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This document lists various veterinary procedures across different specialties including anaesthesia and diagnostic imaging, emergency and critical care, public health and pathology, production animal, and small animal. Procedures range from abdominal ultrasound, induction of anaesthesia, equine cardiovascular examination, limb bandaging, general clinical examination, electrocardiography, slide agglutination, post-mortem inspection, intra-muscular injection, calf dis-budding, ophthalmic exam, and surgical castration.
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Acute compartment syndrome following dvt
A 25-year-old male presented with a swollen and painful calf following exercise. He was suspected of having a deep vein thrombosis (DVT) and was given therapeutic anticoagulation with Fragmin. Six hours later, he developed severe leg pain and swelling. He was diagnosed with compartment syndrome requiring emergency fasciotomy. The administration of anticoagulation for a suspected DVT precipitated acute compartment syndrome in this case, as the actual diagnosis was a gastrocnemius tear. This case highlights the risks of preemptive anticoagulation when the diagnosis is not definitively DVT and complications such as compartment syndrome can result from hemorrhage.
Noninvasive Face Mask Ventilation
This study evaluated the use of noninvasive face mask ventilation in patients with acute respiratory failure due to intrinsic lung disease. Six patients with hypercapnia (high carbon dioxide levels) and four with hypoxemic (low oxygen levels) acute respiratory failure who met criteria for needing mechanical ventilation were treated with pressure control and pressure support ventilation delivered via a tightly strapped clear face mask. The majority of patients had an improved oxygen exchange with face mask ventilation and avoided needing endotracheal intubation, with a mean treatment duration of 33 hours. The results suggest that noninvasive face mask ventilation may be an effective way to manage some cases of respiratory failure.
Tracheal extubation
The document discusses tracheal extubation procedures and complications. It notes that problems after extubation are more common than during intubation. Key considerations for extubation include whether it should be done awake or under anesthesia, the patient's position, and timing during respiration. Common complications include laryngospasm, coughing, sore throat, and respiratory issues. Proper patient positioning, administration of oxygen, and use of topical anesthetics can help reduce risks. Laryngospasm is the most frequent cause of airway obstruction after extubation and requires interventions like deepening anesthesia or suctioning to resolve.
Anaesthesia induction phase
Preoxygenation involves providing supplemental oxygen to a patient before anesthesia to maximize oxygen reserves. There are several intravenous induction agents used including propofol, etomidate, ketamine and barbiturates which differ in their mechanisms of action and side effect profiles. Capnography is important for monitoring exhaled carbon dioxide during anesthesia and ventilation to ensure patient safety.
Rational use of opioids in anesthesiology
This document summarizes rational use of opioids in anesthesiology. It discusses the mechanisms of action of opioids in inhibiting neurotransmitter release and altering ion conductance. It notes that opioids can block the stress response, allow for balanced anesthesia using reduced doses of other agents, and provide postoperative analgesia. However, opioids can also cause issues like histamine release, hypotension, urinary retention, decreased GI motility, and respiratory depression when combined with other sedatives. The effects of specific opioids like fentanyl, hydromorphone, methadone, remifentanil, and their properties, dosing, and comparisons are outlined. It emphasizes administering balanced anesthesia and avoiding morphine in some patients,
Fiberoptic intubation
1) The document discusses the history and techniques of fiberoptic intubation. It began with the first rigid bronchoscopy in 1897 and the development of the flexible fiberoptic bronchoscope in 1966.
2) There are different modes of fiberoptic intubation including anesthetized oral, anesthetized nasal, awake oral, and awake nasal. Proper airway anesthesia and sedation techniques are important to prepare for awake fiberoptic intubation.
3) The document reviews techniques for fiberoptic intubation including how to open the airway, use various airway devices, handle the bronchoscope, advance the scope, and pass the endotracheal tube. It emphasizes the importance of proper setup
Opioid lecture
The document summarizes opioids and their use in pain management. It describes the scheduling of controlled substances including opioids, endogenous and receptor systems, metabolism and excretion pathways, routes of administration considerations, adverse effects and selected opioids like morphine, fentanyl, methadone.
Opioids Drugs
The document discusses several key points about opioids:
1. It describes the endogenous opioid systems and receptors in the body, including proenkephalin, prodynorphin, pro-opiomelanocortin, and the mu, kappa, delta, and other receptors.
2. It summarizes the pharmacokinetics and pharmacodynamics of opioids like morphine and meperidine, how they work in the body to produce analgesia and other effects.
3. The main effects of opioids discussed are analgesia, respiratory depression, nausea/vomiting, and other central nervous system effects. Their use in anesthesia is also covered.
Recommended
Acute compartment syndrome following dvt
A 25-year-old male presented with a swollen and painful calf following exercise. He was suspected of having a deep vein thrombosis (DVT) and was given therapeutic anticoagulation with Fragmin. Six hours later, he developed severe leg pain and swelling. He was diagnosed with compartment syndrome requiring emergency fasciotomy. The administration of anticoagulation for a suspected DVT precipitated acute compartment syndrome in this case, as the actual diagnosis was a gastrocnemius tear. This case highlights the risks of preemptive anticoagulation when the diagnosis is not definitively DVT and complications such as compartment syndrome can result from hemorrhage.
