Acute respiratory distress syndrome (ARDS) is a Sudden failure of the respiratory system. It Can occur in anyone over the age of one who is critically ill. It is a Life- threatening because normal gas exchange does not take place due to severe fluid buildup in both lungs.
Prevention can be achieved by Limiting Blood Loss so decreasing transfusion requirements, Early Stabilization Of unstable Fractures and Early prophylactic mechanical Ventilation.
Established cases with ARDS is treated in the Intensive Care Unit By Mechanical ventilation and Oxygen therapy through a ventilator, Fluids through an IV line to improve blood flow and provide nutrition and medicine to prevent and treat infections and to relieve pain.
different type of lower limb amputation with indication, peri-operative care, surgical steps, post op care complication and different type of prosthesis
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
POLYTRAUMA AND DAMAGE CONTROL ORTHOPAEDICSDr Slayer
polytrauma is Injury to 2 or more organ systems leading potentially to a life threatening condition
Damage control orthopaedics is an approach to contain and stabilize an orthopaedic injury to improve patient’s physiology which are designed to avoid worsening pt’s condition due to “second hit” phenomenon
different type of lower limb amputation with indication, peri-operative care, surgical steps, post op care complication and different type of prosthesis
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
POLYTRAUMA AND DAMAGE CONTROL ORTHOPAEDICSDr Slayer
polytrauma is Injury to 2 or more organ systems leading potentially to a life threatening condition
Damage control orthopaedics is an approach to contain and stabilize an orthopaedic injury to improve patient’s physiology which are designed to avoid worsening pt’s condition due to “second hit” phenomenon
Acute respiratory Distress Syndrome - Medical and Nursing managementVarunMahajani
ARDS is an acute diffuse, inflammatory lung injury leading to pulmonary vascular permeability, increased lung weight, loss of aerated lung tissue with hypoxia, bilateral radiological opacities associated with increased venous admixture, increased physiological dead space, and decreased lung compliance.
this presentation provides in depth view of management of patient with ARDS
ARDS means acute respiratory distress syndrome. It is a respiratory disorder. Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. The fluid keeps the lungs from filling with enough air, which means less oxygen reaches to the bloodstream. This deprives body organs of the oxygen they need to function.
It is a short description or short notes on ards, know we can easily know about this superficially.
It is a condition where in the alveoli, the alveoli is filled with fluid and then the gas exchange can't be done properly..
To Restore Your Gut Bacteria and Health rememder the saying of Messenger of Allah Muhammad pbuh ; "No man fills a container worse than his stomach. A few morsels that keep his back upright are sufficient for him. If he has to, then he should keep one-third for food, one-third for drink and one-third for his breathing.“ [At-Tirmidhi] . Also remember the saying of Hippocrates 460 BC - 370 BC : "Let thy food be thy medicine and thy medicine be thy food". And this saying by Moses Maimonides, the great 12th century physician : "No illness which can be treated by diet should be treated by any other means”.
Aging is the progressive accumulation of damage to an organism over time leading to disease and death. Aging research has been very intensive in the last years aiming at characterizing the Pathophysiology of aging and finding possibilities to fight age-related diseases. Various theories of aging have been proposed. In the last years advanced glycation end products (AGEs) have received particular attention in this context. AGEs are formed in high amounts in diabetes but also in the physiological organism during aging. Higher levels of diabetic complications are due to poor glycemic control. The incidence and prevalence of diabetes mellitus is rising. About 50% of people with diabetes mellitus are unaware of their condition. Pharmacotherapy and Therapeutic lifestyle change (Diet, Regular exercises, Sunshine, Vitamin D and Calcium normal levels) should be the cornerstone of diabetes management.
Epigenetics, the microbiome and the environmentfathi neana
An epigenome consists of a record of the chemical changes to the DNA and histone proteins of an organism. These changes can be passed down to an organism's offspring via transgenerational epigenetic inheritance. Epigenetics, Gut microbiome and the Environment interplay like a vicious triad.
1- The epigenome is highly sensitive to external environment
2- The epigenome is highly sensitive to internal environment (Microbiome)
3- The microbiome (internal environment) is affected by the external environment
Care of the microbiome seems to be a personal issue but as it is affected by the external environment the issue must be global and a worldwide campaign have to be started.
