- Oliguria is defined as urine output <400cc/day and can be caused by pre-renal, intrinsic renal, or post-renal factors.
- An initial assessment of oliguria includes verifying urine output, flushing any Foley catheter, obtaining a bladder scan if no catheter, and reviewing the patient's chart and conducting a physical exam to identify potential causes.
- Life-threatening complications of oliguria like hyperkalemia and acidosis must be promptly recognized and managed while the underlying cause is treated. Fluid boluses can be tried for pre-renal causes but lasix should generally be avoided until the etiology is clear.
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
Urolithiasis is a common disease that is estimated to
produce medical costs of $2.1 billion per year in the United States alone.
Renal colic affects approximately 1.2 million people
each year in USA and accounts for approximately 1% of
all hospital admissions.
Most active emergency departments (EDs) manage
patients with acute renal colic every day.
Most about status asthmaticus, you will find from etiology to treatment and ventilator management. This presentation is made with thanks to medscape and other resources.
Acute kidney injury (AKI) is a potentially life-threatening
syndrome that occurs primarily in hospitalized patients
and frequently complicates the course of critically ill
patient.
Acute Kidney Injury is is (abrupt) reduction in kidney functions as evidence by changed in laboratory values; serum creatinine, blood urea nitrogen(BUN)and urine output
Urolithiasis is a common disease that is estimated to
produce medical costs of $2.1 billion per year in the United States alone.
Renal colic affects approximately 1.2 million people
each year in USA and accounts for approximately 1% of
all hospital admissions.
Most active emergency departments (EDs) manage
patients with acute renal colic every day.
Most about status asthmaticus, you will find from etiology to treatment and ventilator management. This presentation is made with thanks to medscape and other resources.
Acute kidney injury (AKI) is a potentially life-threatening
syndrome that occurs primarily in hospitalized patients
and frequently complicates the course of critically ill
patient.
Acute Kidney Injury is is (abrupt) reduction in kidney functions as evidence by changed in laboratory values; serum creatinine, blood urea nitrogen(BUN)and urine output
LOWER GI HEMORRHAGE- Introduction
#surgicaleducator #babysurgeon
Dear Viewers,
Greetings from “Surgical Educator”
Today I have uploaded an introductory video on Lower GI haemorrhage. In this episode, I have talked about the various causes for lower GI bleeding, applied anatomy,History&Physical exam,investigations and management algorithm for lower GI bleeding. In the subsequent episodes in this series of videos, I will be talking about the individual causes elaborately- one in each video. You can watch this video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
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
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.
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
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
2. Definition of decreased urine output
(oliguria)
Questions to consider when first
presented with oliguria
Recognizing causes of oliguria
Focused review of history and physical
Management of oliguria
◦ Recognizing life threatening
complications
3. Oliguria = Urine output <400cc/day
(<20cc/hr)
◦ Another def: urine output <0.5ml/kg/hr
Anuria = no urine output
◦ Can signify complete mechanical
obstruction of bladder outlet or a blocked
Foley
4. Does the pt have a foley catheter?
YES NO
FLUSH FOLEY CATHETER
WITH 30-50CC NS
OBTAIN PVR (w/ US or cath
[will provide urine sample])
URINE OUTPUT IMPROVED? PVR ≥ 100? (≥ 50 in younger pts)
YESYES NO NO
FOLEY LIKELY
CLOGGED
WITH
SEDIMENT
PROCEDE
WITH
FURTHER
MANAGEMENT
START FOLEY
& PROCEDE W/
FURTHER
MANAGEMENT
PROCEED
WITH
FURTHER
MANAGEMENT
5. Consider the pathophysiology/causes of
decreased urine output. Three categories of
causes:
Prerenal:
◦ Volume depletion/dehydration/inadequate fluid
maintenance/Infection/sepsis
◦ Reduced cardiac output
ICU setting: mechanical ventilation can
also lead to low cardiac output
◦ Drugs
◦ Does the pt have liver cirrhosis
8. Review chart to look for clues that may elicit
etiology (see previous slide)
History (sepsis, CHF, tumors, renal failure…etc)
Meds: diuretics, ace,
aminoglycosides/vancomycin, iv contrast, NSAIDs
Old Labs: BUN/Cr (ratio); urine lytes; blood
cultures; vanco trough levels
9. Obtain new vitals, including orthostatics
Look for:
◦ Jaundice
◦ Crackles, pleural effusion
◦ JVP, CVP if pt has central line
Especially useful in ICU for pt with central line: for
example a CVP of 2 can be good evidence for
hypovolemia
◦ Palpate Kidneys and Bladder
◦ Prostate/Cervical Exam
◦ Rash
10. -Vitals: orthostatics can signify hypovolemia;
Tachycardia - hypovolemia/infection; Fever –
infection/UTI
-Jaundice (liver cirrhosis – hepatorenal)
-Crackles, pleural effusion (CHF, volume
overload)
-JVP, CVP if pt has central line (will help assess
fluid status)
-Palpate Kidneys and Bladder (hydronephrosis,
enlargement in obstruction/post-renal)
-Prostate/Cervical Exam (again for
obstruction/post-renal)
-Rash (AIN, embolic renal failure)
11. If not already done, order basic
electrolytes, CMP (monitor changes in
Cr/GFR), and urine studies (U/A, Na,
BUN, Cr), to further help classify etiology
Adjust/replace/discontinue and
nephrotoxic agents. Also, renally dose the
non-toxic meds
12. -Urine studies: U/A – look for proteinuria,
hematuria, eosinophilia, evidence of
rhabdomyolysis,
RBC/WBC/Granular/Pigmented/epithelial
casts…etc.
-Urine lytes: e.g. urine sodium <20
(prerenal), FENa: <1? Vs >2%/ FeUrea: <35?
-Note: On CMP look for presence and degree
of renal insufficiency.
Also look for possible complications (especially one that can
be life threatening) of renal insufficiency (e.g. hyperkalemia,
metabolic acidosis…etc).
13. Early recognition and intervention of potential
life threatening complications (direct or indirect
causes – e.g. renal failure) is essential
◦ Hyperkalemia: obtain EKG if elevated
◦ CHF/Pulmonary Edema
◦ Metabolic acidosis; Uremia (encephalopathy,
pericarditis)
◦ Advanced complications of above may require dialysis
14. Prerenal:
◦ Treat underlying cause
◦ If volume depleted (see physical exam): NS
boluses (500-1000ml fluid challenges) –
can repeat until response (but need to
monitor for fluid overload)
◦ Avoid/be very cautious about giving
lasix (again investigation of underlying
cause should drive this decision).
15. Postrenal:
◦ Treat underlying cause
◦ Initiate Foley catheter (clear/flush
catheter if already in place)
◦ Obtain Renal Ultrasound to assess for
upper urinary tract problems
Intrarenal:
◦ Treat underlying causes (e.g. sever
sepsis/shock)
16. Verify urine output w/ definition of oliguria in
mind.
If pt has a Foley catheter, flushing Foley is a
good initial step. If no Foley, a PVR can help
assess the need for Foley.
A focused chart review along with a focused
history and physical can help clue in on the
pathophysiology including pre-
renal/intrinsic/post-renal causes.
Recognizing life threatening complications (e.g.
hyperkalemia, acidosis, uremia) is an essential
component of acute/early management.
17. Decreased urine output does NOT mean
lasix deficiency. Administering lasix may
actually exacerbate problem. However very
specific causes may require lasix.
Fluid boluse(s) is a good initial step (be very
cautious in CHF).
Ultimately, regardless of pathophysiology,
treating underlying cause is key for both
acute and long term management.