This document discusses the case of a 27-year-old male who was brought to the emergency department unconscious after having an argument at home. On examination, he was found to have pinpoint pupils, increased muscle tone, and other signs suggestive of organophosphate or carbamate poisoning. The document then goes on to discuss in detail the management of organophosphate poisoning, including decontamination, use of atropine and pralidoxime, and monitoring for intermediate syndrome. Common organophosphate compounds and their mechanism of action via acetylcholinesterase inhibition is also explained.
Organophosphate poisoning is poisoning due to organophosphates (OPs). Organophosphates are used as insecticides, medications, and nerve agents.
Symptoms include increased saliva and tear production, diarrhea, vomiting, small pupils, sweating, muscle tremors, and confusion.
Other names: Organophosphate toxicity
Causes: organophosphates
by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
Founder Chairman.....
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA
This presentation deals with buprenorphine drug profile, from a clinical pharmacist perspective.
Summarized version of drug, including chief ADRs, interactions, and patient and health-care professional counselling tips have been mentioned.
Organophosphate poisoning is poisoning due to organophosphates (OPs). Organophosphates are used as insecticides, medications, and nerve agents.
Symptoms include increased saliva and tear production, diarrhea, vomiting, small pupils, sweating, muscle tremors, and confusion.
Other names: Organophosphate toxicity
Causes: organophosphates
by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
Founder Chairman.....
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA
This presentation deals with buprenorphine drug profile, from a clinical pharmacist perspective.
Summarized version of drug, including chief ADRs, interactions, and patient and health-care professional counselling tips have been mentioned.
Organophosphate Poisoning Treatment - port headland doctor teaching (31-1-12)Bishan Rajapakse
This is an educational talk about the treatment of organophosphorus poisoning (OP) based upon a talk given at the Australasian college of Emergency Medicine, Annual scientific sessions Nov 2010, canberra. If you liked this presentation; please also check out this page created by one of my senior colleagues (and watch the video) :- http://curriculum.toxicology.wikispaces.net/2.2.7.4.5+Organophosphates
Learn more: https://www.brainlab.com/iplan-rt
iPlan® Monte Carlo dose calculation offers fast, accurate dose calculations for more precise treatment of extracranial indications—expanding SBRT treatment possibilities. iPlan Monte Carlo performs dose calculations within seconds for conformal beam and dynamic arc treatments and within minutes for complex IMRT cases. Seamless integration allows for use with all major linear accelerators and multi-leaf collimator (MLC) types. This advanced calculation method eliminates treatment area restrictions of conventional dose calculation algorithms for highly precise treatment delivery to inhomogeneous regions including lung and head & neck indications.
David Collins gives an excellent lecture on Toxicology at the Sydney Intensive Care Network meeting for the Intensive Care Network (www.intensivecarenetwork.com). The podcast to go with this can be found on iTunes (Oli Flower's ICU Podcasts) or on www.intensivecarenetwork.com
Organophosphate poisoning national guidelinecharithwg
publication by Dr-C.Here the given information are based on recommendations by sri lankan medical specialists who have dealt with the issue for a long time. it is quite obvious using agro chemical to deliberate self harm is a tendency in developing countries. it is common in agricultural ares.all the information are correct according to my knowledge. all the materials used to publish the slideshow are international publications. you have the full right to download and read. my personal request is to submit your ideas to me. and suggest different topics. i like to see your responses. i hope you would manage patients like these some day though it is so sad to see such incidents. be confident. do good. do not harm. be kind. keep us in your memories.
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
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
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
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.
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!
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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.
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
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.
Evaluation of antidepressant activity of clitoris ternatea in animals
Organophosphorus poisoning
1. Dr Manazir
Dept of Anaesthesiology & Critical Care
Jawaharlal Nehru Medical College
AMU, Aligarh
2. Raju a 27 yr old male, brought to casualty at
1:00 am with history of sudden loss of
consciousness in his room after having a
family quarrel.
He had 4 episodes of non-bilious vomiting.
No h/o blood in vomitus.
H/O of incontinence of urine and faeces.
H/O Alcoholism
4. Pupils: B/L pinpoint, non reacting to light
Tone: Increased
Power: Movement Against gravity
Plantar reflex: Non elicitable
Bowel sounds: Exaggerated
Normal
Size..???
10. They can be classified as three categories:
A. Derivatives of phosphoric (H3PO4), phosphorus
(H3PO3) & phosphinic acid (H3PO2) e.g
dichlorvos, glufosinate
B. Derivatives of phosphine (PH3).
C. Derivatives of phosphorothioates(c=s) e.g diazinon,
parathion, and bromophos
11. • Nerve agents
• Insecticides
• Glaucoma treatments
• Myasthenia gravis
• Potential uses in alzheimer’s disease and dementia
13. Organophosphates vs. Carbamates
Organophosphates Carbamates
Cholinesterase Non-reversible reversible
Symptoms Vomiting, diarrhea, exhaustion,
convulsion, miosis
Atropine yes Yes
Aging of enzyme Yes No
2-PAM Yes, within a few
hours
No
23. 88% of patients initially deny any exposure history.
Petroleum or garlic-like odor.
If doubt exists a trial of atropine (0.01 to 0.02
mg/kg) may be employed
The absence of s/s of anticholinergic effects
following atropine challenge strongly supports the
diagnosis .
