This document provides guidelines for the management of severe pre-eclampsia and eclampsia. It outlines protocols for maternal monitoring, fetal assessment, controlling blood pressure, preventing and treating seizures, fluid balance, delivery, and postpartum care. The guidelines recommend close monitoring of vitals and lab work. Antihypertensives like nifedipine and hydralazine are used to control blood pressure. Magnesium sulfate is the treatment of choice for preventing and treating seizures. Delivery is recommended after 34 weeks gestation once the mother is stabilized. Postpartum monitoring and follow up is also advised.
Meconium-stained amniotic fluid is common complication, seen in 1 out of every 5 pregnancies.Golden rule for management of MSAF is Foetal Heart Monitoring
Meconium-stained amniotic fluid is common complication, seen in 1 out of every 5 pregnancies.Golden rule for management of MSAF is Foetal Heart Monitoring
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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
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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
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
2. BACKGROUND
Eclampsia (E)
convulsions superimposed on pre-eclampsia.
Preeclampsia (PE)
PIH in association with proteinuria (> 0.3 g/24 h) ±
oedema
Severe PE
Significant proteinuria (1 g/litre) PLUS
DBP ≥ 110 mmHg on 2 occasions OR
SBP ≥ 170 mmHg on 2 occasions OR
DBP ≥ 100 mmHg on 2 occasions & with at least 2 S or
S of imminent E.
HELLP syndrome:
Variant of severe PET (haemolysis, elevated liver
enzymes and low platelet count).ABOUBAKR ELNASHAR
3. Clinical features of severe PET
in addition to hypertension & proteinuria:
Severe headache
Visual disturbance
Papilloedema
Liver tenderness
Epigastric pain and/or vomiting
Signs of clonus
Platelet count <100 x 106/l
Abnormal liver enzymes
(ALT or AST rising to above 70 iu/l)
HELLP syndrome.
ABOUBAKR ELNASHAR
4. MANAGEMENT
I. Maternal monitoring
II. Foetal assessment
III.Control BP
IV.Prevention of seizures
V.Control of seizures
VI. Fluid balance
VII.Delivery
VIII. Postparum
ABOUBAKR ELNASHAR
5. I. Maternal monitoring
1.BP:
/15 m until the woman is stabilised and then /30 m in the
initial phase of assessment.
/4-h if a conservative management plan
2. Input and output chart.
3. Full blood count, liver function and renal function
tests.
Repeated at least daily when the results are normal but
more often if the clinical condition changes
•AST >75 iu/l or ALT >70 iu/l Significant
>150 iu/l: increased maternal morbidity
Uric acid should not be used for clinical decision-making.
Platelet count<100x106: consideration for delivery.
4. Clotting studies
not required if the platelet count >100 x 106/l.ABOUBAKR ELNASHAR
6. •Diagnosis of HELLP syndrome
1. Haemolysis:
LDH levels, or blood film (fragmented red cells).
2. Platelet count: <100 x 106
ABOUBAKR ELNASHAR
7. II. Foetal assessment
•In the acute setting:
CTG
•In labour:
continuous electronic fetal monitoring.
ABOUBAKR ELNASHAR
9. III. Control BP: Antihypertensive treatment
Indications:
1. SBP> 160 mmHg or
DBP>100 mmHg.
2. SBP <160 plus
severe disease :
heavy proteinuria or
disordered liver or haematological test
ABOUBAKR ELNASHAR
10. •Drugs:
•Acute , severe:
Nifedipine: oral not sublingually
IR cap:10 mg initial; repeat after 30 m if necessary
IR cap: 10-30 mg tid; not to exceed 120-180 mg/d
ABOUBAKR ELNASHAR
11. Hydralazine
IV: 5 mg over 5 min, repeat /20 min until
DBP 95 mmHg, No more than 4 doses.
If not give Labetalol or Nifidipine.
Maintenance: 10 mg/h
Add 2ml NS to reconstitute 20 mg
hydralazine.
Withdraw 0.5 ml hydralazine solution
and add 9.5 ml NS to give total 10 ml
solution.
ABOUBAKR ELNASHAR
12. Labetalol:
IV: 20 mg; subsequent doses of 40, 80,
80 mg IV at 20-min intervals.
Maintenance: 40 mg/h
Oral: 100 mg BID
ABOUBAKR ELNASHAR
13. Chronic, moderate
Nifedipine
SR tab: 30-60 mg qd; not to exceed 90-120 mg/d
Hydralazine.
Oral: 25 mg tds
•Methyldopa
was the most commonly used therapies in the UK.
safe in long term follow-up of the delivered babies
some studies have suggested some benefits of labetalol.
•Atenolol
increase in IUGR.
•ACE inhibitors and ARBs
contraindicated {unacceptable fetal adverse effects}.
•Diuretics
relatively contraindicated for hypertension
should be reserved for pulmonary oedema.
ABOUBAKR ELNASHAR
14. IV. Prevention of seizures
Indications:
1. Severe PET:
once a delivery decision has been made and in the
immediate postpartum period.
