1. The document provides tips for using a PowerPoint presentation (ppt) for active learning sessions.
2. It recommends showing blank slides first to elicit what students already know, then showing slides with content.
3. This approach should be repeated through three revisions for an engaging learning experience beneficial for self-study.
* Fluid resuscitation is mandatory in shock from traumatic haemorrhage * Massive use of resuscitative fluids following injury is now being disputed * Adequate resuscitation is no longer judged by presence of normal vital signs * Normalcy of organ and tissue specific measured values are to be achieved * Search for a single endpoint that works for all trauma patients, is unrealistic * Resuscitate with appropriate fluid, in appropriate amount, at appropriate time
* Fluid resuscitation is mandatory in shock from traumatic haemorrhage * Massive use of resuscitative fluids following injury is now being disputed * Adequate resuscitation is no longer judged by presence of normal vital signs * Normalcy of organ and tissue specific measured values are to be achieved * Search for a single endpoint that works for all trauma patients, is unrealistic * Resuscitate with appropriate fluid, in appropriate amount, at appropriate time
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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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
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
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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!
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Light House Retreats: Plant Medicine Retreat Europe
Shock (2).pptx
1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.
5. Is This Patient in Shock?
• Patient looks ill
• Altered mental status
• Skin cool and mottled or
hot and flushed
• Weak or absent peripheral
pulses
• SBP <110
• Tachycardia
Yes!
These are all signs and
symptoms of shock
10. Goals of Treatment
• ABCDE
• Airway
• control work of Breathing
• optimize Circulation
• assure adequate oxygen Delivery
• achieve End points of resuscitation
14. What Type of Shock is This?
• 68 yo M with hx of HTN and DM
presents to the ER with abrupt
onset of diffuse abdominal pain
with radiation to his low back. The
pt is hypotensive, tachycardic,
afebrile, with cool but dry skin
Types of Shock
• Hypovolemic
• Septic
• Cardiogenic
• Anaphylactic
• Neurogenic
• Obstructive
Hypovolemic Shock
20. End Points of Resuscitation
• Goal of resuscitation is to maximize survival and
minimize morbidity
• Use objective hemodynamic and physiologic
values to guide therapy
• Goal directed approach
• Urine output > 0.5 mL/kg/hr
• CVP 8-12 mmHg
• MAP 65 to 90 mmHg
• Central venous oxygen concentration > 70%
24. What Type of Shock is This?
• An 81 yo F resident of a nursing
home presents to the ED with altered
mental status. She is febrile to 39.4,
hypotensive with a widened pulse
pressure, tachycardic, with warm
extremities
Types of Shock
• Hypovolemic
• Septic
• Cardiogenic
• Anaphylactic
• Neurogenic
• Obstructive
Septic
29. Treatment of Septic Shock
• 2 large bore IVs
• NS IVF bolus- 1-2 L wide open (if no
contraindications)
• Supplemental oxygen
• Empiric antibiotics, based on suspected
source, as soon as possible
31. Persistent Hypotension
• If no response after 2-3 L IVF, start a
vasopressor (norepinephrine, dopamine, etc)
and titrate to effect
• Goal: MAP > 60
• Consider adrenal insufficiency:
hydrocortisone 100 mg IV
32. Early Goal Directed Therapy
Rivers E et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock N Engl J Med. 2001:345:1368-1377.
33. Early Goal Directed Therapy
• Septic Shock Study 2001
• 263 patients with septic shock by refractory
hypotension or lactate criteria
• Randomly assigned to EGDT or to standard
resuscitation arms (130 vs 133)
• Control arm treated at clinician’s discretion and
admitted to ICU ASAP
• EGDT group followed protocol for 6 hours then
admitted to ICU
Rivers E et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock N Engl J Med. 2001:345:1368-1377.
35. Treatment Algorithm
Rivers E et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock N Engl J Med. 2001:345:1368-1377.
