1. The document outlines new definitions and guidelines for diagnosing and managing sepsis and septic shock according to the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.
2. Key changes include removing SIRS criteria and defining sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock requires vasopressors to maintain blood pressure and elevated lactate levels.
3. Management guidelines cover initial patient assessment, diagnostic testing, antimicrobial therapy, fluid resuscitation, vasopressors, corticosteroids, mechanical ventilation, glucose control, nutrition, and thromboembolism prophylaxis
The recent definition, concept and terminologies of septic shock, surviving sepsis campaign, management techniques, SOFA score. Also includes antibiotics and supportive modalities.
Latest definition of sepsis, application of qSOFA, latest evidence on treatment of septic shock,role of fluids, role of steroids, isobalance salt solution
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
The recent definition, concept and terminologies of septic shock, surviving sepsis campaign, management techniques, SOFA score. Also includes antibiotics and supportive modalities.
Latest definition of sepsis, application of qSOFA, latest evidence on treatment of septic shock,role of fluids, role of steroids, isobalance salt solution
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection.The definition of sepsis was updated in 2016 following publication of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). This recommended that organ dysfunction should be defined using the Sequential (or Sepsis-related) Organ Failure Assessment (SOFA) criteria or the "quick" (q)SOFA criteria.
Manejo de hemoderivados y anticoagulacion
objetivos
-Monitoria de la coagulación
-Manejo de la anemia y el sangrado
-Manejo de la coagulación
-Terapia anticoagulante y antiplaquetaria
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
1. Sepsis andSepticShock
(SEPSIS–3)
Surviving Sepsis Campaign: International Guidelines
for Management of Sepsis and Septic Shock: 2016
Amiteshwar Singh
SETH G.S. MEDICAL COLLEGE AND KEM HOSPITAL, MUMBAI
2. New
Definitions The SIRS criteria have been removed.
It may present in simple, non-complicated
infection, or in response to non infectious-
triggers (i.e. polytrauma, pancreatitis, post-
cardiac arrest syndrome),
Or may even be absent in critically ill patients
with obvious evidence of a life-threatening
infection.
Sepsis is defined as
LIFE-THREATENING
ORGAN DYSFUNCTION
CAUSED BY A DYSREGULATED HOST
RESPONSE
TO INFECTION.
3. New
Definitions
Septic shock is defined by persisting
hypotension requiring vasopressors to
maintain a mean arterial pressure of 65
mm Hg or higher and a serum lactate
level greater than 2 mmol/L (18 mg/dL)
despite adequate volume resuscitation.
Septic shock is a subset of sepsis with
circulatory and cellular/metabolic
dysfunction associated with a higher
risk of mortality.
Terms like Severe Sepsis/Septicemia
has been removed
4.
5. Clinical
Presentation
Signs and symptoms of sepsis
are often nonspecific and
include the following:
Fever, chills or rigors
Confusion
Anxiety
Difficulty breathing
Fatigue, malaise
Nausea and vomiting
6. Physical examination should first involve
assessment of patients general
condition including the ABCs.
Followed by identification of localizing
signs to a particular organ system.
Shock can be identified with presence of
signs of poor perfusion such as cool skin,
cold extremities and delayed capillary
refill.
Clinical
Presentation
8. Diagnosis
CBC
Coagulation studies
Blood chemistry (eg, sodium, chloride,
magnesium, calcium, phosphate, glucose,
lactate)
Arterial blood gas analysis
RFT and LFT (eg, creatinine, blood urea
nitrogen, bilirubin, alkaline phosphatase, alanine
aminotransferase, aspartate aminotransferase,
albumin, lipase)
Blood cultures
Urinalysis and urine cultures
Gram stain and culture of secretions and tissue
9. Imaging Chest, abdominal, or extremity
radiography
Abdominal ultrasonography
Computed tomography of the body
part suspected to be origin of sepsis.
10. DIAGNOSIS
Two or more sets (aerobic and
anaerobic) of blood cultures are
recommended before initiation of any
new antimicrobial in all patients with
suspected sepsis
Other sites and bodily fluids may be
Cultured as clinically appropriate.
Within 45 minutes
11. Initial
Resuscitation
In the resuscitation from sepsis induced
hypoperfusion, at least 30 mL/kg of IV
crystalloid fluid be given within the first 3 hours
Additional fluids should be guided by frequent
reassessment of hemodynamic status
Reassessment should include evaluation of
available physiologic variables
heart rate
blood pressure
arterial oxygen saturation
respiratory rate
urine output ≥ 0.5 mL/kg/hr
CVP of 8–12 mm Hg
Target mean arterial pressure of 65 mm Hg in
patients with septic shock requiring
vasopressors.
Decrease in lactate levels may be used to guide
resuscitation.
12. IV antimicrobials be initiated as soon as
possible after recognition and within
one hour for both sepsis and septic
shock.
Empiric broad-spectrum therapy with
one or more antimicrobials is
recommended.
Antimicrobial therapy should be
narrowed once pathogen identification
and sensitivities are established and/or
adequate clinical improvement is noted.
