first episode of syncope, should we do workup for Pulmonary embolism well simplified criteria D dimer level CT angiogram ventilation perfusion scanning
step by step approach to arterial blood gas analysisikramdr01
The document provides step-by-step information on interpreting an arterial blood gas (ABG) report. It describes the normal ranges for pH, PCO2, PO2, and other components in an ABG. It then explains how to identify metabolic vs respiratory acidosis and alkalosis based on changes in pH, PCO2, and HCO3 levels. The document also summarizes compensation mechanisms and gives formulas to predict expected pH and HCO3 levels based on primary acid-base disturbances.
This document discusses cerebral blood flow and its regulation. It begins with an introduction to the components inside the skull and the Monro-Kellie doctrine. It then covers the anatomy of brain circulation discovered by Willis in 1664, including the anterior and posterior circulations and collateral pathways. Regulation of cerebral blood flow is achieved through hemodynamic autoregulation, metabolic and chemical mediators, neural control, and circulatory peptides. Clinical measurement techniques include laser Doppler flowmetry, transcranial Doppler, and imaging modalities like CT, MRI, PET, and SPECT. Factors like age, hypertension, and failure of autoregulation can impact cerebral blood flow and its regulation.
The document discusses various aspects of mechanical ventilation settings that impact patient-ventilator synchrony and work of breathing. These include:
1. Rise time, which is the rate of pressure rise during inspiration. Slower rise times can reduce work of breathing.
2. Expiratory sensitivity, which determines the point at which expiration is triggered. Adjusting this setting to account for leaks can improve synchrony.
3. Flow triggering, which detects very small amounts of inspiratory effort from the patient. This results in lower work of breathing compared to pressure triggering.
This document discusses various techniques for monitoring cardiac output (CO), including invasive and non-invasive options. It provides details on pulmonary artery catheters, the Fick principle, transesophageal echocardiography, esophageal Doppler, pulse contour analysis methods (PiCCO, LiDCO, Flowtrac), transthoracic bioimpedance, and transthoracic echocardiography. While some methods like pulmonary artery catheters and LiDCO are well-validated, the document notes that rigorous validation studies are still needed for newer non-invasive options like Flowtrac and transthoracic bioimpedance. Overall, it emphasizes understanding the limitations of different CO monitoring systems and using trends over
This document discusses different ventilator waveforms and modes of ventilation. It describes basic modes like pressure and volume ventilation. It identifies different types of waveform abnormalities that can occur which indicate patient-ventilator desynchrony, such as auto-PEEP, trigger desynchrony, and cycle desynchrony. The document contains diagrams of normal and abnormal ventilator waveforms to help illustrate concepts like auto-PEEP and pressure ventilation flow patterns.
The document discusses the autonomic nervous system and its disorders. It begins by defining the autonomic nervous system and dividing it into the sympathetic and parasympathetic nervous systems. It then discusses methods of assessing autonomic function, including heart rate variation tests, Valsalva maneuver, quantitative sudomotor axon reflex test, and sympathetic skin response. Next, it covers autonomic disorders like reflex syncope, postural tachycardia syndrome, and functional gastrointestinal disorders. Finally, it discusses autonomic storms and Takotsubo cardiomyopathy, which result from excessive autonomic outflow.
This study compared the efficacy of heated humidified high flow nasal cannula (HHHFNC) versus nasal continuous positive airway pressure (NCPAP) as the primary mode of respiratory support in preterm infants with mild to moderate respiratory distress. 88 preterm infants were included in the study and allocated non-randomly to receive either HHHFNC or NCPAP. The primary outcome of treatment failure within 72 hours was not significantly different between the two groups. However, moderate to severe nasal trauma occurred less frequently in infants receiving HHHFNC. While HHHFNC appears to be as effective as NCPAP with less nasal trauma, the study was limited by its non-randomized design and small sample size
step by step approach to arterial blood gas analysisikramdr01
The document provides step-by-step information on interpreting an arterial blood gas (ABG) report. It describes the normal ranges for pH, PCO2, PO2, and other components in an ABG. It then explains how to identify metabolic vs respiratory acidosis and alkalosis based on changes in pH, PCO2, and HCO3 levels. The document also summarizes compensation mechanisms and gives formulas to predict expected pH and HCO3 levels based on primary acid-base disturbances.
This document discusses cerebral blood flow and its regulation. It begins with an introduction to the components inside the skull and the Monro-Kellie doctrine. It then covers the anatomy of brain circulation discovered by Willis in 1664, including the anterior and posterior circulations and collateral pathways. Regulation of cerebral blood flow is achieved through hemodynamic autoregulation, metabolic and chemical mediators, neural control, and circulatory peptides. Clinical measurement techniques include laser Doppler flowmetry, transcranial Doppler, and imaging modalities like CT, MRI, PET, and SPECT. Factors like age, hypertension, and failure of autoregulation can impact cerebral blood flow and its regulation.
The document discusses various aspects of mechanical ventilation settings that impact patient-ventilator synchrony and work of breathing. These include:
1. Rise time, which is the rate of pressure rise during inspiration. Slower rise times can reduce work of breathing.
2. Expiratory sensitivity, which determines the point at which expiration is triggered. Adjusting this setting to account for leaks can improve synchrony.
3. Flow triggering, which detects very small amounts of inspiratory effort from the patient. This results in lower work of breathing compared to pressure triggering.
