This document discusses non-invasive guided goal-directed therapy (GDT) for hemodynamic monitoring and optimization. It describes using a bedside monitor to continuously and non-invasively estimate cardiac output and stroke volume based on pulse wave transit time analysis of ECG and pulse oximetry signals. The method is calibrated using intermittent non-invasive blood pressure readings. Studies show this approach can guide fluid administration and help achieve hemodynamic goals like those used in invasive GDT protocols to improve outcomes. The document provides details on set up, use, and limitations of this non-invasive GDT method for perioperative hemodynamic optimization.
SOLACI Chile Congress 2011. Dr.Ajay Kirtane. Drug-Eluting Stents for Multivessel PCI: Indications and Outcomes. Find more presentations on the web site: www.solaci.org/
Six angiographic indicators of large thrombus burden by
Yip and colleagues,depending upon the angiographic morphology are
features indicated “high-burden thrombus formation”:
1. A cut-off pattern of occlusion
2. Accumulated thrombus proximal to the occlusion
3. A reference lumen diameter of the IRA of >4.0 mm
4. An incomplete obstruction with an angiographic thrombus with
the greatest linear dimension more than 3 times the reference
lumen diameter
5. The presence of floating thrombus proximal to the lesion
6. A persistent dye stasis distal to the occlusion
SOLACI Chile Congress 2011. Dr.Ajay Kirtane. Drug-Eluting Stents for Multivessel PCI: Indications and Outcomes. Find more presentations on the web site: www.solaci.org/
Six angiographic indicators of large thrombus burden by
Yip and colleagues,depending upon the angiographic morphology are
features indicated “high-burden thrombus formation”:
1. A cut-off pattern of occlusion
2. Accumulated thrombus proximal to the occlusion
3. A reference lumen diameter of the IRA of >4.0 mm
4. An incomplete obstruction with an angiographic thrombus with
the greatest linear dimension more than 3 times the reference
lumen diameter
5. The presence of floating thrombus proximal to the lesion
6. A persistent dye stasis distal to the occlusion
Effective, non-invasive cardiac output with good comparison and concordance with ODM.
In Pre-op setting allows advanced cardiac assessment, Inotropy appears to correlate with AT and enables effective use of CVS medication.
Dr. Roberto Machado from the University of Illinois at Chicago presented an update on PAH at a Patient Education Conference on March 15, 2014 hosted by the Scleroderma Foundation, Greater Chicago Chapter.
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.
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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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
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
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
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
8. CardioprotectionPrevention of myocardial ischemia has traditionally focused on maintaining
Myocardial oxygen balance
Heart rate
contractility
afterload
CBF: normal region
CBF: ischemic region
subendocardium
Ischemia
Beta-blocker
Alpha2 agonist
Ca-channel blocker
9. Introduction
Physical Findings (Non-specific)
Clinical signs of hypovolemia are neither sensitive nor specific in the critically ill patient.
Increased sympathetic tone
- Tachycardia, hyperpnea,
- Diaphoresis
Decrease organ perfusion
- Decrease urine output, ileus,
- Altered sensorium,
- Lactic acidosis
- Hypotension occurs late
26. esCO = K × (α × PWTT + β) × HR
α is an experimental constant,
β is calculated based on Pulse-Pressure of IBP or NIBP,
K is calculated based on a given CO value.*
esSV
32. Response to increase
cardiac load obtained
by leg elevation
The ability of the
heart to improve its
performance via
Frank-Starling
mechanism
Anesth Analg 2006;103:289 –96
33. SevofluranePropofol
Anesthetic Induced Physiological Change
Length-dependent Regulation of Myocardial Function Anesthesiology 2001;95:357-63
Both technique: Passive leg elevation or Frank-Starring mechanism
are preserved in perioperative period.
34. DesfluranePropofol
Anesthetic Induced Physiological Change
Length-dependent Regulation of Myocardial Function Anesthesiology 2001;95:357-63
Both technique: Passive leg elevation or Frank-Starring mechanism
are preserved in perioperative period.