Covid -19 informations you have to knowfathi neana
With Corona worldwide pandemic the people who exposed to the virus show different reactions some did not catch the virus and among those who catch the virus most of them did not show any symptoms or mild unnoticeable symptoms but some of them show sever manifestations and are killed by this virulent virus. Luckily enough this last group are the minority. The question is not why some people is affected by the virus but th question should be why most of the people are not affected or even those who are affected can defeat the virus and escape its fatal outcome?. To answer this question we have to know some basic facts.
A vitamin is an organic molecule (or related set of molecules) that is anessential micronutrient which an organism needs in small quantities for the proper functioning of its metabolism. Essential nutrients cannot besynthesized in the organism, either at all or not in sufficient quantities, and therefore must be obtained through the diet.
Vitamins are classified as either water-soluble or fat-soluble. In humans there are 13 vitamins: 4 fat-soluble (A, D, E, and K) and 9 water-soluble (8 B vitamins and vitamin C). Water-soluble vitamins dissolve easily in water and, in general, are readily excreted from the body, to the degree that urinary output is a strong predictor of vitamin consumption. Because they are not as readily stored, more consistent intake is important. Fat-soluble vitamins are absorbed through the intestinal tractwith the help of lipids (fats). Vitamins A and D can accumulate in the body, which can result in dangerous hypervitaminosis. Fat-soluble vitamin deficiency due to malabsorption is of particular significance in cystic fibrosis.
Free radicals are electron missing atoms or molecules. It is very unstable and react quickly with other compounds, trying to capture the needed electron to gain stability.
Generally, free radicals attack the nearest stable molecule, "stealing" its electron.
When the "attacked" molecule loses its electron, it becomes a free radical itself, beginning a chain reaction like snowball.
Once the process is started, it can cascade, finally resulting in the disruption of a living cell. The rule of antioxidants is to give electrons to free radicals and neutralize its destructive effects especially on the DNA.
Intermittent fasting had a strong anti inflammatory effect beside the many other benefits. Intermittent fasting is an eating pattern and Interventional strategy where in individuals are subjected to varying periods of fasting. It doesn’t specify which foods you should eat but rather when you should eat them. Intermittent fasting (IF) is an eating pattern that cycles between periods of fasting and eating. It’s currently very popular in the health and fitness community. Recently attracted attention because:
1- Its Evidence-Based Health Benefits
2- Its potential for correcting metabolic Abnormalities
3- Better adherence than other methods
Emerging evidence indicates that impaired cellular energy metabolism is the defining characteristic of nearly all cancers regardless of cellular or tissue origin. In contrast to normal cells, which derive most of their usable energy from oxidative phosphorylation, most cancer cells become heavily dependent on substrate level phosphorylation to meet energy demands. Evidence is reviewed supporting a general hypothesis that genomic instability and essentially all hallmarks of cancer, including anaerobic glycolysis (Warburg effect), can be linked to impaired mitochondrial function and energy metabolism. A view of cancer as primarily a metabolic disease and how autophagy process is activated will impact approaches to cancer management and prevention.
Lastly the question is Why some people have no cancer ? the answer is it is the life style and the diet rich in Healthy fat, Antioxidants, Vitamin C, Salvestrols and many natural remedies.
Free radicals are very unstable and react quickly with other compounds, trying to capture the needed electron to gain stability.
Generally, free radicals attack the nearest stable molecule, "stealing" its electron.
When the "attacked" molecule loses its electron, it becomes a free radical itself, beginning a chain reaction.
Once the process is started, it can cascade, finally resulting in the disruption of a living cell.
The drawbacks of climate change are so overt. The Disturbance of Great Ocean Conveyor currents led to the extreme changes in temperature around the globe in the form of a cooler northern, warmer tropical and cooler snowy winter, warmer summer. Many deaths from hypothermia were reported especially in refugee camps as it is not well equipped. Hypothermia is a medical emergency that occurs when the body loses heat faster than it can produce heat, causing a dangerously low body temperature. Normal body temperature is around 98.6 F (37 C). Hypothermia occurs as the body temperature falls below 95 F (35 C). When body temperature drops, heart, nervous system and other organs can't work normally. Left untreated, hypothermia can eventually lead to complete failure of heart and respiratory system and eventually to death.
