant GCS was rapidly taken up across the world. Now 40 years on, is it out of date?
There are problems with the GCS – it doesn’t include pupil response, it doesn’t look at ventilation or other autonomic functions hence other systems such as the 4 score system have been proposed. But these take longer, and are poorly known so cannot be used like GCS to rapidly convey in a meaningful way the level of consciousness of a patient between clinicians.
In this talk Mark Wilson goes through the history of the GCS and other conscious measures… is it time to say Goodbye to GCS?
After completion of this unit, students will be able to apply knowledge of emergency and trauma management principles in nursing patients with Cerebrovascular problems using the Glasgow coma scale.
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical history, but not deeper investigation such as neuroimaging.
A coma is a state of unconsciousness where a person is unresponsive and cannot be woken.
It can result from injury to the brain, such as a severe head injury or stroke. A coma can also be caused by severe alcohol poisoning or a brain infection (encephalitis).
People with diabetes could fall into a coma if their blood glucose levels suddenly became very low (hypoglycaemia) or very high (hyperglycaemia).
Signs and symptoms of a coma patient:
Inability to voluntarily open the eyes
A non-existent sleep-wake cycle
Lack of response to physical (painful) or verbal stimuli
Depressed brainstem reflexes, such as pupils not responding to light
Irregular breathing
Scores between 3 and 8 on the Glasgow Coma Scale
Causes: Traumatic brain injuries. These are often caused by traffic collisions or acts of violence. Stroke. Tumors. Tumors in the brain or brainstem can cause a coma. Diabetes. Blood sugar levels that become too high (hyperglycemia) or too low (hypoglycemia) can cause a coma. Lack of oxygen. People who have been rescued from drowning or those who have been resuscitated after a heart attack might not awaken due to lack of oxygen to the brain. Infections. Infections such as encephalitis and meningitis cause swelling of the brain, spinal cord or the tissues that surround the brain. Severe cases of these infections can result in brain damage or a coma. Seizures. Ongoing seizures can lead to a coma. Toxins. Exposure to toxins, such as carbon monoxide or lead, can cause brain damage and a coma. Drugs and alcohol. Overdosing on drugs or alcohol can result in a coma.
It's a presentation on Coma 2023.
A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical history, but not deeper investigation such as neuroimaging.
The Glasgow Coma Scale (GCS) is a neurological scale which aims to give a reliable and objective way of recording the conscious state of a person for initial as well as subsequent assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (more widely used modified or revised scale).
NEW BLOGSITE ADDRESS:
"Nurses Information Site"
http://nursesinfosite.blogspot.com
To evaluate apical impulse. To assess dilatation and dynamics of RV, aorta and pulmonary artery.
To identify apex of the heart. To detect enlargement of RV, aorta and pulmonary artery.
NEW BLOGSITE ADDRESS:
"Nurses Information Site"
http://nursesinfosite.blogspot.com
Arterial Pulse: Radial
To assess cardiac function. To assess state of health.
NEW BLOGSITE ADDRESS:
"Nurses Information Site"
http://nursesinfosite.blogspot.com
Pathology of Pneumonia:
Broncho- pneumonia,
Lobar Pneumonia,
Lung Abscess,
Lung Fungal Absces,
Normal Lung
Please leave a comment after downloading.
THANK YOU ^^
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.
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
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.
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
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
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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
2. Glasco Coma
Scale
www.nursesinformations.blogspot.com
3. Glasco Coma Scale
The Glasgow Coma Scale (GCS) is
used to assess level of consciousness in a
wide variety of clinical settings, particularly
for patients with head injuries.
www.nursesinformations.blogspot.com
4. Glasco Coma Scale
• named for Glasgow Scotland
• a simple way that physicians communicate the
severity and depth of coma in a patient who has
suffered traumatic brain injury
www.nursesinformations.blogspot.com
5. Glasco Coma Scale
Mental alertness varies from fully alert to
lethargic and stuporous all the way to
deep coma, where a patient is minimally
responsive or unresponsive to external
stimuli. The GCS grades this level of
consciousness on a scale from 3 (worst,
deep coma) to 15 (normal, alert).
