Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
A nasopharyngeal airway, also known as an NPA, nasal trumpet (because of its flared end), or nose hose, is a type of airway adjunct, a tube that is designed to be inserted into the nasal passageway to secure an open airway
Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
A nasopharyngeal airway, also known as an NPA, nasal trumpet (because of its flared end), or nose hose, is a type of airway adjunct, a tube that is designed to be inserted into the nasal passageway to secure an open airway
An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an airway adjunct used in airway management.
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an airway adjunct used in airway management.
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
one of the most commonly used techniques of the lung drainage is the postural drainage its non invasive and easy technique ans very useful in hospital as well as home settings.
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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
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
2. Objectives:
To discuss the indications of proning
To increase awareness of the physiological effects
proning has on patients
To identify the contraindications to proning
To be aware of the precautions needed to be
undertaken prior to proning
To discuss the turning procedure
To identify the complications that can occur with
proning
4. Prone position
First studied in 1974 for pediatric group
Studies in ARDS in late 1990’s
5. Prone position:
Is a maneuver used to combat hypoxemia in
patients with acute respiratory distress
syndrome.Despite the fact that this is currently
considered an efficient way to improve
oxygenation,the physiological mechanisms that
bring about improvements in respiratory function
are not yet fully understood.
6. ARDS
Acute Respiratory Distress Syndrome-is a medical
condition occuring in a critically ill patients
characterized by widespread inflammation in the
lungs. It is not a particular disease rather a clinical
phenotype which maybe triggered by various
pathologies such as trauma, pneumonia and sepsis.
7. Prone position
Evidene base
1.Taccone P.et al 2009
2.Gattinoni L.et al 2010
3.Arbroug F.et al 2011
4.Robak O. Et al 2011
5.Guerin C et al 2013
8. Indications:
Bilateral basal lung collapse/consolidation
Early acute respiratory distress syndrome
Acute lung injury
Pao2 more than 9Kpa despite FIO2 more than 0.6
PEEP more than 7
Moderate to severe acute respiratory failure
Mobilization of secretions
Bilateral infiltrates on chest x-ray
9. Indications
No left ventricular failure
Reduced lung compliance
Reducing the risk of iatrogenic lung injury due to
prolonged periods of mechanical ventilation
10. Contraindications
Shock or acute bleeding
Pregnancy (2nd and 3rd trimester)
Unstable spinal fractures
Tracheostomy less than 24 hours old
Demonstration of previous poor tolerance of prone
positioning
Chest wall abnormalities,kyphoscoliosis
Facial trauma and surgery including opthalmic surgery
Multiple trauma and fractures requiring stabilization
such as pelvic,ribs and sternum.
11. Contraindications:
Cardiovascular instability/recent cardiac arrest
Recent cardio thoracic surgery/presence of intra aortic
balloon pump
Obese patients more than 90kg
Pain and /or agitation
Grossly distended abdomen
Bowel ischemia/recent abdominal surgery
Burns/open wounds
Raised ICP and elevated intra abdominal pressure
12. What effects does the prone
position have:
Increased oxygenation due to:
1.blood flow redistribution and improved V/Q match
2.more consistent ventilation and equal distribution of
lung stresses
3.increase basal expansion and better alveolar
recruitment.
4.increased functional residual volume
13. What effects does the prone
position have?
Increased oxygenation due to :
1.increased surface area for gas exchange
2.enhanced drainage of pulmonary secretionss
3.movementof instertitial fluid
4.increased tidal volumes and reduced work of breathing
due to displacement of abdominal and cardiac structures
5.decreased in fio2
6.decrease in PEEP
Helps to prevent further pulmonary injury caused by high
peep,volutrauma and oxygen toxicity.
Improvement in survival of ARDS patients.
