1. Post resuscitation care involves not only return of spontaneous circulation but return to pre-arrest status through management of global ischemia, cardiovascular dysfunction, and persistent precipitant causes.
2. Immediate goals after ROSC include optimization of cardiovascular function and oxygen delivery, ventilation support, temperature management, etiology investigation, and interventions to prevent recurrence.
3. Prognostication is an essential component using markers like neurological exams, EEGs, imaging and biomarkers to predict outcomes in comatose post-cardiac arrest patients.
Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
Post-Cardiac Arrest Syndrome:
Epidemiology, Pathophysiology, Treatment, and Prognostication
A Consensus Statement From the International Liaison Committee on Resuscitation
Circulation. 2008;118:2452-2483
Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
Post-Cardiac Arrest Syndrome:
Epidemiology, Pathophysiology, Treatment, and Prognostication
A Consensus Statement From the International Liaison Committee on Resuscitation
Circulation. 2008;118:2452-2483
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
ACEP Policy for Fever Infants and Children Younger than 2 Years of Age in EDSun Yai-Cheng
Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever
Ann Emerg Med. 2016;67:625-639
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
ACEP Policy for Fever Infants and Children Younger than 2 Years of Age in EDSun Yai-Cheng
Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever
Ann Emerg Med. 2016;67:625-639
Presentación sobre definiciones, etología, fisiopatología, cuadro clínico, diagnostico y tratamiento actualizados según los datos de JAMA 2016 y Surviving Sepsis 2016.
Snake bite ppt by
Dr Sujith Chadala,
Consultant Physician Diabetologist
Ankura Hospitals, Banjara hills, Nanakaramguda,Hyderabad,
Yello Clinics Diagnostics, Kokapet, Hyderabad.
MD,IDCCM,PGPC, CCEBDM,FIDM.Snake envenimation,AntiSnake Venom,Fistaid to Snakebite,Management of Snake bite,Complications of Snakebite,Cobra bite,Viper bite,Krait bite, Complications of Snakebite, ASV indications,20min Whole blood clotting time,Antibiotic in snake bite,average yield per venom, Hemotoxicity of snake bite,Neurotoxicity of snake bite,ASV test dose,ASV administration,ASV reactions,ASv route,ASV in children and pregnant, Hemodialysis in Snakebite,compartment syndrome in Snakebite,local bite management,maximum ASV vials,blood transfusions in snake bite,early and late ASV reactions,discharge criteria in snake bite,Snake bite local tissue care,Snakebite Management,fluids in snakebite,ASV reactions management,Neostigmine test,Intubation in snake bite,ABC management in snakebite,timing of ASV,saw scaled viper bite,ASV forms,fluid resuscitation,vasopressors,torniquet,ICU, Russell's viper,sea snakes,snakebite mortality,pit viper,Kingcobra,Neurotoxins,snake venom composition,hemotological complications of snake bite,neurological complications of Snakebite,local complications of snakebite,generalised complications of snakebite ,Snakebite guidelines,WHO snakebite guidelines, cardiovascular complications of snake bite,renal complications of snakebite,electrotherapy,pressure immobilisation
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
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
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.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
3. Not only
Return of Spontaneous Circulation (ROSC)
But
Return of Pre Arrest Status (ROPAS)
4. To correct
To minimize
Cardiovascular
Brain injury
dysfunction
PCAS
To Manage To Detect &Treat
Persistant
Global ischemia Precipitant
& Reperfusion cause
5.
6. Cardiovascular
Brain injury
dysfunction
PCAS
Persistant
Global ischemia Precipitant
& Reperfusion cause
7. ROSC
Immediate
20 minutes
Early
Life support
6 Hours
8 Hours
Prevent Recurrence
Intermediate
24 Hours
Prognostication
Recovery
72 Hours
Rehabilitation
8. ROSC
Immediate
20 minutes
Early
• Follow 6 Hours
A Intermediate
Life support
24 Hours
B
Prevent Recurrence
Recovery
Prognostication
72 Hours
C
Rehabilitation
Base line neurological
evaluation
9. ROSC
Immediate
Multiple Tasks 20 minutes
Etiology
Early
Search 8 Hours
optmizing
Hemo Investigations
Intermediate
Life support
dynamics
24 Hours
Supportive
care
Prevent Recurrence
Recovery
Prognostication
72 Hours
Ventilatory
Support Interventions
Rehabilitation
10. Optimization of Cardio Vascular function
End
Organ
perfusion
Oxygen delivery
Perfusion pressure
Intra vascular volume
11. ROSC
CV system Optimization 20 minutes
Immediate
( MAP >65 mmHg)
Early
– Convert IO lines
8 Hours
– Intra Venous Fluids
• Fluid boluses if tolerated Intermediate
Life support
• Avoid 24 Hours
– Dextrose containing
Prevent Recurrence
– Hypotonic fluids Recovery
Prognostication
• RL preferred ( 1-2 L) 72 Hours
– Vasoactive agents
• Epinephrine
• Dopamine
Rehabilitation
• Nor Epinephrine
MAP of 80-100 for optimal cerebral perfusion
12. Ventilatory
Support
Pulmonary Respiratory
dysfunction Support
To
Pulmonary
Unload
edema Aspiration Atelectasis Respiratory
demand
22. When ?
• 2 hours
• Bernard SA, Treatment of comatose survivors of
out-of-hospital cardiac arrest with induced
hypothermia. N Engl J Med. 2002;346:557–563.
• 8 hours
• Neumar RW, et al. Circulation. 2008;118: 2452–
2483.
29. Supportive care
• Sedation:
– Opioids, anxiolytics, and sedative-hypnotic
• Various combinations
– Muscel relaxants
• Only in life threatening agitation
• Along with sedation
– Less duration
– Frequent NM Monitoring
30. Supportive care
• Seizure control
– EEG as soon as possible
– All comatose patients
– Myoclonus:
– Clonazepam
– General Seizures
– Benzodiazepines
– Barbiturates
– Phenytoin
– Propofol
31. Supportive care
• Dysrhythmias:
– Standard medical therapies
– No prophylaxis required
• Steroids:
– relative adrenal insufficiency in the post– cardiac
arrest phase
• Associated with higher rates of mortality
– Routine use : Uncertain
38. References
• 1. Part 9: Post–Cardiac Arrest Care: 2010
American Heart Association Guidelines for
Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care
– Circulation. 2010;122:S768-S786,
• 2.UptoDate 2012