Small intestinal bacterial overgrowth (SIBO)fathi neana
Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity (Dysbiosis) is a common finding in several disease states. The types of Dysbiosis are: 1- Loss of beneficial bacteria. 2- Overgrowth of potentially pathogenic bacteria. 3- Loss of overall bacterial diversity. 4- Overgrown in an area they’re not supposed to be in like the small intestine (SIBO).
The overgrowth of microbes in the small intestine results in: 1- fermentation of food in the small intestine, producing hydrogen and other gases. 2- They can also degrade the thin mucus layer and come in contact with the gut barrier, causing inflammation and intestinal permeability (Leaky gut). 3- This can lead to a variety of unpleasant symptoms and consequences like food allergies , sensitivities and chronic inflammatory processes. 4- SIBO leads to both maldigestion and malabsorption as the bacteria interfere with normal enzymatic and metabolic activity of the small intestine. 5- Additionally, these bacteria are associated with increased serum endotoxin and bacterial compounds stimulating production of (pro)inflammatory cytokines. 6- Iron is typically absorbed in the duodenum and the jejunum and SIBO can interfere with this absorption resulting in microcytic anemia. 7- Vitamin B12 is absorbed in the ileum and patients with SIBO often have B12 malabsorbtion which leads to megaloblastic anemia and B12 deficiency.
The best treatment for SIBO, like other forms of bacterial imbalance – or DYSBIOSIS is rehabilitating our microbiome.”
Biological diversity, or biodiversity, is the scientific term for the variety and variability of life on Earth. Biodiversity is the key indicator of the health of an ecosystem. Every living thing, including man, is involved in these complex networks of interdependent relationships, which are called ecosystems.
Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity is a common finding in several disease states.Microbiota Biodiversity helps us : 1- Combat aggressions from other microorganisms, 2- Maintaining the wholeness of the intestinal mucosa. 3- Plays an important role in the immune system, 4- Performing a barrier effect.5- A healthy and balanced gut microbiota is key to ensuring proper digestive functioning. A gut out of balance means a body out of balance which means illness including Inflammation, Allergies, Infections, Nutrient deficiencies, Weight Gain, Asthma-allergies – Autoimmunity
• Arthritis, Metabolic Bone disease, Skin problems e.g. eczema, Rosacia, Mood disorders - Cognitive decline-Alzheimers and Cancer.
Biological diversity, or biodiversity, is the scientific term for the variety and variability of life on Earth. Biodiversity is the key indicator of the health of an ecosystem. Every living thing, including man, is involved in these complex networks of interdependent relationships, which are called ecosystems.
Like all healthy ecosystems, Richness of microbiota species characterizes the GI microbiome in healthy individuals. Conversely, a loss in species diversity is a common finding in several disease states. Microbiota Biodiversity helps us : 1- Combat aggressions from other microorganisms, 2- Maintaining the wholeness of the intestinal mucosa. 3- Plays an important role in the immune system, 4- Performing a barrier effect.5- A healthy and balanced gut microbiota is key to ensuring proper digestive functioning. A gut out of balance means a body out of balance which means illness including Inflammation, Allergies, Infections, Nutrient deficiencies, Weight Gain, Asthma-allergies – Autoimmunity
• Arthritis, Metabolic Bone disease, Skin problems e.g. eczema, rosacia, Mood disorders - Cognitive decline-Alzheimers and Cancer.
Microbiota, Vitamin D Receptor and Autoimmuityfathi neana
1. Vitamins are substances which usually cannot be made by the body itself.
2. The body synthesizes vitamin D from 7-dehydro-cholesterol. Vitamin D is not a vitamin, it is a Gene-Transcriptional-Activator, a paracrine steroid hormone. It is the primary ligand which activate VDR
3. Deactivated VDR causes down regulation of the innate immunity. The burden on adaptive immunity increases creating a state of chronic inflammation with possible maladaptation and autoimmunity
4. What causes VDR deactivation is mostly a state of chronic inflammation caused by the pathogens associated with dysbiosis or leaky gut
5. VDR deactivation lead to Increased 1,25-dihydroxy vitamin-D (calcitriol) as there is no consumption and no breakdown
6. Sunshine, dietry and Ingested Vitamin D are preparing the precursors of 1,25-dihydroxy vitamin-D (calcitriol)in the presence of good liver and kidney function
7. 1,25-dihydroxy vitamin-D (calcitriol) is the active form which act as the primary ligand for VDR
