Off-pump coronary artery bypass grafting (OPCAB) surgery is performed to treat coronary heart disease without the use of cardiopulmonary bypass. During OPCAB, the heart is stabilized with devices while still beating to allow graft attachments to bypass blockages. OPCAB is indicated for high risk patients who cannot tolerate cardiopulmonary bypass or who have conditions like atherosclerosis or aortic disease. The surgery involves harvesting grafts, stabilizing the heart, attaching grafts to coronary arteries while the heart is beating, and closing the chest. Intraoperative monitoring, arterial blood gases, and transesophageal echocardiography are used. Potential complications include embolism, infection, arrhythmias, and
Cardiopulmonary bypass development and history
Indication of cpb
Hardware in cpb
Arterial and venous cannulation
Oxygenator
Heat exchanger
Filter
How to conduct cpb and problems in cpb
Cardioplegia
Heart Transplantation in India, Delhi by expert surgeon Dr. Kewal Krishan. If you have know more information visit us www.kewalkrishan.com or call 91-9650300500 . Patients should receive maximal medical therapy before being considered for transplantation. They should also be considered for alternative surgical therapies including CABG, valve repair / replacement, cardiac septalplasty, etc
A very simple yet comprehensive presentation to understand the concept of CRRT and its implementation in Intensive Care Unit. Intended for the very beginners in ICU. After going through the presentation you will be able to say "Now I know it!"
Cardiopulmonary bypass development and history
Indication of cpb
Hardware in cpb
Arterial and venous cannulation
Oxygenator
Heat exchanger
Filter
How to conduct cpb and problems in cpb
Cardioplegia
Heart Transplantation in India, Delhi by expert surgeon Dr. Kewal Krishan. If you have know more information visit us www.kewalkrishan.com or call 91-9650300500 . Patients should receive maximal medical therapy before being considered for transplantation. They should also be considered for alternative surgical therapies including CABG, valve repair / replacement, cardiac septalplasty, etc
A very simple yet comprehensive presentation to understand the concept of CRRT and its implementation in Intensive Care Unit. Intended for the very beginners in ICU. After going through the presentation you will be able to say "Now I know it!"
Coronary artery bypass grafting (CABG) is a type of surgery that improves blood flow to the heart. It's used for people who have severe coronary heart disease (CHD), also called coronary artery disease.
The Norwood procedure is the first of three surgeries required to treat single-ventricle conditions such as hypoplastic left heart syndrome (HLHS). Because the left side of the heart can’t be fixed, the series of surgeries rebuilds other parts of the heart.
The Norwood procedure is performed in the baby’s first or second week of life.to redirect the blood flow.
Three goals for the Norwood procedure:
1, Build a new aorta.
2, Direct blood from the right ventricle through the new aorta and on to the rest of the body.
3, Direct the right ventricle to pump blood to the lungs until the next surgery.
This presentation is about Heart lung machine used in cardiac surgery where a machine takes over function of heart & lung so that surgeon can stop the heart and operate on it.
This presentation described about history, about various components of hear lung machine starting from cannula, tubing, reservoir, pump head, oxygenator, heater cooler unit, arterial line filter, cardioplegia delivery system, various monitors, safety devices etc.
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.
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
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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
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.
- 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
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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.
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.
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Introduction
Off-pump coronary artery bypass graft surgery is a form of
CABG(coronary artery bypass graft) surgery performed without
CPB(heart-lung machine) as a treatment for coronary heart disease.
During most bypass surgeries, the heart is stopped & a heart-lung
machine takes over the work of the heart lungs.
When a off-pump CABG is performed , the heart is still beating while
the graft attachments are made to bypass a blockage. It is also known
as “Beating Heart surgery”.
