mapleson circuits used in anesthesia practice, are in their way out but it is as important to know the mechanism with which the gases flow to and fro through them.
mapleson circuits used in anesthesia practice, are in their way out but it is as important to know the mechanism with which the gases flow to and fro through them.
A breathing system is a device that conducts gases such as oxygen and anesthetic agents to the patient and conducts waste gases such as CO2 away.
Breathing systems are classified as
Open,
Semi-open,
Semi-closed
Closed.
Semi-closed systems are further divided into
Rebreathing Systems With CO2 Absorption,
Rebreathing Systems Without CO2 Absorption
Non-rebreathing Systems.
More simply, systems can be classified in two groups:
systems with CO2 washout (includes open and semi-open systems)
systems with CO2 absorption (includes closed and semi-closed systems).
A breathing system is a device that conducts gases such as oxygen and anesthetic agents to the patient and conducts waste gases such as CO2 away.
Breathing systems are classified as
Open,
Semi-open,
Semi-closed
Closed.
Semi-closed systems are further divided into
Rebreathing Systems With CO2 Absorption,
Rebreathing Systems Without CO2 Absorption
Non-rebreathing Systems.
More simply, systems can be classified in two groups:
systems with CO2 washout (includes open and semi-open systems)
systems with CO2 absorption (includes closed and semi-closed systems).
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
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.
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
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.
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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
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.
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
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
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!
2. Introduction
Useful in resuscitation equipment.
Remote areas where CO2 absorption not available.
Non rebreathing valve:
- It directs the FGF to the patient & releases expired air
to atmos. Or to a scavenging system.
3. VALVE TERMINOLOGY
VALVE BODY ASSEMBLY:
- It is a housing with associated internal parts including
one or more movable parts which opens,shuts or
partially obstructs one or more parts.
VALVE SEAT:
- It is a surface usually annular,with an opening which
maybe partially or completely obstructed by a movable
part to direct or obstruct the flow.
4. PATIENT PORT:
- It is the part attached to the mask or ET tube.It has
female 15mm with a concentric 22mm connector.
EXHALATION PORT:
A channel through which exhaled gas escape to atm. Or
scavenging system after passing through the valve.
5. POSITIONAL VALVE:
- It is one which must remain horizontal as it requires
gravity to close it completely.
NON POSITIONAL VALVES:
- It is closed by elastic tension or rubber or spring & may
be used in any position.
6. FLAP VALVE:
It is one in which movable part is made of flexible
material & it is secured at its centre or by its edge.
FISH MOUTH VALVE:
- Its a valve in which two flaps approximate at midpoint.
7. The flow of gases in one direction causes the flaps
open like a fish mouth.Reversal of flow prevents
retrograde flow.
8. DISC VALVE:
- Consists of flat disc made of plastic or metal.It is held
in position by gravity or by a spring.
MUSHROOM VALVE:
- It is a hollow balloon like device which when inflated
occludes the opening.
9. CLASSIFICATION OF VALVES
BASED ON MECHANICAL CHARACTERISTICS:
- Like presence or absence of springs,rubber flaps &
knife edge etc.
BASED ON FUNCTIONAL CLASSIFICATION
- Like spontaneous ,controlled or both.
- In spontaneous respiration pressure inside the valve is
negative whereas in controlled ventilation it is
positive.
10. VALVES DESIGNED FOR
SPONTANEOUS VENTILATION
During inspiration ,negative pressure closes the
expiratory valve .
During expiration,positive pressure opens the exh.
Valve.
If this used for controlled ventilation,exp.port must be
closed during inspiration.
11. VALVES DESIGNED FOR
CONTROLLED VENTILATION
Duriung insp. Positive pressure opens the inlet valve &
closes the exh. Port.
During exp. Gases escape through the exp.port.
If spontaneous ventilation is allowed pt. breathes atm.
Air .
These valves are used for resuscitation purpose.
12. VALVES DESIGNED FOR BOTH
SP/CONTROLLED VENTILATION
Also called Automatic non rebreathing valves.
In these valves exh.port is closed & insp.port is opened
whether it is spont. Or controlled.
During exh. Air escapes through unblocked exh.port &
insp.port is blocked to prevent rebreathing.
13. SPECIFIC VALVES
AMBU:
- Classification : controlled resp.
- Construction: Body is clear plastic or metal.
- Contains 2 seats .
- The movable part consists of yellow plastic disc which
is held on to the seat by a spring.
- Locating pin centres the disc.
14.
15. AMBU contd..
FUNCTION:
When bag is squeezed, the force of gas pushes the
disc against seat B closing the exh. port & allowing
gas to flow to pt.