Noninvasive Face Mask Ventilation
This study evaluated the use of noninvasive face mask ventilation in patients with acute respiratory failure due to intrinsic lung disease. Six patients with hypercapnia (high carbon dioxide levels) and four with hypoxemic (low oxygen levels) acute respiratory failure who met criteria for needing mechanical ventilation were treated with pressure control and pressure support ventilation delivered via a tightly strapped clear face mask. The majority of patients had an improved oxygen exchange with face mask ventilation and avoided needing endotracheal intubation, with a mean treatment duration of 33 hours. The results suggest that noninvasive face mask ventilation may be an effective way to manage some cases of respiratory failure.
Tracheal extubation
The document discusses tracheal extubation procedures and complications. It notes that problems after extubation are more common than during intubation. Key considerations for extubation include whether it should be done awake or under anesthesia, the patient's position, and timing during respiration. Common complications include laryngospasm, coughing, sore throat, and respiratory issues. Proper patient positioning, administration of oxygen, and use of topical anesthetics can help reduce risks. Laryngospasm is the most frequent cause of airway obstruction after extubation and requires interventions like deepening anesthesia or suctioning to resolve.
Anaesthesia induction phase
Preoxygenation involves providing supplemental oxygen to a patient before anesthesia to maximize oxygen reserves. There are several intravenous induction agents used including propofol, etomidate, ketamine and barbiturates which differ in their mechanisms of action and side effect profiles. Capnography is important for monitoring exhaled carbon dioxide during anesthesia and ventilation to ensure patient safety.
Rational use of opioids in anesthesiology
This document summarizes rational use of opioids in anesthesiology. It discusses the mechanisms of action of opioids in inhibiting neurotransmitter release and altering ion conductance. It notes that opioids can block the stress response, allow for balanced anesthesia using reduced doses of other agents, and provide postoperative analgesia. However, opioids can also cause issues like histamine release, hypotension, urinary retention, decreased GI motility, and respiratory depression when combined with other sedatives. The effects of specific opioids like fentanyl, hydromorphone, methadone, remifentanil, and their properties, dosing, and comparisons are outlined. It emphasizes administering balanced anesthesia and avoiding morphine in some patients,
Fiberoptic intubation
1) The document discusses the history and techniques of fiberoptic intubation. It began with the first rigid bronchoscopy in 1897 and the development of the flexible fiberoptic bronchoscope in 1966.
2) There are different modes of fiberoptic intubation including anesthetized oral, anesthetized nasal, awake oral, and awake nasal. Proper airway anesthesia and sedation techniques are important to prepare for awake fiberoptic intubation.
3) The document reviews techniques for fiberoptic intubation including how to open the airway, use various airway devices, handle the bronchoscope, advance the scope, and pass the endotracheal tube. It emphasizes the importance of proper setup
Opioid lecture
The document summarizes opioids and their use in pain management. It describes the scheduling of controlled substances including opioids, endogenous and receptor systems, metabolism and excretion pathways, routes of administration considerations, adverse effects and selected opioids like morphine, fentanyl, methadone.
Opioids Drugs
The document discusses several key points about opioids:
1. It describes the endogenous opioid systems and receptors in the body, including proenkephalin, prodynorphin, pro-opiomelanocortin, and the mu, kappa, delta, and other receptors.
2. It summarizes the pharmacokinetics and pharmacodynamics of opioids like morphine and meperidine, how they work in the body to produce analgesia and other effects.
3. The main effects of opioids discussed are analgesia, respiratory depression, nausea/vomiting, and other central nervous system effects. Their use in anesthesia is also covered.
Complete fiberoptic
This document discusses fiberoptic intubation, including:
1. Indications for fiberoptic intubation such as difficult airway cases or cervical spine injuries
2. Topical anesthesia techniques for awake fiberoptic intubation, including nerve blocks to anesthetize the nasal passages, pharynx, and larynx
3. Proper setup and positioning for fiberoptic intubation, including devices to aid visualization and intubation
Extubation presentation
This document discusses the criteria and process for extubating a patient from mechanical ventilation. It begins by defining extubation as the removal of the endotracheal tube, which should only be done once a patient no longer requires ventilation and can protect their airway. Specific criteria are provided for assessing a patient's readiness, including hemodynamic stability, adequate oxygenation, normal blood gases, resolution of underlying conditions, and intact neurological function. Potential complications are also reviewed. The process of extubation involves preparing equipment, explaining to the patient, continuously monitoring their condition, and carefully removing the tube while suctioning and assessing airway patency.
Extubation and reintubation
This document discusses guidelines for extubation and managing risks associated with extubation. It begins by outlining criteria that must be met for safe extubation, such as adequate breathing and hemodynamics. It then describes methods for standard, awake, deep and difficult/high risk extubations. Risks of immediate extubation are outlined. The document provides detailed protocols for managing complications like laryngospasm and laryngeal edema to prevent reintubation. Prophylactic medications, strategies for difficult airways, and criteria for determining pre-extubation airway edema are discussed to ensure extubations are performed safely.
