This document discusses therapeutic hypothermia for patients who experience cardiac arrest. Lowering a patient's core body temperature to 32-34°C for 12-24 hours after resuscitation can improve outcomes by reducing neurological injury from reperfusion. Clinical studies show increased survival rates and neurological function for patients who receive therapeutic hypothermia. The document reviews different methods for inducing and maintaining therapeutic hypothermia, as well as barriers to implementing these protocols more widely. It advocates for the establishment of specialized cardiac arrest centers to optimize post-cardiac arrest care.
Niklas Nielsen talks about the TTM trial as seen through a 2019 lens.
The video and references from the talk and all the rest of the goodness from The Big Sick 2019 in Zermatt is up at
https://scanfoam.org/
Nurses as the primary care providers would be the immediate health care professional to assess the patient's response and to determine whether he is improving or deteriorating. Signs of brain death can be identified and reported early by a nurse with adequate knowledge.
Post-Cardiac Arrest Syndrome:
Epidemiology, Pathophysiology, Treatment, and Prognostication
A Consensus Statement From the International Liaison Committee on Resuscitation
Circulation. 2008;118:2452-2483
Survival after cardiac arrest is poor but some therapies can make a difference. This presentation discusses the evidence for therpauetic hypothermia, normoxia, management of blood pressure and early cardiac catherterisation. It also makes the case that these might be elements of a bundle of care.
Niklas Nielsen talks about the TTM trial as seen through a 2019 lens.
The video and references from the talk and all the rest of the goodness from The Big Sick 2019 in Zermatt is up at
https://scanfoam.org/
Nurses as the primary care providers would be the immediate health care professional to assess the patient's response and to determine whether he is improving or deteriorating. Signs of brain death can be identified and reported early by a nurse with adequate knowledge.
Post-Cardiac Arrest Syndrome:
Epidemiology, Pathophysiology, Treatment, and Prognostication
A Consensus Statement From the International Liaison Committee on Resuscitation
Circulation. 2008;118:2452-2483
Survival after cardiac arrest is poor but some therapies can make a difference. This presentation discusses the evidence for therpauetic hypothermia, normoxia, management of blood pressure and early cardiac catherterisation. It also makes the case that these might be elements of a bundle of care.
A brief tutorial on Big Data and its applications to healthcare. The discussion is centered around technical aspects related to this method of computing rather than concrete examples of its use in medical practice.
Powerpoint Presentation - exported from Keynote Mac presentation. Introduction to Cardiac Point of Care U/S. Talk was meant for Emergency Medicine Residents PG1-3 level. Modest tweaks of font and spacing required prior to your own use. Associated PDF file in original Keynote format.
Terapötik Hipotermi Post-Arrest Protokolleri - Prof. Dr. Şule AkınAnış Arıboğan
Prof. Dr. Şule Akın'ın Başkent Üniversitesi Adana Uygulama ve Araştırma Merkezi'nde yapılan Doğu Akdeniz Yoğun Bakım Toplantıları'nda (DAYOBA) sunduğu Terapötik Hipotermi Post-Arrest Protokolleri başlıklı sunum
Introduction to therapeutic hypothermia for cardiopulmonary arrest after admission to the ICU
Edward Omron MD, MPH, FCCP
Pulmonary and Critical Care Medicine
Morgan Hill, CA 95037
A presentation for EMS personnel about prehospital cooling of patients with return of spontaneous circulation in the field post cardiac arrest; research and application
PRINCIPLES OF CRYOSURGERY
Cryosurgery (cryotherapy) is the application of extreme cold to destroy abnormal or diseased tissue.
The term comes from the Greek words cryo ("icy cold") and surgery meaning "hand work" or "handiwork".
Cryosurgery has been historically used to treat several diseases and disorders, especially variety of benign and malignant skin conditions.
Mechanism of cryosurgery
o The destructive effect of freezing tissue has been categorized into two major mechanisms-
Immediate cell destruction.
