Critically ill patients requiring noninvasive or invasive ventilation often present to emergency departments, and due to hospital crowding and constrained critical care services, may remain in the emergency department for a prolonged duration. Compared with their intensive care unit counterparts, emergency department clinicians may have variable exposure to management of this patient population and may lack knowledge and expertise, particularly in their
longitudinal management beyond initial stabilization. This
review has discussed several key aspects of management
of noninvasive and invasive ventilation, with a particular emphasis on initiation and ongoing monitoring priorities,
and focused on maintaining patient safety and improving
patient outcomes.
An excellent tool to treat refractory hypoxia. Target audience are ICU junior physicians and Respiratory Therapists. It will take away the fear of "What is APRV?" from your hearts and you will feel ready to give it a try.
An excellent tool to treat refractory hypoxia. Target audience are ICU junior physicians and Respiratory Therapists. It will take away the fear of "What is APRV?" from your hearts and you will feel ready to give it a try.
Presentation of Dr. Dean Hess at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
Laboratory management in kamboj Haryana SIGMA DIAGNOSTICS Satish Kamboj
LABORATORY MANAGEMENT
This concise summary of the most common clinical laboratory management topics emphasizes the need for the entry-level laboratory practitioner to be aware of the financial, personnel, operational, and marketing issues affecting the laboratory in order to successfully perform and compete in the rapidly changing health care environment. Using examples, case studies, and commentaries, this book covers all topics relevant to laboratory management, including professionalism, ethics, employment interviews and selection, diversity, stress management, team building, communication and interpersonal relationships, public relations, scheduling, quality control, information systems, and legal considerations. Medical technologists and clinical laboratory scientists with less than 3 years' experience would benefit from this discussion of basic management topics.
As diarrheal fluid is rich in sodium, bicarbonate and potassium diarrhea leads to hypokalemic hyperchloremic metabolic acidosis with dehydration. Mild dehydration: up to 5% total body water (2 to 3L in 70kg man) Normal mental state, dry mucous membranes, usually thirsty, blood pressure and heart rate normal, lower than normal urine output and skin turgor almost normal.
Moderate dehydration: 5-10% total body water (4 to 5 L in 70kg man) Disinterest in surrounding, can be drowsy, increased heart rate and respiratory rate, orthostatic hypotension, decreased skin turgor and reduced urine output
Severe dehydration: 10-15% total body water (7 to 8 L in 70kg man) Reduced conscious level, fast heart rate, low blood pressure, respiratory distress and oliguria/anuria
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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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
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.
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.
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of 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
2. Non Invasive Ventilation(NIV)
ventilation to the lungs without
•Delivery of(endotracheal or tracheostomy) an invasive
airway
effects of intubation or
•Avoid the adverse(early and late)
tracheostomy
3. Types of NIV
•Negative pressure ventilation (iron or tank-chest cuirass)
•Abdominal Displacement(Pneumobelt-Rocking bed)
•Positive pressure ventilation(pressure BIPAP- CPAP,Volume)
4. Negative Pressure Ventilation (NPV)
• Negative pressure ventilators apply a negative pressure
intermittently around
the patient’s body or chest wall
•
The patient’s head (upper airway) is exposed to room air
•
An example of an NPV is the iron lung or tank ventilator
5. Function of Negative Pressure Ventilators
• Negative pressure is applied intermittently to the thoracic area
resulting in a pressure drop around the thorax
negative pressure is transmitted to the pleural
• This creating a pressure gradient between the insidespace and
alveoli
of the lungs
and the mouth
• As a result gas flows into the lungs
6. Benefits of Using NPPV
•
•
•
NPPV provides greater flexibility in initiating and removing mechanical
ventilation
Permits normal eating, drinking and communication with your patient
Preserves airway defense, speech, and swallowing mechanisms
Benefits of Using NPPV Compared to Invasive Ventilation
•
•
•
Avoids the trauma associated with intubation and the complications
associated with artificial airways
Reduces the risk of ventilator associated pneumonia (VAP)
Reduces the risk of ventilator induced lung injury associated with high
ventilating pressures
7. Other Benefits of Using NPPV
•
•
Reduces inspiratory muscle work and helps to avoid respiratory muscle
fatigue that may lead to acute respiratory failure
Provides ventilatory assistance with greater comfort, convenience and
less cost than invasive ventilation
•
Reduces requirements for heavy sedation
•
Reduces need for invasive monitoring
8. clinical Benefits of Noninvasive Positive Pressure Ventilation
ACUTE CARE
• Reduces need for intubation
• Reduces incidence of nosocomial pneumonia