8. Olmesartan, a VDR agonist, restores innate immune activity, allows (slow) recovery from advanced disease.
9. Treatment on the long term should be directed to reactivation of VDR by the Natural Ways that Increase Calcitrol and Vitamin D Receptor Gene Expression
10. restoring a balanced Microbiota and overcoming the leaky gut play a major rule in VDR reactivation
Successful management of Polytrauma must achieve the following goals, 1- Keep someone alive that would be dead without you 2- Prioritize treatment to prevent killing someone 3- Treat extremity injuries to return the patient to a functional life. The Priorities are 1- Life threatening, 2- Limb threatening, 3- Function threatening. The question about the best strategy in the management Polytrauma and the choice between an Early Total Care (ETC) vs. Damage Control Orthopedics (DCO) will be answered in this presentation.
Microbiota, vitamin D receptor VDR and autoimmuityfathi neana
The big question is what is behind sickness during our life ?. How the pathogens can prevail and what happen to our immune system and microbiota. How the pathogens in a clever way shut down the innate immunity causing persistent chronic illness, chronic inflammation, maladaptive autoimmunity and other chronic diseases. What is the rule of vitamin D and its receptor VDR . What about the current debate regarding the best choice for managing vitamin D deficient function. Hope we can find the answer in this presentation.
DIC is not a disease entity but an event that can accompany various disease processes. It is an “Acquired” Pathological process. Widespread activation of the clotting cascade lead to formation of blood clots in small blood vessels throughout the body causing a compromise of tissue blood flow leading to multiple organ damage MOD. The coagulation process consumes clotting factors and platelets,normal clotting is disrupted and severe bleeding can occur from various sites. Patients with DIC should be treated at hospitals with appropriate critical care units (ICU) with available Subspecialty expertise, such as hematology, blood bank, or surgery. Patients who present to hospitals without those capabilities and who are stable enough for transfer should be referred expeditiously to a hospital that has those resources. Treatment of DIC includes the underlying disorder, supportive treatment and hemostatic Therapy.
Deep vein thrombosis (DVT) & pulmonary embolism (PE). Life-threatening complications following trauma. Incidence of 5 to 63%. Risk factors: Pelvic and lower extremity fractures,Head injury and Prolonged immobilization. DVT prophylaxis is essential in the management of trauma patients.
Sepsis is the systemic inflammatory response syndrome (SIRS) due to severe infection. Sepsis simply is a Race to death between the host immune system and the pathogens. Micro-organisms grow out of control => hyperinflammatory response, With this insidious pathology the body attacks itself (auto immunity) leading to life threatening risk of organ dysfunction, septic shock and death. Micro-organisms can invade the body through wounds, IV lines, catheters etc. Sepsis kills more than 210,000 people in the US /year. It kills about 1,400 people worldwide every day. Significant decrease in Mortality due to increased Recognition and early Treatment.
Fat Embolism Syndrome (FES) is a Syndrome characterized by: Hypoxia, Confusion and Petechiae. Presenting soon after long bone fracture and soft tissue injury. Diagnosed by exclusion of other causes 0f (Hypoxia & Confusion). It occurs in 0.9 – 8.5% of all fracture patients. Up to 35% of the multiply injured. Mortality 2.5 – 15 - 20%. Rare in upper limb injury and children.
Treatment includes prompt stabilization of long bone fractures and supportive measures which includes: 1- Oxygen Therapy to maintain PaO2. 2- Mechanical Ventilation. 3- Adequate Hydration.
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.
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.
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
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
Are There Any Natural Remedies To Treat Syphilis.pdf
Polytrauma part 2 (ards)
1. Dr. Fathi Neana, MD
Chief of Orthopaedics
Dr. Fakhry & Dr. A. Al-Garzaie Hospital
January, 11 - 2019
Polytrauma
Part 2
(ARDS)
Acute Respiratory Distress
Syndrome
6. 3 Rights
Right Patient, Right Hospital, Right Time
Delayed arrival increase Infection rate (3rd
peak of death)
Delayed or Inappropriate Surgery increase ARDS rate
(2nd
peak of Death)
Trauma centre vs. usual G. hospital
Treating Team (senior orthopedic trauma)