This document discusses various techniques for monitoring cardiac output (CO), including invasive and non-invasive options. It provides details on pulmonary artery catheters, the Fick principle, transesophageal echocardiography, esophageal Doppler, pulse contour analysis methods (PiCCO, LiDCO, Flowtrac), transthoracic bioimpedance, and transthoracic echocardiography. While some methods like pulmonary artery catheters and LiDCO are well-validated, the document notes that rigorous validation studies are still needed for newer non-invasive options like Flowtrac and transthoracic bioimpedance. Overall, it emphasizes understanding the limitations of different CO monitoring systems and using trends over
This document discusses different ventilator waveforms and modes of ventilation. It describes basic modes like pressure and volume ventilation. It identifies different types of waveform abnormalities that can occur which indicate patient-ventilator desynchrony, such as auto-PEEP, trigger desynchrony, and cycle desynchrony. The document contains diagrams of normal and abnormal ventilator waveforms to help illustrate concepts like auto-PEEP and pressure ventilation flow patterns.
The document discusses the autonomic nervous system and its disorders. It begins by defining the autonomic nervous system and dividing it into the sympathetic and parasympathetic nervous systems. It then discusses methods of assessing autonomic function, including heart rate variation tests, Valsalva maneuver, quantitative sudomotor axon reflex test, and sympathetic skin response. Next, it covers autonomic disorders like reflex syncope, postural tachycardia syndrome, and functional gastrointestinal disorders. Finally, it discusses autonomic storms and Takotsubo cardiomyopathy, which result from excessive autonomic outflow.
This study compared the efficacy of heated humidified high flow nasal cannula (HHHFNC) versus nasal continuous positive airway pressure (NCPAP) as the primary mode of respiratory support in preterm infants with mild to moderate respiratory distress. 88 preterm infants were included in the study and allocated non-randomly to receive either HHHFNC or NCPAP. The primary outcome of treatment failure within 72 hours was not significantly different between the two groups. However, moderate to severe nasal trauma occurred less frequently in infants receiving HHHFNC. While HHHFNC appears to be as effective as NCPAP with less nasal trauma, the study was limited by its non-randomized design and small sample size
This document provides an overview of hypoxemia, acid-base disorders, and case studies analyzing arterial blood gas (ABG) results. It begins with basic principles of hypoxemia and acid-base disorders. It then presents 16 case studies analyzing ABG results to determine the underlying causes of hypoxemia or acid-base imbalances. The case studies demonstrate the application of algorithms to methodically analyze ABG results and arrive at diagnoses. The document serves as a teaching guide on interpreting ABG results in clinical scenarios.
1) Ventilator graphics display waveforms that facilitate assessment of a patient's condition on mechanical ventilation. The most commonly used graphics are scalars (flow vs time, pressure vs time, volume vs time) and loops (pressure-volume, flow-volume).
2) Scalar graphics show the relationship between flow, volume, or pressure over time. Loops show the relationship between pressure and volume or flow and volume. These graphics provide information about ventilator settings, lung mechanics, and the identification of common issues like airway obstruction or air trapping.
3) Proper analysis of ventilator graphics is essential for optimizing ventilator settings and recognizing abnormalities that may require intervention to improve a patient's ventilation
This document summarizes different methods for measuring cardiac output, including clinical assessment, minimally invasive techniques, and invasive pulmonary artery catheterization. Clinical assessment involves evaluating end organ perfusion rather than direct cardiac output measurements. Minimally invasive techniques discussed include thoracic bioimpedance and esophageal Doppler. Invasive pulmonary artery catheterization provides direct cardiac output measurements via thermodilution but carries risks of complications. The document evaluates the advantages, limitations, and evidence for various cardiac output monitoring methods.
Reexpansion pulmonary edema is a serious complication after sudden expansion of collapsed lung.Re-expansion pulmonary edema is an uncommon complication following drainage of a pneumothorax , pleural effusion or removal of any space occupying lesion.
The incidence referred is less than 1%, andmortality can reach up to 20%.
The document discusses the different modes, parameters, and variables of mechanical ventilation, providing definitions and examples of various modes like volume control, pressure control, PRVC, SIMV, and pressure support and discussing parameters like tidal volume, respiratory rate, PEEP, and I:E ratio that must be set and monitored to effectively ventilate patients using these different modes.
Presentation of Dr.Lluis Blanch at Pulmonary Critical Care Egypt 2014 , January2014, the leading critical care conference and medical exhibition in Egypt.www.pccmegypt.com
This document discusses respiratory failure and various modes of mechanical ventilation. It begins by distinguishing between respiratory failure and respiratory insufficiency. It then covers initiating mechanical ventilation using either volume ventilation or pressure ventilation. Various modes are discussed including volume-targeted modes like control, assist, SIMV+PS. Pressure-targeted modes like pressure control ventilation and PSV are also covered. The document discusses the challenges of ventilating ARDS patients and how newer dual modes and closed-loop modes can help minimize ventilator-induced lung injury while maintaining lung recruitment and pressures. It also introduces APRV and bi-level ventilation as newer modes to apply PEEP above the lower inflection point.
The document discusses several cardiac reflexes that contribute to regulating cardiac function and maintaining homeostasis. It describes the baroreceptor reflex, which senses changes in blood pressure via stretch receptors in the carotid sinus and aortic arch. When pressure is high, it decreases heart rate and contractility. The chemoreceptor reflex senses low oxygen or acidosis via carotid and aortic bodies and increases ventilation and heart rate. Other reflexes discussed include the Brainstem reflex, Bezold-Jarisch reflex, Valsalva maneuver, Cushing reflex, and occulocardiac reflex.
This document provides an overview of fluid therapy and electrolyte disturbances. It discusses the basic physiology of body fluids, including total body water content and distribution. It then covers various electrolyte abnormalities like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia, and hypermagnesemia. It also addresses acid-base balance disturbances and different intravenous fluid options for fluid resuscitation and maintenance.