26. Red cell acetylcholinesterase inhibition is a good
marker of severity
Red cell ACEs ≥ 30% - normal muscle function,
no atropine
Less than 10% - deranged funct., high dose
atropine
Between 10-30%- moderate impairment and need
for atropine.
Recovers @ 1% per day
27. Plasma butyrylcholinesterase activity does not
relate to severity of poisoning
More easily performed
A depression of 25% or more – severe .
Recovers @ 7% per day
28. These enzymes facilitate the decision
about
When to stop oxime and
Allow cautious weaning of a patient
30. 1. Check airway, breathing, circulation.
2. Monitor Vitals and cardiac rhythm
3. Look for signs & symptoms
4. Obtain IV access
5. Remove contaminated clothes & wash the
skin thoroughly with soap & water.
Management of organophosphate
poisoning
31. 6. Atropine intravenously as soon as possible for
symptomatic patient
7. Pralidoxime (Reactivator)
8. Gastric lavage once the patient is stabilized &
within 2 hours of ingestion with activated
charcoal (50 g in 200 ml)
9. Maintenance atropine infusion
32. Wash at least 3 times with soap (containing
chlorhexidine and alcohol) and water, paying
particular attention to hair, skin folds and
underneath nail beds.
33. Gastric lavage decreases absorption by 42% if
done within 20 min
By 16% if performed at 60 min
Choice of fluid is tap water @ 5-10 ml/kg
Performed by first aspirating the stomach and
then repetitively instilling & aspirating fluid
34. Lateral position better - delays spont.
Absorption
No evidence that larger tube better
Preferably done on awake patients
ET tube preferred if GCS is low.
35. Start with 1.8-3.0 mg fast iv bolus
After 3-5minutes check
1. Bronchorroea & bronchospasm
2. Bradycardia ( <60 )
3. Miosis
4. Excessive sweating
5. Hypotension
If not corrected double the dose of atropine every
5 minutes until signs of atropinization.
36. 1. Clear chest on auscultation with no wheeze
2. Heart rate >80 beats/min
3. Pupils no longer pinpoint
4. Dry axillae
5. Systolic blood pressure >80 mmHg
37. D5 + 10-20% of the total initial dose of
atropine on an hourly basis. (after
stabilization)
STOP atropine infusion if features of toxicity
42. 1. Acute cholinergic crisis
2. Intermediate syndrome (IMS)—major cause
of morbidity and mortality
3. Delayed neuropathy
43. Excess acetylcholine at NMJ causes downregulation
of nicotinic receptors- muscles affected
Inadequate oxime therapy,
Respiratory failure without muscarinic signs
Muscle necrosis,
Failure of postsynaptic acetylcholine release, and
oxidative stress-related myopathy.
44. C/F typically occur within 24 to 96 hours &
persists for 4-18 days
Affecting conscious patients without cholinergic
signs, and
Involve the muscles of respiration, proximal
limb muscles, neck flexors, and muscles
innervated by motor cranial nerves
45. Assess flexor neck strength regularly (head
lift & hold against resistance)
Weakness is a sign of peripheral respiratory
failure (intermediate syndrome).
TV checked every 4 hrly.
TV< 5 mL/kg / VC<15 mL/kg, PaO2<
60mmHg on FiO2 of >60% or apnoeic spells
suggest mechanical Ventilation need.
46. 1. Organophosphate induced delayed neuropathy
(OPIDN)
o 2-3 weeks after large dose
oPeripheral/distal neuropathy (proximal sparing)
oDue to inhib Neuropathy Target Esterases (NTE)
oRecovery can take up to 12 month
2. Chronic organophosphate induced
neuropsychiatric disorder (COPIND)
48. Prophylactic diazepam shown to decrease
neurocognitive dysfunction after poisoning.
Diazepam 0.1-0.2 mg/kg IV, repeat as necessary if
seizures occur.
Phenytoin has no effect on organophosphate agent-
induced seizures.
49. FRUSEMIDE – for persistent pulmonary
oedema after full atropinization.
50. Magnesium
Reduces acetylcholine release
Block pre-synaptic calcium channel
Clonidine
Decrease the presynaptic synthesis and release of acetylcholine
(Central > peripheral synapse)
NaHCO3
Reversible Ach esterase - pyridostigmine
Glutamate antagonist
54. It is a dual chamber autoinjector
1. Atropine sulfate and
2. Pralidoxime
Only effective against the nerve agents tabun
(ga), sarin (gb), soman (gd) and vx.
55. A newer model, the ATNAA (Antidote
Treatment Nerve Agent Auto-Injector),[1]
Has atropine and the pralidoxime in one
syringe
56. Signs &
Symptoms
Atropine Dose 2-PAM Dose
Severe Respiratory
Distress,
Agitation
3 Auto-injectors (6
mg)
Monitor every 5
minutes
3 Auto-injectors
(1.8 gms)
Mild Respiratory
Distress
2 Auto-injectors (4
mg)
Monitor every 10
minutes
1 Auto-injector
(600 mg)
Asymptomatic
None
Monitor for signs &
symptoms
every 15 minutes
none
57. Read the label before
selecting and applying
any pesticide.