This document discusses shock and hemorrhage. It defines shock and classifies it into hypovolaemic, cardiogenic, obstructive, distributive, and endocrine shock. Cardiogenic shock is caused by cardiac pump failure, while hypovolaemic shock is caused by decreased intravascular volume from hemorrhage or fluid loss. Distributive shock results from diminished systemic vascular resistance and includes septic, anaphylactic, and neurogenic shock. The document further discusses the pathogenesis and treatment of septic shock, hemorrhage classification, and methods of determining acute blood loss.
The presentation deals with the basics of hemorrhage i.e. classification, etiology. It also covers the mechanism of hemostasis and the various methods to achieve hemostasis.
Hope you like it! Suggestions and feedback will always be well appreciated. :)
STOMA CARE- OSTOMIES
#surgicaleducator #stomacare #ostomies #usmle #babysurgeon #surgicaltutor
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Stoma care- Ostomies - a didactic lecture.
• I have discussed the definition, types, preparation, post-op care, stoma appliances, complications and general care of different Stomas- Ostomies
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Cardiogenic shock is a condition of diminished cardiac output that severely impairs cardiac perfusion. In this condition in which the heart suddenly can't pump enough blood to meet the body's needs.
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
The presentation deals with the basics of hemorrhage i.e. classification, etiology. It also covers the mechanism of hemostasis and the various methods to achieve hemostasis.
Hope you like it! Suggestions and feedback will always be well appreciated. :)
STOMA CARE- OSTOMIES
#surgicaleducator #stomacare #ostomies #usmle #babysurgeon #surgicaltutor
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Stoma care- Ostomies - a didactic lecture.
• I have discussed the definition, types, preparation, post-op care, stoma appliances, complications and general care of different Stomas- Ostomies
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Cardiogenic shock is a condition of diminished cardiac output that severely impairs cardiac perfusion. In this condition in which the heart suddenly can't pump enough blood to meet the body's needs.
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
Shock is a life-threatening condition that occurs when the body is not getting enough blood flow. Lack of blood flow means the cells and organs do not get enough oxygen and nutrients to function properly. Many organs can be damaged as a result.
Orthodontics correction of malposed teeth
creates gingival contour s that are more conductive to
periodontal health .
Lower incisor may be extracted to correct crowding
,provided the extractions creates sufficient space for
proper alignment of the of the remaining teeth and
ad anterior guidance can be established in extensive
movements . in judicious extraction of mandibular
incisors although it corrects localized crowding ,may
result in an increase in the over jet and create
undesirable periodontal and aesthetic sequel
consultation with an orthodontist is recommended
before a lower incisor is extracted to eliminate
crowding
2 cases of colorectal trauma - one due to blunt trauma abdomen and one due to penetrating trauma to rectum are discussed in the light of colorectal trauma
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
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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.
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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!
2. • Definition: Shock is a physiologic state characterized by
systemic reduction in tissue perfusion, resulting in
decreased tissue oxygen delivery.
According to Bailey and Love:
Classification of shock:
• Hypovolaemic shock
• Cardiogenic shock
• Obstructive shock
• Distributive shock
• Endocrine shock
3. • Cardiogenic : Shock caused as a result of cardiac
pump failure
Causes:
• Myocardial Infarction
• Arrythmias (Atrial fibrillation, ventricular
tachycardias, bradycardias, etc)
• Mechanical abnormalities (valvular defects)
• Extracardiac abnormalities (PE, pulm HTN,
tension pneumothorax)
4. • Hypovolemic: Shock caused by decreased
preload due to intravascular volume loss.
Causes:
• Hemorrhagic – trauma, GI bleed, hemorrhagic
pancreatitis, fractures
• Fluid loss induced – Diarrhea, vomiting, burns
5. • Distributive: Shock as a result of severely
diminished systemic vascular resistance.
– Septic: secondary to an overwhelming infection
– Anaphylactic: secondary to an overwhelming
infection
– Neurogenic: secondary to a sudden loss of the
autonomic nervous system function.
