This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
This presentation was done by Dr. Julius P. Kessy,MD. An intern Doctor at Dodoma Regional Referral Hospital (DRRH) during pediatrics unit clinical meeting and supervised by Dr. Christina K. Galabawa,MD,Mmed2, Pediatrics and Child Health, University of Dodoma (UDOM) in November, 2017.
Shock
what is shock
stages of shock
types of shock, their presentation and management
presentation is made for medical students using kumar and clark and guyton.
Bleeding, also called hemorrhage, is the name used to describe blood loss. It can refer to blood loss inside the body, called internal bleeding, or to blood loss outside of the body, called external bleeding. Blood loss can occur in almost any area of the body.
Multisystem inflammatory syndrome with covid 19 in pediatricsMounika Bhallam
Multisystem Inflammatory Syndrome with COVID-19 in pediatrics:- this topic will make u to get knowledge in MISC condition in children and management of covid child with MISC along with Nursing care
Critical Care Nurse Student | Assistant Clinical Researcher | Chairperson National Nurses of Kenya-Siaya Branch | Mentor | SRHR & Boys Advocate.
Young and energetic healthcare professional with a strong belief in the basic tenets of human development and quality of life. My key qualities include integrity, hardworking, team player and keenness to achieve results.
Subject: Medical Surgical Nursing / Adult Health Nursing
Title: Shock
Prepared by: Misfa Khatun, Nursing tutor
Content:
- Introduction
- Definition of Shock
- Classify Shock
- Stages of Shock
- Enumerate the Causes of shock
- Pathophysiology of Shock
- Identify the Signs and symptoms of Shock
- First ais management of Shock
- Treatment of Shock
- Management of Shock
- Nursing management of Shock
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
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
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
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
the 11 DSM-5 behaviors be present within a 12-month period (mild
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
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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
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
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
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.
- 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
2. • “ ACUTE CIRCULATORY FAILURE “
with inadequate or inappropriately
distributed tissue perfusion
resulting in generalized cellular
hypoxia
3. • Body’s inability to deliver adequate oxygen to
meet the metabolic demands of the tissues.
• Initially compensated
• Continued presence of an inciting trigger +
body’s exaggerated response
lead to progression of shock
if untreated,irreversible tissue injury
irreversible shock
4.
5. CLASSIFICATION
• 5 major types of shock
1.HYPOVOLEMIC
2.CARDIOGENIC
3.OBSTRUCTIVE
4.DISTRIBUTIVE
5.SEPTIC
6. HYPOVOLEMIC SHOCK
• Characterized by fluid loss ( internal / external )
• Decreased preload
Water/electrolyte plasma blood
loss loss loss
7. CARDIOGENIC SHOCK
• Poor myocardial contractility leading to cardiac
pump failure
• Due to :
CHD
Myocarditis
Cardiomyopathies
Arrhythmias
8. OBSTRUCTIVE SHOCK
• Decreased cardiac output secondary to restriction
of all cardiac chambers
• Due to :
Tension pneumothorax
Pericardial tamponade
Pulmonary embolism
Anterior mediastinal masses
Coarctation of aorta
9. DISTRIBUTIVE SHOCK
• Caused by inadequate vasomotor tone
Capillary leak
Maldistribution of fluid into interstitium
• Post-spinal cord or brainstem injury
Anaphylaxis
Poisonings
10. SEPTIC SHOCK
• Complex interaction of
distributive,cardiogenic and hypovolemic
shock
• Bacterial/Viral/Fungal
11. Hypovolemic shock – blood VOLUME
problem
Cardiogenic shock - blood PUMP
problem
Distributive shock – blood VESSEL
problem
13. COMPENSATORY MECHANISMS
• >> Heart rate
• >> Stroke volume
• >> Vascular smooth muscle tone
• >> O2 extraction from the blood
• Redistributing blood flow to
brain,kidneys,adrenals and heart at the
expense of skin and GIT
