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ARDS is defined by acute onset hypoxemia caused by bilateral lung infiltrates from non-cardiogenic pulmonary edema. The Berlin definition categorizes ARDS as mild, moderate, or severe based on oxygenation levels. Mechanical ventilation can worsen lung injury so strategies aim to limit tidal volumes and pressures while using PEEP to recruit alveoli. Additional techniques like prone positioning, inhaled nitric oxide, and alternative modes may help in severe cases but require more study.
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This document defines acute respiratory distress syndrome (ARDS) and discusses its pathophysiology, risk factors, diagnosis, management, and ventilator strategies. ARDS is defined as acute onset bilateral pulmonary infiltrates, hypoxemia, and no heart failure. It was initially defined in 1971 and revised definitions in 1988 and 1994 established clearer criteria. Common causes are pneumonia, aspiration, and sepsis. Management involves treating the underlying cause, supportive ICU care, and lung protective ventilation with low tidal volumes (6 ml/kg) and moderate PEEP levels. Adjuncts like conservative fluid management, prone positioning, and recruitment maneuvers may provide benefits.
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This document provides an overview of capnography, which is a technology that objectively measures ventilation by detecting exhaled carbon dioxide. It can be used for both intubated and non-intubated patients to continuously monitor ventilation and the patient's ABCs. The document reviews the history of capnography, from its initial use in operating rooms to new portable technologies suitable for emergency medical services. It also outlines the clinical applications of capnography such as verifying endotracheal tube placement and monitoring treatment effectiveness.
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John, a 43-year-old man with asthma, presents with worsening respiratory symptoms and hypoxemia. His hypoxemia is caused by a combination of ventilation-perfusion mismatching and intrapulmonary shunting, likely due to his pneumonia and bronchospasm worsening gas exchange. After intubation and mechanical ventilation, his hypoxemia persists due to an elevated alveolar-arterial oxygen gradient, indicating significant underlying lung pathology beyond his hypercapnia. Shunting occurs when blood flows through unventilated lung regions, mixing deoxygenated blood back into the pulmonary circulation.
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The document discusses arterial blood gas interpretation and key concepts related to pH, PaCO2, PaO2, and bicarbonate levels. It covers the four equations used to interpret blood gases, focusing on the PaCO2 equation and how it relates to alveolar ventilation and carbon dioxide production. Hypercapnia, or elevated PaCO2, is explained as resulting from inadequate alveolar ventilation. Clinical assessment of hypercapnia is shown to be unreliable.
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ARDS is defined by acute onset hypoxemia caused by bilateral lung infiltrates from non-cardiogenic pulmonary edema. The Berlin definition categorizes ARDS as mild, moderate, or severe based on oxygenation levels. Mechanical ventilation can worsen lung injury so strategies aim to limit tidal volumes and pressures while using PEEP to recruit alveoli. Additional techniques like prone positioning, inhaled nitric oxide, and alternative modes may help in severe cases but require more study.
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This document defines acute respiratory distress syndrome (ARDS) and discusses its pathophysiology, risk factors, diagnosis, management, and ventilator strategies. ARDS is defined as acute onset bilateral pulmonary infiltrates, hypoxemia, and no heart failure. It was initially defined in 1971 and revised definitions in 1988 and 1994 established clearer criteria. Common causes are pneumonia, aspiration, and sepsis. Management involves treating the underlying cause, supportive ICU care, and lung protective ventilation with low tidal volumes (6 ml/kg) and moderate PEEP levels. Adjuncts like conservative fluid management, prone positioning, and recruitment maneuvers may provide benefits.
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John, a 43-year-old man with asthma, presents with worsening respiratory symptoms and hypoxemia. His hypoxemia is caused by a combination of ventilation-perfusion mismatching and intrapulmonary shunting, likely due to his pneumonia and bronchospasm worsening gas exchange. After intubation and mechanical ventilation, his hypoxemia persists due to an elevated alveolar-arterial oxygen gradient, indicating significant underlying lung pathology beyond his hypercapnia. Shunting occurs when blood flows through unventilated lung regions, mixing deoxygenated blood back into the pulmonary circulation.
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The document discusses arterial blood gas interpretation and key concepts related to pH, PaCO2, PaO2, and bicarbonate levels. It covers the four equations used to interpret blood gases, focusing on the PaCO2 equation and how it relates to alveolar ventilation and carbon dioxide production. Hypercapnia, or elevated PaCO2, is explained as resulting from inadequate alveolar ventilation. Clinical assessment of hypercapnia is shown to be unreliable.