When conservative management of a woman with
severe hypertension and a premature fetus is made
it would be reasonable not to treat until the decision
to deliver has been made.
ABOUBAKR ELNASHAR
15. If Mg So is given:
1. It should be continued for 24 h following delivery
or 24 h after the last seizure
2. Regular assessment of:
a. Urine output: <20 ML/H: STOP
b. Deep tendon reflexes: Loss: Stop
c. Respiratory rate:
d. Oxygen saturation
Antidote: Ca gluconate 1 g (10 ml) over 10 m
ABOUBAKR ELNASHAR
16. V. Control of seizures
I. 1. Do not leave the patient alone. Prevent maternal
injury during the convulsion.
2. Call for help and place a code blue call- Medical
Emergency call.
4. Initiate resuscitation.
5. Turn the patient into left lateral position when able
to do so.
6. Inform the consultant obstetrician and anesthetist
on call.
II. AIRWAY
1. Assess and maintain patency, using oral suction if
necessary.
2. Insert a plastic oral airway if possible
3. administer oxygen therapy via face mask.
ABOUBAKR ELNASHAR
17. III. BREATHING
1. Assess respiratory rate and ambubag using
facial mask/laryngeal mask or endotracheal tube if
necessary.
IV. CIRCULATION
1. Evaluate Pulse and B P. If absent, initiate CPR.
2. Secure IV access as soon as possible with main
line infusion, with three-way tap attached, of
Hartmann's Solution, administered at a very slow
rate, as fluid intake will be restricted to 1 ml/kg/h
3. Pulse oximetry is helpful.
ABOUBAKR ELNASHAR
18. 2. Mg SO4 is the therapy of choice
Loading dose: 4 g given by infusion
pump over 5–10 min
Maintenance: infusion of 1 g/h for 24 h
after the last seizure.
Prepare loading dose:
Add 4g (8ml) of 50% MgS04 to 12ml of
NS. Administer slowly IV over 10 m.
Prepare Maintenance dose:
Add 50g (100ml) of 50% MgS04 to
400ml of NS (withdraw 100mls from
500ml bag of NS, prior to adding
MgS04).
Administer IV via volumetric pump at
10ml/h =1g/h.
ABOUBAKR ELNASHAR
19. 3. Once stabilized
plans should be made to deliver the woman but
there is no particular hurry and a delay of several hrs
to make sure the correct care is in hand is
acceptable
The woman’s condition will always take priority
over the fetal condition.
ABOUBAKR ELNASHAR
20. Recurrent seizures.
1. Increase the rate of infusion of Mg So4 to 1.5 g
or 2.0 g/h
2. Diazepam or thiopentone may be used, but only
as single doses,
3. Intubation
4. Transfer to intensive care facilities with
intermittent positive pressure ventilation
ABOUBAKR ELNASHAR
21. VI. Fluid balance
1. Total fluids should be limited to 80 ml/h or 1
ml/kg/h
2. The regime of fluid restriction should be
maintained until there is a postpartum diuresis
3. If there is associated maternal hge, fluid balance
is more difficult and fluid restriction is inappropriate.
ABOUBAKR ELNASHAR
22. VII. Delivery
When:
•> 34W: Once the woman is stable
•<34 w and delivery can be deferred >24 h:
corticosteroids
•Conservative management at very early
gestations(26W) may improve the perinatal outcome
but must be carefully balanced with maternal
wellbeing, only be considered if the mother remains
stable
ABOUBAKR ELNASHAR
23. How?
Depend on
1.presentation
2.fetal condition
3.likelihood of success of IOL after assessment of
the cervix.
•>34 w with a cephalic presentation:
vaginal delivery should be considered.
Discuss the mode of delivery with the mother.
Vaginal prostaglandins will increase the chance of
success.
Anti-hypertensive tt should be continued throughout
assessment and labour.
•<32 w: CS is more likely as the success of induction
is reduced
ABOUBAKR ELNASHAR
24. The third stage:
5 u IM Syntocinon or 5 u IV Syntocinon given slowly.
Ergometrine or Syntometrine should not be given for
prevention of hge
ABOUBAKR ELNASHAR
25. VIII. Postpartum management
1. .
a. Women who develop hypertension or symptoms
of PE postnatally (headaches, visual
disturbances, nausea and vomiting or epigastric
pain): referred for a specialist opinion and
investigation to exclude PE.
b. Women who deliver with severe PET (or E): close
observation postnatally for 4 days or more
c. Careful review to ensure improving clinical signs
is needed before discharge.
ABOUBAKR ELNASHAR
26. 2. Anti-hypertensive
•Continued as dictated by BP.
•BP should not be allowed to exceed 160/110
mmHg
•A reduction in anti-hypertensive therapy should be
made in a stepwise fashion.
•Avoid alpha methyldopa
•In breastfeeding:
labetalol, atenolol, nifedipine and enalapril can be
given
ABOUBAKR ELNASHAR
27. 3. Follow-up and final diagnosis
1. An assessment of BP and proteinuria at the 6 w.
If hypertension or proteinuria persists then further
investigation is recommended.
2. Preconceptional counselling
ABOUBAKR ELNASHAR