Updated global adult sepsis guidelines, released in October 2021 by the Surviving Sepsis Campaign (SSC), place an increased emphasis on improving the care of sepsis patients after they are discharged from the intensive care unit (ICU) and represent greater geographic and gender diversity than previous versions.
The new guidelines specifically address the challenges of treating patients experiencing the long-term effects of sepsis. Patients often experience lengthy ICU stays and then face a long, complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families are often uncertain how to coordinate care that promotes recovery and matches their goals of care.
Updated global adult sepsis guidelines, released in October 2021 by the Surviving Sepsis Campaign (SSC), place an increased emphasis on improving the care of sepsis patients after they are discharged from the intensive care unit (ICU) and represent greater geographic and gender diversity than previous versions.
The new guidelines specifically address the challenges of treating patients experiencing the long-term effects of sepsis. Patients often experience lengthy ICU stays and then face a long, complicated road to recovery. In addition to physical rehabilitation challenges, patients and their families are often uncertain how to coordinate care that promotes recovery and matches their goals of care.
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
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.
Latest definition of sepsis, application of qSOFA, latest evidence on treatment of septic shock,role of fluids, role of steroids, isobalance salt solution
MR. MOHAMMAD TALAL AL JOHANY
RESPIRATORY THERAPIST
Meqaat Hospital Madina
POST TEST
https://forms.gle/apSH6sR5mRTwRvjJ6
https://youtube.com/channel/UCUlJw6wef_dhQi3TXNTkn6g
OVID-19 Management experience
What we learned from bedside experience in COVID-19 treatment
Dr. Essam A. Salem, ICU Registrar, Meeqat GENERAL.HOSPITAL, Head OF ICU Unit Meeqat General Hospital
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
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
Chapter 3 - Islamic Banking Products and Services.pptx
sepsis SSC 2021 Updates Ventilation and additional therapy
1. SSC 2021 Updates
Ventilation and additional therapy
DR. Mohamed Saber
ICU Physician
Meeqat General hospital - KSA
Part 3
2. Conservative oxygen targets (generally defined as PaO2 55–70
mmHg; SpO2 88–92%)
Types of respiratory failure:
Type 1 (Hypoxemic): PaO2 < 60 mmHg
Type 2 (Hypercapnic): PCO2 > 50 mmHg ± PaO2 < 60mmHg
3. WOB mild improvement
FiO2 95%-100%
Can avoid NIV
complications
Mild PAP
Can improve WOB
FiO2 up to100%
NIV complications:
• Increased risk of gastric insufflation and
aspiration
• Facial skin breakdown
• Excessively high tidal volumes
• Patient discomfort related to inability to
eat or effectively phonate during therapy.
PAP
Both therapies avoid the complications of intubation
and invasive mechanical ventilation
4. If NIV is used for patients with
sepsis-associated hypoxic
respiratory failure, we suggest
monitoring for an early
reduction in work of
breathing and close monitoring
NIV may be able to achieve similar
physiologic benefits including
improved gas exchange and reduced
work of breathing in select patients,
while avoiding complications
associated with intubation, invasive
ventilation, and accompanying
sedation.
In contrast, NIV can cause mask-
related discomfort, unrecognized
patient-ventilator asynchrony due to
leaks, and gastric insufflation.
The main risk of NIV for the
indication of acute respiratory failure
is the potential for delaying needed
intubation
5. According to Berlin definition (2012):
Mild ARDS (Previously Acute lung injury): PO2/FiO2 =
200-300
Moderate ARDS: PO2/FiO2 = 100-200
Severe ARDS: PO2/FiO2 < 100
Example: PaO2 = 90 mmHg on FiO2 60% (0.6)
So P/F ratio = 90/0.6 = 150 → Moderate ARDS
6.
7. Recommended:
Set the ventilator to CPAP mode and
increase the pressure to 30–40 cm
H2O for 30–40 s
Not Recommended:
Use pressure controlled ventilation
Set respiratory rate to zero and turn off
apnea alarm
increase PEEP to 40 cmH20 for 40 seconds
8.
9. NBMA benefits:
May improve chest wall compliance
Prevent respiratory dyssynchrony
Reduce peak airway pressures
May reduce oxygen consumption by decreasing the work of breathing
17. Eligible patients are those with septic shock
(within 48 h of the onset of vasopressor therapy
and AKI
AKI is defined as oliguria (< 0.3 ml/kg/h for ≥
24 h), anuria for 12 h or more, or a serum
creatinine level 3 times baseline accompanied by
a rapid increase of ≥ 0.5 mg/dl.
Indications for
dialysis
Uremic complications
Refractory academia
Refractory fluid
overload
Hyperkalemia).
18.
19.
20.
21.
22. RECAP
1.No sufficient recommendation of using Target SpO2 88-92% in Adults with
sepsis-induced RF.
2.For adults with sepsis-induced RF: We suggest using HFNC > NIV
3.For adults with sepsis-induced RF: No sufficient recommendation for the use
of NIV over IPPV
4.Use of low Vt (<6ml/kg) in sepsis-induced ARDS
5.Use of low Vt (6-8ml/kg) in sepsis-induced RF without ARDS
6.For sepsis-induced ARDS: use an upper limit gal for pPlateau of 30 cm H2O
7.For sepsis-induced ARDS: use of Higher PEEP > Lower PEEP
8.For sepsis-induced moderate-severe ARDS: using traditional recruitment
maneuvers
9.We recommend against Against using incremental PEEP titration/strategy
23. 12.For adults with sepsis-induced severe ARDS: using VV ECMO when
conventional MV fails
13.For adults with septic shock: using IV 200mg hydrocortisone at
norepinephrine dose ≥ 0.25 mcg/kg/min at least 4 h after initiation.
14.For adults with sepsis or septic shock: we suggest against Polymexin B
hemoperfusion
15. No sufficient evidence to make a recommendation on the use of other blood
purification techniques.
16.For adults with sepsis or septic shock we recommend using Hb threshold <
7g/dl not Hb < 9 g/dl
17.For adults with sepsis or septic shock: We suggest using IVIG
15.For adults with sepsis or septic shock/at risk of GIB: We suggest using stress
Ulcer prophylaxis
16.For adults with sepsis or septic shock: we recommend using pharmacologic
24. 17.For adults with sepsis or septic shock and AKI who require renal replacement:
We suggest either continuous or intermittent renal replacement therapy.
18.We recommend against RRT without indication.
19.For adults with sepsis or septic shock: We recommend initiating insulin
therapy at a glucose of ≥ 180mg/dL
20.For adults with sepsis or septic shock: We suggest against using IV vitamin C.
21.For adults with sepsis or septic shock and hypoperfusion-induced lactic
academia We suggest against using Na HCO3
22.For adults with septic shock: pH ≤ 7.2 + AKI (AKIN score 2 or 3) We suggest
Using Na HCO3.
23.For adults with sepsis or septic shock: We suggest early (within 72 h)
initiation of enteral nutrition.