The document provides information on sepsis epidemiology, pathogenesis, diagnosis, management and prognosis. Some key points:
- Sepsis cases and deaths are increasing worldwide, with the highest incidence among Black males, older adults, and in winter months. Regional disparities exist with most cases in low-income countries.
- Common infectious organisms include gram-positive bacteria and opportunistic fungi/viruses in immunocompromised patients. Culture-negative sepsis occurs in around half of cases.
- Sepsis diagnosis is based on life-threatening organ dysfunction caused by infection, as indicated by a SOFA score ≥2. Septic shock requires vasopressors to maintain blood pressure.
- Management
approach to urosepsis/sepsis/septic shock.
general approach to sepsis, severe sepsis, septic shock according to the latest guidelines. SCG2016/ EGDT2018/EUA2020
Septic shock, updated presentation, including latest guidelines from Intensive care societies and how to approach to the diagnosis with few notes about Early Goal Directed Therapy and role of steroids
It is the first kind of cases that I had to learn to manage. The cases ere so abundant and management so rapid that it took me a while to wrap my head around it. I did not sepsis from septic shiock, I did not know the signs and symptoms and I definitely did not how it all came together. Sepsis bundles included in the presentation need to be updated.
This lecture details the science of sepsis care in 2015 with compliments to the multiple online sources used, some of which are other lectures on SlideShare.
approach to urosepsis/sepsis/septic shock.
general approach to sepsis, severe sepsis, septic shock according to the latest guidelines. SCG2016/ EGDT2018/EUA2020
Septic shock, updated presentation, including latest guidelines from Intensive care societies and how to approach to the diagnosis with few notes about Early Goal Directed Therapy and role of steroids
It is the first kind of cases that I had to learn to manage. The cases ere so abundant and management so rapid that it took me a while to wrap my head around it. I did not sepsis from septic shiock, I did not know the signs and symptoms and I definitely did not how it all came together. Sepsis bundles included in the presentation need to be updated.
This lecture details the science of sepsis care in 2015 with compliments to the multiple online sources used, some of which are other lectures on SlideShare.
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!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
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
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.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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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
2. EPIDEMILOGY
• The incidence of sepsis and the number of sepsis-related
deaths are increasing because of an increased use of
immunosuppressive medications. The incidence varies by
race and sex. The highest incidence is among Black males.
The incidence also shows seasonal variation, with the
highest number of cases in winter, probably because of the
increased prevalence of respiratory infections during this
season. Older patients (≥65 years) account for most (60-
85%) sepsis cases, attributable to multiple comorbidities and
frequent hospitalizations.
3. • A recent scientific publication estimated that in 2017 there were 48.9 million
cases and 11 million sepsis-related deaths worldwide, which accounted for
almost 20% of all global deaths .
• In 2017, almost half of all global sepsis cases occurred among children, with
an estimated 20 million cases and 2.9 million global deaths in children under
5 years of age .
• Regional disparities in sepsis incidence and mortality exist; approximately
85% of sepsis cases and sepsis-related deaths worldwide occurred in low-
and middle-income countries .
• Health care-associated infections are one of the most frequent types of
adverse event to occur during care delivery and affect hundreds of millions
of patients worldwide every year.
4. PATHOGEN
•The predominant infectious organisms that
cause sepsis have changed over the years.
Gram-positive bacteria are the most common
etiologic pathogens, although the incidence of
gram-negative sepsis remains substantial. The
incidence of fungal sepsis has been rising with
more patients on immunosuppressive
therapies and more cases of HIV infection. In
approximately half of sepsis cases, the
organism is not identified (culture-negative
sepsis)
7. •Septic shock
“a subset of sepsis in which particularly profound
circulatory, cellular, and metabolic abnormalities are
associated with a greater risk of mortality than with
sepsis alone”, identified clinically by a vasopressor
requirement to maintain a MAP ≥ 65 and serum lactate
≥ 2 mmol/L in the absence of hypovolemia.
9. • Multiple organ dysfunction
syndrome (MODS)
is characterized by progressive
organ dysfunction in a severely
ill patient, with failure to maintain
homeostasis without
intervention such as pressors or
IV fluids
10. • Pseudo sepsis
is defined as fever, leukocytosis, and hypotension due to
causes other than sepsis. Examples might include the clinical
picture seen with salicylate intoxication, methamphetamine
overdose, or bilateral adrenal hemorrhage.