ASA Guidelines for Management of the Difficult Airway
Practice Guidelines for Management of the Difficult Airway
An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway
Anesthesiology 2013; 118(2):251-270
Difficult airway managemnt
Difficult Airway Management describes the challenges of managing difficult airways in emergency departments. Factors that can make intubation difficult include limited pre-procedure evaluation, hypoxia, and dynamic medical conditions in non-controlled settings. Predicting difficult airways involves considering history of conditions like small mouths or infections and performing a physical exam including the Mallampati score, thyromental distance, and neck mobility. Management involves having an emergency airway trolley with various equipment available, using the most senior staff, delivering oxygen, and following an emergency airway algorithm that may include alternative techniques like laryngeal masks, fiberoptic intubation, or surgical airway as a last resort.
Mech Vent monitoring
This document provides guidelines for mechanical ventilation monitoring and management. It outlines an algorithm for initial intubation settings and adjustments based on oxygen saturation levels. It describes strategies for improving ventilation and oxygenation such as correcting PaCO2 abnormalities by adjusting rate and tidal volume, and using FiO2 and PEEP to optimize oxygenation levels while avoiding lung injury. Key concepts covered include permissive hypercapnia, selecting optimal PEEP, and indications for PEEP therapy.
Awake intubation distribution
The document discusses awake intubation, including indications, patient preparation, pharmacological considerations like using lidocaine to anesthetize the airway via various methods to block different nerves, equipment needs, and personnel requirements to safely perform an awake intubation. It also reviews closed claims analyses related to airway management and difficult intubation, and the ASA's difficult airway algorithm.
Oxygenation and ventilation monitoring
This document discusses oxygenation and ventilation monitoring techniques including indices of oxygenation such as pulse oximetry and capnography. It provides details on how to interpret pulse oximetry readings and capnography waveforms. Common abnormalities in capnography waveforms are described along with their potential causes. The uses of capnography in intubated and non-intubated patients are outlined. Arterial blood gases and the steps to analyze them are also reviewed.
Bag & mask equipment
This document discusses positive pressure ventilation for compromised newborns during resuscitation. There are two types of resuscitation bags - flow inflating bags and self inflating bags. Flow inflating bags require an oxygen source and tight seal to inflate properly, while self inflating bags can deliver positive pressure without an external oxygen source but require a reservoir to provide 100% oxygen. The document also covers recommended bag sizes, pressure valves, masks and testing procedures for the bags.
Anatomical and physiological differences
Children's bodies differ from adults' in many key systems:
1. The gastrointestinal system of children has a large tongue, small nasal passages, a relaxed cardiac sphincter, and faster emptying and passage of food compared to adults.
2. In the respiratory system, children have more delicate airways that do not produce mucus, a shorter and straighter eustachian tube, and larger tonsils involved in antibody production.
3. The heart of children beats faster, their blood pressure is lower, and pulse rate is higher compared to adults.
This summarizes some of the key differences between children's and adults' bodies outlined in the document.
Fentanylo
El documento describe las propiedades y uso del fentanilo, un potente agonista opiode sintético utilizado en analgesia y anestesia. El fentanilo es aproximadamente 100 veces más potente que la morfina, actúa principalmente en receptores μ, y tiene efectos analgésicos, sedantes y depresores del sistema respiratorio y cardiovascular. Se usa comúnmente para cirugía menor, anestesia general y regional, y sedación prolongada.
Endotracheal tube
An endotracheal tube (ETT) is inserted into the trachea to provide a clear airway and facilitate ventilation during general anesthesia, respiratory failure, cardiac arrest, or unconsciousness. The ETT is properly sized and inserted using a laryngoscope to visualize the vocal cords. Placement is confirmed with end tidal CO2 monitoring, chest rise, breath sounds, and cuff palpation before securing. Complications include trauma, laryngeal injury, esophageal intubation, and perforation.
Anesthesia 5th year, 7th & 8th lectures (Dr. Aamir)
Intravenous anesthetic agents include barbiturates, benzodiazepines, opioids, and miscellaneous drugs. They are used for induction and maintenance of anesthesia, as well as sedation. Barbiturates like thiopental are used for induction but have cumulative effects. Benzodiazepines provide sedation and are used in regional anesthesia and intensive care. Opioids like fentanyl, alfentanil, and remifentanil provide analgesia before and after surgery. They can cause respiratory depression, nausea, and vomiting. Ketamine is used in shocked patients and where equipment is limited due to rapid onset and short duration.
Bvm
This document provides information about bag valve masks (BVM), including:
- What a BVM is and its components
- Its history of being discovered in 1953 by a German engineer and anesthesiologist
- Its uses in respiratory failure, arrest, ventilator failure, and patient transfers
- Potential complications if not used properly like gastric insufflation and lung injuries
- Tips for its proper use including ensuring a seal and using two rescuers when possible
Difficult Airway Management for EMS
1) Capt. Duckworth provides a summary of techniques for managing a patient's airway including use of oral and nasal airways, supraglottic airways, endotracheal intubation, and cricothyrotomy.