www.nursesinformations.blogspot.com
6. Glasco Coma Scale
• The GCS assesses the two aspects of
consciousness:
– Arousal or wakefulness: being aware of the
environment;
– Awareness: demonstrating an understanding
of what has been said.
www.nursesinformations.blogspot.com
7. Glasco Coma Scale
• The 15-point scale assesses the patient's
level of consciousness by evaluating three
behavioural responses:
• Eye opening;
• Verbal response;
• Motor response.
www.nursesinformations.blogspot.com
8. Glasco Coma Scale
Eye opening
• Assessment of eye opening involves the
evaluation of arousal (being aware of the
environment):
www.nursesinformations.blogspot.com
9. Glasco Coma Scale
• Score 4: eyes open spontaneously;
• Score 3: eyes open to speech;
• Score 2: eyes open in response to pain
only, for example trapezium squeeze
(caution if applying a painful stimulus);
• Score 1: eyes do not open to verbal or
painful stimuli.
www.nursesinformations.blogspot.com
10. Glasco Coma Scale
Record 'C' if the patient is unable to
open her or his eyes because of swelling,
ptosis (drooping of the upper eye lid) or a
dressing.
www.nursesinformations.blogspot.com
12. Glasco Coma Scale
• Score 5: orientated;
• Score 4: confused;
• Score 3: inappropriate words;
• Score 2: incomprehensible sounds;
• Score 1: no response. This is despite both
verbal and physical stimuli.
www.nursesinformations.blogspot.com
13. Glasco Coma Scale
Record 'D' if the patient is dysphasic
and 'T' if the patient has a tracheal or
tracheostomy tube in situ.
www.nursesinformations.blogspot.com
14. Glasco Coma Scale
Motor response
• Assessment of motor response is
designed to determine the patient's ability
to obey a command and to localise, and to
withdraw or assume abnormal body
positions, in response to a painful
stimulus:
www.nursesinformations.blogspot.com
15. Glasco Coma Scale
• Score 6: obeys commands. The patient
can perform two different movements;
• Score 5: localises to central pain. The
patient does not respond to a verbal
stimulus but purposely moves an arm to
remove
the cause of a central painful stimulus;
www.nursesinformations.blogspot.com
16. Glasco Coma Scale
• Score 4: withdraws from pain. The patient
flexes or bends the arm towards the
source of the pain but fails to locate the
source of the pain (no wrist rotation);
• Score 3: flexion to pain. The patient flexes
or bends the arm; characterised by
internal rotation and adduction of the
shoulder and flexion of the elbow, much
slower than normal flexion;
www.nursesinformations.blogspot.com
17. Glasco Coma Scale
• Score 2: extension to pain. The patient
extends the arm by straightening the
elbow and may be associated with internal
shoulder and wrist rotation;
• Score 1: no response to painful stimuli.
www.nursesinformations.blogspot.com
18. Glasco Coma Scale
Painful stimulus
• A true localising response to pain involves
the patient bringing an arm up to chin
level.
www.nursesinformations.blogspot.com
19. Glasco Coma Scale
• Painful stimuli that can
elicit this response
include trapezium
squeeze.
www.nursesinformations.blogspot.com
20. Glasco Coma Scale
• suborbital ridge
pressure (not
recommended if there
is a
suspected/confirmed
facial fracture)
www.nursesinformations.blogspot.com
21. Glasco Coma Scale
• sternal rub (caution,
not recommended in
some organisations)
www.nursesinformations.blogspot.com
22. Glasco Coma Scale
• In general, head injury is classified as
mild, moderate or severe based on the
Glasgow Coma Scale as such:
– Mild: GCS ≥ 13
– Moderate: GCS 9 - 12
– Severe: GCS ≤ 8
www.nursesinformations.blogspot.com
23. Glasco Coma Scale
• Mild (13-15):
– Loss of consciousness and/or confusion and
disorientation is shorter than 30 minutes.