Trauma Mortality
Factors Affecting Mortality
7. Ventilation and Gas exchange
under the control of the autonomic nervous
system from parts of the brain stem, the
medulla oblongata and the pons
Immune functions
Metabolic and endocrine functions of the lungs
Vocalization
Temperature control
Coughing and sneezing
Air & Oxygen are free to all
The Respiratory system
8. 18
If you try to reckon up Allah's blessings, you
cannot count them. Indeed, He is Forgiving and
Compassionate, (16:18) Alnahl
Air and Oxygen are free to all
9. The right lung is slightly larger than the left.
Hairs in the nose help to clean the air we breathe as
well as warming it.
The highest recorded "sneeze speed" is 165 km per
hour.
The surface area of the lungs is roughly the same size
as a tennis court.
The capillaries in the lungs would extend 1,600
kilometers if placed end to end.
We lose half a liter of water a day through breathing.
This is the water vapour we see when we breathe
onto glass.
A person at rest usually breathes between 12 and 15
times a minute.
The breathing rate is faster in children and women
than in men.
Amazing Facts about the
Respiratory System
10. Lung Compliance
• Measurement of how easy or hard it is to inflate the lungs.
• COMPLIANCE IS RECIPROCAL OF ELASTANCE.
• Compliance = ∆ Volume
∆ Pressure
• Normal Values
– Lung 0.2 L/cm H20
– Thorax 0.2 L/cm H20
– Total 0.1 L/cm H20
13. Acute Respiratory Distress
Syndrome (ARDS)
Acute Respiratory Distress or
Failure
40 - 50% Mortality rate
Big Cats Tigers and Lions know
how to suffocate their prey?
14. • Acute respiratory distress syndrome (ARDS) is a life-threatening
lung condition that prevents enough oxygen from getting into the
blood.
• Acute respiratory distress syndrome was first described in 1967 by
Ashbaugh and colleagues.
• ARDS is also referred with variety of terms like
• Stiff Lung
• Shock lung
• Wet lung
• Post traumatic lung
• Adult respiratory distress syndrome
• Adult hyaline membrane disease
• Capillary leak syndrome &
• Congestive atelectasis.
Mr. sanjay. M. Peerapur, Principal, KLES Institute of Nursing Sciences, Hubli
Acute Respiratory Distress Syndrome (ARDS)
Introduction
15. Acute Respiratory Distress Syndrome (ARDS)
Definition
Acute Respiratory Distress Syndrome (ARDS)
is a clinical syndrome:
- Severe dyspnea of rapid onset
- Hypoxemia
-Alveolar capillary membrane damage
-Diffuse pulmonary infiltrates
Inflammatory cells and proteinaceous fluid
accumulate in the alveolar spaces leading to a
decrease in diffusing capacity and hypoxemia
- Respiratory failure
16. Lung Injury
• Acute Lung Injury (ALI)
– Normal barriers to
fluid movement
within the lungs is
disrupted.
– If it is severe enough
to cause acute
hypoxemic
respiratory failure it is
termed:
• Acute respiratory
distress syndrome
(ARDS)
– Most severe gas
exchange
abnormalities
– Multiple Organ
Dysfunction
Syndrome (MODS)
17. Criteria Differentiating
ALI and ARDS
• PaO2/FiO2 ratio
• Example
– 100 mm Hg/.21 = 476
– As the number decreases, oxygenation is
getting worse
• ALI is when the ratio is LESS THAN 300
• ARDS the ratio LESS THAN 200
18. Acute lung injury (ALI) and acute respiratory
distress syndrome (ARDS)
ALI is the term used for
patients with significant
hypoxemia (PaO2/FiO2 ratio
of ≤ 300)
ARDS is the term used for
a subset of ALI patients
with severe hypoxemia
(PaO2/FiO2 ratio of ≤ 200)
Normal → ALI → ARD
Clinical Spectrum
19. Tissue injury
Infection
Inflammatory
Mediators
(Decompensated SIRS)
Organ
Injury
ARDS is related to Multi organ dysfunction (MOD)
Persistent release of (inflammatory mediators) results in Systemic inflammatory
response syndrome (SIRS). Inefficient compensatory anti inflammatory response
syndrome (CARS) leads to Multi organ dysfunction (MOD) including Lungs (ARDS)
Acute Respiratory Distress Syndrome (ARDS)
Pathophysiology
20. Multi organ Failure in ARDS
(ARDS) is related to Multi organ
dysfunction (MOD)
25. The Inflammatory Response
Inflammation is an Adaptive response to noxious conditions (Infection and
Tissue injury) an attempt to restore homeostasis
1- Induced by immune recognition of infection or tissue damage (usually
good). But if the immune recognition is hypersensitive to environmental or
auto inflammatory components (autoimmune disease)
2- Inflammation depends upon the Immune Recognition of infection or tissue
damage. a very Balanced process, Normally end with Recovery but Errors, in
recognition - Hypo or Hyper sensitivity end by Death from the Disease or
Inflammation
3- Opsonisation, Antibody opsonization is the process by which the
pathogen is marked for ingestion and eliminated by the phagocytes.