37. EGDT Group
• First 6 hours in ED
• More fluid (5 L vs 3.5 L)
• More transfusion (64.1% vs 18.5%)
• More dobutamine (13.7% vs 0.8%)
• Outcome
• 3.8 days less in hospital
• 2 fold less cardiopulmonary complications
• Better: SvO2, lactate, base deficit, PH
• Relative reduction in mortality of 34.4%
• 46.5% control vs 30.5% EGDT
39. What Type of Shock is This?
• A 55 yo M with hx of HTN,
DM presents with “crushing”
substernal CP, diaphoresis,
hypotension, tachycardia and
cool, clammy extremities
Types of Shock
• Hypovolemic
• Septic
• Cardiogenic
• Anaphylactic
• Neurogenic
• Obstructive
Cardiogenic
45. Etiologies
• What are some causes of cardiogenic shock?
• AMI
• Sepsis
• Myocarditis
• Myocardial contusion
• Aortic or mitral stenosis, HCM
• Acute aortic insufficiency
49. Treatment of Cardiogenic Shock
• AMI
• Aspirin, beta blocker, morphine, heparin
• If no pulmonary edema, IV fluid challenge
• If pulmonary edema
• Dopamine – will ↑ HR and thus cardiac work
• Dobutamine – May drop blood pressure
• Combination therapy may be more effective
• PCI or thrombolytics
• RV infarct
• Fluids and Dobutamine (no NTG)
• Acute mitral regurgitation or VSD
• Pressors (Dobutamine and Nitroprusside)
51. What Type of Shock is This?
• A 34 yo F presents to the ER after
dining at a restaurant where shortly
after eating the first few bites of her
meal, became anxious, diaphoretic,
began wheezing, noted diffuse pruritic
rash, nausea, and a sensation of her
“throat closing off”. She is currently
hypotensive, tachycardic and ill
appearing.
Types of Shock
• Hypovolemic
• Septic
• Cardiogenic
• Anaphylactic
• Neurogenic
• Obstructive
Anaphylactic
54. Anaphylactic Shock
• Anaphylaxis – a severe systemic
hypersensitivity reaction characterized by
multisystem involvement
• IgE mediated
• Anaphylactoid reaction – clinically
indistinguishable from anaphylaxis, do not
require a sensitizing exposure
• Not IgE mediated
55. • What are some symptoms of anaphylaxis?
Anaphylactic Shock
• First- Pruritus, flushing, urticaria appear
•Next- Throat fullness, anxiety, chest tightness,
shortness of breath and lightheadedness
•Finally- Altered mental status, respiratory
distress and circulatory collapse
56. • Risk factors for fatal anaphylaxis
• Poorly controlled asthma
• Previous anaphylaxis
• Reoccurrence rates
• 40-60% for insect stings
• 20-40% for radiocontrast agents
• 10-20% for penicillin
• Most common causes
• Antibiotics
• Insects
• Food
Anaphylactic Shock
57. • Mild, localized urticaria can progress to full anaphylaxis
• Symptoms usually begin within 60 minutes of exposure
• Faster the onset of symptoms = more severe reaction
• Biphasic phenomenon occurs in up to 20% of patients
• Symptoms return 3-4 hours after initial reaction has cleared
• A “lump in my throat” and “hoarseness” heralds life-
threatening laryngeal edema
Anaphylactic Shock
59. Anaphylactic Shock- Diagnosis
• Clinical diagnosis
• Defined by airway compromise, hypotension, or
involvement of cutaneous, respiratory, or GI
systems
• Look for exposure to drug, food, or insect
• Labs have no role
61. • ABC’s
• Angioedema and respiratory compromise require
immediate intubation
• IV, cardiac monitor, pulse oximetry
• IVFs, oxygen
• Epinephrine
• Second line
• Corticosteriods
• H1 and H2 blockers
Anaphylactic Shock- Treatment
62. • Epinephrine
• 0.3 mg IM of 1:1000 (epi-pen)