Cardiac output can be measured through various invasive and non-invasive methods. The pulmonary artery catheter using thermodilution is still considered the gold standard but is invasive. Minimally invasive methods include lithium dilution, pulse contour analysis devices, esophageal Doppler, and transesophageal echocardiography. Non-invasive methods include partial gas rebreathing, thoracic bioimpedance, and Doppler ultrasound. The ideal monitor is accurate, continuous, non-invasive and provides reliable measurements during different physiological states.
The document discusses basic principles of mechanical ventilation including factors that can lead to ventilatory failure, airway resistance, lung compliance, hypoventilation, V/Q mismatch, intrapulmonary shunting, and diffusion defects. It also covers different types of ventilator waveforms including pressure, volume, flow and pressure/volume loops which can be used to assess a patient's respiratory status and response to therapy.
Mechanical ventilation graphics provide important information to interpret patient response, disease status, and ventilator function. Scalars plot pressure, volume, or flow over time, while loops plot pressure versus volume or flow versus volume with no time component. Common waveforms include square, ramp, and sine waves. Pressure modes result in square pressure waves while volume modes produce ramp waves. Loops can indicate breath type and assess issues like air trapping, resistance, compliance, and asynchrony. Graphical analysis is a critical tool for ventilator management and optimization.
Brain Death and Preparation for Organ DonationRanjith Thampi
This document discusses brain death, including definitions, causes, mechanisms, diagnostic criteria and confirmatory tests. It provides details on:
- Loss of brainstem and cortical function constituting brain death
- Common causes like stroke, trauma, hypoxia
- Mechanism of increased intracranial pressure leading to circulatory arrest
- Clinical criteria including apnea testing over multiple examinations
- Confirmatory tests like EEG, evoked potentials, angiography and imaging to demonstrate lack of cerebral blood flow
Effect of hydrocortisone on development of shock amongDr fakhir Raza
effects of hydrocortisone on development of shock among patients with severe sepsis the HYPRESS Randomized Clinical Trial American Medical Association caring for the critically ill patients Surviving sepsis campaign, to determine weather hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock
Postoperative vision loss (POVL) is an uncommon complication associated with nonocular surgeries like cardiac surgery and spine surgery done in the prone position. It results from ischemia to the visual pathway, particularly the optic nerve and retina, which receive their blood supply from the ophthalmic artery. The posterior portion of the optic nerve is more susceptible due to less vascular supply. Causes of POVL include ischemic optic neuropathy, central retinal artery occlusion, cortical blindness, and posterior reversible encephalopathy syndrome. Risk factors for POVL after cardiac and spine surgery include low hematocrit, vascular disease, long bypass or surgery time, blood transfusions, and direct eye compression during prone positioning. Prevention strategies focus on maintaining adequate hematocrit,
This document summarizes different intravenous (IV) fluid options used in intensive care, including crystalloids, colloids, and specific fluid products. Crystalloids like saline readily diffuse out of blood vessels, while colloids like albumin, hetastarch, and pentastarch remain in circulation longer due to their larger size. Albumin is the main protein in blood plasma and expands volume the least of colloids. Hetastarch is a synthetic starch that expands volume more than albumin but can cause coagulopathy in large doses. Pentastarch is a newer low-molecular-weight hetastarch derivative that may cause fewer side effects.
This document discusses various topics related to ARDS including definitions, causes, ventilator strategies, and treatments. It provides the American-European Consensus definition of ARDS which requires bilateral infiltrates, hypoxemia, and no evidence of cardiogenic pulmonary edema. Common causes of ARDS are also mentioned. Regarding ventilator management, low tidal volumes, appropriate PEEP levels based on oxygen needs, and maintaining low plateau pressures are emphasized. Additional strategies discussed include prone positioning, recruitment maneuvers, and neuromuscular blockade. While high frequency oscillatory ventilation and inhaled treatments were investigated, they did not show clear benefits.
1) The patient presented with severe ARDS due to bilateral pneumonia and septic cardiomyopathy. She required intubation and mechanical ventilation with hypoxemia.
2) She was treated with prone ventilation for 20 hours which improved her oxygenation with PaO2/FiO2 ratio increasing from 96 to 207.
3) Prone positioning has physiological benefits for ARDS including improving ventilation distribution and oxygenation, reducing ventilator-induced lung injury, and facilitates secretion clearance. It has been shown to reduce mortality in patients with severe ARDS.
This document discusses different types of patient-ventilator dyssynchrony. It begins with background information on how the main purpose of a ventilator is to decrease the work of breathing. Normally, respiratory muscles account for 1-3% of oxygen consumption, but this can increase to 20% for patients in acute respiratory failure undergoing CPR due to the increased work of breathing.
The document then discusses different factors that can contribute to different types of patient-ventilator dyssynchrony, including trigger-related dyssynchrony from a high trigger threshold, muscle weakness, leaks, auto-PEEP, or expiratory flow limitation. Target-related and cycle-related dyssynchrony are also mentioned
This study aimed to determine the prevalence of pulmonary embolism (PE) in patients hospitalized for a first episode of syncope. The study enrolled 560 consecutive patients from 11 Italian hospitals who were admitted for syncope. PE was confirmed in 97 of the 560 patients using D-dimer testing, modified Wells criteria, and CT pulmonary angiography or VQ scanning. This represents a prevalence of PE of 17.3% among patients hospitalized for first-time syncope. Over 60% of confirmed PEs involved the main pulmonary artery or lobar arteries. While the study identified a non-negligible prevalence of PE in syncopatic patients, it did not determine whether the identified PEs caused the syncope episodes
This document discusses the use of corticosteroids for the treatment of sepsis. It provides a timeline of important discoveries in sepsis research from 430 BC to present day. It then summarizes several major studies from the 1980s onward that have investigated the potential benefits of corticosteroids for sepsis patients. The document concludes by outlining the ADRENAL trial, a large ongoing study of hydrocortisone treatment in patients with septic shock being conducted across multiple hospitals in Australia, New Zealand, Asia, Europe and North America.
