This document outlines guidelines for procedural sedation and analgesia. It recommends having appropriate monitoring equipment and administering analgesics before sedatives. Patients should be monitored until recovery to their baseline mental status. At minimum, procedural sedation requires one clinician to perform the procedure while another continuously monitors the patient. Regular monitoring of vital signs, oxygen saturation, and ventilation is important. The use of capnography may help detect respiratory complications earlier than pulse oximetry alone. Patients must meet discharge criteria related to symptoms, vital signs, and orientation before being discharged.
A "bundle" is a
group of evidence-based care components
for a given disease that, when executed together, may result in better outcomes than if implemented individually.
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
A "bundle" is a
group of evidence-based care components
for a given disease that, when executed together, may result in better outcomes than if implemented individually.
Post anesthesia care unit or , High Dependency unit is part of hospital for Post surgery/procedures recovery.Nursing, anesthesiologist, surgeons, hospital administration need to know about ideal conditions.
Monitoring is essential in any kind of medical practice. It is the observation of disease, condition and several other parameters over time. Usually a medical monitor is used for continuously measuring vital signs.
Introduction to the Visual Infusion Phlebitis (VIP) scoreivteam
The Visual Infusion Phlebitis score is a standardised approach to monitoring peripheral IV catheter sites.
The fact that it encourages site observation means that it also has an impact on other peripheral IV catheter problems such as dislodgement, infiltration and infection.
The innovation of this tool is the recognition of the visual nature of peripheral IV problems and the subsequent benefits of a visual tool to identify these issues early.
As health care workers we have a duty of care to monitor the condition of a patients IV site.
Failure to monitor IV sites is seen as failure in duty of care.
The VIP score is internationally acknowledged as a proven standardised tool for the monitoring of peripheral IV catheter sites.
Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level
Hassan Mohamed Ali
Associate professor of anesthesia and pain management, Anesthesia department, Cairo University.
MB.B.ch, M Sc, M.D, FCAI, DESA
Meeqat General Hospital, Madinah Munawarah
Monitoring is essential in any kind of medical practice. It is the observation of disease, condition and several other parameters over time. Usually a medical monitor is used for continuously measuring vital signs.
Introduction to the Visual Infusion Phlebitis (VIP) scoreivteam
The Visual Infusion Phlebitis score is a standardised approach to monitoring peripheral IV catheter sites.
The fact that it encourages site observation means that it also has an impact on other peripheral IV catheter problems such as dislodgement, infiltration and infection.
The innovation of this tool is the recognition of the visual nature of peripheral IV problems and the subsequent benefits of a visual tool to identify these issues early.
As health care workers we have a duty of care to monitor the condition of a patients IV site.
Failure to monitor IV sites is seen as failure in duty of care.
The VIP score is internationally acknowledged as a proven standardised tool for the monitoring of peripheral IV catheter sites.
Nursing tool used in a medsurg environment to detect early changes in patient conditions monitoring temperature, respirations level of consciousness and oxygen level
Hassan Mohamed Ali
Associate professor of anesthesia and pain management, Anesthesia department, Cairo University.
MB.B.ch, M Sc, M.D, FCAI, DESA
Meeqat General Hospital, Madinah Munawarah
Post-Operative Managment
• The post operative period begins from the time
• The patients leaves the operating room and ends with the
follow up visit by the surgeon.
• The post operative care is provided by
-- PACU
-- SICU
How to manage a case of acute exacerbation of COPD according to GOLD guidelines. Sincere thanks to Dr. Amardeep Toppo who has prepared most of this presentation.
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.
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
2. Key Principles of Procedural Sedation
and Analgesia
• Determine appropriate level of sedation
desired
• Have appropriate monitoring and rescue
equipment
• Administer analgesic before sedative
• Titrate agents to desired level of sedation
• Observe and monitor until recovery to
baseline mental status
5. Procedural Sedation Monitoring
• Interactive monitoring:
Direct observation of patient to access
- Depth of sedation
- Respiratory function & Hemodynamics
Unobstructed view of the
patient’s face, mouth,
chest wall
6. In patients undergoing procedural sedation and
analgesia in the emergency department,
what is the minimum number of personnel
necessary to manage complications?
7. • Mostly, one clinician performs the
procedure while another (usually a
nurse) observe and continuously
monitor the patient
Level C recommendations
Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department
Ann Emerg Med. 2014;63:247-258.