www.nursesinformations.blogspot.com
24. Glasco Coma Scale
• Moderate Disability (9-12):
– Loss of consciousness greater than 30
minutes
– Physical or cognitive impairments which may
or may resolve
– Benefit from Rehabilitation
www.nursesinformations.blogspot.com
25. Glasco Coma Scale
• Severe Disability (3-8):
– Coma: unconscious state. No meaningful
response, no voluntary activities
www.nursesinformations.blogspot.com
26. Glasco Coma Scale
• Vegetative State (Less Than 3):
– Sleep wake cycles
– Arousal, but no interaction with environment
– No localized response to pain
www.nursesinformations.blogspot.com
27. Glasco Coma Scale
• Persistent Vegetative State:
– Vegetative state lasting longer than one
month
• Brain Death:
– No brain function
– Specific criteria needed for making this
diagnosis
www.nursesinformations.blogspot.com
30. Pupillary Assessment
• Evaluation of pupillary reaction is
effectively an assessment of the third
cranial nerve (oculomotor nerve), which
controls constriction of the pupil.
Compression of this nerve will result in
fixed dilated pupils.
www.nursesinformations.blogspot.com
31. Pupillary Assessment
• Evaluation of pupillary reaction is
effectively an assessment of the third
cranial nerve (oculomotor nerve), which
controls constriction of the pupil.
Compression of this nerve will result in
fixed dilated pupils.
www.nursesinformations.blogspot.com
32. Pupillary Assessment
• Any changes in the patient’s pupil
reaction, size or shape, together with other
neurological signs, are an indication of
raised intracranial pressure (ICP) and
compression of the optic nerve.
www.nursesinformations.blogspot.com
33. Pupillary Assessment
Pupil size and shape
• Pupil size should be measured, ideally
with reference to a neurological
observation chart or similar.
• The average size is 2-5mm (Bersten et al,
2003). The pupils should be equal in size.
www.nursesinformations.blogspot.com
35. Pupillary Assessment
Pupil size and shape
• Pupil shape should be ascertained. It
should be round; abnormal shapes may
indicate cerebral damage; oval shape
could indicate intracranial hypertension
(Fairley, 2005). The pupils should be
identical in shape.
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36. Pupillary Assessment
Reaction to a bright light
• brisk and after removal of the light source,
the pupil should return to its original size
• consensual reaction to the light source
• documented as per local policy, for example
B (brisk), S (sluggish) or N (no reaction).
• Both pupils should react equally to light.
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37. Pupillary Assessment
• Unreactive pupils can be caused by an
expanding mass, for example a blood clot
exerting pressure on the third cranial
nerve;
• a fixed and dilated pupil may be due to
herniation of the medial temporal lobe.
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39. Indications
• Loss of consciousness
• Facial or oral trauma
• Copious respiratory secretions
• Respiratory distress
• Need for mechanical ventilator
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40. Types of Airways
1. Oropharyngeal airway
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41. Types of Airways
2. Nasopharyngeal airway (nasal trumpet)
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42. Types of Airways
3. Endotracheal tube -
flexible tube inserted
through the mouth or
nose and into the
trachea beyond the
vocal cords that acts as
artificial airways.
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43. Types of Airways
3. Endotracheal tube
• allows for deep tracheal suction and
removal of secretions
• permits mechanical ventilator
• inflated balloon seals off trachea so
aspiration from the G.I tract cannot occur.
• generally easy to insert in an emergency,
but maintaining placement is more difficult
so this is not for long term use.
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44. Types of Airways
4. Tracheostomy tube
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45. Mallampati Score
In anesthesiology, the Mallampati score,
also Mallampati classification, is used to
predict the ease of intubation.
It is determined by looking at the anatomy of
the oral cavity; specifically, it is based on the
visibility of the base of uvula, faucial
pillars (the arches in front of and behind the
tonsils) and soft palate.
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46. Mallampati Score
Scoring may be done with or without
phonation.