This document provides an overview of hypoxemia, acid-base disorders, and case studies analyzing arterial blood gas (ABG) results. It begins with basic principles of hypoxemia and acid-base disorders. It then presents 16 case studies analyzing ABG results to determine the underlying causes of hypoxemia or acid-base imbalances. The case studies demonstrate the application of algorithms to methodically analyze ABG results and arrive at diagnoses. The document serves as a teaching guide on interpreting ABG results in clinical scenarios.
1) Ventilator graphics display waveforms that facilitate assessment of a patient's condition on mechanical ventilation. The most commonly used graphics are scalars (flow vs time, pressure vs time, volume vs time) and loops (pressure-volume, flow-volume).
2) Scalar graphics show the relationship between flow, volume, or pressure over time. Loops show the relationship between pressure and volume or flow and volume. These graphics provide information about ventilator settings, lung mechanics, and the identification of common issues like airway obstruction or air trapping.
3) Proper analysis of ventilator graphics is essential for optimizing ventilator settings and recognizing abnormalities that may require intervention to improve a patient's ventilation
This document summarizes different methods for measuring cardiac output, including clinical assessment, minimally invasive techniques, and invasive pulmonary artery catheterization. Clinical assessment involves evaluating end organ perfusion rather than direct cardiac output measurements. Minimally invasive techniques discussed include thoracic bioimpedance and esophageal Doppler. Invasive pulmonary artery catheterization provides direct cardiac output measurements via thermodilution but carries risks of complications. The document evaluates the advantages, limitations, and evidence for various cardiac output monitoring methods.
Reexpansion pulmonary edema is a serious complication after sudden expansion of collapsed lung.Re-expansion pulmonary edema is an uncommon complication following drainage of a pneumothorax , pleural effusion or removal of any space occupying lesion.
The incidence referred is less than 1%, andmortality can reach up to 20%.
The document discusses the different modes, parameters, and variables of mechanical ventilation, providing definitions and examples of various modes like volume control, pressure control, PRVC, SIMV, and pressure support and discussing parameters like tidal volume, respiratory rate, PEEP, and I:E ratio that must be set and monitored to effectively ventilate patients using these different modes.
Presentation of Dr.Lluis Blanch at Pulmonary Critical Care Egypt 2014 , January2014, the leading critical care conference and medical exhibition in Egypt.www.pccmegypt.com
This document discusses respiratory failure and various modes of mechanical ventilation. It begins by distinguishing between respiratory failure and respiratory insufficiency. It then covers initiating mechanical ventilation using either volume ventilation or pressure ventilation. Various modes are discussed including volume-targeted modes like control, assist, SIMV+PS. Pressure-targeted modes like pressure control ventilation and PSV are also covered. The document discusses the challenges of ventilating ARDS patients and how newer dual modes and closed-loop modes can help minimize ventilator-induced lung injury while maintaining lung recruitment and pressures. It also introduces APRV and bi-level ventilation as newer modes to apply PEEP above the lower inflection point.
The document discusses several cardiac reflexes that contribute to regulating cardiac function and maintaining homeostasis. It describes the baroreceptor reflex, which senses changes in blood pressure via stretch receptors in the carotid sinus and aortic arch. When pressure is high, it decreases heart rate and contractility. The chemoreceptor reflex senses low oxygen or acidosis via carotid and aortic bodies and increases ventilation and heart rate. Other reflexes discussed include the Brainstem reflex, Bezold-Jarisch reflex, Valsalva maneuver, Cushing reflex, and occulocardiac reflex.
This document provides an overview of fluid therapy and electrolyte disturbances. It discusses the basic physiology of body fluids, including total body water content and distribution. It then covers various electrolyte abnormalities like hyponatremia, hypernatremia, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hypomagnesemia, and hypermagnesemia. It also addresses acid-base balance disturbances and different intravenous fluid options for fluid resuscitation and maintenance.
Cardiac output can be measured through various invasive and non-invasive methods. The pulmonary artery catheter using thermodilution is still considered the gold standard but is invasive. Minimally invasive methods include lithium dilution, pulse contour analysis devices, esophageal Doppler, and transesophageal echocardiography. Non-invasive methods include partial gas rebreathing, thoracic bioimpedance, and Doppler ultrasound. The ideal monitor is accurate, continuous, non-invasive and provides reliable measurements during different physiological states.
The document discusses basic principles of mechanical ventilation including factors that can lead to ventilatory failure, airway resistance, lung compliance, hypoventilation, V/Q mismatch, intrapulmonary shunting, and diffusion defects. It also covers different types of ventilator waveforms including pressure, volume, flow and pressure/volume loops which can be used to assess a patient's respiratory status and response to therapy.
Mechanical ventilation graphics provide important information to interpret patient response, disease status, and ventilator function. Scalars plot pressure, volume, or flow over time, while loops plot pressure versus volume or flow versus volume with no time component. Common waveforms include square, ramp, and sine waves. Pressure modes result in square pressure waves while volume modes produce ramp waves. Loops can indicate breath type and assess issues like air trapping, resistance, compliance, and asynchrony. Graphical analysis is a critical tool for ventilator management and optimization.