8. Monitoring Depth of sedation
• Check response to verbal commands
• If verbal response is not possible, “thumbs up”
• Deep sedation: response to a more profound
stimulus
• Response limited to reflex withdrawal from a
painful stimulus is not considered a
purposeful response
9. Scale monitoring depth of sedation
Moderate sedation: Do not exceed level 4
Deep sedation score: Level 5
11. Bispectral Index monitoring
• uses processed electroencephalogram signals
to measure the depth of sedation
• 100 = complete alertness,
• 0 = no cortical activity at all
• 40 - 60 is believed to be consistent with GA
14. Arterial oxygenation
• Pulse oxymetry is not a substitute for
monitoring ventilation
• Hypoventilation or apnea develop before
oxygen saturation decreases especially
“Patient who receive supplemental oxygen”
15. Ventilation
• Capnography
• ETco2 correlates with arterial Pco2
• ETco2 > 50 mmHg or ↑>10 mmHg
indicates hypoventilation
16.
17. In patients undergoing procedural sedation and
analgesia in the emergency department,
Does the routine use of capnography
reduce the incidence of adverse
respiratory events?
18. Level B recommendation
• Capnography* may be used as an adjunct to
pulse oximetry and clinical assessment to
detect hypoventilation and apnea earlier than
pulse oximetry and/or clinical assessment
alone in patients undergoing procedural
sedation and analgesia in the ED.
• Capnography includes all forms of quantitative
exhaled carbon dioxide analysis.
19. Vital Signs
• Before the procedure
• After each dose of sedative
• Regular intervals during the procedure
• During initial of recovery period
• Before discharge
20. Recommendations
Level of
Sedation
LOC Heart Rate Respiratory
Rate
BP O2
Saturation
Capno
graphy
Minimal Observe
frequently
q 15 min q 15 min q 15 min
and after
sedative
boluses
Continuously -
Moderate
or
Dissociative
Observe
constantly
Continuously Continuous
direct
observation
q 5 min
& after
sedative
boluses
Continuously Consider
continuously
Deep Observe
constantly
Continuously Continuous
direct
observation
q 5 min
& after
sedative
boluses
Continuously Recommend
continuously
If recording is performed automatically,
Device alarms should be set to alert
21. Cardiac monitoring
Recommended for:
• Preexisting cardiac disease
• Dysrhythmias
• During procedures in which the cardiac
rhythm is of interest
22. Post-Sedation Recovery
• Recovery and discharge under supervision of
operating practitioner or a licensed physician.
• A nurse or other individual should monitor
until appropriate discharge criteria are
satisfied
• Preparation for management of complications.
23. Observation Duration
• In most cases, prolong observation beyond 30
min is unlikely to be necessary
• Longer duration in patients who receive
reversal agents
24. Discharge Criteria
• Low risk procedure that additional monitoring is
un necessary.
• Symptoms should be well-controlled.
• Stable V/S and respiratory and cardiac function
• Alert and oriented or returned to baseline
• A reliable person who can provide support and
supervision at least a few hours.
• Scoring systems may assist in documentation.
• Patient instruction
28. Pediatric Discharge Criteria
• Young infants or children who are
handicapped should return to the level of
responsiveness observed before sedation
• Because of the significant risk of apnea after
sedation, term infants with postconceptual
ages (PCA) ≤45 weeks and former premature
infants with PCA <60 weeks should undergo
prolonged observation of respiratory status
prior to discharge
29. Minimum Duration of Observation for
Infants
• All infants with PCA ≤45 weeks – 12 hours
• Pre-term infants with PCA 46 to 60 weeks and
significant comorbidities – 12 hours
• Healthy pre-term infants with PCA 46 to 60
weeks – 6 hours (12 hours if given opioids or
other medications with significant respiratory
depressant effects)
30. • Patients, who develop apnea during
observation, warrant prolonged observation
until they are free of apnea for at least 12
hours.
• In some patients with frequent apneic
episodes, caffeine administration may be
appropriate.
Level C recommendation
Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department
Ann Emerg Med. 2005;45:177-196
Phase I: At the start of exhalation, CO2 concentration in the exhaled gas is essentially zero, representing gas from the anatomic dead space that does not participate in gas exchange. Phase II: As the anatomic dead space is exhaled, CO2 concentration rises as alveolar gas exits the airway. Phase III: For most of exhalation, CO2 concentration is constant and reflects the concentration of CO2 in alveolar gas. Phase IV: During inhalation, CO2 concentration decreases to zero as atmospheric air enters the airway. [Reproduced with permission from Brauss B, Hess DR: Capnography for procedural sedation and analgesia in the emergency department. Ann
Capnography allows continuous measurement of exhaled
carbon dioxide and displays the resulting waveform graphically. It
provides an advantage over pulse oximetry alone by identifying
respiratory depression more consistently. Capnometry is the
numeric display of exhaled carbon dioxide concentrations.
ETCO2 is the highest value of carbon dioxide measured during
the end of expiration of each breath