Physiological monitoring of surgical patients allows assessment of physiological reserve and response to treatment. It includes monitoring of vital signs like temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation. Specific organ systems that are monitored include the cardiovascular, respiratory, nervous, renal, hematological, and hepatic systems. This is done through methods like ECG, arterial blood gas analysis, capnography, intracranial pressure monitoring, EEG, urinalysis, renal function tests, and liver function tests. Scoring systems like APACHE, MEWS, SOFA, and NEWS are also used to assess patient status. Close physiological monitoring is important for optimizing patient care and outcomes during surgery and recovery.
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
Brief description of hepatectomy with indications, procedure, pre operative, intra operative and post operative management of the patient. Also describes the various techniques and instrument available for liver resection.
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
Brief description of hepatectomy with indications, procedure, pre operative, intra operative and post operative management of the patient. Also describes the various techniques and instrument available for liver resection.
Bile duct injury:How safe is emergency laparoscopic cholecystectomy?KETAN VAGHOLKAR
laparoscopic cholecystectomy has become the gold standard . But its safety in acute cholecystitis is debatable. The traditional dictum to wait for 6 weeks before contemplating removal of the gall bladder still remains the safest option rather than removing the gall bladder on an emergency basis and heightening the chances of bile duuct injury leading to a surgical disaster.The presentation outlines the evaluation and management of bile duct injuries.
Every upcoming surgeon practising minimal access surgery should know the basics of urology , so that he or she can put his or her,s capabilities as a surgeon
OPEN CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #opencholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy and Modified Radical Mastectomy.
• In this video today, I have discussed Open Cholecystectomy.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Whipple's procedure - Indications, Steps, ComplicationsVikas V
Whipple's Procedure - Explaining the History of Whipple's Procedure, Indications, Contraindications, Step wise detailed procedure, Complications, Perioperative Management.
The Presentation Includes Detailed Step wise approach to the procedure assisted with Pictorial Representation of The steps
Functional Anatomy and Innervation of Urinary TractSiewhong Ho
Dr Ho Siew Hong lectured on the anatomy and innervation of the urinary tract with special emphasis on clinical relevance during the 3rd Japan ASEAN Conference 08
Bile duct injury:How safe is emergency laparoscopic cholecystectomy?KETAN VAGHOLKAR
laparoscopic cholecystectomy has become the gold standard . But its safety in acute cholecystitis is debatable. The traditional dictum to wait for 6 weeks before contemplating removal of the gall bladder still remains the safest option rather than removing the gall bladder on an emergency basis and heightening the chances of bile duuct injury leading to a surgical disaster.The presentation outlines the evaluation and management of bile duct injuries.
Every upcoming surgeon practising minimal access surgery should know the basics of urology , so that he or she can put his or her,s capabilities as a surgeon
OPEN CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #opencholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy and Modified Radical Mastectomy.
• In this video today, I have discussed Open Cholecystectomy.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Whipple's procedure - Indications, Steps, ComplicationsVikas V
Whipple's Procedure - Explaining the History of Whipple's Procedure, Indications, Contraindications, Step wise detailed procedure, Complications, Perioperative Management.
The Presentation Includes Detailed Step wise approach to the procedure assisted with Pictorial Representation of The steps
Functional Anatomy and Innervation of Urinary TractSiewhong Ho
Dr Ho Siew Hong lectured on the anatomy and innervation of the urinary tract with special emphasis on clinical relevance during the 3rd Japan ASEAN Conference 08
Nursing management client with Increased intracranial pressure ( ICP)ANILKUMAR BR
The rigid cranial vault contains brain tissue (1,400 g), blood (75 ml), and CSF (75 ml)
The volume and pressure of these three components are usually in a state of equilibrium and produce the ICP.
ICP is usually measured in the lateral ventricles; normal ICP is 10 to 20 mm hg.
The Monro-kellie hypothesis states that because of the limited space for expansion within the skull, an increase in any one of the components causes a change in the volume of the others.
Increased ICP is a syndrome that affects many patients with acute neurologic conditions.
This is because pathologic conditions alter the relationship between intracranial volume and pressure.
Although an elevated ICP is most commonly associated with head injury, it also may be seen as a secondary effect in other conditions, such as brain tumors, subarachnoid hemorrhage, and toxic and viral encephalopathies.
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.
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.
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
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
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!
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.
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
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physiological monitoring of a surgical patient.pptx
1. Dr. Bruce Okari
ENT part 2
Supervisor: Dr. P. Mwika
Date: 06/12/2021
PHYSIOLOGICAL MONITORING
OF A SURGICAL PATIENT
2. Introduction
• Physiological response to stress is important in determining the
outcome
• monitoring of physiological response
allows determination of physiological reserve
allows assessment of baseline of effective treatment.
3. • physiologic monitoring of a surgical patient ranges from the routine
and intermittent measurement of the classical vital signs such as;
temperature
HR
arterial BP
RR
SPO2.