4- Phagocytosis—Process in which phagocytes engulf and digest the
(Opsonised) microorganisms and cellular debris.
5- Recruitment, The Complement (Opsonin) and the Phagocytes
(Exist mainly in blood). A mechanism to recruit these elements to the
invaded tissue led to inflammatory response (inflammation)
26. Vasodilatation .. increase blood flow ..
Capillary permeability ..
Passage large immune cells + proteins
Increase in body heat .. swing the balance
of chemical reactions in favour of the host
The tissues become red. warm, swollen,
painful , Organ dysfunction
Inflammatory process once started it
continues until infection is eradicated
Phagocytes continue to consume and
destroy bacteria
The acquired immune system binds &
disposes harmful toxins
Pus is produced
The Effects of the Inflammatory Response
The Effects of the Inflammatory
Response
Cornelius Celsus in De Medicina, 1st
century A.D.
rubor et tumor cum calore et
dolore”
(Redness and Swelling with Heat
and Pain)
later “functio laesa” (Disturbance of
Function) was added
27. When the infection has been eradicated, and there is no more foreign
antigen
The helper T cells stop emitting the stay-alive signal, thus allowing the
cells involved in the inflammatory response to die off (apoptosis)
If foreign antigen is not eradicated, or if the immune cells receive the
stay-alive signal from another source, then chronic inflammation may
develop
How does the inflammatory response end ?
28. The inflammatory response
Conclusion
Acute inflammation: influx of white blood cells and fluid from blood to fight
infection and aid tissue repair
Chronic inflammation: inducer of inflammation is not removed Leads to
tissue damage and loss of tissue function (joint destruction, lung fibrosis,
etc.)
Current view: aggressively fight inflammation in certain chronic diseases to
decrease / delay progressive loss of function
Current research suggests that inflammation may play an important role in
common chronic diseases including atherosclerosis, type 2 diabetes,
neurodegeneration, and cancer
29.
30. Sudden failure of the respiratory
system
Can occur in anyone over the age of
one who is critically ill
Life- threatening because Normal gas
exchange does not take place
Due to severe fluid buildup in both
lungs
What is Acute respiratory distress syndrome
(ARDS)?
Characterized by:
Rapid breathing
Difficulty getting enough air into the
lungs
Low blood oxygen levels
Cough and fever (if caused by
pneumonia)
Low blood pressure
Confusion & Extreme tiredness
31. Acute respiratory distress syndrome (ARDS)
Clinical Definition
– Acute onset of symptoms
– Ratio of PaO2 to FIO2 of 200 mm Hg or less
(PaO2
) =Arterial partial pressure of oxygen = 95 mm Hg
FIO2 = fraction of inspired oxygen".
