Septic shock is a life-threatening condition that arises when sepsis leads to dangerously low blood pressure and problems in organ function. It results from an infection that causes changes throughout the body. Early recognition and treatment are important, including administering antibiotics within an hour, aggressive fluid resuscitation, and monitoring for organ dysfunction. Goals of management are restoring blood pressure, reversing signs of low perfusion, and treating the underlying infection while avoiding additional organ injury.
Latest definition of sepsis, application of qSOFA, latest evidence on treatment of septic shock,role of fluids, role of steroids, isobalance salt solution
Latest definition of sepsis, application of qSOFA, latest evidence on treatment of septic shock,role of fluids, role of steroids, isobalance salt solution
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.
The recent definition, concept and terminologies of septic shock, surviving sepsis campaign, management techniques, SOFA score. Also includes antibiotics and supportive modalities.
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
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.
The recent definition, concept and terminologies of septic shock, surviving sepsis campaign, management techniques, SOFA score. Also includes antibiotics and supportive modalities.
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
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Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
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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
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disorder called alcohol use disorder (AUD), with mild, moderate,
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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
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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
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comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
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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!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
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Septic shock
1. SEPTIC SHOCK
Presentor : Dr. Sudhanshu Goyal,
PGY-1, General Surgery,
Civil Hospital Aizawl
Dated : 28th July 2015, Tuesday
2. What is SEPTIC SHOCK?
Invasion of normally
sterile host tissue
by microorganism
Inflammatory
response to the
presence of
microorganism
Infection
Two or more
of following
Hyothermia or
hyperthermia
Tachycardia
Tachypnoea or
Paco2 <32
mmHg
Leucocytosis or
leucopenia
SIRS
SIRS
Plus
Documented
Infection
Sepsis
Sepsis +
Organ
dysfunction
Plus
Hypotension
Steptic
Shock
4. Clinical Presentation
Symptoms
Fever: insensitive indicator
Hypothermia: more predictive of severity
and death
Confusion/Disorientation: metabolic
encephalopathy ?altered a.a.
metabolism
Hyperventilation: stimulation of
respiratoty centres by inflammatory
mediators
Organ system localizing symptoms
Signs
Rectal temperature
Extremities: Warm vs Cold shock
Tachycardia and Pulse pressure
Tachypnoea
Altered mental status
Organ system localizing signs
5. Workup
CBC with DLC
Coagulation studies :
PT & aPTT and fibrin split products elevated with fibrin levels decreased in DIC
Biochemical tests:
Lactate levels
Serum Electrolytes
KFT
LFT
Microbiology:
SSC recommends atleast 2 blood cultures before antibiotics
One percutaneous
Other(s) through each vascular access (if >48hrs)
Urine RME and Culture
Gram stain and culture of secretions and tissues (at least 1ml/gm)
6. Workup continued…
Imaging
Chest radiograph is warranted in every case
Abdomen
CT is preferred over radiography
USG if suspected Gall bladder pathology
Extremities radiograph if suspected lesion
Lumbar puncture
Suspected meningitis or encephalitis
8. Management Principles
Early recognition
Early and adequate antibiotic therapy
Source control
Early hemodynamic resuscitation and continued support
Proper ventilator management with low tidal volume in patients with acute
respiratory distress syndrome (ARDS)
9. General Management
2 large bore IV lines for aggressive fluid resuscitation and antibiotics
Central venous access is useful but not mandatory
Urinary catheterization to monitor UOP
All cases of sepsis should be given oxygen
Intubation in cases of respiratory distress due to DAD and ALI
Patients who do not respond to initial fluid resuscitation needs ICU admission
10. Specific Management
ProCESS, ARISE and ProMISe trials have concluded that
Measuring lactate, targeting ScvO2 values and insertion of central venous
catheter, no improved outcomes
Direct and individualized care
Culture and early institution of broad spectrum antibiotics
Restoration of BP
Reversal of evidence of end organ perfusion
11. Fluid Resuscitation
Challenge with 1-2 L (30mL/kg) of crystalloids within 30-60 mins
Continue as long as improvement continues
End points:
signs of volume overload
sustained rise of >5mm Hg in cardiac filling pressure
Rapid increase of CVP by >2 mm Hg
Absolute CVP > 8-12 mm Hg
Crystalloids versus Colloids
SAFE trial, no significant difference
Trend towards better outcome with 4% albumin