2) Key steps include being prepared to intubate, attempting first pass intubation, using appropriate tools and techniques, evaluating the airway before proceeding, and addressing issues quickly through re-intubation or cricothyrotomy if needed.
3) Factors like proper patient positioning, mouth obstructions, and equipment issues can impact success and should be addressed through evaluation and use of appropriate techniques.
Bag and mask Ventilation
Bag and mask ventilation is a basic airway management technique used to oxygenate and ventilate patients until a more definitive airway can be established. It involves manually squeezing an ambu bag attached to a face mask to deliver breaths. Key aspects of bag and mask ventilation include maintaining a proper seal and head position, delivering appropriate volume and rate of breaths, and assessing ventilation effectiveness through chest rise and oxygen saturation. While bag and mask is preferred for prehospital airway support in pediatrics, it has limitations and risks if ventilation is inadequate or contraindications like upper airway obstruction are present.
Recognition And Management Of Difficult Airway
This document discusses recognition and management of difficult airways. It defines difficult airway as difficulty with mask ventilation or tracheal intubation. It discusses incidence, risk factors, assessment techniques like Mallampati classification and thyromental distance, and management strategies including awake intubation, use of airway adjuncts like LMA, and the ASA difficult airway algorithm which provides a structured approach. The key points are assessing risk factors, having proper equipment and backup plans, and pursuing oxygenation throughout management of a difficult airway.
3.general anesth
General anesthesia requires a combination of drugs to safely induce analgesia, amnesia, unconsciousness and muscle relaxation in patients. A balanced anesthesia approach uses multiple drugs together to benefit from their individual effects while minimizing adverse effects. Preanesthetic medication is commonly used before anesthesia to decrease anxiety, provide amnesia, relieve pain if present, and reduce risks associated with some anesthetic agents. It typically involves sedatives/hypnotics, opioid analgesics, anticholinergic agents, and drugs that reduce gastric acidity.
Applied anatomy and physiology of paediatric anaesthesia
This document discusses the key anatomical and physiological differences between pediatric and adult patients that are important for anesthesia. It notes that infants have proportionally larger tongues, narrower airways that are more prone to obstruction, and an anterior larynx. Infant respiratory systems are also more compliant, with lower functional residual capacity. Their cardiovascular systems have higher heart rates and are more sensitive to bradycardias. Infant renal, hepatic and glucose metabolism are also immature. The document provides guidance on pre-operative evaluation, fluid management, and considerations for intubation and induction for pediatric anesthesia. It emphasizes being aware of potential unexpected responses due to the anatomical and physiological differences between pediatric and adult patients.
Awake Intubation the EMCrit Way
Scott Weingart revisits his famous video, illustrating how awake intubation can be done efficiently and effectively, with the proper preparation.
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Insectsplayamajorroleinthedeteriorationoffoodgrainscausingbothquantitativeandqualitativelosses
Wellprovedthatnogranariescanbefilledwithgrainswithoutinsectsastheharvestedproducecontainegg(or)larvae(or)pupae(or)adultinsectinthembecauseoffieldcarryoverinfestationwhichcannotbeavoidedindevelopingcountrieslikeIndia
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Complete fiberoptic
This document discusses fiberoptic intubation, including:
1. Indications for fiberoptic intubation such as difficult airway cases or cervical spine injuries
2. Topical anesthesia techniques for awake fiberoptic intubation, including nerve blocks to anesthetize the nasal passages, pharynx, and larynx
3. Proper setup and positioning for fiberoptic intubation, including devices to aid visualization and intubation
Extubation presentation
This document discusses the criteria and process for extubating a patient from mechanical ventilation. It begins by defining extubation as the removal of the endotracheal tube, which should only be done once a patient no longer requires ventilation and can protect their airway. Specific criteria are provided for assessing a patient's readiness, including hemodynamic stability, adequate oxygenation, normal blood gases, resolution of underlying conditions, and intact neurological function. Potential complications are also reviewed. The process of extubation involves preparing equipment, explaining to the patient, continuously monitoring their condition, and carefully removing the tube while suctioning and assessing airway patency.
Extubation and reintubation
This document discusses guidelines for extubation and managing risks associated with extubation. It begins by outlining criteria that must be met for safe extubation, such as adequate breathing and hemodynamics. It then describes methods for standard, awake, deep and difficult/high risk extubations. Risks of immediate extubation are outlined. The document provides detailed protocols for managing complications like laryngospasm and laryngeal edema to prevent reintubation. Prophylactic medications, strategies for difficult airways, and criteria for determining pre-extubation airway edema are discussed to ensure extubations are performed safely.
ASA Guidelines for Management of the Difficult Airway
Practice Guidelines for Management of the Difficult Airway
An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway
Anesthesiology 2013; 118(2):251-270
Difficult airway managemnt
Difficult Airway Management describes the challenges of managing difficult airways in emergency departments. Factors that can make intubation difficult include limited pre-procedure evaluation, hypoxia, and dynamic medical conditions in non-controlled settings. Predicting difficult airways involves considering history of conditions like small mouths or infections and performing a physical exam including the Mallampati score, thyromental distance, and neck mobility. Management involves having an emergency airway trolley with various equipment available, using the most senior staff, delivering oxygen, and following an emergency airway algorithm that may include alternative techniques like laryngeal masks, fiberoptic intubation, or surgical airway as a last resort.