A high Mallampati score (class 4) is
associated with more difficult intubation as
well as a higher incidence of sleep apnea
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47. Mallampati Score
• Modified Mallampati Scoring is as follows:
Class 1: Full visibility of tonsils, uvula and
soft palate
Class 2: Visibility of hard and soft palate,
upper portion of tonsils and uvula
Class 3: Soft and hard palate and base of
the uvula are visible
Class 4: Only Hard Palate visible
Class 0: visibility of Epiglottis
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49. INTUBATION
• An introduction of a tube into a hollow
organ (as the trachea).
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50. Indications
• Failure to protect the airway
• Institution of controlled ventilation
• Suctioning of secretions
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51. Types of Intubation
1. Endotracheal Intubation
- maybe inserted through the nose or
the mouth.
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52. Types of Intubation
1. Endotracheal Intubation
a. Orotracheal
Disadvantages:
increased oral secretions
decreased patient comfort
difficulty with stabilization
inability of patient to use lip
movement as a communication
means
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55. Types of Intubation
1. Endotracheal Intubation
b. Nasotracheal
Disadvantages:
blind insertion is required
possible development of pressure
necrosis of nasal airway
sinusitis
otitis media
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60. Types of Intubation
1. Endotracheal Intubation
c. Tube Types
Sizes:
Usual in adult are
6.0, 7.0, 8.0, 9.0 mm
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66. Types of Intubation
1. Endotracheal Intubation
d. Contraindications
glottis is obscured by
vomitus, bleeding, foreign body
trauma
cervical spine injury or deformity
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67. Types of Intubation
2. Tracheostomy
- inserted into the
trachea via incision
created at the level at
the second or third
cartilage ring.
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68. Indications of
ET intubation / Tracheostomy
Acute respiratory failure
CNS depression
neuromuscular disease
pulmonary disease
chest wall injury
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69. Indications of
ET intubation / Tracheostomy
Upper airway obstruction
tumor
inflammation
foreign body
laryngeal spasm
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70. Indications of
ET intubation / Tracheostomy
Anticipated upper airway
obstruction from edema or soft tissue
swelling due to head and neck trauma
some past-operative head and neck
procedures involving the airway
facial or airway burns
decreased level of consciousness
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71. Indications of
ET intubation / Tracheostomy
Aspiration Prophylaxis
Fracture of cervical vertebrae with spinal
cord injury (SCI) requiring ventilator
assistance.
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73. Endotracheal Intubation
• Laryngoscope with curved or straight
blade and working light source (check
batteries and bulb regularly)
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75. Endotracheal Intubation
• Endotracheal tube with low-pressure cuff
and adapter to connect tube to ventilator
or resuscitation bag
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76. Endotracheal Intubation
• Stylet to guide the endotracheal tube
• Oral airway (assorted sizes) or bite block
to keep patient from biting into and
occluding the endotracheal tube
• Adhesive tape or tube fixation system
• Sterile anesthetic lubricant jelly (water-
soluble)
• 10 mL syringe
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79. Endotracheal Intubation
• Suction source
• Suction catheter and tonsil suction
• Resuscitation bag and mask connected to
oxygen source
• Sterile towel
• Gloves
• Face shield
• End tidal CO2 detector
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83. Endotracheal Intubation
• PREPARATORY PHASE
• Assess the patient’s heart rate, level of
consciousness, and respiratory status
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84. Endotracheal Intubation
• PERFORMANCE PHASE
1.Remove the patient’s dental bridgework
and plates.
2.Remove headboard of bed (optional).
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85. Endotracheal Intubation
• PERFORMANCE PHASE
3. Prepare equipment.
a) Ensure function of resuscitation bag with mask and
suction
b) Assemble the laryngoscope. Make sure the light
bulb is tightly attached and functional
c) Select an endotracheal tube of the appropriate size
(6.0 to 9.0 mm for average adult).
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86. Endotracheal Intubation
• PERFORMANCE PHASE
3. Prepare equipment.
d.) Place the endotracheal tube on a sterile towel.
e.) Inflate the cuff to make sure it assumes a
symmetric shape and holds volume without leakage.
Then deflate maximally.
f.) Lubricate the distal end of the tube liberally with
the sterile anesthetic water-soluble jelly.
g.) Insert the stylet into the tube (if oral intubation is
planned). Nasal intubation does not employ use of the
stylet.