NS versus LR
Randomized double blinded trials
LR has less chances hyperkalaemia and acidosis
Mortality was higher in the saline group
12. Vasopressor Therapy
When to start:
no response with ≥4 L of crystalloid
if evidence of fluid overload
persistent hypotension
First line therapy: DOPAMINE vs NORADRENALINE
Noradrenaline
Potent α agonist with minimal β agonist activity
5-20 mcg/min irrespective of weight
Dopamine
30% patients fail to reach target MAP
“No beneficial effect on renal blood flow and function in
setting of circulatory shock of any etiology”
Useful in cold shock with co-existent bradycardia
Dose: begin with 5-10 mcg/kg/min upto 20 mcg/kg/min
13. Vasopressor Therapy continued…
Second line agents:
If poor clinical response to first line agents
Adrenaline
Increase Cardiac Index and Stroke Volume as well as HR and SVR
Increase oxygen delivery and consumption
Vasopressin
Reserved for salvage therapy
VASS Trial, decrease requirement of catecholamines but no significant
effect on mortality
Dose: 0.03 U/min
Phenylephrine
Rarely used
If tachyarrythmias limit therapy with other agents
14. Ionotrope therapy
Useful if inadequate:
Cardia Index
MAP
SmvO2
Despite adequate volume resuscitation and vasopressor therapy
Dobutamine
β receptor mediated increase in CO
If myocardial dysfunction or hypoperfusion in presence of adequate fluid resuscitation and
adequate MAP
Dose: Upto 20 mcg/kg/min
15. Corticosteroids
CORTICUS study, patients who received hydrocortisone had
rapid resolution of shock and faster improvement of organ dysfunction
Higher incidence of recurrent sepsis and super-infections
Recommendations (ACCCM)
In patients with septic shock administer
Hydrocortisone 200mg/day in 4 divided doses or 100mg bolus f/b 10mg/hr for 7 or more days
In patients with early severe ARDS
Methylprednisolone 1mg/kg/day continuous infusion for 14 or more days
Do not use dexamethasone
Weaning when vasopressor is not needed
Steroids not to be used in absence of shock
16. Antibiotic therapy
Broadspectrum empiric antibiotic therapy within 1 hr of recognition
Use of 1 or more agents active against presumed source of infection plus capable of
penetration in adequate concentrations
Daily re-evaluation for potential de-escalation
Combination empiric therapy if:
Difficult to treat multidrug resistant organism (eg pseudomonas)
Severe infections associated with respiratory failure and septic shock
Septic shock and bacteremia from pneumocci
Combination therapy to be limited to 3-5 days, switch to monotherapy based on
culture and sensitivity results
17. Antibiotic Selection
Must cover Gram positive, gram negative and anaerobic bacteria
If antibiotic experienced
Aminoglycoside over quinolone or cephalosporine for gram negative
For covering MRSA
Vancomycin or linezolid to be used
For ESBL producing organisms
Cephamycins (eg cefotetan) and carbapenems (eg imipenem, meropenem and ertapenem)
In immunicompetent adequate coverage is offered by
Carbapenems (eg imipenem and meropenem)
3rd and 4th generation cephalosporins (eg cefotaxime, cefoperazone, ceftazidime and cefepime)
Extended spectrum penecillins (eg ticarcillin and piperacillin)
No need for Nephrotoxic aminoglycoside
18. Glycemic Control
Based on NICE-SUGAR trials, SSC Guidelines suggest:
Target blood glucose level is < 180 mg/dL
Start insulin if 2 consecutive blood glucose levels are >180 mg/dL
Monitor 1-2 hrly if stable 4 hrly
Capillary blood to be interpreted catiously
19. Blood Products
Hemoglobin
If Hb < 7g/dL transfusion is recommended
Target Hb 7-9 g/dL
No role of erythropoietin
Platelet transfusion if
< 10,000
< 20,000 and risk of bleeding
< 50,000 if surgery or invasive procedures are planned
FFP
Not recommended for lab clotting abnormalities
Only if planned for surgery or invasive procedures
20. Metabolic and Nutritional Support
K, Mg and PO4 levels should be measured and corrected
High protein and energy requirement state
Early nutritional support with preferred oral/enteral route
Gastroperesis can be treated with motility agents or small bowel feeding tube
Advantages of enteral route
Protection of gut mucosa
Prevention of translocation of organisms from GIT
Reduced complication
Low cost
21. Mechanical Ventilation
Lung protective and pressure-limited ventilation
TV of 5-8 ml/kg, transpulmonary pressure not more than 30 cm of H2O
Permissive hypercapnea
PEEP to prevent alveolar collapse
Prone position ventilation
22. DVT prophylaxis
Low dose unfractionated heparin 2-3 times a day
Low molecular weight heparin in high risk patients (eg severe sepsis and previous
DVT, trauma or orthopedic surgery)
If creatinine clearance < 30 mL/min use deltaparin
Use mechanical DVT prevention devices in presence of CI
23. Other measures
Renal replacement
Intermittent hemodialysis and continuous venovenous hemofiltration are equivalent
CVVH is better for hemodynamically unstable patient
Sedation and NMB
Use intermittent bolus sedation or continuous infusion sedation
Daily lightening to produce awakening
Avoid NMB where possible
Use of bicarbonate is not recommended
Stress ulcer prophylaxis
PPI or H2 blocker
Prone position ventilation
24. Sepsis at its Inception is
Difficult to Recognize but
Easy to Treat
Left Unattended it becomes
Easy to Recognize but
Difficult to Treat