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This document provides guidelines for interpreting arterial blood gas results, including:
1. It describes how to summarize the acid-base and oxygenation status based on pH, PCO2, HCO3, PO2, and other values.
2. It outlines the steps to determine if a disturbance is respiratory or metabolic in nature, and whether it is acute or chronic.
3. Causes and compensation mechanisms for various acid-base imbalances like respiratory acidosis/alkalosis and metabolic acidosis/alkalosis are reviewed.
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2) Normal lung ultrasound findings include lung sliding, the seashore sign, A-lines, and the lung pulse. Absence of lung sliding can indicate a pneumothorax.
3) B-lines appear as laser-like artifacts that arise from the pleural line and indicate excess fluid or interstitial syndrome. A higher number of B-lines correlates with decompensated heart failure.
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ABGs or VBGs interpretation made simple straight forward easy to remember and easy to apply. The presentation is designed to help the residents and junior ER physicians. The second part will discuss the oxygenation and the third part will review the "Stewart Approach" while fourth and last part is meant for the Experts.
ARDS
This document provides an overview of ARDS (acute respiratory distress syndrome) including its history, definition, pathophysiology, assessment, and treatment strategies. ARDS is characterized by acute hypoxemia, stiff lungs, and diffuse pulmonary infiltrates caused by inflammatory lung injury from direct or indirect insults. Key evidence-based treatment strategies discussed include lung protective ventilation with low tidal volumes, higher PEEP levels, targeting driving pressure, prone positioning, and rescue therapies like recruitment maneuvers which can improve oxygenation but their benefits are uncertain. The PROSEVA trial showed a significant reduction in 28-day mortality for prone positioning in severe ARDS patients.
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The document discusses updates to guidelines for the management of valvular heart disease and atrial fibrillation. Some of the key changes in the 2021 guidelines compared to 2017 include:
- Left atrial appendage occlusion should be considered for stroke prevention in AF patients undergoing valve surgery with a CHA2DS2-VASc score of 2 or higher.
- NOACs are now recommended over VKAs for stroke prevention in AF patients with aortic stenosis, aortic regurgitation, or mitral regurgitation.
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As presented at EUSEM 2015, this presentation discusses how venous blood gas analysis fits into clinical care in emergency departments. The evidence is correct as of Sept 2015
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All available content from SSAI2017: https://scanfoam.org/ssai2017/
Content delivered in collaboration between scanFOAM, SSAI & SFAI.
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1) Transpulmonary pressure, the difference between airway opening and pleural space pressures, is the relevant pressure for the lung, but determining it requires measuring esophageal pressure, which is complicated.
2) A new simple method determines transpulmonary pressure using PEEP steps - by changing PEEP levels, one can measure the change in end-expiratory lung volume (EELV) and use it to calculate lung compliance and transpulmonary pressure without complex measurements.
3) This PEEP step method allows clinicians to monitor transpulmonary pressures at the bedside and optimize ventilation settings to prevent ventilator-induced lung injury, which is caused by high transpulmonary pressures.
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This document provides guidelines for interpreting arterial blood gas results, including:
1. It describes how to summarize the acid-base and oxygenation status based on pH, PCO2, HCO3, PO2, and other values.
2. It outlines the steps to determine if a disturbance is respiratory or metabolic in nature, and whether it is acute or chronic.
3. Causes and compensation mechanisms for various acid-base imbalances like respiratory acidosis/alkalosis and metabolic acidosis/alkalosis are reviewed.
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Acute respiratory distress syndrome (ARDS) is characterized by acute lung injury and hypoxemia caused by a profound inflammatory response and diffuse alveolar damage. ARDS has an incidence of 5-71 per 100,000 people and costs $5 billion annually to treat in the US. Standard treatment focuses on treating the underlying cause, maintaining adequate oxygen levels through ventilator support using lung-protective strategies, and considering approaches like prone positioning to improve oxygenation. While mortality was historically high, outcomes have improved with application of evidence-based protocols, though ARDS still carries significant morbidity and risk of long-term complications.
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Allergic Bronchopulmonary Aspergillosis (ABPA) is a pulmonary disorder caused by hypersensitivity to the fungus Aspergillus fumigatus that complicates asthma and cystic fibrosis. It presents with uncontrolled asthma, recurrent pulmonary infiltrates, and bronchiectasis. Diagnosis involves clinical features like wheezing and hemoptysis, elevated eosinophil counts and IgE levels, positive skin tests or serum IgE to A. fumigatus, and chest imaging showing transient pulmonary opacities or bronchiectasis. Proper diagnosis is important to distinguish ABPA from other severe asthma phenotypes and initiate corticosteroid treatment.