14. Preparations:
Inform relatives if they are present
4-5 nurses must be present,1 respiratory therapist
Physician
Ensure patient is well sedated and paralyzed if
necessary
Ensure slide sheets is in position
Ensure that ETT is well secured
Protect the eyes with ointment and eyepads
Ensure that all equipment and medicine for
15. Preparations:
Potential resuscitation are within easy reach
Disconnect and remove all equipment that the patient
can do without, maintaining asepsis
Adjust the remaining lines and monitor leads to
prevent kinking and disconnection
Empty ileostomy/colostomy drainage bags
Repostion ecg leads just before turning
16. Procedures:
The direction of the first turn should be towards the
ventilator,where possible ,to minimize the risk of
disconnection or extubation.
Place the pillows over the patient’s chest and pelvis to
avoid abdominal pressure from the mattress
Place a pillow over the shins to flex the knees and
reduce stretching of the achilles tendon.
Place a sheet over the patient
Pull the patient to the edge of the bed and slowly turn
him over onto the pillows
17. Potential complications:
Ett and trachy tube displacement
Difficulty in assessing the patients airway
Increased oral and tracheal secretions
Facial and periorbital edema, increased intraocular
pressure, corneal injury
Difficulty performing eye, oral and facial care
Displacement ,compression or difficulty accessing iv
line ,enteral feed line or invasive monitoring devices.
Breakdown of pressure areas or vulnerable areas
18. Potential complications:
Such as face,cheeks,breasts,genitalia,knees,pelvic area
Gastric regurgitation, intolerance of enteral feeding
Joint stiffness or damage ,nerve compression
Cardiovascular instability
Inadequate sedation or analgesia
19. Nursing care:
Any specific care intervention,clinical procedure or
sheet change should be completed prior to proning
Eyelids should be closed using eyepads to prevent
corneal abrasions
Place absorbent material under the dependent side of
the face to absorb excess saliva
Perform regular oral suctioning
Monitor for evidence of gastric regurgitation
Place in reverse t-burg position to minimize gastric
regurgitation and facial edema
20. Nursing care:
Used closed suction system to facilitate suction of
ett/trachy tube
Use pressure relieving mattress and appropriated head
support
Laterally rotate the head 2-3 hours ,placing it away
from the elevated arm(if possible) and avoiding neck
extension
Avoid pressure on the knees and stretching of the
achilles tendon by pillow placement under the shins
Abduct the hips
21. Nursing care:
Reposition the upper limbs 2-3 hours using the
swimmer’s position
Avoid stretching of the brachial plexus and over
distention of the shoulder
Nurse allocation should ensure an appropriate
experienced nurse is available to care of prone patient
In case of emergency situation such as cardiac arrest,
loss of airway ,return the patient in supine position as
22. Summary
Discussed the indications for proning.
Increased awareness of the physiological effects
proning has on patients,to be benificial prone early.
Identified the contraindications to proning
Increased awarenss of the precautions needed to be
undertaken prior to proning,
Discussed the practicalities involved in the turning
procedure.
Identified the complications that can occur with
proning.
24. References
ARDS,ECMO,NO which works,Dr.Fadi S.
Aljamaan,Critical care consultant,King Khalid
University
Ball C,Adams J,Boyce S and Robinson P.(2001)Clinical
guidelines for the use of prone position in acute
respiratory distress .Intensive and critical care nursing
vol 17 pp94=104
Chantler J and Soanes C (2014) AICU/CICU Guidelines
for Prone ventilation in Severe Hypoxic ARDS Oxford
University Hospital.NHS Trust
26. Answer me!
1.Prone positioning has been proven to improve
mortality of what condition?
A.Skin breakdown
B.Acute respiratory distress illness
C.Bronchitis
D.COPD
27. Answer me!
2.How long should a patient with ARDS be in the
prone position.
A.1-2 hours a day
B.Any amount of time is as effective as another
C.16 hours +
D.Continuosly
28. Answer me!
3.What effects does the prone position have on cardiac
function?
A.Decreased stroke volume
B.Decreased heart rate
C.Decreased vascular tone
29. Answer me!
4.How should the patient’s feet and toes be protected
from pressure damage?
A.Padding
B.Padding and Elevation
C.Only through positioning
D.All of the above