7 to 10 days is adequate for most serious
infections associated with sepsis and
septic shock.
ANTIMICROBIAL
THERAPY
13. Decision for empiric antimicrobial is driven by
factors such as
Anatomic site of infection
Prevalent pathogens within the community,
hospital, and even hospital ward
The resistance patterns of those prevalent
pathogens
The presence of specific immune defects
such as neutropenia, splenectomy, poorly
controlled HIV infection,
Age and patient comorbidities including
chronic illness (e.g., diabetes) and chronic
organ dysfunction (e.g., liver or renal
failure) that compromise the defense to
infection.
ANTIMICROBIAL
THERAPY
14. SOURCE
CONTROL
The principle of source control in the
management of sepsis and septic shock
includes removal of the potential source
of ongoing microbial contamination.
For example
The drainage of an abscess,
Debridement of infected necrotic
tissue
Peritoneal wash and closing
gastrointestinal perforation
A time lag of no more than 6 to 12 hours
after diagnosis should be targeted for
source control after initial resuscitation.
15. FLUID
THERAPY
Crystalloids are the fluid of choice for
initial resuscitation and subsequent
intravascular volume replacement
Albumin should be used in addition to
crystalloids for initial resuscitation and
subsequent intravascular volume
replacement when substantial amounts
of crystalloids are required
Crystalloids to be preferred over
Gelatins
Use of hydroxyethyl starches is not
recommended
16. VASOACTIVE
MEDICATIONS
InitiateVasopressor therapy if MAP is
persistently below 65 mm Hg despite adequate
fluid resuscitation.
Noradrenaline as the first-choice vasopressor
2nd line vasopressors include adrenaline or
vasopressin
Dopamine as an alternative vasopressor agent to
norepinephrine may be used only in highly
selected patients (e.g., patients with low risk of
tachyarrhythmias or with low heart rate)
Low-dose dopamine for renal protection is no
longer recommended.
Dobutamine may be administered or added to
vasopressor (if in use) in the presence of (a)
myocardial dysfunction or (b) persistent
hypoperfusion, despite achieving adequate
intravascular volume and adequate MAP
17. CORTICO-
STEROIDS
IV hydrocortisone at a dose of 200 mg
per day is recommended if adequate
fluid resuscitation and vasopressor
therapy are unable to restore
hemodynamic stability.
Taper steroids once vasopressors are not
required.
18. BLOOD
PRODUCTS
Transfuse packed RBC only when hemoglobin
concentration decreases to < 7.0 g/dL in adults in
the absence of extenuating circumstances, such as
myocardial ischemia, severe hypoxemia, or acute
haemorrhage.
Fresh frozen plasma (FFP) may be transfused only
when there is a documented deranged coagulation
profile (increased PT/INR) and the presence of
active bleeding or before surgical or invasive
procedures.
Prophylactic platelet transfusion is recommended
when counts are < 10,000/mm3 in the absence of
apparent bleeding and when counts are <
20,000/mm3 if the patient has a significant risk of
bleeding. Higher platelet counts (≥ 50,000/mm3)
are advised for active bleeding, surgery, or
invasive procedures
19. MECHANICAL
VENTILATION
The goals of mechanical ventilation
include the following:
Improving gas exchange
Reducing work of breathing
Avoiding oxygen toxicity
Minimizing high airway pressures
Avoiding further lung damage
Allowing the injured lung to heal
Management of ARDS using lung
protective proctocols.
20. GLUCOSE
CONTROL
Target an upper blood glucose level ≤
180 mg/dL
Monitor Blood Glucose Q2H till glucose
and insulin infusion rates are stable,
then every 4 hours thereafter.
21. BICARBONATE
THERAPY
No to use of sodium bicarbonate
therapy to improve
hemodynamics or to reduce
vasopressor requirements in
patients with hypoperfusion-
induced lactic acidemia with pH ≥
7.15
23. STRESS
ULCER
PROPHYLAXIS
Use of either proton pump
inhibitors or histamine-2 receptor
antagonists is recommended for
stress ulcer prophylaxis
24. NUTRITION
Early initiation of enteral feeding rather
than a complete fast or only IV glucose is
recommended in critically ill patients with
sepsis or septic shock who can be fed
enterally.
Use of parenteral nutrition alone or in
combination with enteral feeding is not
recommended in the first 7 days
Use of arginine, glutamine, omega-3 fatty
acids as an immune supplement is not
recommended.
Consider placement of post-pyloric feeding
tubes in critically ill patients with feeding
intolerance or who are considered to be at
high risk of aspiration
25. TAKE HOME
MESSAGE
Start adequate antibiotic therapy (proper
dosage and spectrum) as early as possible.
Resuscitate the patient, using supportive
measures to correct hypoxia, hypotension,
and impaired tissue oxygenation
(hypoperfusion)
Identify the source of infection, and treat
with antimicrobial therapy, surgery, or both
(source control)
Earlier inotropes, use noradrenaline
Maintain adequate organ system function,
guided by cardiovascular monitoring, and
interrupt the progression to multiple organ
dysfunction syndrome (MODS)