4. Types of surgical injuries
• Injury/ trauma
• acute blood loss
• shock
• hypoxia
• acidosis
• hypothermia
• altered microcirculatory blood flow
• altered coagulation and immune system
• pain
5. Physiological monitoring entails:
• Homeostasis of:
CVS
Respiratory system
nervous system
renal system
hematologic system
hepatic function
Scoring systems
6. CVS
• Pulse rate
• Blood pressure - Non invasive arterial BP monitoring
-Invasive BP monitoring;- intra arterial, CVC
• ECG
• Temperature
7. Pulse rate
• Pulse is a wave of blood created
by alternate expansion and
recoil of elastic arteries after
each contraction of the left
ventricle of the heart.
-Resting PR; 60-100 BPM
9. Arterial blood pressure
• Affected by changes in the volume status of the patient, vasomotor
tone and cardiac output.
• If blood pressure is inadequate then tissue perfusion will be
inadequate .
• In critical illness autoregulatory mechanisms in vascular beds such as
the brain and kidney may become impaired and perfusion to these
organs will be pressure dependent.
10. Non invasive BP monitoring
• Manual and automated means use an inflatable sphygmomanometer
cuff to increase pressure around an extremity to detect the presence
or absence of arterial pulsations.
• The time-honored approach is the auscultation of the Korotkoff
sounds, which are heard over an artery distal to the cuff.
• Systolic pressure is defined as the pressure in the cuff when tapping
sounds are first audible. Diastolic pressure is the pressure in the cuff
when audible pulsations first disappear.
11. Invasive arterial BP
• Direct and continuous monitoring
of arterial pressure in critically ill
patient using fluid-filled tubing to
connect an intra-arterial catheter
to an external strain-gauge
transducer
• sites include the radial, femoral
and axillary artery
• Cannulation can be associated with
complications; thrombosis,
ischemia, infection, bleeding,
fistula, pseudoaneurysm
12. Invasive arterial BP monitoring indications
• Shock states
• Hypertensive crisis
• Extensive surgery in high risk patients
• Use of potent vasoactive or inotropic drugs
• High level of respiratory support (ventilator)
• High risk patients undergoing extensive surgery
• Controlled hypotensive anesthesia
• Any situation leading to rapid alteration in cardiac function
13. Central Venous Pressure (CVP)
• Useful but not very accurate in assessing volume status
• Indications;
hypovolaemia following trauma
shock
burns
Sepsis
Normally CVP ranges between 6 and 12 mmHg
15. CVP- Complications
• Pneumothorax
• Central line associated bloodstream infections
• Staphylococcus aureus and Staphylococcus
• epidermidis sepsis
• Air embolism
• Haemorrhage
• Nerve injury
• Arrhythmias
16. ECG
• ECG records the electrical
activity associated with cardiac
contraction by detecting
voltages on the body surface.
• Dysrhythmias can be detected
by continuously monitoring the
ECG tracing, and timely
intervention may prevent
serious complications
17. Temperature monitoring
• The purpose of temperature monitoring is to detect thermal
disturbances and maintain appropriate body temperature during
anesthesia.
• Core body temperature should be measured in most patients given
general anesthesia for more than 30 min.
• Core temperature monitoring is appropriate during most general
anesthetics both to facilitate detection of malignant
hyperthermia and to quantify hyperthermia and hypothermia
18. Respiratory system
• Assessing whether there is need to put patient on oxygen or
mechanical ventilation and in weaning off a ventilator
Respiratory rate
Pulse oximetry
ABG
Capnography
19. Pulse oximetry
• Non invasive measure of arterial
oxygen saturation of Hb and
pulse rate.
• Provides instant feedback on
oxygenation.
• Disadvantage: can’t distinguish
between carboxyhaemoglobin
and oxyhaemoglobin due to a
similar absorption spectrum.
20. Arterial blood gas analysis
• Assess adequacy of ventilation and
oxygenation
• Aids in diagnosing respiratory failure
and assessing severity of respiratory
failure
• Assesses changes in acid- base
homeostasis.
• Helps guide treatment plan
• Helps in management of ICU patients.
• Should be interpreted in relation to
the inspired oxygen tension (FIO2)
• COPD patients can tolerate abnormal
blood gas values.
21. Capnography
• Non invasive measurement of partial pressure
of CO2 in exhaled breath expressed as the
CO2 concetration over time.
• Relationship of CO2 concentration to time is
graphically represented by the CO2
waveform, or capnogram.
• Provides instant information on;
Ventilation
Perfusion
Metabolism.
Predictable relationship with arterial CO2
Monitoring is important in detecting
pulmonary emboli
Correlates with cardiac output and coronary
perfusion during resuscitation
22.
23. Nervous system
• monitoring CNS function by Glasgow coma score and other assessments of
routine neurological status is an essential part of the management of the
critically ill patient.
