Rigid bronchoscopy is a technique that uses a rigid metal tube to visualize the trachea and main bronchi. It allows for suctioning of debris and insertion of stents or other devices. The rigid bronchoscope contains a rigid telescope and light source for visualization of the airways. Various sizes are available depending on the patient. Intubation is usually done under direct visualization using the rigid telescope, with the bronchoscope gently advanced into the trachea after the epiglottis is lifted. Careful technique is important to avoid complications from trauma or prolonged hypoxemia.
Tracheostomy decannulation is always challenging and this presentation address the various issues, indications, contra-indications, problems and solutions.
Tracheostomy decannulation is always challenging and this presentation address the various issues, indications, contra-indications, problems and solutions.
Is your application system process facing problem? With the help of System-level analysis you can save your application from failures at different levels. It analyzes how the components are interacting at multiple layers & technologies. Keep your system efficient and secure.
Virtual Machines are a mainstay in the enterprise. Apache Hadoop is normally run on bare machines. This talk walks through the convergence and the use of virtual machines for running ApacheHadoop. We describe the results from various tests and benchmarks which show that the overhead of using VMs is small. This is a small price to pay for the advantages offered by virtualization. The second half of talk compares multi-tenancy with VMs versus multi-tenancy of with Hadoop`s Capacity scheduler. We follow on with a comparison of resource management in V-Sphere and the finer grained resource management and scheduling in NextGen MapReduce. NextGen MapReduce supports a general notion of a container (such as a process, jvm, virtual machine etc) in which tasks are run;. We compare the role of such first class VM support in Hadoop.
Moving From a Selenium Grid to the Cloud - A Real Life StorySauce Labs
Come hear how Anshul Sharma, Senior QA Engineer at Emmi Solutions, made the move from testing on an in-house Selenium Grid to the Cloud while expanding test coverage and making great strides in moving to a full continuous integration workflow.
Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy.
A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide.
The insertion of a cannula or a tube into a hollow organ such as intestines or trachea, to maintain an opening or passageway is known as intubation.
The insertion of a long breathing tube or artificial airway (endotracheal tube - ETT) into the trachea (windpipe) via the mouth is called endotracheal intubation
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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.
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
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
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
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. Rigid Bronchoscopy:Instrumentation
• Rigid bronchoscopy is a technique that visualizes the
trachea and proximal bronchi.
• Usually performed in the operating room under general
anaesthesia.
• Most commonly used to manage patients who have
obstruction of either their trachea or a proximal
bronchus, the large lumen facilitates suctioning and the
removal of debris, or for interventional procedures such
as insertion of airway stents.
Bolliger CT et al. ERS/ATS statement on interventional pulmonology.. Eur Respir J 2002; 19:356.
Ernst A ET al Interventional pulmonary procedures: Guidelines from theaccp. Chest 2003; 123:1693.
3. • The rigid bronchoscope is also known as an open tube
bronchoscope, open tube, straight bronchoscope, or
ventilating bronchoscope.
• It is a rigid, straight, hollow metal tube that is available
in several sizes. Its purpose is to provide access to the
airways.
4. • The rigid bronchoscope, through which a rigid telescope
is placed, provides access to the central airways.
• External diameters and lengths vary depending upon the
manufacturer.
5. • The external diameter of a rigid bronchoscope varies
from 2 to 14 mm, wall thickness ranges from 2 to 3 mm,
and length varies from a very short tube (for pediatric
cases) to a long or extra long tube (for adults).
• Tubes with an extra large diameter have been developed
for exceptional cases of tracheobronchomalacia, but they
are not readily available.
6. • The distal end of the rigid bronchoscope is usually
beveled to facilitate intubation and lifting of the
epiglottis; the proximal portion is equipped to
accommodate attachments, provide side port ventilation,
and permit insertion of ancillary instruments.
7.
8.
9.
10. • VISUALIZING EQUIPMENT — During rigid
bronchoscopy, a rigid telescope and light source are
generally inserted through a rigid bronchoscope to
visualize the airways.
• A flexible bronchoscope inserted through the rigid
bronchoscope is a reasonable alternative.
11. • Rigid telescopes — Rigid telescopes visualize the
airways at angles of 0, 30, 40, 50, 90, 135, and 180
degrees with respect to the axis of the telescope. This
facilitates visualization of the upper lobe, lower lobe,
and mainstem bronchi bilaterally.