Mech Vent monitoring
This document provides guidelines for mechanical ventilation monitoring and management. It outlines an algorithm for initial intubation settings and adjustments based on oxygen saturation levels. It describes strategies for improving ventilation and oxygenation such as correcting PaCO2 abnormalities by adjusting rate and tidal volume, and using FiO2 and PEEP to optimize oxygenation levels while avoiding lung injury. Key concepts covered include permissive hypercapnia, selecting optimal PEEP, and indications for PEEP therapy.
Awake intubation distribution
The document discusses awake intubation, including indications, patient preparation, pharmacological considerations like using lidocaine to anesthetize the airway via various methods to block different nerves, equipment needs, and personnel requirements to safely perform an awake intubation. It also reviews closed claims analyses related to airway management and difficult intubation, and the ASA's difficult airway algorithm.
Oxygenation and ventilation monitoring
This document discusses oxygenation and ventilation monitoring techniques including indices of oxygenation such as pulse oximetry and capnography. It provides details on how to interpret pulse oximetry readings and capnography waveforms. Common abnormalities in capnography waveforms are described along with their potential causes. The uses of capnography in intubated and non-intubated patients are outlined. Arterial blood gases and the steps to analyze them are also reviewed.
Bag & mask equipment
This document discusses positive pressure ventilation for compromised newborns during resuscitation. There are two types of resuscitation bags - flow inflating bags and self inflating bags. Flow inflating bags require an oxygen source and tight seal to inflate properly, while self inflating bags can deliver positive pressure without an external oxygen source but require a reservoir to provide 100% oxygen. The document also covers recommended bag sizes, pressure valves, masks and testing procedures for the bags.
Anatomical and physiological differences
Children's bodies differ from adults' in many key systems:
1. The gastrointestinal system of children has a large tongue, small nasal passages, a relaxed cardiac sphincter, and faster emptying and passage of food compared to adults.
2. In the respiratory system, children have more delicate airways that do not produce mucus, a shorter and straighter eustachian tube, and larger tonsils involved in antibody production.
3. The heart of children beats faster, their blood pressure is lower, and pulse rate is higher compared to adults.
This summarizes some of the key differences between children's and adults' bodies outlined in the document.
Fentanylo
El documento describe las propiedades y uso del fentanilo, un potente agonista opiode sintético utilizado en analgesia y anestesia. El fentanilo es aproximadamente 100 veces más potente que la morfina, actúa principalmente en receptores μ, y tiene efectos analgésicos, sedantes y depresores del sistema respiratorio y cardiovascular. Se usa comúnmente para cirugía menor, anestesia general y regional, y sedación prolongada.
Endotracheal tube
An endotracheal tube (ETT) is inserted into the trachea to provide a clear airway and facilitate ventilation during general anesthesia, respiratory failure, cardiac arrest, or unconsciousness. The ETT is properly sized and inserted using a laryngoscope to visualize the vocal cords. Placement is confirmed with end tidal CO2 monitoring, chest rise, breath sounds, and cuff palpation before securing. Complications include trauma, laryngeal injury, esophageal intubation, and perforation.
Anesthesia 5th year, 7th & 8th lectures (Dr. Aamir)
Intravenous anesthetic agents include barbiturates, benzodiazepines, opioids, and miscellaneous drugs. They are used for induction and maintenance of anesthesia, as well as sedation. Barbiturates like thiopental are used for induction but have cumulative effects. Benzodiazepines provide sedation and are used in regional anesthesia and intensive care. Opioids like fentanyl, alfentanil, and remifentanil provide analgesia before and after surgery. They can cause respiratory depression, nausea, and vomiting. Ketamine is used in shocked patients and where equipment is limited due to rapid onset and short duration.
Bvm
This document provides information about bag valve masks (BVM), including:
- What a BVM is and its components
- Its history of being discovered in 1953 by a German engineer and anesthesiologist
- Its uses in respiratory failure, arrest, ventilator failure, and patient transfers
- Potential complications if not used properly like gastric insufflation and lung injuries
- Tips for its proper use including ensuring a seal and using two rescuers when possible
Difficult Airway Management for EMS
1) Capt. Duckworth provides a summary of techniques for managing a patient's airway including use of oral and nasal airways, supraglottic airways, endotracheal intubation, and cricothyrotomy.
2) Key steps include being prepared to intubate, attempting first pass intubation, using appropriate tools and techniques, evaluating the airway before proceeding, and addressing issues quickly through re-intubation or cricothyrotomy if needed.
3) Factors like proper patient positioning, mouth obstructions, and equipment issues can impact success and should be addressed through evaluation and use of appropriate techniques.
