Shock is a state of poor tissue perfusion that can result from various causes like hemorrhage, infection, trauma, etc. It impairs cellular metabolism. There are several types of shock including hypovolemic, cardiogenic, obstructive, distributive, and neurogenic shock. The management involves treating the underlying cause, improving cardiac function and tissue perfusion through fluid resuscitation, vasopressors, inotropes, and other supportive measures. The goals are to maintain adequate blood pressure, urine output, oxygen delivery and other parameters. Early identification and treatment of the cause is critical to reversing shock.
Perioperative Management of Hypertensionmagdy elmasry
Hypertension is most common medical reason for postponing surgery.How important is peri-operative hypertension?Hypertensive comorbidities associated with adverse perioperative outcomes .New Guidelines for managing patients with high blood pressure before surgery
Consequences of anesthesia on blood pressure regulation.
Perioperative Management of Hypertensionmagdy elmasry
Hypertension is most common medical reason for postponing surgery.How important is peri-operative hypertension?Hypertensive comorbidities associated with adverse perioperative outcomes .New Guidelines for managing patients with high blood pressure before surgery
Consequences of anesthesia on blood pressure regulation.
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.
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.
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
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!
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.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
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
1. SHOCK,
Types & Management
Moderator: Dr. Mubasher Ahmad
Asst. professor dept. of anaesthesiology & critical care
GMC & associated hospitals, srinagar
Speaker: Dr.Faisal Rasool
Post graduate scholar (1st year)
anaesthesiology & critical care
2. • Definition
• Review basic physiologic aspects of shock
• Different categories with Etiology &Clinical features
• Management aspects
Objectives:
3. Shock is a state of poor tissue perfusion
with impaired cellular metabolism leading
to serious pathophysiological
abnormality.
Definition:
4. In other words;
• It’s a condition, in which circulation fails to meet the
metabolic need of the tissue & at the same time fails
to remove the metabolic waste products.
• Usually result of inadequate blood flow and/or
oxygen delivery
• Inadequate peripheral perfusion leading to failure of
tissue oxygenation
Definition (cont.):
17. Clinical Features:
Features of shock depend on the degree of loss
of volume & on duration of shock.
Types
• Mild shock.
• Moderate shock.
• Severe shock.
18. Mild Shock:
Features
• Collapse of subcutaneous
veins of extremities esp. the
feet, which become pale and
cool
• Sweat on forehead, hand and
feet
• Urine output normal.
• heart rate normal or slight
tachycardia present.
• Blood pressure normal.
• Patient feels thirst and cold.
19. Moderate Shock:
Features
• Mild shock features +
drowsy & confused
• Oliguria(U/O <0.5ml/kg/hr)
• Tachycardia, HR usually less
then 100/min.
• Blood pressure normal
initially then falls in later
stage.
21. Stages of shock:
• Initial : The cells become leaky and switch to anaerobic
metabolism.
• Non-progressive(compensated stage): Attempt to correct
the metabolic upset of shock.
• Progressive (decompensated stage ): Eventually the
compensation will begin to fail.
• Refractory : Organs fail and the shock can no longer be reversed.
24. • PCWP/CVP ( PCWP is considered better guide for fluid
resuscitation than CVP but due to cost and tech.
feasibility generally CVP is preferred)
• Blood gas analysis (metabolic acidosis usu. Present)
• Mixed venous oxygen saturation (SVO2): best guide
for tissue perfusion.
SPECIFIC MONITORING:
26. Principles of Resuscitation:
• C: Circulation
• placement of adequate IV access
• A: Airway
• patent upper airway
• B: Breathing
• adequate ventilation and
oxygenation
27. Aim of management is to maintain:
• MAP> 60-65 mmHg
• CVP between 5-10 cm H2o or PAWP = 12 - 18 mmHg
• Urine output >0.5ml/kg/hr
• Saturation> 90%
• SVO2> 60%
• Hemoglobin > 9 g/dl
• Cardiac Index > 2.2 L/min/m2
Aim of Management:
28. Fluid Therapy in Shock:
• Crystalloid Solutions
• Ringers Lactate solution ( preferred mostly)
• Normal saline( preferred in hyponatremia and
brain injury)
• Colloid Solutions
• Blood transfusion
29. Crystalloids are preferred over colloids because:
i. They replace both intra and extra vascular volume.
ii. They don’t interfere with clotting factors.
iii. Risk of anaphylactic reaction with colloids
iv. Colloids are expensive
colloids are reserved for severe shock where
intravascular volume is vital
Fluid therapy (cont.)
30. Dynamic Fluid Response:
Infusing 250-500ml of Fluid rapidly in 5 - 10 mts.
• Responders – Improvement
• Transient responders – revert back
• Non – responders
Fluid therapy (cont.):
31. Fluid therapy (cont.):
• Oxygen Carrying Capacity:
• Only RBC contribute to oxygen carrying capacity
(hemoglobin)
• Replacement with all other solutions will
• support volume
• Improve end organ perfusion
• Will Not provide additional oxygen carrying capacity
32. (a) Vasopressors:
• Phenylephrine
• Ephedrine
• Nor epinephrine
• Mephenteramine
• Vasopressin
• adrenaline
Drugs:
Vasopressors are more effective if
sympathetic blockade is present
therefore they are useful in:
1.Neurogenic shock: Phenylephrine is
preferred
2.Spinal hypotension: Ephedrine is
preferred
3.Septicemic shock: Nor epinephrine is
preferred
33. (b) Inotropes:
i. Dopamine
ii. Dobutamine
iii. Milrinone lactate(phosphodiesterase iii inhibitor)
mostly used in cardiogenic and septicemic shock,
but can be used in other shock types if required.
Drugs (cont.):
34. (c) Vasodilators: e.g nitroglycerine, sodium
nitroprusside. Particularly effective in CHF.
(d) steroids: used mostly in hypovolemic and septicemic
shock.
contraindicated in cardiogenic shock, as they can
alter the healing process of myocardium.
(e) Antibiotics: early use in septic shock has shown
better outcome.
Drugs (cont.):
35. • Shock is mostly accompanied by metabolic acidosis.
• It should be treated by improving tissue perfusion.
• Sodium bicarbonate should only be used when
acidosis is severe (pH<7.2), as it can worsen cellular
acidosis by producing CO2.
Acid-base management:
36. End Points of Resuscitation:
Classic / Traditional
Restoration of blood
pressure
Normalization of heart rate
and urine output
Appropriate mental status
Improved / Global
All of the above plus
Normalization of serum
lactate levels
Resolution of base deficit
Goal directed approach
• MAP> 60-65 mmHg
• CVP between 5-10 cm H2o or
PAWP = 12 - 18 mmHg
• Urine output >0.5ml/kg/hr
• Saturation> 90%
• SVO2> 60%
most important!!! Identify the cause of shock and treat it .