Brain Death and Preparation for Organ DonationRanjith Thampi
This document discusses brain death, including definitions, causes, mechanisms, diagnostic criteria and confirmatory tests. It provides details on:
- Loss of brainstem and cortical function constituting brain death
- Common causes like stroke, trauma, hypoxia
- Mechanism of increased intracranial pressure leading to circulatory arrest
- Clinical criteria including apnea testing over multiple examinations
- Confirmatory tests like EEG, evoked potentials, angiography and imaging to demonstrate lack of cerebral blood flow
Effect of hydrocortisone on development of shock amongDr fakhir Raza
effects of hydrocortisone on development of shock among patients with severe sepsis the HYPRESS Randomized Clinical Trial American Medical Association caring for the critically ill patients Surviving sepsis campaign, to determine weather hydrocortisone therapy in patients with severe sepsis prevents the development of septic shock
Postoperative vision loss (POVL) is an uncommon complication associated with nonocular surgeries like cardiac surgery and spine surgery done in the prone position. It results from ischemia to the visual pathway, particularly the optic nerve and retina, which receive their blood supply from the ophthalmic artery. The posterior portion of the optic nerve is more susceptible due to less vascular supply. Causes of POVL include ischemic optic neuropathy, central retinal artery occlusion, cortical blindness, and posterior reversible encephalopathy syndrome. Risk factors for POVL after cardiac and spine surgery include low hematocrit, vascular disease, long bypass or surgery time, blood transfusions, and direct eye compression during prone positioning. Prevention strategies focus on maintaining adequate hematocrit,
This document summarizes different intravenous (IV) fluid options used in intensive care, including crystalloids, colloids, and specific fluid products. Crystalloids like saline readily diffuse out of blood vessels, while colloids like albumin, hetastarch, and pentastarch remain in circulation longer due to their larger size. Albumin is the main protein in blood plasma and expands volume the least of colloids. Hetastarch is a synthetic starch that expands volume more than albumin but can cause coagulopathy in large doses. Pentastarch is a newer low-molecular-weight hetastarch derivative that may cause fewer side effects.
This document discusses various topics related to ARDS including definitions, causes, ventilator strategies, and treatments. It provides the American-European Consensus definition of ARDS which requires bilateral infiltrates, hypoxemia, and no evidence of cardiogenic pulmonary edema. Common causes of ARDS are also mentioned. Regarding ventilator management, low tidal volumes, appropriate PEEP levels based on oxygen needs, and maintaining low plateau pressures are emphasized. Additional strategies discussed include prone positioning, recruitment maneuvers, and neuromuscular blockade. While high frequency oscillatory ventilation and inhaled treatments were investigated, they did not show clear benefits.
1) The patient presented with severe ARDS due to bilateral pneumonia and septic cardiomyopathy. She required intubation and mechanical ventilation with hypoxemia.
2) She was treated with prone ventilation for 20 hours which improved her oxygenation with PaO2/FiO2 ratio increasing from 96 to 207.
3) Prone positioning has physiological benefits for ARDS including improving ventilation distribution and oxygenation, reducing ventilator-induced lung injury, and facilitates secretion clearance. It has been shown to reduce mortality in patients with severe ARDS.
This document discusses different types of patient-ventilator dyssynchrony. It begins with background information on how the main purpose of a ventilator is to decrease the work of breathing. Normally, respiratory muscles account for 1-3% of oxygen consumption, but this can increase to 20% for patients in acute respiratory failure undergoing CPR due to the increased work of breathing.
The document then discusses different factors that can contribute to different types of patient-ventilator dyssynchrony, including trigger-related dyssynchrony from a high trigger threshold, muscle weakness, leaks, auto-PEEP, or expiratory flow limitation. Target-related and cycle-related dyssynchrony are also mentioned
This study aimed to determine the prevalence of pulmonary embolism (PE) in patients hospitalized for a first episode of syncope. The study enrolled 560 consecutive patients from 11 Italian hospitals who were admitted for syncope. PE was confirmed in 97 of the 560 patients using D-dimer testing, modified Wells criteria, and CT pulmonary angiography or VQ scanning. This represents a prevalence of PE of 17.3% among patients hospitalized for first-time syncope. Over 60% of confirmed PEs involved the main pulmonary artery or lobar arteries. While the study identified a non-negligible prevalence of PE in syncopatic patients, it did not determine whether the identified PEs caused the syncope episodes
This document discusses the use of corticosteroids for the treatment of sepsis. It provides a timeline of important discoveries in sepsis research from 430 BC to present day. It then summarizes several major studies from the 1980s onward that have investigated the potential benefits of corticosteroids for sepsis patients. The document concludes by outlining the ADRENAL trial, a large ongoing study of hydrocortisone treatment in patients with septic shock being conducted across multiple hospitals in Australia, New Zealand, Asia, Europe and North America.
Acute coronary syndrome for critical care examDr fakhir Raza
This presentation is made to help students prepare for EDIC exam. this is board review for any exam for critical care examining acute MI, myocardial infarction, acute coronary syndrome.
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.
VAP/HAP management guidelines by IDSA/ATS (2016) -: Dr.Tinku JosephDr.Tinku Joseph
This document discusses ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP). It defines VAP and HAP and outlines their incidence and impact. Guidelines for diagnosing VAP/HAP using microbiologic methods and biomarkers like CPIS are presented. The document reviews controversies around defining healthcare-associated pneumonia (HCAP) and its inclusion in future guidelines. Empiric and pathogen-directed treatment options for VAP/HAP are discussed, along with optimizing antibiotic dosing and the potential role of inhaled antibiotics.
Recent advances in Asthma & COPD by Dr.Tinku JosephDr.Tinku Joseph
This document summarizes recent advances in asthma and COPD presented between January and December 2016. It describes several studies on new drug combinations that increase lung function and quality of life for COPD patients. It also discusses trials of endobronchial valves and coils that improve outcomes for selected patients with severe emphysema. New biologic drugs targeting specific inflammatory pathways in asthma are presented, along with trials of these new therapies.