11. clinical tool to aid in the recognition of sepsis and septic
shock
SIRS
SOFAqSOFA
NEWS 2
1- Systemic inflammatory response
syndrome
2- Sequential organ failure
assessment
3- quick sofa
4- National early warning score
12.
13.
14.
15.
16.
17.
18.
19. Sources of sepsis
• Skin/soft tissue: Necrotizing fasciitis, cellulitis, myonecrosis, or gas
gangrene
• Wound infection: Inflammation, edema, erythema, discharge of
pus, with positive Gram stain and culture results from incision and
drainage or deep cultures
• Upper respiratory tract: Pharyngitis, tonsillitis, or sinusitis
• Lower respiratory tract: Pneumonia, empyema, or lung abscess
23. Risk Factors
ICU admission with subsequent nosocomial infection
Bacteremia
Advanced age (≥65 years)
Immunosuppression
Community-acquired pneumonia
Previous hospitalization and antibiotic therapy in the preceding 90 days
Genetic factors - Defects of cellular and humoral immunity (low or absent antibody
production,T cells, phagocytes, natural killer cells, complement)
Urosepsis due to benign prostatic hypertrophy (BPH) in older males or complicated UTI
Major trauma and burn injuries
24. Clinical picture
General
signs and
symptom
s of
sepsis
may
include
the
following
Fever, with
or without
shaking
chills
(temperatu
re >38.3ºC
or < 36ºC)
Impaired mental
status (in the
setting of fever
or
hypoperfusion)
Increased
breathing
rate (>20
breaths/min)
resulting in
respiratory
alkalosis
Warm or
cold skin,
depending
on the
adequacy of
organ
perfusion
and dilation
of the
superficial
skin vessels
Hypotension
requiring
pressor
agents to
maintain
systolic
blood
pressure
above 65
mm Hg
25.
26.
27. Special considerations
• Elderly patients may present with peritonitis and may not experience
rebound tenderness of the abdomen.
• Elderly individuals, persons with diabetes, and patients on beta-blockers
may not exhibit an appropriate tachycardia as blood pressure falls.
• Younger patients develop a severe and prolonged tachycardia without
hypotension until acute decompensation occurs.
• Patients with chronic hypertension may develop critical hypoperfusion at a
blood pressure that is higher than in healthy patients (ie, relative
hypotension).
• An acute surgical abdomen in a pregnant patient may be difficult to
diagnose. The most common cause of sepsis in pregnancy is urosepsis.
29. GeneralWork up for sepsis
CBC
CHEMEISTRY AND ELECTROLYTES
CO AGULATION PROFILE
LACTATE
PROCALCITONINE
BLOOD GASES
CRP
URINE ANALYSIS &CULTURE
BLOOD CULTURE
CHEST X RAY
ABDOMINAL US IF NEEDED
CRP
30. Unique laboratory findings
• Leukocytosis (WBC count >12,000/µL) or leukopenia (WBC count <
4000/µL)
• Normal WBC count with greater than 10% immature forms (left shift
with bandemia)
• Hyperglycemia (plasma glucose level >140 mg/dL or 7.7 mmol/L) in
the absence of diabetes
• Plasma C-reactive protein level of more than 2 standard deviations
above the reference value
• Arterial hypoxemia (PaO 2/FiO 2 ratio < 300 mm Hg)
• Acute oliguria (urine output < 0.5 mL/kg/hour for at least 2 hours
despite adequate fluid resuscitation)
• Creatinine increase >0.5 mg/dL or 44.2 mmol/L
• Coagulation abnormalities (INR >1.5 or PTT >60 seconds)
31. • Thrombocytopenia (platelet count < 100,000/µL)
• Hyperbilirubinemia (plasma total bilirubin >4 mg/dL or 70
mmol/L)
• Adrenal insufficiency (eg, hyponatremia, hyperkalemia) and
euthyroid sick syndrome can also be found in sepsis.
• Hyperlactatemia (serum lactate >2 mmol/L) can result from
organ hypoperfusion in the presence or absence of
hypotension and indicates a poor prognosis. A serum lactate
level of 4 mmol/L or more (especially arterial lactate)
indicates septic shock.