Delayed cell destruction.
Application techniques
Probe freezing: It is done by direct application of a probe tip to the lesion. The cryogen circulates through the probe tip and super cools it, when allowed to contact the target tissue. Probe freezing can be accomplished by one of the two mechanisms: contact freezing and penetration freezing.
In contact freezing, firm contact is made between the cryoprobe and the target tissue.
While in penetration freezing probe penetrates the target tissue, providing a large area of direct contact.
Spray freezing: It is done by direct application of the liquid nitrogen to the tissue and is the most destructive method. Liquid nitrogen is delivered to the target tissue at such a volume and velocity that it evaporates at the edge of the lesion. The spray orifice allows deeper and faster tissue penetration than the probe tip but the probe method is safer and more precise.
Benefits of Cryosurgery in Veterinary Medicine
Painless.
No Preparation.
No post op care.
No open wounds – No Bleeding.
No suturing.
No general anaesthesia – safe for older animals.
Rapid treatment time – only seconds.
Cost Effective.
Pressure to treat lesion.
Pinpoint Accuracy.
CryoProbe’s different micro applicators tips allow pinpoint accuracy to treat skin lesions from 1mm to 8mm in size.
Blue dot applicator Applications 1-3 mm.
White dot applicator Applications 2-4 mm.
Green dot applicator Applications 3-6 mm.
Yellow dot applicator Applications 4-10 mm.
Lesions
With the CryoProbe you will be able to treat (but not limited) to the following lesions successfully:
Perianal Adenomas.
Epuli.
Papilloma.
Lick Granulomas.
Warts.
Small Sarcoids.
Eye Lid Tumors.
You will be able to quickly and easily treat skin lesions that you could not treat before without undesired side effects.
Disadvantages of Cryosurgery
As with the advantages of cryosurgery, the disadvantages can also be categorized into those for the clinician and those for the patient.
Disadvantages for the clinician include the following:
Liquid nitrogen needs to be delivered and stored. A liquid nitrogen generator may be purchased. If that is not done, nitrous oxide tanks or other supplies will need to be replenished as needed.
Perinatal asphyxia is an insult to the fetus or the newborn due to lack of oxygen (hypoxia) and or a lack of perfusion (ischemia) to various organs. Hypoxia ischemia remains a significant cause of neonatal mortality and morbidity and adverse neurodevelopmental outcome. Therapeutic hypothermia found to improve neurodevelopmental outcome in asphyxiated babies.
- 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
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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!
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
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.
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.
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
5. HACA* Study Group
Witnessed Cardiac Arrest (VF ^ VT)
Age 18-75 yr
Est time Reanimation attempt 5-15 min
ROSC ≤ 60 mins
275 of 3,551 Arrests Met Inclusion Criteria
137 Randomized to Hypothermia
Body Core Temperature 32-34° C X 24 hr
Rewarmed over 8 hr
* Hypothermia After Cardiac Arrest
6. Principle Results I
Cumulative Survival in the Normothermia and Hypothermia Groups
The Hypothermia after Cardiac Arrest Study Group, . N Engl J Med 2002;346:549-556
7. Principle Results II
The Hypothermia after Cardiac Arrest Study Group, . N Engl J Med 2002;346:549-556
8. Current AHA (Y2005) Guideline
Unconscious adult patients with ROSC after
out-of-hospital arrest cooled to 32 - 34 °C
(89.6 - 93.2° F) X 12-24 hr in V Fib
Arrest(Class IIa)
Similiar therapy may be beneficial for out-of
hospital or in-hospital non-VF arrest (Class
IIb)
10. Surface Cooling I
Conventional Surface Cooling (circulating cold water blankets or cold air-forced blankets) can take 4-8 hrs to
reach 32-34° and temperature titration can be difficult CritiCool System uses 3-D CureWrap™ one piece garment
with temperature controller resulting in high efficiency precisely controlled external cooling
11. Surface Cooling II
Advantages
Application in 2 minutes
Portable no power requirements
High Cooling Capacity
Radioluminescent
User friendly
Suitable for induction and maintenance of cooling
Low investment costs
12. Medivance Arctic Sun™
Patented Design
Arctic Sun and
ArcticGel™ Pads
enables transfer of
up to five times
more thermal
energy than
conventional
methods such as
water blankets,
wraps or ice packs.