• Repeat every 5-10 min as needed
• Caution with patients taking beta blockers- can cause severe
hypertension due to unopposed alpha stimulation
• For CV collapse, 1 mg IV of 1:10,000
• If refractory, start IV drip
Anaphylactic Shock- Treatment
67. What Type of Shock is This?
• A 41 yo M presents to the ER after
an MVC complaining of decreased
sensation below his waist and is
now hypotensive, bradycardic, with
warm extremities
Types of Shock
• Hypovolemic
• Septic
• Cardiogenic
• Anaphylactic
• Neurogenic
• Obstructive
Neurogenic
69. • Loss of sympathetic tone results in warm
and dry skin
• Shock usually lasts from 1 to 3 weeks
• Any injury above T1 can disrupt the entire
sympathetic system
• Higher injuries = worse paralysis
Neurogenic Shock
70. Neurogenic Shock
• Shock :spinal cord injury, regional anesthesia,
autonomic blockade
• Mechanism: loss of vasomotor control, expansion
of venous capacitance bed
• Signs: warm skin, normal or low HR, normal CO,
low SVR
• Tx: Fluids / pressors / +- steroids
71. • A,B,Cs
• Remember c-spine precautions
• Fluid resuscitation
• Keep MAP at 85-90 mm Hg for first 7 days
• Thought to minimize secondary cord injury
• If crystalloid is insufficient use vasopressors
• Search for other causes of hypotension
• For bradycardia
• Atropine
• Pacemaker
Neurogenic Shock- Treatment
72. Neurogenic Shock- Treatment
• Methylprednisolone
• Used only for blunt spinal cord injury
• High dose therapy for 23 hours
• Must be started within 8 hours
• Controversial- Risk for infection, GI bleed
74. What Type of Shock is This?
• A 24 yo M presents to the ED after
an MVC c/o chest pain and
difficulty breathing. On PE, you
note the pt to be tachycardic,
hypotensive, hypoxic, and with
decreased breath sounds on left
Types of Shock
• Hypovolemic
• Septic
• Cardiogenic
• Anaphylactic
• Neurogenic
• Obstructive
Obstructive
81. Case 1
• 55y M post-op day 0 s/p colectomy
• Called for tachycardia, hypotension, altered mental
status, abdominal distension, decreased UOP
• PE: pale, disoriented, abdomen tense, UOP 15mL/hr
• What is your diagnosis?
• What additional information should you obtain?
• What is the plan?
82. Case 1: Continued
• Dx: hemorrhagic shock
• Additional information: CBC, coags, T&C
• Management
– ABC (intubate, IV access)
– Resuscitate (isotonic IVF)
– Prepare for take-back
83. Case 2
• 75y M h/o CAD, PVD, DM, POD 1 s/p AAA
repair c/o nausea
• What do you need to think about?
• What is the plan?
84. Case 2: Continued
• Dx: MI
• Plan:
– ABC
– MONA, beta-blockade
– Labs/x-rays: cardiac enzymes Q8H x3 sets
w/EKG, chemstick, BMP, CXR
– Cardiology consult
85. Case 2: Continued
• Cath w/critical stenosis of left main s/p balloon
angioplasty
• PE: intubated, 80/50, UOP 10mL/hr
• Echo: severe LV dysfunction
• What is the diagnosis?
• What is the plan?
86. Case 2: Continued
• Dx: Post-myocardial infarction (cardiogenic) shock
• Plan:
– ABC
• Pressor support as needed
• Placement of Swan-Ganz catheter
• +/- Intra-aortic balloon pump, cardiac assist
device
87. Case 4
• 55y M POD 0 s/p colectomy, w/epidural placed
for post-op pain control
• Called by nurse for hypotension and bradycardia
• PE: AAOx3, abdomen ND, NT
• Recent post-op labs: HCT 35
• What is your working diagnosis?
88. Case 4: Continued
• DX: Neurogenic shock 2/2 epidural
• Treatment is:
– IVF
– Turn down or turn off epidural
– If BP does not respond to IVF, initiate pressor
support w/alpha-agonist such as phenylephrine
89. Case 5
• 45y M p/w diffuse abdominal pain. PMHx PUD,
chronic NSAID usage.
• PE: febrile, tachycardic, hypotensive, lethargic,
rigid abdomen w/ involuntary guarding
• What is your working diagnosis?
• What is your plan?
90. Case 5
• Dx: septic shock 2/2 duodenal perforation
• Plan:
– ABC
– Broad-spectrum IV antibiotics
– Emergent OR for ex-lap, washout & repair
92. Shock: Take Home Points
• Shock = inadequate tissue perfusion
• Types of shock: hypovolemic, septic, cardiogenic,
neurogenic, anaphylactic
• Signs of shock: altered MS, tachycardia, hypotension,
tachypnea, low UOP
• Always start with ABCs
• Resuscitation begins with fluid
• Use RL/NS
• Dopamine is rarely required and in neurogenic and
early septic shock only.
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