• Plasma procalcitonin and presepsin elevation is associated
with bacterial infection and sepsis
32. • Imaging modalities should be focused on areas of clinical concern,
based on the history and physical examination, and may include the
following:
• Chest radiography (to rule out pneumonia and diagnose other
causes of pulmonary infiltrates)
• Chest CT scanning (to further evaluate for pneumonia or other lung
pathology)
• Abdominal ultrasonography (for suspected biliary tract obstruction)
• Abdominal CT scanning or MRI (for assessing a suspected non-
biliary intra-abdominal source of infection or delineating intrarenal and
extrarenal pathology)
• Site-specific soft tissue imaging, including ultrasonography, CT
scanning, or MRI (to assess for possible abscess, fluid collection, or
necrotizing skin infection)
• Contrast-enhanced CT scanning or MRI of the brain/neck (to assess
for possible masses, abscess, fluid collection, or necrotizing infection)
35. BASICS OF SEPSIS MANGEMENT
AIRWAY FLUID
ANTIBIOTIC
VASOPRES
SORS
36. Management
• Early aggressive medical therapy is indicated in patients
with suspected sepsis
• AIRWAY
High-flow nasal cannula (HFNC): in sepsis-induced hypoxemic respiratory
failure, HFNC is recommended over non-invasive positive pressure ventilation
Intubation: low tidal volume strategy and upper plateau pressure of 30 cm H2O;
in ARDS, consider using higher PEEP
V-V ECMO can be considered if conventional mechanical ventilation fails
37. Fluid resuscitation
•Patients with sepsis should receive an
intravenous balanced crystalloid at 30
mL per kg within the first three
hours.21 Infusing an initial 1-L bolus
over the first 30 minutes is an accepted
approach.The remainder of fluid
resuscitation should be given by repeat
bolus infusions
38. ANTIBIOTIC
• Multiple studies indicate that early initiation of appropriate antibiotic
therapy is associated with improved clinical outcomes.The precise timing
is controversial. SSC guidelines recommend administration of antibiotics
within the first hour.
• In patients with possible sepsis without shock, consider investigating for
other causes for up to 3 hours before starting antimicrobial therapy
(adjusted from 1 hour from previous guidelines)
39.
40.
41.
42.
43. vasopressor
In most patients, norepinephrine is the first-line vasopressor, followed by
vasopressin, then epinephrine
• In patients with cardiac dysfunction, use norepinephrine as first line then
dobutamine or epinephrine alone
• Vasopressor therapy clearly improves survival in these patients and
should be started within the first hour following initial fluid
resuscitation. Failure to initiate early vasopressor therapy in patients with
septic shock increases mortality rates by 5% per hour of delay
44. Goal of initial resuscitation first 6 hours
Central venous pressure 8-12
mmhg
Venous oxygen saturation 65 %
ScvO 2 >70 %
Map more than 65 mmhg
Urine out put > 0.5mlkgh
50. Post-sepsis syndrome (PSS) is a condition that
affects up to 50% of sepsis survivors.
Physical Psychological
51. Physical –
Difficulty sleeping, either difficulty getting to sleep or staying
asleep
• Fatigue, lethargy
• Shortness of breath, difficulty breathing
• Disabling muscle or joint pain
• Swelling in the limbs
• Repeat infections, particularly in the first few weeks and months
following the initial bout of sepsis
• Poor appetite
• Reduced organ function, eg kidney, liver, heart
• Hair loss
• Skin rash
52. • Psychological or emotional
• Hallucinations
• Panic attacks
• Flashbacks
• Nightmares
• Decreased cognitive (mental) functioning
• Loss of self-esteem
• Depression
• Mood swings
• Difficulty concentrating
• Memory loss
• Post-traumatic stress disorder (PTSD)
53. TAKE HOME MESSAGE
Calculate NEWS to detect subtle cases of occult septic shock.
Less saline, more Ringer’s, even if acute heart failure, especially in renal failure and severe acidosis.
Norepinephrine whenever MAP <65 – earlier rather than later.
Early antibiotics (within 1hr of the diagnosis rather than 1 hour of arrival at ED), given over 5 minutes (except
vancomycin over 30 minutes), chosen wisely according to local antibiograms.
Use a combination of MAP, GCS, urine output, initial lactate, capillary refill time, POCUS IVC to guide initial fluid
resuscitation, individualized to each patient.
If the lactate is rising despite resuscitative efforts call your intensivist. Early to ICU is preferable, but remember that
capillary refill time may be as good, or even better than lactate at guiding resuscitation.
Consider vasopressin and hydrocortisone if a MAP of 65 cannot be maintained with 35mcg/min norepinephrine and
ongoing fluid resuscitation.