This document summarizes the Recovery trial which compared early surgical aortic valve replacement (AVR) to conservative care for asymptomatic patients with very severe aortic stenosis. The trial found that the cumulative incidence of the primary endpoint of operative mortality or death from cardiovascular causes was 1% at 4 and 8 years for early surgery patients, compared to 6% at 4 years and 26% at 8 years for conservative care patients, providing evidence to support early AVR. However, the trial was limited by being unblinded, having small numbers of patients, and only including relatively young asymptomatic patients with very severe aortic stenosis.
Shortness of breath in a 51 year old womanescardio
This document describes the case of a 51-year-old woman presenting with progressive shortness of breath on exertion for 2 years. Echocardiography revealed features consistent with rheumatic mitral stenosis, including restricted leaflet motion and a mitral valve area of 1.1 cm2 by planimetry and 0.64 cm2 by pressure half-time. Due to favorable clinical factors but unfavorable anatomy, the patient underwent percutaneous mitral commissurotomy (PMC), which was successful in increasing her mitral valve area to 1.6 cm2 with only mild residual mitral regurgitation. She was discharged the next day on anticoagulation and maintained improved exercise capacity at 1
Primary Pulmonary HTN Seminar on 19/11/2018
The seminar covered topics related to pulmonary hypertension (PH) including definitions, epidemiology, challenges in diagnosis and treatment, anatomy, pathobiology, genetics, and clinical presentation. PH is defined as a mean pulmonary arterial pressure of >25 mmHg and can be caused by various underlying disorders. Delayed diagnosis and treatment are common problems. The diagnosis requires right heart catheterization, though this test is underutilized. Guidelines for treatment are not always followed consistently.
1. Atrioventricular septal defect (AVSD) is a congenital heart defect where there is a common atrioventricular valve, defects in the atrial and ventricular septum, and it can be complete or partial. It accounts for around 5% of congenital heart defects.
2. Perioperative management of complete AVSD aims to address issues like pulmonary hypertension, low cardiac output, and arrhythmias. Optimal timing of repair is between 3-6 months of age when weight is over 4kg.
3. Expected early postoperative outcomes include a median hospital stay of 9 days, potential need for reoperation for valve issues or outflow tract obstruction, and low mortality rates in the
This document provides an overview of pulmonary embolism (PE), including its epidemiology, pathophysiology, diagnosis, assessment of severity and prognosis, treatment options, and special considerations. It discusses diagnostic tests and strategies like D-dimer testing, CT pulmonary angiography, echocardiography, and their appropriate use. Treatment options covered include anticoagulation, reperfusion therapies, and inferior vena cava filters. Key messages emphasize the importance of risk stratification to guide management, and selecting the best reperfusion option for high-risk PE based on patient risk profile and hospital resources.
This document summarizes a study on deaths related to haemoglobinopathies in the UK from 2005-2006. It reviewed 47 cases and aimed to identify remediable factors in patient care. Key findings included a lack of understanding about sickle cell trait, inconsistent vaccination records, irregular outpatient attendance, and issues with both ongoing and acute pain management including opioid overdoses. Causes of death included stroke, acute chest syndrome, and renal failure, where timely recognition and management could have made a difference. The study made recommendations around improving protocols, guidelines, multi-disciplinary care, and clinician education about haemoglobinopathies.
LONG-TERM OUTCOMES OF PATENT FORAMEN OVALE 1.pptxddocofdera
PFO closure with the Amplatzer device was found to be associated with a lower risk of recurrent ischemic stroke compared to medical therapy alone in patients aged 18-60 who experienced a cryptogenic stroke. Over a median follow up of 5.9 years, the rate of recurrent stroke was 0.58 events per 100 patient-years in the PFO closure group versus 1.07 events in the medical therapy group. However, PFO closure was also associated with a higher rate of venous thromboembolism such as pulmonary embolism and deep vein thrombosis compared to medical therapy.
This study evaluated a novel transcatheter interatrial shunt device for treating heart failure with preserved ejection fraction (HFPEF). 64 patients underwent successful implantation of the device. At 6 months follow up, 71% of patients had a reduction in pulmonary capillary wedge pressure at rest or during exercise compared to baseline. The procedure was well tolerated with no safety issues. The results suggest the device may help reduce left atrial pressure and improve functional status for patients with HFPEF, though the study had limitations as an open-label single-arm trial with short follow up.
- This document summarizes the case of a 45-year-old woman who presented with shortness of breath and chest pressure. Exams found elevated jugular venous pressure and signs of right ventricular strain on EKG.
- Differential diagnosis includes pulmonary embolism. Imaging with CTA and invasive hemodynamics confirmed massive pulmonary embolism with right heart strain. Treatment options discussed include anticoagulation with heparin or thrombolysis. Risks and benefits of thrombolysis versus anticoagulation alone were debated based on the degree of right ventricular dysfunction seen.
A No-Prophylaxis Platelet-Transfusion Strategyfor Hematologic CancersShadab Ahmad
The effectiveness of platelet transfusions to prevent bleeding in
patients with hematologic cancers remains unclear.
This trial assessed whether a policy of not giving prophylactic platelet
transfusions was as effective and safe as a policy of providing prophylaxis.
In patients with hematologic cancers, severe thrombocytopenia
frequently develops as a consequence of the disease or its treatment.
Effect of restrictive versus liberal transfusion strategies on outcomes in pa...Mohd Saif Khan
Restrictive red cell transfusion policies are recommended as safe for most hospital patients with anaemia. Uncertainty exists for patients with cardiovascular disease, whose hearts may be more susceptible to limited coronary oxygen supply.