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87. Endotracheal Intubation
4. Aspirate stomach contents if nasogastric tube is in
place.
5. If time allows, inform the patient of impending inability
to talk and discuss alternative means of
communication.
6. If the patient is confused, it may be necessary to
apply soft wrist restraints.
7. Put on gloves and face shield.
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88. Endotracheal Intubation
8. During oral intubation if cervical spine is not injured,
place patient’s head in a “sniffing” position (ie,
extended at the junction of the neck and thorax and
flexed at the junction of the spine and skull).
9. Spray the back of the patient’s throat with anesthetic
spray if time is available.
10.Ventilate and oxygenate the patient with the
resuscitation bag and mask before intubation.
11.Hold the handle of the laryngoscope in the left hand
and hold the patient’s mouth open with the right hand
by placing crossed fingers on the teeth.
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89. Endotracheal Intubation
12.Insert the curved blade of the laryngoscope along the
right side of the tongue, push the tongue to the left,
and use right thumb and index finger to pull patient’s
lower lip away from lower teeth.
13.Lift laryngoscope forward (toward ceiling) to expose
the epiglottis.
14.Lift laryngoscope upward and forward at 45-degree
angle to expose glottis and visual vocal cords.
15.As the epiglottis is lifted forward (toward ceiling), the
vertical opening of the larynx between the vocal cords
will come into view
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90. Endotracheal Intubation
16.Once vocal cords are visualized, insert tube into the
right corner of the mouth and pass the tube while
keeping vocal cords in constant view.
17.Gently push the tube through the triangular space
formed by the vocal cords and back wall of trachea.
18.Stop insertion just after the tube cuff has disappeared
from view beyond the cords.
19.Withdraw laryngoscope while holding endotracheal
tube in place. Disassemble mask from the
resuscitation bag, attach bag to ET tube, and
ventilate the patient.
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91. Endotracheal Intubation
20. Inflate cuff with the minimal amount of air required to occlude the
trachea.
21. Insert bite block if necessary.
22. Ascertain expansion of both sides of the chest by observation and
auscultation of breath sounds.
23. Record distance from proximal end of tube to the point where the
tube reaches the teeth.
24. Secure tube to the patient’s face with adhesive tape or apply a
commercially available endotracheal tube stabilization device.
25. Obtain chest x-ray to verify tube position.
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92. Endotracheal Intubation
• FOLLOW-UP PHASE
1.Record tube type and size, cuff pressure, and
patient tolerance of the procedure. Auscultate
breath sounds every 2 hours or if signs and
symptoms of respiratory distress occur.
Assess ABGs after intubation if requested by
the health care provider.
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93. Endotracheal Intubation
• ABGs may be prescribed to ensure adequacy
of ventilation and oxygenation. Tube
displacement may result in extubation (cuff
above vocal cords), tube touching carina
(causing paroxysmal coughing), or intubation
of a mainstem bronchus (resulting in collapse
of the unventilated lung).
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94. Endotracheal Intubation
2. Measure cuff pressure with manometer;
adjust pressure. Make adjustment in tube
placement on the basis of the chest x-ray
results.
• The tube may be advanced or removed
several centimeters for proper placement on
the basis of the chest x-ray results.
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95. Complications of
ET or tracheostomy tubes
Laryngeal or tracheal injury
1. Sore throat, tracheal injury
2. Glottic edema
3. Ulceration or necrosis of tracheal mucosa
4. Vocal cord ulceration, granuloma or polyps
5. Vocal cord paralysis
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96. Complications of
ET or tracheostomy tubes
Laryngeal or tracheal injury
6. Past extubation tracheal stenosis
7. Tracheal dilation
8. Formation of tracheal-esophageal fistula
9. Formation of tracheal-arterial fistula
10.Innominate artery erosion
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97. Complications of
ET or tracheostomy tubes
Pulmonary infection and sepsis
Dependence on artificial airway
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98. Specialist Group Hospital and
Trauma Center
Intensive Care Unit Department
Presentation
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Louie Ray Roldan, R.N.
SGHTC – ICU Senior Staff Nurse
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