• Includes monitoring:
intracranial pressure (ICP)
Transcranial near-infrared spectroscopy
Brain tissue oxygen tension
EEG and evoked potentials
Cerebral function monitoring (CFM)
Transcranial doppler U/S
Jugular venous oximetry
24. Intracranial pressure (ICP)
• The goal of ICP monitoring is to ensure that cerebral perfusion
pressure (CPP) is adequate to support perfusion of the brain. CPP is
equal to the difference between MAP and ICP: CPP = MAP – ICP.
• Normal ICP in adults; 5-15mm HG (7.5- 20 cm H2O)
Measures intraventricular pressure directly or indirectly.
Recommended in patients with TBI, GCS<8
Intracranial
pressure (ICP)
25. Increased ICP is seen in;
Head injury
SAH
Hepatic encephalopathy
Brain tumors or SOL
Encephalitis
26. ICP ct
• ICP above 20-25mmHg often amenable to therapeutic intervention
including;
Control of hypercapnia (using mechanical ventilation to maintain a
PaCO2 of 4kPa),
Mannitol
Slight head-up tilt
Sedation with an intravenous anaesthetic agent such as propofol or
thiopental
27. EEG
• Measures voltage fluctuations resulting from ionic current flows
within the neurons of the brain.
• Indications;
Epilepsy
Coma
Encephalitis
Brain death
28. EEG utilization;
• Continuous EEG (CEEG) monitoring in the intensive care unit permits
ongoing evaluation of cerebral cortical activity. It is especially useful in
obtunded and comatose patients.
• CEEG also is useful for monitoring of therapy for status epilepticus
and detecting early changes associated with cerebral ischemia.
• An advance in EEG monitoring is the use of the bispectral index (BIS)
to titrate the level of sedative medications.
• The BIS also has been validated as a useful approach for monitoring
the level of sedation for ICU patients, using the revised Sedation-
Agitation Scale as a gold standard
29. Renal system
• Renal function monitoring, in critically-ill patients, allows detection of
changes in glomerular filtration rate (GFR) and promptly diagnose AKI,
via;
Urinalysis,
Urine output,
RFTs, and
serum creatinine level
30. Urinalysis and urine output
• Measurement of the specific gravity and osmolality of the urine is
used to differentiate between pre-renal and renal failure.
• Hourly urine output is a very useful guide to the adequacy of cardiac
output, splanchnic perfusion and renal function and a marker of
adequate hydration.
0.5-1 mL/kg/hr (30-40mls/hr) for adults
1 mL/kg/hr for children
1-2 mL/kg/hr in toddlers < 2 years
31. GFR
• Creatinine clearance is the most reliable method for GFR assessment
Measurements over 24hrs, but 2hr clearance reasonably accurate.
32. Tubular Function Tests
• Primarily used in differential
diagnosis of oliguria
• Differentiate pre-renal cause
from intrinsic failure due to
tubular dysfunction
• Fractional excretion of sodium
most reliable lab test
• Value of <1 suggests pre-renal
• >2-3 compromised tubular
function
33. Hematological
• CBC;
WBC levels
Hb level
HCT levels/drop
Platelet levels
• Assessment of clotting function by measuring, PT, APTT, FDPs and D-
dimer.
• Main causes of clotting factor deficiencies; liver disease, vit K
deficiency, anti-coagulation drugs, DIC and massive blood transfusion.
34. Hepatic
Wide range of functions including detoxification, protein synthesis
and production of biochemicals necessary for digestion
Has a high functional reserve
Importance of monitoring LFTs to assess liver function
Importance of differentiating between hepatocellular damage (?
transaminases) obstructive picture (? alk phosph)
35. Hepatic Ct
• Albumin, clotting factors, anti-thrombin III and protein C all
synthesized in the liver
• Usually albumin not used in assessing acute liver function due to its
long half-life
• Clotting and prothrombin time are useful indicators of liver function
Factor
• VII useful in assessing severity of coagulopathy even where fresh
frozen plasma has been given (its half-life 4-8hrs)
36. Scoring systems
• Acute physiological and chronic
health evaluation (APACHE)
• Modified early warning score
(MEWS)
• qSOFA
• SOFA
• NEWS
39. References
• Swartz’s Principles of Surgery 11th edition- Chapter 13
• https://pubs.asahq.org/anesthesiology/article/134/1/111/108291/Periope
rative-Temperature-Monitoring
• Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced
Recovery After Surgery (ERAS) Society Recommendations: 2018
• https://jamanetwork.com/journals/jamasurgery/article-abstract/2595921
• https://pssjournal.biomedcentral.com/articles/10.1186/s13037-019-0213-
5
• https://pubmed.ncbi.nlm.nih.gov/20079469/
• https://www.sccm.org/Clinical-Resources/Guidelines/Guidelines/Surviving-
Sepsis-Guidelines-2021
• Google images.
Editor's Notes
BIS use has been associated with lower consumption of anesthetics during surgery and earlier awakening and faster recovery from anesthesia