1) Massive pulmonary embolism (PE) occurs when over 50% of the pulmonary artery is blocked, causing low blood pressure. It can rapidly lead to death if not treated.
2) Initial treatment includes oxygen, intravenous fluids, medications to support blood pressure, and potentially thrombolytics to dissolve clots. Thrombolytics may improve heart and lung function temporarily but do not reliably reduce mortality.
3) For patients who cannot receive thrombolytics or if thrombolytics fail, emergency surgical removal of clots or catheter-based clot removal may be considered to prevent death from massive PE. Outcomes vary but can be lifesaving in some cases.
VALIDATION OF THE SAN FRANCISCO SYNCOPE RULE TO PREDICT PATIENTS WITH SERIOU...Srihari Cattamanchi
This study aimed to validate the San Francisco Syncope Rule for predicting serious outcomes in emergency department patients with syncope. 371 syncope patients were prospectively evaluated. 13.7% had a serious outcome within 30 days. The San Francisco Syncope Rule criteria (history of congestive heart failure, hematocrit <30%, abnormal ECG, complaint of shortness of breath, systolic blood pressure <90 mm Hg) had high sensitivity and specificity for predicting serious outcomes. The study validated that the San Francisco Syncope Rule is a valuable tool for risk stratifying syncope patients to guide clinical decision-making.
This study aimed to determine the prevalence of central sleep apnea (CSA) in children with heart failure secondary to dilated cardiomyopathy (DCM) and examine its clinical relevance. Of 37 children who underwent overnight polysomnography, 7 (19%) had a CSA as defined by an apnea-hypopnea index over 1. Those with CSA tended to be younger. While CSA occurs at lower rates in children with heart failure compared to adults, this first prospective study establishes CSA can affect some pediatric patients with DCM. Larger studies are needed to better understand CSA in this population.
Remote Ischaemic Conditioning: A Paper Review & Uses in Paramedic Practicebgander23
A 2 part presentation. Part 1 reviews a paper on the long-term clinical outcomes of STEMI patients undergoing remote ischaemic perconditioning prior to primary percutaneous coronary intervention. The 2nd part looks at how this technique can be used in Paramedic practice.
1) Preoperative hypertension is common and increases the risk of perioperative complications, however well-controlled hypertension may not need surgery postponement.
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The document discusses acute kidney injury (AKI) in patients with dengue fever. It reports on a study of 120 dengue patients that found:
1) The prevalence of AKI among dengue patients was 27.5%, indicating AKI is not uncommon.
2) Significant predictors of AKI in dengue patients included male gender, older age, low blood pressure, high serum creatinine and blood urea at admission, low platelet count at admission, signs of polyserositis, and other complications.
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1) A study of 455 patients undergoing transradial cardiac catheterization found that the rate of radial artery occlusion (RAO) was significantly higher when a 6-French sheath was used (30.5%) compared to a 5-French sheath (13.7%).
2) Multivariate analysis identified female sex, younger age, presence of peripheral artery disease, and use of a 6-French sheath as independent predictors of RAO.
3) For patients who developed symptomatic RAO, treatment with low molecular weight heparin showed a higher rate of recanalization (55.6%) compared to patients who did not receive anticoagulation (13.5%).
This document provides definitions for various medical terminology related to cardiopulmonary and respiratory systems. It includes terms for different types of breathing difficulties, oxygen and carbon dioxide levels in blood, heart conditions like arrhythmias, heart attacks, and heart failure. Diagnostic tests are also defined such as ECG, CXR, ABG's, pulmonary function tests, bronchoscopy, echocardiograms, CT scans, and cardiac catheterization. Emergency procedures like CPR, intubation, chest tube insertion, and defibrillation are also listed.
The Foundation of Medicine Curriculum includes topics like medical terminology, history of medicine, concepts of health and disease, and communication skills. Medical terminology is the professional language of healthcare and uses word roots from Latin and Greek to name body parts and diseases. There are four main elements to a medical term: word root, combining form, suffix, and prefix. By understanding the meanings of these elements like word roots for body parts and suffixes for processes, the meaning of complex medical terms can be deduced by analyzing the smaller word parts. Correct pronunciation of terms is aided by inserting combining vowels between word parts.
1. The document discusses acid-base imbalances and how to interpret arterial blood gases (ABGs).
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This document summarizes specific organ support considerations in the ICU, including the brain, heart, lungs, kidneys, liver, hematology/coagulation, skin/soft tissue, and endocrine system. Key points covered include oxygenation and ventilation strategies for respiratory support, indications for renal replacement therapy, transfusion thresholds for blood products, and general measures to prevent complications like bed sores.
The document discusses monitoring respiratory mechanics during mechanical ventilation. It describes the resistive and elastic components of the respiratory system and how peak pressure, plateau pressure, compliance, and elastance are measured and affected. Peak pressure is the maximum pressure achieved in a breath and is impacted by resistance, flow, volume, and elastance. Plateau pressure measures lung parenchymal properties at a given volume. Compliance is the change in volume per unit change in pressure and can be measured statically or dynamically.
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This document discusses mechanical ventilation and the mechanics of breathing. It explains that breathing can occur spontaneously through the work of respiratory muscles, or through positive pressure ventilation using devices like endotracheal tubes. The balance between the lungs' elastic recoil inward and the chest wall's recoil outward determines lung volume. Transpulmonary pressure, the difference between alveolar and pleural pressures, increases to inflate the lungs either through spontaneous breathing or positive pressure ventilation. Boyle's law states that for a fixed amount of gas, pressure and volume are inversely proportional.