43. Bellamy MC. Br J Anaesth. 2006;97:755-757.
Complications
Volume Load
OPTIMAL
Edema
Organ dysfunction
Adverse outcome
Hypoperfusion
Organ dysfunction
Adverse outcome
OverloadedHypovolemic
Optimal Volume Administration
(and the impact of excessive and insufficient administration)
44. Evolution of Fluid Management
The “Conventional” approach
is trying to predict the amount of volume /
fluids needed based upon a the duration and
severity of a particular procedure
Stolting et. al. Basics of Anesthesia, 5th ed. Elsevier - China, p. 349, 200
Michard F. Changes in arterial pressure during mechanical ventilation. Anesthesiology. 2005; 103: 419-28 7
The “Restrictive” fluid approach is
based on minimizing fluids based on Blood
Pressure
“Goal-Directed Therapy” approach considers
optimizing volume / fluids via the Frank Starling Curve and individualizing to
goals
45. Early Goal-directed Therapy
Supplemental oxygen ± endotracheal
intubation and mechanical ventilation
Central venous and
arterial catheterization
CVP
Crystalloid
Colloid
<8 mm Hg
MAP
8-12 mm Hg
Vasoactive agents
<65 mm Hg
>90 mm Hg
ScvO2
≥65 and ≤90 mm Hg
Goals
achieve
d
≥70%
Hospital admission
Yes
No
Sedation and/or
paralysis
(if intubated)
Transfusion of red cells to
hematocrit ≥30%
<70%
Inotropic agents
<70%
≥70%
Rivers et al NEJM 2001;345:1368
Volume
Pressor
Inotrope
46. StaticCardiac filling pressure
Marik P E et al. Chest 2008;134:172-178Osman D. Crit Care Med 2007; 37:64-8
Preload ≠ Fluid Responsiveness
CVP
SVV & PPV
Dynamic
51. SVV ≥ 12 % SVV < 12 %
200 ml fluid
challenge over 5
min
Measure and record
Cardiac index (CI)
CI > 2.5 CI ≤ 2.5
Start dopamine
And titration
Until CI > 2.5
GDT group
Measure and record
SVV
Give
vasopressors
No
MAP ≥ 65
mmHg
Yes
A comparison of return of gastrointestinal function between
perioperative goal-directed therapy and traditional fluid
therapy in major abdominal surgery patients
: A prospective randomized
controlled study
52. Control GDT p Value
Age (y) 54 ± 10 58 ± 13 0.402
Body mass index (kg/m2) 21 ± 2 22 ± 3 0.097
ASA Classification 2 ± 0 2 ± 0
Operation time (min) 244 ± 97 282 ± 123 0.519
Total blood loss (ml) 850 ± 1409 900 ± 667 0.930
Fluid replacement
- Crystalloid (ml) 3144 ± 4097 1807 ± 696 0.351
- Colloid (ml) 1163 ± 650 879 ± 488 0.874
- PRC (ml) 765 ± 644 572 ± 357 0.161
- FFP (ml) 912 ± 863 755 ± 228 0.119
- Total (ml) 4135 ± 5636 3080 ± 1266 0.617
Lactate (mmol/L)
- Preoperative 1.34 ± 0.45 1.51 ± 0.68 0.560
- Postoperative 4.74 ± 3.89 3.57 ± 1.37 0.481
Return of bowel function (d) 3.0 ± 1.4 0.8 ± 0.6 0.031*
Length of stay in hospital (d) 14.0 ± 7.7 13.1 ± 6.1 0.799
A comparison of return of gastrointestinal function between perioperative goal-
directed therapy and traditional fluid therapy in major abdominal surgery patients
: A prospective randomized controlled study
62. PVI ≥ 17 % PVI < 17 %
200 ml fluid
challenge over 5
min
Estimated Cardiac index
esCCI
esCCI > 2.5 esCCI ≤ 2.5
Start dopamine
And titration
Until esCCI > 2.5
GDT group
Measure and record
PVI
Give
vasopressors
No
MAP ≥ 65
mmHg
Yes
A comparison of return of gastrointestinal function between
perioperative goal-directed therapy and traditional fluid
therapy in major abdominal surgery patients
: A prospective randomized
controlled study
University Hospital