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1) Noninvasive ventilation (NIV) can be used to treat acute respiratory failure from COPD exacerbations, cardiogenic pulmonary edema, and severe asthma. It can reduce the need for intubation compared to standard oxygen therapy alone.
2) When using NIV, careful attention should be paid to the interface and fit to minimize leaks, patient-ventilator asynchrony, and skin breakdown. Appropriate ventilator settings are also important to provide effective ventilation while avoiding overdistention.
3) Nocturnal NIV may provide benefits for stable COPD such as improved gas exchange and sleep, but the evidence is less clear. Patient selection is important, and further research is still needed on its
Ards and ventilator management
The document discusses the case of a 27-year-old postpartum woman presenting with worsening dyspnea and hypoxia. It then reviews the key considerations and management strategies for acute respiratory distress syndrome (ARDS), including low tidal volume ventilation, open lung strategies using recruitment maneuvers and high positive end-expiratory pressure, unconventional approaches like airway pressure release ventilation and high frequency oscillatory ventilation, and adjunctive therapies such as prone positioning. The optimal ventilator mode, settings, and adjunctive strategies depend on the individual patient's severity of lung injury and response to different interventions.
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Provides a simple organized way for ABG analysis with special emphasis on Acid-base balance interpretation & its crucial rule in clinical toxicology practice.
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1) Lung ultrasound is a useful technique for evaluating pulmonary conditions at the bedside with several advantages over other imaging modalities.
2) Normal lung ultrasound findings include lung sliding, the seashore sign, A-lines, and the lung pulse. Absence of lung sliding can indicate a pneumothorax.
3) B-lines appear as laser-like artifacts that arise from the pleural line and indicate excess fluid or interstitial syndrome. A higher number of B-lines correlates with decompensated heart failure.
Interpreting Blood Gases, Practical and easy approach
ABGs or VBGs interpretation made simple straight forward easy to remember and easy to apply. The presentation is designed to help the residents and junior ER physicians. The second part will discuss the oxygenation and the third part will review the "Stewart Approach" while fourth and last part is meant for the Experts.
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This document provides an overview of ARDS (acute respiratory distress syndrome) including its history, definition, pathophysiology, assessment, and treatment strategies. ARDS is characterized by acute hypoxemia, stiff lungs, and diffuse pulmonary infiltrates caused by inflammatory lung injury from direct or indirect insults. Key evidence-based treatment strategies discussed include lung protective ventilation with low tidal volumes, higher PEEP levels, targeting driving pressure, prone positioning, and rescue therapies like recruitment maneuvers which can improve oxygenation but their benefits are uncertain. The PROSEVA trial showed a significant reduction in 28-day mortality for prone positioning in severe ARDS patients.
Hepato pulmonary syndrome
Hepatopulmonary syndrome involves liver disease, impaired oxygenation, and intrapulmonary vascular abnormalities called intrapulmonary vascular dilatations. These dilatations range from 15-160 microns and cause ventilation-perfusion mismatching and oxygen diffusion limitations, leading to hypoxemia. Clinical features include dyspnea, cyanosis, and worsening in the upright position. Liver transplantation can resolve the syndrome by correcting the underlying liver disease.
Capnography in emergency room
The document discusses the role of capnography in the emergency room. It begins by defining capnography as the noninvasive measurement of carbon dioxide levels in exhaled breath. It then covers the basic science behind capnography, different equipment used, how to interpret the waveform, and various clinical uses in pre-hospital and emergency room settings. Specific topics include assessing ventilation, optimizing ventilation rates, evaluating shock, pulmonary embolism, asthma, mechanical obstructions, and emphysema. The document emphasizes that capnography can provide valuable information about a patient's ventilation, perfusion, and metabolism.
Cardiac surgical procedures
The document discusses guidelines for coronary artery bypass grafting (CABG). It summarizes that the left internal thoracic artery is associated with improved outcomes compared to leg vein grafts for CABG. The guidelines were updated to recommend using the left internal thoracic artery to bypass the left anterior descending artery when needed. The document also provides an overview of the CABG procedure and preoperative considerations for patients undergoing the surgery.
Lactate by jack.