• The Hopkins lens rigid telescope is the most popular
type of rigid telescope.
• Light source — Illumination is extremely important
during rigid bronchoscopy, A cold light source (ie,
xenon and halogen lamps) is the most frequently used
illumination device in rigid bronchoscopy.
12. • Video equipment — ideal for teaching and
documenting procedures, as well as allowing viewing
by multiple individuals.
• Video imaging is enhanced by the high quality of the
optics in a rigid telescope. Single chip or three-chip
video cameras can be easily connected to the proximal
aspect or eyepiece of a rigid telescope via direct
connection devices, Snap-on lenses, or standard C-
mounts.
• Alternatively, a flexible bronchoscope with digital video
capability can be used.
13. • ACCESSORY INSTRUMENTS —
forceps for biopsy
forceps that facilitate foreign-body removal
suction tubing
Instruments used to insert and remove airway
prostheses (eg, stents).
14.
15. Rigid bronchoscopy: Intubation
techniques
• PATIENT PREPARATION:
• Topical anesthesia is applied using lidocaine or tetracaine.
• Patients are oxygenated by mask, and pharyngeal secretions
are aspirated.
• Dentures are removed, and the teeth and gums are carefully
inspected.
16. • Depending upon the position of the glottis and the
laryngotracheobronchial axis, it may be necessary to use
one, two, or no pillows beneath the patient's head.
• Careful attention should be paid to patients with cervical
spine disease.
17. DIRECT INTUBATION
• Direct intubation using a rigid telescope is the method of
choice for rigid bronchoscopic intubation.
• With this technique, the rigid telescope is placed inside
the bronchoscope, and the laryngeal structures are
viewed directly through the telescope.
18. • Illumination is provided through the distal aspect of the
rigid telescope, which is attached via a light cable to a
cold light source.
• If a rigid telescope is not used, the bronchoscope is
introduced using only the naked eye.
19. Steps required for direct intubation using a rigid
telescope:
• The bronchoscopist stands directly behind the head of
the supine patient.
• The rigid bronchoscope is held in the right hand with its
tip uppermost. The middle finger of the left hand is used
to protect the upper teeth and gums and to control head
movements. The telescope should not extend beyond the
edge of the rigid bronchoscope.
20. • The bronchoscope is inserted with its tip facing forward.
Looking through the telescope, the bronchoscopist
identifies the uvula posteriorly, and the bronchoscope is
advanced along the route of the tongue.
21. • The rigid bronchoscope is gently lifted upwards and the
epiglottis is brought into view . The anterior aspect of the
beveled tip of the bronchoscope is then slid under the
epiglottis. Gentle advancement of the rigid tube provides
further access to the larynx.
• After both arytenoids are identified, the rigid tube is
lifted more anteriorly and the vocal cords are seen.
22. • As the vocal cords are approached, the tip of the
bronchoscope is rotated 90 degrees laterally so that the
beveled tip lies between them.
• The bronchoscope is advanced and rotated to enter the
trachea without traumatizing the larynx.
• Once beyond the level of the cricoid cartilage, the
bronchoscope may be rotated so that the beveled tip lies
along the posterior wall of the trachea.
23. • For operators who are uncomfortable with direct
intubation but who are adept at laryngoscopy, the vocal
cords may be visualized using the rigid laryngoscope
alone.
• Intubation through a tracheostomy is a relatively simple
technique. the rigid bronchoscope can be inserted
directly through the stoma from a lateral position.
24.
25.
26. SUMMARY AND RECOMMENDATIONS
• The rigid bronchoscope is a potentially dangerous
instrument.
• It consists of a hollow stainless steel tube that provides
access to the central airways and through which a rigid
telescope is placed.
• The technique of rigid bronchoscopic intubation is one
that is gradually perfected over time.
27. • Direct intubation using a rigid telescope is the method of
choice for rigid bronchoscopic intubation.
• The bronchoscope can and should be introduced gently,
delicately, and with substantial care.
• Most complications of rigid bronchoscopy are related to
poor insertion technique, prolonged trauma of the larynx
and vocal cords, hypercapnia, hypoxemia, or
hemodynamic instability.