– Bilateral infiltrates on CXRs
– Pulmonary arterial wedge pressure of 18 mm Hg or less or no
clinical signs of left atrial hypertension
– American-European Consensus Conference (AECC) on ARDS,
94
32. Acute respiratory distress syndrome (ARDS)
in the post traumatic period
• Incidence 5% – 8% after
polytrauma
• Much lower in isolated fracture
• Mortality up to 40 -50%
• Uncommon in Children and the
Elderly
Characterized by:
• Decreased PaO2
And
• Diffuse and often massive
extravasations of fluid from the
pulmonary vasculature to the
interstitial space of the lungs
33. Acute respiratory distress syndrome (ARDS)
Common Causes & risk factors
(Multifactorial)
• Trauma
• Shock
• Massive Transfusion
• Embolism
• Sepsis (bacterial infection of
the blood)
• Pneumonia or other lung
infection
• Aspiration , vomit , salt water
• Breathing in harmful smoke
or fumes
• Prolonged LOC
• Cardiopulmonary Bypass
• Pancreatitis
• Major Burns
• Abdominal Distension
• Narcotics
• Sedatives
• Overdoses of tricyclic
antidepressants
34. Medical history, Physical exam and Medical
tests
Abnormal Breathing or Heart sounds
Edema means heart or kidneys dysfunction
Arterial blood gas test
Chest x-ray
Chest CT scan
Blood tests for infection
Heart tests look for heart failure
ARDS usually diagnosed in a Hospitalized
patient with a Critical illness such as Shock,
Sepsis or Trauma
Acute respiratory distress syndrome (ARDS)
Diagnosis
Chest Radiograph
Autopsy Specimen
Chest CT Scan
35. • Radiopaque – white
• The more severe the ARDS, the whiter
the lungs appear
• Often described as “White Out” or
diffuse “fluffy” infiltrates
– Non-homogenous
– “Baby Lungs”
• Heart size is normal
• Air Bronchograms
• Honeycombing or Ground Glass
Acute respiratory distress syndrome (ARDS)
Chest X-ray
37. Image shows subtle manifestations of barotrauma, pulmonary interstitial
emphysema, and subcutaneous emphysema. This patient was being treated with
noninvasive ventilation. Importantly, recognize that barotrauma can be
associated with noninvasive ventilation.
38. • Limiting Blood Loss
Decreasing Transfusion
Requirements
• Early Stabilization Of Unstable
Fractures
• Early Prophylactic Mechanical
Ventilation
Temporary Ex-Fix For Stabilization
Acute respiratory distress syndrome (ARDS)
Prevention
39. There is no specific treatment for ARDS
ARDS is treated in the Intensive Care Unit
By Mechanical ventilation & Oxygen therapy
Treatments may include:
Oxygen through a ventilator
Fluids through an IV line to improve blood flow
and provide nutrition
Medicine to prevent and treat infections and to
relieve pain
Acute respiratory distress syndrome (ARDS)
Management
40. • Ventilator Support
– Acceptable ABG’s
Normal Value, Range. pH, 7.4, 7.35 to 7.45.
Pa02, 90mmHg, 80 to 100 mmHg.
– Avoid further alveolar damage
• Toxic FIO2
• Barotrauma
• General Organ Support
• Research
– Optimal ventilator settings
– Pharmacological agents
Acute respiratory distress syndrome (ARDS)
Management
41.
42. • Reversal of underlying
associated disorder
• Oxygen & Diuretics (keep on
dry side)
• Steroids (after 7 days if no
infection)
• Antibiotics
• Mechanical Ventilation
• Proning or lateral rotation
therapy
• Nutritional support
Acute respiratory distress syndrome (ARDS)
Management
• Minimize O2 demand by reducing
metabolic rate
– Control fevers
– Control anxiety and pain
• Altered Style of Ventilation
– Bi-Level Ventilation (APRV)
– High frequency ventilation
– Recruitment Maneuvers
– Proning
• Experimental Treatments:
– Nitric Oxide
– Extracorporeal membrane
oxygenation (ECMO)
– Exogenous Surfactant
Administration
43. Proning
Prone positioning was first proposed in the 1970s
as a method to improve gas exchange
• Should see improvement in 1 hour
– Response should be significant
– PaO2 improves from 60 – 100
mm Hg
• Works better in indirect ARDS
– Pancreatitis
• May improve oxygenation but
does not improve mortality
• Facial Edema can be severe
44.
45. Indications for Mechanical Ventilation
• Acute Hypercapnic
Respiratory Failure
– Respiratory Acidosis
• Acute Hypoxemic
Respiratory Failure
– PaO2 less than normal
– FiO2 greater than 60%
oxygen
• Positive End Expiratory
Pressure (PEEP)
• Set PEEP at lower infection point
to recruit alveoli and keep them
open
• Shunting will improve with
improved PaO2
• PEEP may decrease blood
pressure and cardiac output so
monitor both closely
– Do not allow oxygen delivery
to decrease
46. Ventilation Strategies
• Use higher PEEP levels (10 – 15
cm H20)
• Set low tidal volumes at 5-7
mL/kg
• KEEP ALVEOLAR (PLATEAU)
PRESSURE LESS THAN 30 – 35 cm
H20
• This may result in permissive
hypercapnia.