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How to ventilate COPD and ARDS in Intensive care unit. safe lung ventilation. PEEP, Tidal volume, mode of ventilation. limits of ventilation. ventilator alarms
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A – Assess, Prevent and Manage Pain
B – Both SATs and SBTs
C – Choice of Sedation
D – Delirium: Assess, Prevent and Manage
E – Early Mobility and Exercise
F – Family Engagement and Empowerment
*www.iculiberation.org
latest knowledge practical points short presentation
It will serve as guideline for Covid-19 corona virus
it will help in preparing ICU as well as policy making
institutions should device their own strategy
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
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Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
1. Presented in Journal club by Dr Fakhir Raza Haidri
Specialist MICU
1st November 2016
2. Introduction
• Syncope: Defined as
a transient loss of consciousness that has a rapid onset, short duration
(in current study less than 1 minute), and spontaneous resolution and
is believed to be caused by temporary cerebral hypoperfusion
Eur Heart J. 2009 Nov;30(21):2631-71. doi: 10.1093/eurheartj/ehp298. Epub 2009 Aug 27
3. Flow chart of Syncopal Attack
Eur Heart J. 2009 Nov; 30(21): 2631–2671.
5. Background
• The prevalence of pulmonary embolism among patients hospitalized
for syncope is not well documented, and current guidelines pay little
attention to a diagnostic workup for pulmonary embolism in these
patients.
6. Question
• Do All Patients with 1st Time Syncope need a Pulmonary Embolism
Workup?
• Outcome measure: Prevalence of Pulmonary Embolism among
Patients with a First Episode of Syncope
7. Methods
• Cross sectional study
• older than 18 years of age
• first episode of syncope
• Definition of syncope used: Syncope was defined as a transient loss of
consciousness with rapid onset, short duration (i.e., <1 minute), and
spontaneous resolution, with obvious causes such as epileptic
seizure, stroke, and head trauma ruled out
8. Exclusion criteria
• Previous Episodes of Syncope
• On Anticoagulation Therapy
• Pregnant
• Did Not Provide Informed Consent
9. Method
• 2584 patients with first-time syncope were screened in 11 Italian
emergency departments – 9 of which were non-academic
• 72% of these patients were discharged home based on a clinical
evaluation by a physician in the emergency department
• 717 patients were admitted to the hospital
• 157 were excluded for the following reasons: 118 were receiving
anticoagulation therapy, 82 had atrial fibrillation, 36 had other
reasons, 35 had recurrent syncope, 4 declined to participate.
• So 560 inpatients were then all evaluated for pulmonary embolus.
13. Thrombotic Burden
• CT finding Among the 72 patients in whom PE confirmed
• Main pulmonary artery in 30 patients (41.7%),
• Lobar artery in 18 patients (25.0%),
• Segmental artery in 19 patients (26.4%),
• Subsegmental artery in 5 patients (6.9%).
14. Thrombotic Burden
• VQ finding in 24 patients
• Perfusion defect involved more than 50% of the area of both lungs in
4 patients
• 26 to 50% of the area of both lungs in 8 patients
• 1 to 25% of the area of both lungs in the remaining 12 patients
• In the 1 patient who died, pulmonary embolism involved both main
pulmonary arteries.
15. Clinical symptoms in confirmed PE patients
• Tachypnea: 45.4% vs. 7.1%
• Tachycardia: 33.0% vs. 16.2%
• Hypotension: 36.1% vs. 22.9%
• clinical signs or symptoms of deep-vein thrombosis: 40.2% vs. 4.5%
previous venous thromboembolism: 11.3% vs. 4.3%
• Active cancer 19.6% vs. 9.9%
• No clinical manifestations 24.7%
16. Conclusion
• Among patients who were hospitalized for a first episode of syncope
and who were not receiving anticoagulation therapy, pulmonary
embolism was confirmed in 17.3% (approximately one of every six
patients).
• The rate of pulmonary embolism was highest among those who did
not have an alternative explanation for syncope
17. Discussion
Patient Population or Problem:
Intervention (or Exposure): Which medical event or therapy do you
need to study the effect of? NON INTERVENTIONAL
Comparison (if known): With what will you compare the
intervention's results? NO COMPARISON
Outcomes: What are the relevant effects (outcomes) you'll be
monitoring? IT WAS CROSS SECTIONAL STUDY, PATIENTS NOT
FOLLOWED, MORTALITY NOT ASSESSED
18. Strengths
• Multi center study
• Presence or absence of PE assessed with a validated algorithm based
on pretest clinical probability
19. Limitations (weaknesses)
• Hugely biased selection of patients (None of the discharged patients
included)
• A specific syncope workup was not mandated by all hospitals involved
in the study
• Imaging for PE was only performed in patients with an elevated D-
Dimer and/or had a high pretest probability for PE
• Confirmation of DVT in symptomatic patients was also not mandated
20. Limitations (weaknesses)
• Search for other causes of syncope was left to the discretion of the
physician, meaning other causes of syncope may have been under
reported
• No information was collected on treatment and follow-up of patients;
therefore, we don’t know what the clinical outcomes of these
patients was
• Imaging to confirm PE was not done at admission, but up to 48 hours
after admission. Immobility during hospitalization is a known to cause
VTE
21. Other points in discussion
• Authors conclusion of PE confirmation in approximately one in every
six patients (17.3%) however these numbers are grossly inflated. 2427
patients were actually included in this study (157 were excluded).
Excluding all patients will overestimate the results, as was done in this
study
• 97 patients had PE confirmed so instead of 97/230 (42.2%) the
number should be 97/2427 (3.9%)
• To take this one step further…if you exclude subsegmental PEs (i.e.
Unclear clinical significance) the number is actually 80/2427 (3.2%)