2. During exh. The pressure on the bag side falls & the
spring pushes the disc onto seat A.
3. Gases escape through exh.port.
4. If pt.breathes spont. Air enters through exh.part.
1.
16. AMBU contd..
CARE & CLEANING:
- it can be opened & cleaned.
- Guiding pin must be inserted properly.
17. AMBU E VALVE
CLASS:
- sp/controlled.
- Construction: transparent plastic with inlet coloured
blue .
- Contains two moulded shutters – for inh. & exh.
18.
19. FUNCTION:
- -VE pressure during insp. Closes the exh. shutter& gas
is drawn through inlet shutter.
- During contro. Venti. Positive pressure opens insp.
Shutter & occludes exh.shutter.
- During exp. Insp. Shutter collapses & exp. Shutter
opens.
20. If there is overflow both shutters open & vent the gases
-
-
out.
EVALUATION:
Resistance : 0.6 – 0.25.
Dead space: 10ml.
Back flow: 9% of TV.
21. AMBU E2 VALVE
CLASSIFICATION: SPONT/CONTROLLED.
Construction: clear plastic body with 1 shutters.
No exhalation shutter.
FUNCTION:
- -ve pressure during inh. Opens inh. Shutter & also air is
drawn from exh. Channel .
22.
23. It is mixture of FGF & air.
During controlled venti.,during insp. Insp.shutter
occludes the exp. Channel & gases go to the pt.
During exh.insp. Shutter closes & gases go out.
24. EVALUATION:
- RESISTANCE: not available.
- DEAD SPACE: 10ml.
- BACK FLOW: 9%.
CARE & CLEANING:
- It can be disassembled ,cleaned with soapwater or
sterilizing solution.parts can be boiled or autoclaved.
25. AMBU HESSE
It is similar to ambu E2 valve but bigger in size.
EVALUATION:
- resistance :0.2 -0.9 cmH2O.
- Back flow :7.3% of TV.
26. FINK VALVE
CLASSIFICATION: SPONT/CONTROLLED.
CONSTRUCTION:body made of metal.
- A flexible diaphragm is positioned above the exh.port.
- A pressure tube leads from the inlet side of the
insp.flap valve to the space above the diaphragm.
27.
28.
29. This space can communicate to the atm.through a
vent.
At the top of the valve an adjustable knob which is
connected to rotating disc.
Knob turned max. counterclock wise,pressure tube
communicates with the space above the diaphragm&
vent to atm. Is closed.
30. If the knob is turned clockwise disc closes the pressure
tube & vent.
At an intermediate position vent & pressure tube are
partially closed .
FUNCTION:
- spont: knob is turned clockwise ,insp.-ve pressure
opens the insp.flap valve & closes the exp.flap valve.
31. - During exh.insp.valve is closed by exhaled gas & it
escapes through exh.port.
- Cotn.ventilation:knob turned fully counter clockwise
bag squeezes the pr in the inlet inc. & it is transmitted
to the space above the diaphragm & it is pushed on to
the exp.flap. Gases go to the pt.
32. During exh.pr in the inlet dec. ,inh.flap closes
-
-
,diaphragm goes up,exh.flap opens.
EVALUATION:
DEAD SPACE:11.5CC
BACK FLOW: NO
RESISTANCE:0.5-8cmH2O.
33. CARE & CLEANING:
- Can be disassembled ,washed with water & can be
autoclaved.
34. FRUMIN VALVE
CLASSI:spont/contr.
CONSTRUCTION:
- Consists of a clear plastic body containing rubber or
silicon insp. flap & an inflating rubber valve which
covers the exh.port.
- A pr channel connects the mushroom valve with
inlet.
35.
36. FUNCTION:sp.venti.
- During insp.the insp.valve is opened & fresh air drawn
towards the pt.
- Normal resting position of the M valve seals off the
exp.port.
- During inadequate gas flow the –ve pr during insp.
Collapses the M valve & exp.port is also opened & atm.air is
drawn in.
37. During contr.venti. The pr in the inlet & M valve is
same but as the area of M valve is more it seals off the
exp.valve(prmultiplied by area).
During exh. The pr at inlet drops soalso in the M valve
& insp.valve is closed & gases go out.
39. LAERDAL VALVE
CLASSI:spont/contr.
CONSTRUCTION:
- It is a clesr plastic body & yellow rubber insp.fish
mouth valve with a circular flange .
- A circular exh.flap valve occludes the exh.port.
FUNCTION: SP.
- During insp. Fish mouth valve allows air to go to the pt.
40.
41.
42. - exh. Flap prevents inh.of room air.