Bag and mask Ventilation
Bag and mask ventilation is a basic airway management technique used to oxygenate and ventilate patients until a more definitive airway can be established. It involves manually squeezing an ambu bag attached to a face mask to deliver breaths. Key aspects of bag and mask ventilation include maintaining a proper seal and head position, delivering appropriate volume and rate of breaths, and assessing ventilation effectiveness through chest rise and oxygen saturation. While bag and mask is preferred for prehospital airway support in pediatrics, it has limitations and risks if ventilation is inadequate or contraindications like upper airway obstruction are present.
Recognition And Management Of Difficult Airway
This document discusses recognition and management of difficult airways. It defines difficult airway as difficulty with mask ventilation or tracheal intubation. It discusses incidence, risk factors, assessment techniques like Mallampati classification and thyromental distance, and management strategies including awake intubation, use of airway adjuncts like LMA, and the ASA difficult airway algorithm which provides a structured approach. The key points are assessing risk factors, having proper equipment and backup plans, and pursuing oxygenation throughout management of a difficult airway.
3.general anesth
General anesthesia requires a combination of drugs to safely induce analgesia, amnesia, unconsciousness and muscle relaxation in patients. A balanced anesthesia approach uses multiple drugs together to benefit from their individual effects while minimizing adverse effects. Preanesthetic medication is commonly used before anesthesia to decrease anxiety, provide amnesia, relieve pain if present, and reduce risks associated with some anesthetic agents. It typically involves sedatives/hypnotics, opioid analgesics, anticholinergic agents, and drugs that reduce gastric acidity.
Applied anatomy and physiology of paediatric anaesthesia
This document discusses the key anatomical and physiological differences between pediatric and adult patients that are important for anesthesia. It notes that infants have proportionally larger tongues, narrower airways that are more prone to obstruction, and an anterior larynx. Infant respiratory systems are also more compliant, with lower functional residual capacity. Their cardiovascular systems have higher heart rates and are more sensitive to bradycardias. Infant renal, hepatic and glucose metabolism are also immature. The document provides guidance on pre-operative evaluation, fluid management, and considerations for intubation and induction for pediatric anesthesia. It emphasizes being aware of potential unexpected responses due to the anatomical and physiological differences between pediatric and adult patients.
Awake Intubation the EMCrit Way
Scott Weingart revisits his famous video, illustrating how awake intubation can be done efficiently and effectively, with the proper preparation.
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Immersive Learning That Works: Research Grounding and Paths Forward
We will metaverse into the essence of immersive learning, into its three dimensions and conceptual models. This approach encompasses elements from teaching methodologies to social involvement, through organizational concerns and technologies. Challenging the perception of learning as knowledge transfer, we introduce a 'Uses, Practices & Strategies' model operationalized by the 'Immersive Learning Brain' and ‘Immersion Cube’ frameworks. This approach offers a comprehensive guide through the intricacies of immersive educational experiences and spotlighting research frontiers, along the immersion dimensions of system, narrative, and agency. Our discourse extends to stakeholders beyond the academic sphere, addressing the interests of technologists, instructional designers, and policymakers. We span various contexts, from formal education to organizational transformation to the new horizon of an AI-pervasive society. This keynote aims to unite the iLRN community in a collaborative journey towards a future where immersive learning research and practice coalesce, paving the way for innovative educational research and practice landscapes.
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Wellprovedthatnogranariescanbefilledwithgrainswithoutinsectsastheharvestedproducecontainegg(or)larvae(or)pupae(or)adultinsectinthembecauseoffieldcarryoverinfestationwhichcannotbeavoidedindevelopingcountrieslikeIndia
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JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDS
The pathway(s) to seeding the massive black holes (MBHs) that exist at the heart of galaxies in the present and distant Universe remains an unsolved problem. Here we categorise, describe and quantitatively discuss the formation pathways of both light and heavy seeds. We emphasise that the most recent computational models suggest that rather than a bimodal-like mass spectrum between light and heavy seeds with light at one end and heavy at the other that instead a continuum exists. Light seeds being more ubiquitous and the heavier seeds becoming less and less abundant due the rarer environmental conditions required for their formation. We therefore examine the different mechanisms that give rise to different seed mass spectrums. We show how and why the mechanisms that produce the heaviest seeds are also among the rarest events in the Universe and are hence extremely unlikely to be the seeds for the vast majority of the MBH population. We quantify, within the limits of the current large uncertainties in the seeding processes, the expected number densities of the seed mass spectrum. We argue that light seeds must be at least 103 to 105 times more numerous than heavy seeds to explain the MBH population as a whole. Based on our current understanding of the seed population this makes heavy seeds (Mseed > 103 M⊙) a significantly more likely pathway given that heavy seeds have an abundance pattern than is close to and likely in excess of 10−4 compared to light seeds. Finally, we examine the current state-of-the-art in numerical calculations and recent observations and plot a path forward for near-future advances in both domains.
MICROBIAL INTERACTION PPT/ MICROBIAL INTERACTION AND THEIR TYPES // PLANT MIC...
MICROBIAL INTERACTION PPT/ MICROBIAL INTERACTION AND THEIR TYPES // PLANT MIC...ABHISHEK SONI NIMT INSTITUTE OF MEDICAL AND PARAMEDCIAL SCIENCES , GOVT PG COLLEGE NOIDA
Microbial interaction
Microorganisms interacts with each other and can be physically associated with another organisms in a variety of ways.