8. Pathophysiology of septic shock:
General Clinical Signs:
• Flu-like symptoms – fever, chills – general malaise, irritability, lethargy
• Tachycardia and hypotension
• Hyperventilation
• Site of infection may or may not be evident
Cardiovascular:
• Systemic vasodilation and hypotension (Psys < 90 mmHg)
• Tachycardia (>100 beats/min)
• Increased cardiac output (hyperdynamic), although contractility is
depressed; hypodynamic in late shock
• Ventricular dilation; decreased ejection fraction
• Loss of sympathetic responsiveness
• Hypovolemia due to vascular leakage; central venous pressure may be
decreased or increased depending upon fluid resuscitation
• Compromised nutrient blood flow to organs; decreased organ oxygen
extraction
9. Cardiovascular:
• Systemic vasodilation and hypotension (Psys < 90
mmHg)
• Tachycardia (>100 beats/min)
• Increased cardiac output (hyperdynamic), although
contractility is depressed; hypodynamic in late shock
• Ventricular dilation; decreased ejection fraction
• Loss of sympathetic responsiveness
• Hypovolemia due to vascular leakage; central venous
pressure may be decreased or increased depending
upon fluid resuscitation
• Compromised nutrient blood flow to organs;
decreased organ oxygen extraction.
10. Pulmonary and renal:
• Hyperventilation with respiratory alkalosis
• Pulmonary hypertension and edema
• Hypoxemia (arterial pO2 < 50 mmHg)
• Reduced pulmonary compliance; increased work
• Respiratory muscle failure
• Renal hypoperfusion; oliguria
• Acute tubular necrosis and renal failure
11. Other
• Disseminated intravascular coagulation (DIC)
• Blood dyscrasias:
– Leukopenia
– Thrombocytopenia
– Polycythemia
• Central and peripheral nervous dysfunction
• Increased lactate occurs early
12. Management
Diagnosis:
• Before the initiation of antimicrobial therapy, at least two
blood cultures should be obtained
• At least one drawn percutaneously.
• At least one drawn through each vascular access device if
inserted longer than 48 hours
• Other cultures such as urine, cerebrospinal fluid, wounds,
respiratory secretions or other body fluids should be
obtained as the clinical situation dictates
• Other diagnostic studies such as imaging and sampling
should be performed promptly to determine the source
and causative organism of the infection may be limited by
patient stability.
13. Treatment primarily consists of:
• Volume resuscitation
• Early antibiotic administration
• Early goal directed therapy
• Rapid source identification and control.
• Support of major organ dysfunction.
• Sequestration of lipopolysaccharides.
18. MODS
• Multiple organ dysfunction syndrome (MODS),
previously known asmultiple organ
• failure (MOF) or multisystem organ failure
(MSOF), is altered organ function in an acutely
ill patient requiring medicalintervention to
achieve homeostasis. Multiple organ failure is
defined as two or more failed organ systems.
19. • Cause: The condition usually results from infection,
injury (accident, surgery), hypoperfusion and
hypermetabolism. The primary cause triggers an
uncontrolled inflammatory response.
• Sepsis is the most common cause in operative and non-
operative patients. Sepsis may result in septic shock. In
the absence of infection, a sepsis-like disorder is
termed as systemic inflammatory response syndrome
(SIRS).
• Both SIRS and sepsis could ultimately progress to
multiple organ dysfunction syndrome.
• However, in one-third of the patients no primary focus
can be found Multiple organ dysfunction syndrome is
well established as the final stage of a continuum: SIRS
+ infection leads to sepsis can turn to severe
sepsis can lead to Multiple organ dysfunction
syndrome.
21. SIRS
Criteria for Four Categories of the Systemic Inflammatory
Response Syndrome
Systemic Inflammatory Response Syndrome (SIRS)
• Two or more of the following:
• Temperature (core) >38°C or <36°C
• Heart rate >90 beats/min
• Respiratory rate of >20 breaths/min for patients
spontaneously ventilating or a PaCO2 <32 mm Hg
• White blood cell count >12,000 cells/mm3 or <4000
cells/mm3 or >10% immature (band) cells in the
peripheral blood smear
22. • Sepsis : Same criteria as for SIRS but with a
clearly established focus of infection
• Severe Sepsis: Sepsis associated with organ
dysfunction and hypoperfusion.