• Shortens stay in intensive care unit
• Shortens hospital stay
• Reduces mortality
• Preserves airway defenses
• Improves patient comfort
• Reduces need for sedation
CHRONIC CARE
• Alleviates symptoms of chronic hypoventilation
• Improves duration and quality of sleep
• Improves functional capacity
• Prolongs survival
9. Potential indicators of success in NPPV use
Younger age
Lower acuity of illness (APACHE score)
Able to cooperate, better neurologic score
Less air leaking
Moderate hypercarbia (PaCO2 >45 mmHG, <92 mmHG)
Moderate acidemia (pH <7.35, >7.10)
Improvements in gas exchange and heart respiratory rates within first
2 hours
10. Indication ,Signs and Symptoms ,and Selection Criteria for Noninvasive Positive
Pressure Ventilation in Acute Respiratory Failure in Adults
Indications
Signs and Symptoms
Acute exacerbation of chronic obstructive
Selection Criteria
Moderate to severe dyspnea
PaCO 2 > 45 torr , PH <
7.35
pulmonary disease(COPD)
Acute asthma
RR > 24 breaths/min
or
Use of accessory muscles
<200
Hypoxemic respiratory failure
Community – acquired pneumonia
Cardiogenic pulmonary edema
Immunocompromised patients
Postoperative patients
Postextubation (weaning) status
“Do not intubate”statuse
Paradoxical breathing
PaCO2 / F1 O2
11. Contraindications to NPPV
Cardiac or respiratory arrest
Nonrespiratory organ failure
Severe encephalopathy (eg, GCS <10)
Severe upper gastrointestinal bleeding
Hemodynamic instability or unstable cardiac arrhythmia
Facial or neurological surgery, trauma, or deformity
Upper airway obstruction
Inability to cooperate/protect airway
Inability to clear secretions
High risk for aspiration
12. Exclusion Criteria for Noninvaseive Positive Pressure Ventilation
1. Respiratory arrest or need for immediate intubation
2. Hemodynamic instability
3. Inability to protect the airway (impaired cough or
swallowing)
4. Excessive secretions
5. Agitated and confused patient
6. Facial deformities or conditions that prevent mask from
fitting
7. Uncooperative or unmotivated patient
8. Brain injury with unstable respiratory drive
9. Untreated pneumothorax
13. Indication , Symptoms ,and Selection Criteria for Noninvasive Positive Pressure
Ventilation in Chronic Disorders
Indications
Restrictive thoracic disorders
Symptoms
Selection Criteria
Fatigue
Muscular dystrophy
<=88% for 5 consecutive
Multiple sclerosis
Amyotrophic lateral scloresis
Kyphpscoliosis
predicted
Post-polio syndrome
Stable spinal cord injuries
Severe stable chronic obstructive
mm Hg
Pulmonary disease (COPD)
PaCO 2 >= 45 mm Hg
Dyspnea
Nocturnal SpO 2
Morning headache
Hypersomnolence
minutes
MIP < 60 cm H 2
Cognitive dysfunction
After optimal therapy with
FVC < 50%
PaCO 2 >55
bronchodialators, O 2 , and other
PaCO2 50 to
therapy , COPD patients must
for 5
54 mm Hg with SpO2 <88%
consecutive minutes
demonstrate the following :
54 mm Hg with recurrent
Fatigue
hospitalizations for hypercapnic
Dyspnea
respiratory failure (morethan two
Morning hedache
PaCO2 50 to
14.
15. Continuous Positive Airway Pressure – CPAP
of noninvasive support is CPAP
• Another formthrough a mask-type device that is
usually applied
• CPAPadoes not actually provide volume change nor does it
support patient’s minute ventilation
• However, it is often grouped together in discussions about
noninvasive ventilation
16. CPAP
• CPAP is most often used for two different clinical situations
is a common therapeutic
• First, CPAPobstructive sleep apnea technique for treating
patients with
is used
to help improve
• Second, CPAP examplein the acute care facilitycongestive heart
oxygenation, for
in patients with acute
failure (more on this later)
17. Mask CPAP in Hypoxemic Failure
Recruits lung units
•
•
•
improved V/Q matching > rapid correction of PaO2 & PaCO21
increased functional residual capacity
decreased respiratory rate and WOB2
Reduces airway resistance2
Improves hemodynamics in pulmonary edema
decreases venous return
• decreases afterload and increases cardiac index (in 50%)1-4
• decreases heart rate1-3
•
Average requirement: 10cmH2O
19. Nasal Masks
Dual density
foam bridge
forehead
support
Thin flexible &
bridge
material
Respironics Contour Deluxe™ Mask
Dual flap
cushion
360°
swivel
standard
elbow
20. Full Face Masks
•
Most often successful in the critically ill patient
Double-foam
cushion
Adjustable
Forehead Support
Entrainmen
t valve
Respironics PerformaTrak® Full Face Mask
Pressure
pick-off
port
Ball and
Socket Clip
21. Nasal Pillows or Nasal Cushions (continued)
•
Suitable for patients with
– Claustrophobia
– Skin sensitivities
– Need for visibility
Respironics Comfort Lite™ Nasal Mask
22. Advantages of Nasal Masks
•
•
•
•
•
Less risk of aspiration
Enhanced secretion clearance
Less claustrophobia
Easier speech
Less dead space
Disadvantages of Nasal Masks
•
•
•
•
Mouth leak
Less effectiveness with nasal obstruction
Nasal irritation and rhinorrhea
Mouth dryness
23. Nasal vs. oronasal (full-face) masks: advantages and
disadvantages
Variables
Nasal
Oronasal
Comfort
+++
++
Claustrophobia
+
++
Rebreathing
+
++
Lowers CO2
+
++
Permits expectoration*
++
+
Permits speech•
++
+
Permits eatingΔ
+
-
Function if nose
obstructed
-
+
24. Complications Associated with Mask CPAP/NPPV Therapy
complications
Mask discomfort
Excessive leaks around mask
Pressure sores
Nasal and oral dryness or nasal
congestion
Mouthpiece/lip seal leakage
Aerophagia , gastric distention
Aspiration
Mucous plugging
Hypotension
Corrective Action
• Check mask for correct size and fit.