One organism can be located on the surface of another organism as an ectobiont or located within another organism as endobiont.
Microbial interaction may be positive such as mutualism, proto-cooperation, commensalism or may be negative such as parasitism, predation or competition
Types of microbial interaction
Positive interaction: mutualism, proto-cooperation, commensalism
Negative interaction: Ammensalism (antagonism), parasitism, predation, competition
I. Mutualism:
It is defined as the relationship in which each organism in interaction gets benefits from association. It is an obligatory relationship in which mutualist and host are metabolically dependent on each other.
Mutualistic relationship is very specific where one member of association cannot be replaced by another species.
Mutualism require close physical contact between interacting organisms.
Relationship of mutualism allows organisms to exist in habitat that could not occupied by either species alone.
Mutualistic relationship between organisms allows them to act as a single organism.
Examples of mutualism:
i. Lichens:
Lichens are excellent example of mutualism.
They are the association of specific fungi and certain genus of algae. In lichen, fungal partner is called mycobiont and algal partner is called
II. Syntrophism:
It is an association in which the growth of one organism either depends on or improved by the substrate provided by another organism.
In syntrophism both organism in association gets benefits.
Compound A
Utilized by population 1
Compound B
Utilized by population 2
Compound C
utilized by both Population 1+2
Products
In this theoretical example of syntrophism, population 1 is able to utilize and metabolize compound A, forming compound B but cannot metabolize beyond compound B without co-operation of population 2. Population 2is unable to utilize compound A but it can metabolize compound B forming compound C. Then both population 1 and 2 are able to carry out metabolic reaction which leads to formation of end product that neither population could produce alone.
Examples of syntrophism:
i. Methanogenic ecosystem in sludge digester
Methane produced by methanogenic bacteria depends upon interspecies hydrogen transfer by other fermentative bacteria.
Anaerobic fermentative bacteria generate CO2 and H2 utilizing carbohydrates which is then utilized by methanogenic bacteria (Methanobacter) to produce methane.
ii. Lactobacillus arobinosus and Enterococcus faecalis:
In the minimal media, Lactobacillus arobinosus and Enterococcus faecalis are able to grow together but not alone.
The synergistic relationship between E. faecalis and L. arobinosus occurs in which E. faecalis require folic acid
在线办理(salfor毕业证书)索尔福德大学毕业证毕业完成信一模一样
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Randomised Optimisation Algorithms in DAPHNE
Slides from talk:
Aleš Zamuda: Randomised Optimisation Algorithms in DAPHNE .
Austrian-Slovenian HPC Meeting 2024 – ASHPC24, Seeblickhotel Grundlsee in Austria, 10–13 June 2024
https://ashpc.eu/
SDSS1335+0728: The awakening of a ∼ 106M⊙ black hole⋆
Context. The early-type galaxy SDSS J133519.91+072807.4 (hereafter SDSS1335+0728), which had exhibited no prior optical variations during the preceding two decades, began showing significant nuclear variability in the Zwicky Transient Facility (ZTF) alert stream from December 2019 (as ZTF19acnskyy). This variability behaviour, coupled with the host-galaxy properties, suggests that SDSS1335+0728 hosts a ∼ 106M⊙ black hole (BH) that is currently in the process of ‘turning on’. Aims. We present a multi-wavelength photometric analysis and spectroscopic follow-up performed with the aim of better understanding the origin of the nuclear variations detected in SDSS1335+0728. Methods. We used archival photometry (from WISE, 2MASS, SDSS, GALEX, eROSITA) and spectroscopic data (from SDSS and LAMOST) to study the state of SDSS1335+0728 prior to December 2019, and new observations from Swift, SOAR/Goodman, VLT/X-shooter, and Keck/LRIS taken after its turn-on to characterise its current state. We analysed the variability of SDSS1335+0728 in the X-ray/UV/optical/mid-infrared range, modelled its spectral energy distribution prior to and after December 2019, and studied the evolution of its UV/optical spectra. Results. From our multi-wavelength photometric analysis, we find that: (a) since 2021, the UV flux (from Swift/UVOT observations) is four times brighter than the flux reported by GALEX in 2004; (b) since June 2022, the mid-infrared flux has risen more than two times, and the W1−W2 WISE colour has become redder; and (c) since February 2024, the source has begun showing X-ray emission. From our spectroscopic follow-up, we see that (i) the narrow emission line ratios are now consistent with a more energetic ionising continuum; (ii) broad emission lines are not detected; and (iii) the [OIII] line increased its flux ∼ 3.6 years after the first ZTF alert, which implies a relatively compact narrow-line-emitting region. Conclusions. We conclude that the variations observed in SDSS1335+0728 could be either explained by a ∼ 106M⊙ AGN that is just turning on or by an exotic tidal disruption event (TDE). If the former is true, SDSS1335+0728 is one of the strongest cases of an AGNobserved in the process of activating. If the latter were found to be the case, it would correspond to the longest and faintest TDE ever observed (or another class of still unknown nuclear transient). Future observations of SDSS1335+0728 are crucial to further understand its behaviour. Key words. galaxies: active– accretion, accretion discs– galaxies: individual: SDSS J133519.91+072807.4
Anti-Universe And Emergent Gravity and the Dark Universe
Recent theoretical progress indicates that spacetime and gravity emerge together from the entanglement structure of an underlying microscopic theory. These ideas are best understood in Anti-de Sitter space, where they rely on the area law for entanglement entropy. The extension to de Sitter space requires taking into account the entropy and temperature associated with the cosmological horizon. Using insights from string theory, black hole physics and quantum information theory we argue that the positive dark energy leads to a thermal volume law contribution to the entropy that overtakes the area law precisely at the cosmological horizon. Due to the competition between area and volume law entanglement the microscopic de Sitter states do not thermalise at sub-Hubble scales: they exhibit memory effects in the form of an entropy displacement caused by matter. The emergent laws of gravity contain an additional ‘dark’ gravitational force describing the ‘elastic’ response due to the entropy displacement. We derive an estimate of the strength of this extra force in terms of the baryonic mass, Newton’s constant and the Hubble acceleration scale a0 = cH0, and provide evidence for the fact that this additional ‘dark gravity force’ explains the observed phenomena in galaxies and clusters currently attributed to dark matter.
