Acute pulmonary embolism - risk stratification and managementPrithvi Puwar
what is the guideline recommendation and ideal to be done in management of acute pulmonary embolism. the presentation includes risk stratification, recommendation and approach to investigations (guidelines based) and management options with evidence.
Acute pulmonary embolism - risk stratification and managementPrithvi Puwar
what is the guideline recommendation and ideal to be done in management of acute pulmonary embolism. the presentation includes risk stratification, recommendation and approach to investigations (guidelines based) and management options with evidence.
Point of critical care Ultrasound play a pivotal role in management of critically ill patients admitted in ICU . Its usage in this regard is ever growing . Here we discus about pearls and pitfalls of POCUS in Intensive care medicine.
Reexpansion pulmonary edema is a serious complication after sudden expansion of collapsed lung.Re-expansion pulmonary edema is an uncommon complication following drainage of a pneumothorax , pleural effusion or removal of any space occupying lesion.
The incidence referred is less than 1%, and mortality can reach up to 20%.
Point of critical care Ultrasound play a pivotal role in management of critically ill patients admitted in ICU . Its usage in this regard is ever growing . Here we discus about pearls and pitfalls of POCUS in Intensive care medicine.
Reexpansion pulmonary edema is a serious complication after sudden expansion of collapsed lung.Re-expansion pulmonary edema is an uncommon complication following drainage of a pneumothorax , pleural effusion or removal of any space occupying lesion.
The incidence referred is less than 1%, and mortality can reach up to 20%.
Diagnosis of Pulmonary Embolism is often difficult. This presentation highlights step-wise and practical approach to the diagnosis of PE in short and precise fashion.
Physician should have a high suspicion to diagnose patient with pulmonary Embolism, this slides will give you precise Diagnosis, Investigation and guideline directed Treatment.
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
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
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
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Pulmonary embolism - 2019 ESC Guidelines by Dr. Vaibhav Yawalkar MD DM Cardiology
1. 2019 ESC Guidelines for the
diagnosis and management of
acute pulmonary embolism
Presented by:
2. Epidemiology
• 3rd most frequent acute cardiovascular syndrome
behind MI and stroke
• Annual incidence rates for PE range from 39-115
per 100 000 population
• Risk increases with age
• In last decade only 7% patients were correctly
diagnosed as PE before death
• Recently case fatality rate shows decreasing trend
15. Clinical Presentation
• Dyspnea severe in central PE, mild & transient in
peripheral PE
• Chest pain (pleuritic) in small distal PE (Pulmonary
infarction or pleuritis)
• Typical angina in Central PE (? RV ischemia)
24. Echocardiography
• RV dilation, RV / RA Thrombus
• 60/60 sign (Pulmonary ejection acceleration time
<60 msec & Peak systolic TV gradient < 60 mm Hg)
• McConnell’s Sign
• ↓ TAPSE
• In stable patients rules out other DDs & in
Unstable patients rules out PE if no characteristics
findings
27. D-Dimer Testing
• Normal D-dimer level renders acute PE or DVT
unlikely (Negative Predictive Value)
• Increased in Cancer, sepsis, pregnancy, other
illness etc.
• Use of the age-adjusted (Age x 10 ug/L for age >
50 years) instead of the ‘standard’ 500 ug/L cut-off
increased NPV
• D-dimer values along with 3 parameters of Well’s
score (Signs of DVT, Hemoptysis, Alternate
diagnosis less likely) has more NPV
28.
29. CTPA
• Sensitivity 83% & Specificity 96%
• Predictive value depends on Pre-test clinical
probability
• Excludes PE in patients with Low & Intermediate
clinical probability
• In high clinical probability with negative CTPA
further testing may be needed
31. Lung Scintigraphy (V/Q scanning)
• Purpose of the ventilation scan is to increase
specificity
• Lower-radiation and contrast medium sparing
procedure
• Preferred over CTPA when low clinical probability
,Normal chest Xray &
• Young (particularly female) patients
• In pregnant women
• History of contrast anaphylaxis
• Patients with severe renal failure
32.
33. Compression ultrasonography
• In majority of cases, PE originates from DVT in a
lower limb
• DVT was found in 70% of patients with proven PE
• Lower-limb CUS has largely replaced venography
for diagnosing DVT
• CUS has a sensitivity >90% and a specificity of
95% for proximal symptomatic DVT
• Finding a proximal DVT in patients suspected of
having PE is considered sufficient to warrant
anticoagulant treatment without further testing
34. Compression ultrasonography
• Four point examination (bilateral groin and popliteal
fossa)
• Incomplete compressibility of the vein, indicates the
presence of a clot
• For PE it has high diagnostic specificity (96%) and
a low sensitivity (41%)
• If used along with Echocardiography , increases
specificity
35.
36. Assessment of pulmonary embolism
severity
• Mandatory for determining the appropriate
therapeutic management approach
• Clinical, imaging, laboratory indicators
• Presence of comorbidity
• Other aggravating conditions
41. Treatment in Acute Phase
Oxygen therapy and ventilation
• Supplemental oxygen is indicated in patients with
PE and SaO2 <90%.
• Severe refractory hypoxemia may indicate right to
left shunt
• High-flow oxygen (nasal cannula) and mechanical
ventilation (non-invasive or invasive) should be
considered
• Intubation should be performed only if the patient is
unable to tolerate non-invasive ventilation
44. • UFH is largely restricted to patients with overt
hemodynamic instability
• Imminent hemodynamic decompensation in whom
primary reperfusion treatment will be necessary.
• For patients with serious renal impairment creatinine
clearance (CrCl) < 30 mL/min or severe obesity.
Initial Anticoagulation
48. Thrombolytic regimens
• Accelerated i.v. administration of rtPA; 100 mg over 2 h is preferable to
prolonged infusions of first-generation thrombolytic agents (streptokinase and
urokinase)
• UFH may be administered during continuous infusion of alteplase, but should be
discontinued during infusion of streptokinase or urokinase