• Minimize headgear tension.
• Use spacers or change to another style of mask.
• Use wound care dressing over nasal bridge.
• Add or increase humidification.
• Irrigate nasal passages with saline.
• Apply topical decongestants.
• Use chin strap to keep mouth closed.
• Change to full face mask.
• Use nose clips.
• Use custom –made oral appliances.
• Use lowest effective pressures for adequate tidal volume delivery.
• Use simethicone agents.
• Make sure patients are able to protect the airway.
• Ensure adequate patient hydration.
• Ensure adequate humidification.
• Avoid excessive oxygen flow rates (>20 l/min).
• Allow short breaks from NPPV to permit directed
coughing techniques.
• Avoid excessively high peak pressures (<=20 cm H O)
2
25. Protocol for initiation of noninvasive positive pressure ventilation
1. Appropriately monitored location, oximetry, respiratory impedance, vital signs as
clinically indicated
2. Patient in bed or chair at >30 angle
3. Select and fit interface
4. Select ventilator
5. Apply headgear; avoid excessive strap tension (one or two fingers under strap)
6. Connect interface to ventilator tubing and turn on ventilator
7. Start with low pressure in spontaneously triggered mode with backup rate; pressure
limited: 8 to 12 cm H2O inspiratory pressure; 3 to 5 cm H2O expiratory pressure
8. Gradually increase inspiratory pressure (10 to 20 cm H2O) as tolerated to achieve
alleviation of dyspnea, decreased respiratory rate, increased tidal volume (if being
monitored), and good patient-ventilator synchrony
9. Provide O2 supplementation as need to keep O2 sat >90 percent
10. Check for air leaks, readjust straps as needed
11. Add humidifier as indicated
12. Consider mild sedation (eg, intravenously administered lorazepam 0.5 mg) in agitated
patients
13. Encouragement, reassurance, and frequent checks and adjustments as needed
14. Monitor occasional blood gases (within 1 to 2 hours) and then as needed
26. Steps For Initiating NPPV
1. Place patient in an upright or sitting position.Carefully explain the procedure
for noninvasive positive pressure ventilation, including the goals and possible
complications.
2. Using a sizing gauge , make sure a mask is chosen that is the proper size and fit.
3. Attach the interface and circuit to the ventilator . Turn on the ventilator and
adjust it initially to low pressure setting.
4. Hold or allow the patient to hold the mask gently to the face until the patient
becomes comfortable with it. Encourage the patient to use proper breathing
technique.
5. Monitor oxygen ( O2 ) saturation; adjust the fractional inspired oxygen ( F 1 O2 )
to maintain O2 saturation; above 90%.
6. Secure the mask to the patient . Do not make the straps too tight.
7. Titrate the inspiratory and end-expiratory positive airway pressures (IPAP and
EPAP) to achieve patient comfort ,adequate exhaled tidal volume, and
synchrony with the ventilator. Do not allow peak pressures to exceed 20 cm
H2O.
8. Check for leaks and adjust the Straps if necessary
9. Monitor the respiratory rate, heart rate,level of dyspnea, O 2 saturation ,
minute ventilation,and exhaled tidal volume.
27. Criteria for Terminating Noninvasive Positive Pressure Ventilation and
Switching to Invasive Mechanical Ventilation
•Worsening pH and arterial partial pressure of carbon dioxide
(PaCO2 )
•Tachypnea (over 30 breaths/min)
•Hemodynamic instability
•Oxygen saturation by pulse oximeter (SpO
•Decreased level of consciousnees
•Inability to clear secretions
•Inability to tolerate interface
2
) less than 90%