Dr. Jakeer Hussain discusses lactic acidosis, which occurs when blood lactate levels are elevated above 5 mmol/L along with metabolic acidosis. Lactic acidosis can be type A, due to tissue hypoperfusion, or type B, which has no evidence of hypoperfusion. Common causes of lactic acidosis include shock, metformin use, mesenteric ischemia, sepsis, lung injury, and certain drugs. The presentation depends on the underlying condition, but resolving lactic acidosis generally indicates successful resuscitation in shock.
PiCCO Monitor
This document discusses PiCCO (Pulse Contour Cardiac Output) monitoring. PiCCO enables assessment of a patient's hemodynamic status by measuring various volumetric and cardiac parameters. It requires a central venous pressure catheter and arterial line. PiCCO works by transpulmonary thermodilution, using cold saline injections to calculate volumes, and pulse contour analysis of the arterial waveform to provide continuous cardiac output monitoring. The document defines various parameters measured by PiCCO like preload, contractility, lung function, and afterload, and provides normal ranges. It also outlines indications, contraindications and the decision tree for hemodynamic monitoring using PiCCO.
Vili
This document discusses ventilator induced lung injury (VILI). It begins by outlining the principles of beneficence, non-maleficence, justice and autonomy in medical care. It then describes the mechanisms of mechanical ventilation and various adverse effects it can cause including volutrauma, barotrauma, atelectrauma and biotrauma. The pathophysiology of VILI is explained as well as ways to assess and prevent VILI through limiting tidal volumes, inspiratory pressures, respiratory rates and using PEEP. Recent developments to monitor and prevent VILI through measures like particle flow rate monitoring and time controlled adaptive ventilation are also summarized.
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Lo mejor en cardiopatía isquémica e intervencionismo coronario. Lo mejor del ...Sociedad Española de Cardiología
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Ispor cost effectiveness_analysis_gm
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thesis
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REALITY Trial
- 1. Ana Viana TejedorREALITY Trial
- 2. Ana Viana TejedorREALITY Trial • Anemia in patients with myocardial infarction (MI) is a relatively frequent issue, resulting in poorer outcome. • There is uncertainty as to which transfusion strategy is best. • RCTs have compared a restrictive and a liberal transfusion strategy in cardiac and non-cardiac surgery or in patients with GI bleeding but have excluded patients with acute MI. BACKGROUND AND RATIONALE Presentation by Philip Gabriel Steg. ESC Congress 2020
- 3. Ana Viana TejedorREALITY Trial
- 4. Ana Viana TejedorREALITY Trial BACKGROUND AND RATIONALE • 2017 ESC STEMI Guidelines: no mention. • 2020 ESC NSTEMI-ACS Guidelines: “based on inconsistent study results and the lack of adequately powered RCTs, a restrictive policy of transfusion in anemic patients may be considered”. No formal recommendation. • Given the costs and risks of transfusion, a cost-effectiveness and cost-utility analysis becomes key to determining the role of each strategy.
- 5. Ana Viana TejedorREALITY Trial • Objective: determine the efficacy, cost-effectiveness and cost-utility of liberal vs restrictive red blood cell transfusion strategies in patients with acute myocardial infarction and anaemia. • Diseño: randomized, open label, parallel assignment. 630 patients. • Participating sites: France and Spain. Las estrategias debían mantenerse hasta el alta hospitalaria o durante 30 días (lo que sucediese primero). Se permitía transfundir si: sangrado masivo, se presumía una caída importante de la Hb sin tiempo a esperar la cifra real de Hb, shock tras la randomización.
- 6. Ana Viana TejedorREALITY Trial PATIENT SELECTION
- 7. Ana Viana TejedorREALITY Trial HYPOTHESIS AND SAMPLE SIZE
- 8. Ana Viana TejedorREALITY Trial
- 9. Ana Viana TejedorREALITY Trial
- 10. Ana Viana TejedorREALITY Trial Saved 414
- 11. Ana Viana TejedorREALITY Trial
- 12. Ana Viana TejedorREALITY Trial
- 13. Ana Viana TejedorREALITY Trial
- 14. Ana Viana TejedorREALITY Trial
- 15. Ana Viana TejedorREALITY Trial 1500 €
- 16. Ana Viana TejedorREALITY Trial
- 17. Ana Viana TejedorREALITY Trial CONCLUSIONES • La estrategia de transfusión restrictiva: Es NO INFERIOR a una estrategia liberal para prevenir los MACE a 30 días en los pacientes con IAM y anemia Ahorra sangre Es segura • El análisis de coste-efectividad indica que la estrategia restrictiva puede ahorrar costes además de mejorar los resultados (dominante). • Estos resultados apoyan el uso de una estrategia restrictiva.