System’s precision
enables slow
rewarming thought
to be critical for
therapeutic benefit.
The Arctic Sun has
received 510(k) FDA
clearance in the
U.S.
14. Invasive Cooling Methods I
30ml/kg Lacated Ringers Solution @ 4°
C infused via femoral catheter over 30
mins => T 35.5 to 33.8° C
Rapid & predictable + volume infusion
blunts hypothermia induced diuresis
Maintenance therapy cooling blankets
Bernard, S. et al. Induced hypothermia using large volume, ice-cold intravenous fluid in comatose
survivors of out-of-hospital cardiac arrest: A preliminary report. Resuscitation 2003;56:9-13)
15. Invasive Cooling Methods II
Shivering blunts
external cooling
efforts unless
moderated by
Propofol or
Benzo’s
Zoll (Formerly Alsius)
Thermogard XP System
16. Thermal Regulatory Performance
Cincinnati
Medeco
Icy Catheter Arctic Sun Subzero Conventional
Caircooler
Blanketrol III
External H20
Cooling IV Heat External Gel- External Air Cold Saline, Ice,
Circulating Circulating Pads
Method Exchange coated Pads bags, Etc.
Pads
Cooling Rate
(°C) 1.46 1.04 1.33 0.18 0.32
% of time Temp
out of range
(>0.2 °C from 3.2 44.2 50.5 74.1 69.8
Target Temp)
Hoedemaekers CW, et al. Comparison of different cooling methods to induce and maintain normo- and
hypothermia in ICU patients: a prospective intervention study. Critical Care 2007; 11:R91.
19. Practical Approach
Induction Phase (within 4 hr of arrest)
Cold IV Saline
NG Iced Lavage
Cold Packs in Groin & Axilla
Maintenance Phase (12 to 24 hr)
IV Cooling Catheter
External Cooling Patches or Arctic Sun System
Rewarming Phase (Precise Temp Control VITAL)
0.25 - 0.5 ° C/hr
20. Financial Analysis
Avg Avg Direct
Avg Direct
Revenue Margin Per
Cost Per Pt
Per Pt Pt
Discharged
$57,783 $37,099 $20,684
Alive
Expired in
$12,014 $8,686 $3,329
Hospital
Take Heart America Program
St Cloud Minn - Dec 05- Nov 07
21. Financial Analysis
On average, each SCA patient delivered
alive to ED generated $27,900 of
revenue & $9,400 of direct margin
regardless of outcome in the hospital
22. Financial Analysis
St Cloud saw a 131% increase in arrest
survival rate compared to previous year
=> $1,088,000 additional hospital
revenue with direct margin of $366,000
over 19 month period of the study
23. Knowledge Transition
HACA Theory Into Practice
Europe & USA 30-40%
Implementation of therapeutic hypothermia
guidelines for post-cardiac arrest syndrome at a
glacial pace: Seeking guidance from the
knowledge translation literature
Resuscitation - Volume 77, Issue 3,
Pages 286-292 (June 2008)
24. Barrier’s To Implementation
500% variation in post arrest survival
Therapeutic Nihilism & Fatalism
Stove-piped Processes
Inability To Effectively Team
Lack of Physician Champion
Institutional Financial Concerns
25. Level I Cardiac Arrest Center
Minimum of 40 reanimated patient’s
annually
Aligned with STEMI Primary PCI
Treatment of re-arrest
EP assessment and/or ICD assessment
and implantation