Compexometric titration/Chelatorphy titration/chelating titration
Classification
Metal ion ion indicators
Masking and demasking reagents
Estimation of Magnisium sulphate
Calcium gluconate
Complexometric Titration/ chelatometry titration/chelating titration, introduction, Types-
1.Direct Titration
2.Back Titration
3.Replacement Titration
4.Indirect Titration
Masking agent, Demasking agents
formation of complex
comparition between masking and demasking agents,
Indicators/Metal ion indicators/ Metallochromic indicators/pM indicators,
Visual Technique,PM indicators (metallochromic), Indicators of pH, Redox Indicators
Instrumental Techniques-Photometry
Potentiometry
Miscellaneous methods.
Complex titration with EDTA.
Signatures of wave erosion in Titan’s coasts
The shorelines of Titan’s hydrocarbon seas trace flooded erosional landforms such as river valleys; however, it isunclear whether coastal erosion has subsequently altered these shorelines. Spacecraft observations and theo-retical models suggest that wind may cause waves to form on Titan’s seas, potentially driving coastal erosion,but the observational evidence of waves is indirect, and the processes affecting shoreline evolution on Titanremain unknown. No widely accepted framework exists for using shoreline morphology to quantitatively dis-cern coastal erosion mechanisms, even on Earth, where the dominant mechanisms are known. We combinelandscape evolution models with measurements of shoreline shape on Earth to characterize how differentcoastal erosion mechanisms affect shoreline morphology. Applying this framework to Titan, we find that theshorelines of Titan’s seas are most consistent with flooded landscapes that subsequently have been eroded bywaves, rather than a uniform erosional process or no coastal erosion, particularly if wave growth saturates atfetch lengths of tens of kilometers.
BIRDS DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptx
Ahota Beel, nestled in Sootea Biswanath Assam , is celebrated for its extraordinary diversity of bird species. This wetland sanctuary supports a myriad of avian residents and migrants alike. Visitors can admire the elegant flights of migratory species such as the Northern Pintail and Eurasian Wigeon, alongside resident birds including the Asian Openbill and Pheasant-tailed Jacana. With its tranquil scenery and varied habitats, Ahota Beel offers a perfect haven for birdwatchers to appreciate and study the vibrant birdlife that thrives in this natural refuge.
Describing and Interpreting an Immersive Learning Case with the Immersion Cub...
Current descriptions of immersive learning cases are often difficult or impossible to compare. This is due to a myriad of different options on what details to include, which aspects are relevant, and on the descriptive approaches employed. Also, these aspects often combine very specific details with more general guidelines or indicate intents and rationales without clarifying their implementation. In this paper we provide a method to describe immersive learning cases that is structured to enable comparisons, yet flexible enough to allow researchers and practitioners to decide which aspects to include. This method leverages a taxonomy that classifies educational aspects at three levels (uses, practices, and strategies) and then utilizes two frameworks, the Immersive Learning Brain and the Immersion Cube, to enable a structured description and interpretation of immersive learning cases. The method is then demonstrated on a published immersive learning case on training for wind turbine maintenance using virtual reality. Applying the method results in a structured artifact, the Immersive Learning Case Sheet, that tags the case with its proximal uses, practices, and strategies, and refines the free text case description to ensure that matching details are included. This contribution is thus a case description method in support of future comparative research of immersive learning cases. We then discuss how the resulting description and interpretation can be leveraged to change immersion learning cases, by enriching them (considering low-effort changes or additions) or innovating (exploring more challenging avenues of transformation). The method holds significant promise to support better-grounded research in immersive learning.
Male reproduction physiology by Suyash Garg .pptx
Physiology of Male reproduction.
Video mentioned at page no. 23 as summary for better understanding
TOPIC OF DISCUSSION: CENTRIFUGATION SLIDESHARE.pptx
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