Indicators of hypoperfusion:
• Systolic blood pressure <90 mm Hg
• >40 mm Hg fall from normal systolic blood
pressure
• Lacticacidemia
• Oliguria
• Acute mental status changes
23. Septic Shock
• Patients with severe sepsis who
• Are not responsive to intravenous fluid
infusion for resuscitation.
• Require inotropic or vasopressor agents to
maintain systolic blood pressure
24. HAEMORRHAGE
• Types of haemorrgage:
• Recognition of types of haemorrhage:
• Arterial/ venous/capillary:
• Arterial haemorrhage: Arterial haemorrhage is recognised as bright red
blood, spurting as a jet which rises and falls in time with the pulse. In
protracted bleeding, and when quantities of intravenous fluids other
than blood are given, it can become watery in appearance.
• Venous haemorrhage: Venous haemorrhage is a darker red, a steady
and copious flow. The colour darkens still further from excessive oxygen
desaturation when blood loss is severe, or in respiratory depression or
obstruction. Blood loss is particularly rapid when large veins are
opened, e.g. common femoral or jugular. Venous bleeding can be under
increased pressure as in asphyxia, or from ruptured varicose veins
• Capillary haemorrhage: Capillary haemorrhage is bright red, often
rapid, ooze. If continuing for many hours, blood loss can become
serious, as in haemophilia.
25. Primary/reactionary/secondary:
• Primary haemorrhage: Primary haemorrhage occurs at
the time of injury or operation. Reactionary
haemorrhage
• Reactionary haemorrhage: may follow primary
haemorrhage within 24 hours (usually 4—6 hours) and
is mainly due to rolling (‘slipping’) of a ligature,
dislodgement of a clot or cessation of reflex
vasospasm.
• Secondary haemorrhage: Secondary haemorrhage
occurs after 7—14 days, and is due to infection and
sloughing of part of the wall of an artery. Predisposing
factors are pressure of a drainage tube, a fragment of
bone, a ligature in an infected area or cancer. It is also a
complication of arterial surgery and amputations.
26. External/internal:
• External haemorrhage: External haemorrhage is visible,
revealed haemorrhage.
• Internal haemorrhage: Internal haemorrhage is
invisible, concealed haemorrhage. Internal bleeding
may be concealed as in ruptured spleen or liver,
fractured femur, ruptured ectopic gestation or in
cerebral haemorrhage. Concealed haemorrhage may
become revealed as in haematemesis or melaena from
a bleeding peptic ulcer, as in haematuria from a
ruptured kidney, or via the vagina in accidental uterine
haemorrhage of pregnancy.
28. • Methods of determining acute blood loss:
• Assessment and management of blood loss must be
related to the pre-existing circulating blood volume,
which can be derived from the patient’s weight:
• • Infant 80—85 ml/kg;
• • Adult 65—75 ml/kg.
•
• Measuring blood loss:
• • Blood clot: The size of a clenched fist is roughly
equal to 500 ml.
• • Swelling in closed fractures: Moderate swelling in
closed fracture of the tibia equals 500—1500 ml
blood loss. Moderate swelling in a fractured shaft of
femur equals 500—2000 ml blood loss.
29. • Swab weighing. In the operating theatre, blood loss can be
measured by weighing the swabs after use and subtracting the dry
weight. The resulting total obtained (1 g = 1 ml) is added to the
volume of blood collected in the suction or drainage bottles. In
extensive wounds and operations, the blood loss is grossly
underestimated, due to evaporation of water from the swabs
before weighing each batch.Prompt transfer of discarded swabs
into polythene bags reduces this source of error. Blood, plasma and
water are also lost from the vascular system because of evaporation
from open wounds, into the tissues, sweating and expired water via
the lungs. Indeed, for operations such as radical mastectomy or
partial gastrectomy it may be necessary to multiply the swab
weighing total by a factor of 1.5. For prolonged surgery via larger
wounds, as in abdominothoracic or abdominoperineal operations,
the total measured may need to be multiplied by 2.