3. Indications
• Coronary artery disease requiring surgical revascularization
• High risk or contraindications for cardiopulmonary bypass and aortic
cross-clamping
• Severely atheromatous or heavily calcified aorta
• Aortic disease with risk of dissection, rupture or embolization
• Patients who can not tolerate PTCA & don’t response well to drug therapy
• Hemodynamic instability
• Impaired left ventricular function
• Acute myocardial infarction
• History of transient ischemic attacks or cerebrovascular accidents
• Impaired renal function or need for dialysis in patients with chronic renal
failure
• Patients who refuse blood transfusions
4. Contraindication
s
• Infection
• Bleeding
• Irregular heart rhythms
• Blood clots leading to stroke or heart attack
• Complications from anesthesia
• Kidney failure
• Congenetal bleeding disorder
• Valvular Heart disease
5. OPCAB tissue stabilization &heart positioning devices
Genzyme Immobilizer
utilizes a stabization platform & silastic vessel loops.
The Medtronic Octopus4 tissue stabilizer & starfish2 heart
positioner utilize vacuum suction to stabilize & position the
heart.
Illustrates silastic snares that are looped around the target
coronary vessel & then fixed to a small immobile plate , thus
directly immobilizing the target vessel.
6. OPCAB Demands
Exposure of posterior lateral wall of the heart.
Stabilization of target area.
Visualization Occlusion of the Coronary artery or Shunt.
Stable Hemodynamics.
7. Pre Operative Assessment
• For optimization of diabetes, hypertention, reactive airway & other
coexisting morbidities.
• To alley anxiety related to the procedure.
• Preoperatative assessment of the carotid arteries.
• Essential Investigation to be done : Coagulation profile, Lipid profile,
Electrolytes, Blood Grouping & Serology, Renal & Liver function tests,
CXR, ECG, Echo, USG abdomen(elderly males), PFT.
8. Intra Operative Monitoring
• ECG – lead ii & V5 – well visualized “P” wave & QRS
complex prior to commencing the surgery.
• SpO2, ETCO2
• Temperature Monitoring
• Urinary output monitoring
• Invasive blood pressure (IBP) monitoring – by radial or
femoral artery.
9. Pulmonary Artery Catheter
•Usually placed via the right internal jugular vein.
•Indication:-
•Ejection Fraction <0.4
•Significant abnormality of the left ventricular
wallmotion.
•LVEDP > 18 mm Hg at rest.
•Recent Ml & unstable angina.
10. Transesophageal echocardiography (TEE)
• Advantages:-
• Identify myocardial ischemia early by detecting regional wall
motion abnormalities.
• Assess left ventricular dysfunction intra operatively.
• Assessing the improvement in myocardial function after the
completion of revascularization.
• Disadvantage:-
• Inability to image the required part of the heart during
grafting.
11. Arterial Blood Gas Test
(ABG)
• Check for severe breathing and lung problem such as Asthma , Cystic
Fibrosis, Chronic obstructive pulmonary disease or obstructive sleep apnia.
• Check how treatments for lung problems are working
• Check whether you need extra oxygen or other help with breathing.
• Check your acid-base balance. You can have too much acid in your
body from kidney failure, a severe infection, specific toxic ingestions,
or complications of diabetes.
12. Steps OF OPCAB
• Position : Supine
• Anaesthesia : General Anaesthesia with Endotracheal tube.
• Incision : Median sternotomy
Procedure
Surgical skin prepare (shaving,draping,dressing) is done.
A vertical incision is given at the center of the chest.
Chest is opened via median sternotomy.
Thoracotomy is done creating a 6-8 inch incision.
14. The grafts are being hervested.
Blood vessels can be as graft from leg(saphenous vein) ,internal mammary artery ,radial artery.
After thoracotomy a incision is given to pericardium to reveal the beating heart.
After hervesting patient is given heparine to prevent blood clots
Then a stabilizer is attached to stabilize the desired place.
A perfusionist must be present there to connect the CPB if any emergency situation occurs.
After this the reserved graft is anatomose to the coronary artery with 70 polipropiine suture.
15. Pericardium is properly closed with suture.
Chest tubes are placed in the mediastinum & plural space to drain blood from and around heart & lungs.
After completing instrument counting sternum is closed with alluminium wire & the incisions are closed with suture.
Clossure of every incision is done.
Dressing is done.
OPCAP successfully performed