- During exh.fish mouth valve closes ,gas escapes
through exh.port.
- contr. Same as above.
EVALUATION:
- RESISTANCE:0.3-2.8CMH2O.
43. CARE & CLEANING:
- Can be disassembled,cleaned with water,chemicals
,can be autoclaved.
44. LEWIS – LEIGH VALVE
CLASSI: sp/contr.
CONSTRUCTION:
- Consists of a clear plastic body with a chimney which
can be rotated by 90degrees.
- This changes the position of exh.valve seat at the
bottom of the chimney.
- A disc type valve is located at the top of the
exh.chimney.
45.
46. FUNCTION:
- Spont. vent: if flap valve is rotated counter clockwise
,insp.gas goes to the pt. Disc valve prevents fresh air
entry to th pt .During exp.flap valve seat & gas goes to
the chimney.
- Contr.venti: chimney is rotated clockwise
90degrees,the flap valve can seat on either the ridge or
the body or lower edge of chimney.
47. - During insp. Flap valve blocks exh.valve, gas goes to
the pt.
- During exp.the flap valve seats on the ridge of the body
allowing the gas to the chimney & gas goes out
through disc valve.
- During overflow – both valves are opened.
48. RUBEN VALVE
CLASSI: sp/contr.
CONSTRUCTION:
- Clear plastic body with metal fittings .
- Blue- inlet .
- Red -patient
- Gold -outlet.
- Inside the body ,a spool shaped piston held on to a
seat A by a spring.
49.
50. - A disc type valve is near the exh.port.
FUNCTION:
- CONTR.VENTI – during insp. The piston is pushed to
right against seat B .
- Gas enters the pt.
- Exp.valve prevents the rush of atm.air.
- During exp. ,as the pr drops the spring pushes the
piston against the seat A & exp.valve opens.
51. Spont.vent:
- exp. Valve will not be there .
- Pt. takes atm air.
EVALUATION:
- RESISTANCE: 0.8-1CMH2O.
- Back leak :5%.
- Dead space : 9ml.
52. DISADVANTAGES:
- Clicking noise.
- Sticking of valve in insp. Position.
- Sticking of bobbin & exh.valve.
CARE & CLEANING:
- Cleaned by flushing with soap water,chemical solutins.
Deteriorates when exposed to heat .
- Can be gas sterilised .
53. STEPHEN – SLATER VALVE
CLASSI: spont.
CONSTRUCTION:
- Valve body made of metal.
- Has 2 rubber flaps each secured by a shaft at centre .
FUNCTION:
- insp. –ve pr opens the inh. Flap valve allowing the gas
to the pt.
54.
55. - -ve pr keeps the exh.flap closed.
- Exp. -- posi pr opens the exp. Valve & closes the insp
-
flap.
EVALUATION:
RESISTANCE – 1.75CMH2O.
DEADSPACE – 10CC.
BACKLEAK – 30CC WITH 500ML TV.
56. DISADVANTAGES:
- With prolonged & repeated use,exp.leaf may curl &
allow air dilution.
CARE & CLEANING:
- Can be washed ,gas sterilised .
- Rubber valves should not be autoclaved or boiled.
57. HEIDBRINK VALVE
APL valve, exp valve or pop off valve.
It allows expired air and surplus gases to go out without
permitting entry of outside air even during –ve phase.
The pr required to open valve must be low.
It should not allow spont collapsing of R bag.
58. CLASSI: spont/contr.
CONSTRUCTION:
- Metal structure with a disc & spring .
- Disc rests on a “knife edge” seating.
- It has a stem to ensure proper position.
- Clockwise closure ,anticlockwise open.
- Screw down fully closes the valve.
- Small grub screws & a groove prevents falling of the
valve.
61. Advantages of unidirectional valves
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
CO2 Absorption system avoided
Light weight
Compact
Mobile
Inexpensive
Simple
Minute volume can be estimated
Less dead space, less resistance, less rebreathing
Composition of delivered and inspired gas is same
Better feel of lungs
62. Disadvantages of unidirectional valves
1.
2.
3.
4.
5.
6.
7.
8.
9.
Large volumes of inspired mixture leading to O.T.
pollution
Higher cost , Explosion
Noisy and sticky valves
Some times two hands may be needed to ventilate
Cleaning and sterilisation is some what difficult
Valves must be located near the patient possible
disconnection of E.T.tube
Increased resistance with higher flows
Some rebreathing can occur
Some difficulty to use with scavenging systems
63. Disadvantages of unidirectional valves
10. No standardisation among the valves
11. More dead space in some valves in pediatric patients
12. Fresh gas flow must be matched to minute volume.