47. 1. Ineffective breathing pattern related to
decreased lung compliance, decreased
energy as characterized by dyspnea,
abnormal ABGs, cyanoisis & use of
accessory muscles.
2. Impaired gas exchange related to
diffusion defect as characterized by
hypoxia (restlessness, irritability & fear of
suffocation), hypercapnia, tachycardia &
cyanosis.
3. Risk for decreased Cardiac output
related to positive pressure ventilation
4. Ineffective protection related to positive
pressure ventilation, decreased pulmonary
compliance & increased secretions as
characterized by crepitus, altered chest
excursion, abnormal ABGs & restlessness.
5. Impaired physical mobility related to
monitoring devices, mechanical
ventilation & medications as
characterized by imposed restrictions of
movement, decreased muscle strength &
limited range of motion.
6. Risk for impaired skin integrity related
to prolonged bed rest, prolonged
intubation & immobility.
7. Knowledge deficit related to health
condition, new equipment &
hospitalization as characterized
by increased frequency of questions
posed by patient and significant others.
Nursing care and diagnosis
49. Acute respiratory distress syndrome (ARDS)
Outcome
Mortality :
• Significant Cause of Mortality
• Polytrauma second peak 0f death (2-7
Days) 40 - 50% Mortality rate
• Major Cause of Death in Patients with the
Lowest ISS scores
– Mortality Rate Slowly Decreasing with
Changing & Improving Therapy
– Mortality rates have declined over the
past two decades to 30 – 40%
50. Recovery:
• Extent of recovery depends on:
– Severity of the initial lung injury
– Influence of secondary forms of injury
• Oxygen toxicity
• Nosocomial infections
• DIC
• Barotrauma with mechanical ventilation
• Normal lung function after 1 year
• Residual effects may result in decreased flow rates and
DLCO (Diffusing capacity of the lungs for carbon monoxide (DLCO)
Acute respiratory distress syndrome (ARDS)
Outcome
51. Acute respiratory distress syndrome (ARDS)
Outcome
Survivors:
• Good function in many
• Diffuse pulmonary fibrosis and pulmonary
hypertension in severe cases
• Prognostic markers:
– Extreme pO2 decrease
– fibrosis
Editor's Notes
First phase is immediate death or shortly thereafter due to severe brain injury, or disruption of the heart, aorta, or great vessels.
Second phase: Death occurs minutes to a few hours. Deaths are due to lifethreating injuries such as subdural, epidural hematomas, hemopneumothoraces, severe abdominal injuries, long bone fractures, multiple injuries associated with blood loss. This is the group that with rapid evacuation , resuscitation and proper early management can be given the best chance for survival and improved outcomes.
Third phase: Patients die days to weeks from multiple system organ failure and sepsis.
Specialized centers with their expertise and experience can reduce mortality in the second and third phases
First phase is immediate death or shortly thereafter due to severe brain injury, or disruption of the heart, aorta, or great vessels.
Second phase: Death occurs minutes to a few hours. Deaths are due to lifethreating injuries such as subdural, epidural hematomas, hemopneumothoraces, severe abdominal injuries, long bone fractures, multiple injuries associated with blood loss. This is the group that with rapid evacuation , resuscitation and proper early management can be given the best chance for survival and improved outcomes.
Third phase: Patients die days to weeks from multiple system organ failure and sepsis.
Specialized centers with their expertise and experience can reduce mortality in the second and third phases
First phase is immediate death or shortly thereafter due to severe brain injury, or disruption of the heart, aorta, or great vessels.
Second phase: Death occurs minutes to a few hours. Deaths are due to lifethreating injuries such as subdural, epidural hematomas, hemopneumothoraces, severe abdominal injuries, long bone fractures, multiple injuries associated with blood loss. This is the group that with rapid evacuation , resuscitation and proper early management can be given the best chance for survival and improved outcomes.
Third phase: Patients die days to weeks from multiple system organ failure and sepsis.
Specialized centers with their expertise and experience can reduce mortality in the second and third phases