14. To compensate for the metabolic acidosis,
- >> RR with >>CO2 elimination
- Renal excretion of hydrogen ions
- Retention of bicarbonate ions
To maintain intravascular volume,
- Sodium regulation through RAAS
- ADH secretion
- Cortisol and catecholamine synthesis and release
23. TREATMENT
1.Assess airway
2.Administer oxygen
3.Establish IV access
4.Fluid bolus of 20ml/kg isotonic fluid given
5.Continue fluid boluses (maximum of 3) until
perfusion improves or hepatomegaly develops
6.In case of shock refractory to fluids,start
inotrope (dopamine)
GOAL – RESTORE CIRCULATING VOLUME AND TISSUE
PERFUSION , CORRECT THE CAUSE
24. CARDIOGENIC SHOCK
Impaired pumping ability of LV
Inadequate systolic emptying of LV
>>LV filling pressure << Stroke volume
>>Left atrial pressure << CO
>>Pulmonary capillary pressure
Pulmonary interstitial and intralveolar edema
PATHOPHYSIOLOGY
26. TREATMENT
GOAL - >> CO, treat reversible causes, <<
myocardial workload
1.Assess airway , administer
oxygen/mechanical ventilation
2.IV access
3.Inotropic agents,vasoactive drugs to >>
cardiac contractility and to decrease
systemic vascular resistance
27. 4.Cautious administration of fluids
(5-10ml/kg boluses over longer time)
5. Morphine to decrease preload and
anxiety
6.Vasodilators for afterload reduction
7.Short acting beta blockers for refractory
tachycardia
29. CLINICAL PRESENTATION
• Muffled heart sounds
• Distended neck veins
• Pulsus paradoxus ( << in SBP by
more than 10mmHg on inspiration )
• Signs of right heart failure plus
cyanosis,tachycardia,hypotension
PERICARDIAL
EFFUSION
PULMONARY
EMBOLISM
30. TREATMENT
• Pericardial drainage in case of
pericardial effusion
• Immediate needle decompression then
thoracostomy for chest tube in case of
tension pneumothorax
• Anticoagulants or embolectomy for
pulmonary embolism
31. DISTRIBUTIVE SHOCK
Maldistribution of blood flow
Some tissues inadequately Some tissues
perfused over perfused
(splanchnic circulation) (skeletal muscle,
skin)
PATHOPHYSIOLOGY
37. DEFINITIONS
SIRS
• Requires 2 of the following 4 features to be
present:
o Temperature >38.5° or <36.0° C
o Tachypnea >2SD ABOVE NORMAL FOR AGE
o Tachycardia >2SD ABOVE NORMAL FOR AGE
o WBC ELEVATED OR DEPRESSED FOR AGE/>10%
IMMATURE NEUTROPHILS
38. INFECTION
• Suspected or proven infection or a clinical
syndrome associated with high probability
of infection
SEPSIS
• SIRS plus a suspected or proven infection
39. SEVERE SEPSIS
• Sepsis plus organ dysfunction,hypoperfusion
or hypotension
(including but not limited to lactic
acidosis,oliguria,acute mental status changes)
40. Identifying Acute Organ Dysfunction as a
Marker of Severe Sepsis
Tachycardia
Hypotension
CVP
PAOP
Jaundice
Enzymes
Albumin
PT
Altered
Consciousness
Confusion
Psychosis
Tachypnea
PaO2 <70 mm Hg
SaO2 <90%
PaO2/FiO2 300
Oliguria
Anuria
Creatinine
Platelets
PT/APTT
Protein C
D-dimer
41.
42. MODS
• Presence of altered organ function such that
homeostasis cannot be maintained without
medical intervention
43. WORK UP
• Laboratory studies
o CBP
o Comprehensive chemistry panel (serum elec,abg,BUN,serum
creat,GRBS,LFT,serum lactate)
o Coagulation studies
o Blood & urine cultures
• Imaging studies
o Chest radiography
o Abdominal radiography
o Others according to the suspected cause.
45. •Antibiotics should be administered within the first hour of
recognition of septic shock
•Selection of antibiotic agents is empirically based on
an assessment of patient's immunity
the potential source of infection
the most likely responsible organisms.
•Antibiotic choice must be broad spectrum, covering gram-positive,
gram-negative, and anaerobic bacteria when the source is unknown
•Regimen for septic shock of unknown cause is
oGentamicin
o3rd generation cephalosporin
o if pseudomonas is suspected,ceftazidime
46. • Vancomycin must be added if resistant
staphylococci or enterococci are suspected.
• If there is an abdominal source, a drug effective
against anaerobes should be included
“metronidazole”
• Antibiotics are continued for at least 5 days after
shock resolves and evidence of infection subsides
• Abscesses must be drained and necrotic tissues
(eg, infarcted bowel) surgically excised.