30. • Haemoglobin level
• This is estimated in g/100 ml (g/dl), normal
values being 12—16 g/100 ml (12—16 g/dl).
There is no immediate change in haemorrhage,
but after some hours the level falls by influx of
interstitial fluid info the vascular compartment in
order to restore the blood volume.
• Measurement of central venous pressure
• Continuous tissue oxygen tension measurement
31. Managing internal bleeding:
• ABC’s
• High concentration oxygen
• Assist ventilations
• Control external bleeding
• Stabilize fractures
• RICE – resuscitation, investigations, clinical
examination, evaluation
• Transport rapidly to appropriate facility.
32. Control of external bleeding:
• Pressure Dressing: Use bandage to secure dressing in
place
• Tourniquets:
• Final resort when all else fails
• Used for amputations
• 3-4” wide (blood pressure cuffs)
• Write “TK” and time of application on forehead of
patient
• Notify other personnel
• Once applied, DO NOT REMOVE
33. Treatment of haemorrgagic shock:
• The primary treatment of hemorrhagic shock is to control
the source of bleeding as soon as possible and to replace
fluid.
• In controlled hemorrhagic shock (CHS), where the source of
bleeding has been occluded, fluid replacement is aimed
toward normalization of hemodynamic parameters.
• In uncontrolled hemorrhagic shock (UCHS), in which the
bleeding has temporarily stopped because of hypotension,
vasoconstriction, and clot formation, fluid treatment is
aimed at restoration of radial pulse or restoration of
sensorium or obtaining a blood pressure of 80 mm Hg by
aliquots of 250 mL of lactated Ringer's solution
(hypotensive resuscitation).
34. • Crystalloid is the first fluid of choice for
resuscitation. Immediately administer 2 L of isotonic
sodium chloride solution or lactated Ringer’s
solution in response to shock from blood loss.
• Fluid administration should continue until the
patient's hemodynamics become stabilized.
Because crystalloids quickly leak from the vascular
space, each liter of fluid expands the blood volume
by 20-30%; therefore, 3 L of fluid need to be
administered to raise the intravascular volume by 1
L.
35. • Alternatively, colloids restore volume in a 1:1
ratio. Currently available colloids include human
albumin, hydroxy-ethyl starch products (mixed in
either 0.9% isotonic sodium chloride solution or
lactated Ringer’s solution), or hypertonic saline-
dextran combinations. The sole product that is
avoided routinely in large-volume (>1500 mL/d)
restoration is the hydroxy-ethyl starch product
mixed in 0.9% isotonic sodium chloride solution
because it has been associated with the induction
of coagulopathy.
36. • In patients with hemorrhagic shock, hypertonic
saline has the theoretical benefit of increasing
intravascular volume with only small amounts of
fluid. The combination of dextran and hypertonic
saline may be beneficial in situations where
infusion of large volumes of fluid may be harmful,
such as in elderly persons with impaired cardiac
activity.
• PRBCs should be transfused if the patient remains
unstable after 2000 mL of crystalloid
resuscitation. For acute situations, O-negative
noncrossmatched blood should be administered.
Administer 2 U rapidly, and note the response.
For patients with active bleeding, several units of
blood may be necessary.
37. • There are recognized risks associated with the
transfusion of large quantities of PRBCs. As a result,
other modalities are being investigated. One such
modality is hemoglobin-based oxygen carriers
(HBOC).
38. • If at all possible, blood and crystalloid infusions
should be delivered through a fluid warmer.
• A blood sample for type and cross should be drawn,
preferably before blood transfusions are begun.
• Start type-specific blood when available.
• Patients who require large amounts of transfusion
inevitably will become coagulopathic.
• FFP generally is infused when the patient shows signs
of coagulopathy, usually after 6-8 U of PRBCs.
• Platelets become depleted with large blood
transfusions.
• Platelet transfusion is also recommended when a
coagulopathy develops.