1) Thoracic anesthesia presents unique physiologic challenges including lung mechanics changes with lateral positioning, open pneumothorax risks, and one lung ventilation complications like hypoxic pulmonary vasoconstriction inhibition.
2) Careful patient evaluation and optimization is important preoperatively, including pulmonary function tests and cardiac evaluation. Intraoperatively, techniques like double lumen tubes, lung isolation, and thoracic epidural analgesia are utilized.
3) Postoperative complications can include pulmonary issues like edema, hemorrhage, or respiratory failure. Prolonged air leaks or bleeding may require chest tube insertion.
In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
In critical care medicine the invasive life saving techniques are often employed and when all goes well such interventions will be withdrawn to all for normal physiology to resume. Identifying this point for safe withdrawal for the resumption of normal respiratory function is of utmost importance.
This PowerPoint presentation provides an in-depth overview of pneumothorax, a medical condition that occurs when air leaks into the pleural cavity, causing the lung to collapse. The presentation covers the causes, symptoms, and diagnostic procedures for pneumothorax, including chest x-rays and CT scans.
The presentation also discusses the various treatment options available for pneumothorax, such as thoracentesis, chest tube insertion, and surgery. The benefits and risks of each treatment are also explained in detail, providing the audience with a comprehensive understanding of the condition and its management.
In addition, the presentation includes several case studies and real-life examples to help illustrate the impact of pneumothorax on patients and the importance of early diagnosis and treatment. It is an ideal resource for medical professionals, students, and anyone interested in learning more about this common medical condition.
Overall, this PowerPoint presentation provides a valuable resource for understanding pneumothorax, its causes, symptoms, and treatment options, helping to improve patient outcomes and quality of care.
The global spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of M. tuberculosis have resulted in a resurgence of almost incurable and even fatal cases for which only a few therapeutic options are available. Surgery has been applied to improve treatment success rates in MDR-TB patients and a combined medical and surgical approach is increasingly being used to treat patients with M/XDR-TB. This presentation discuss the history, indications,contraindication and the perioperative workup for TB patients that might need surgery
this presentation is based on the lastest WHO recommendation for surgery for pulmonary TB
Physiotherapy in surgery in abdominal and thoracic surgeryDrKhushbooBhattPT
Rehabilitation is one of the important aspect in pre and post surgery care.
This presentation is mainly focusing on the "thoracic and abdominal rehabilitation" and also gives details about assessment and management of "intercostal drains".
Journal club covid vaccine neurological complications ZIKRULLAH MALLICK
the risks of adverse neurological events following SARS-CoV-2 infection are much greater than those associated with vaccinations, highlighting the benefits of ongoing vaccination programs.
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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
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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.
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.
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
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
4. • What happens to lung mechanics during
lateral decubitus position?
• Awake state?
• After induction of anesthesia?
5.
6. AWAKE STATE:
V/Q: Preserved
Dependent lung:
More perfused
Receives more ventilation
Contraction of hemidiaphragm more
efficient
More favourable part of compliance curve
7. • V/Q : mismatch and hypoxia
• Induction of G.A: FRC & moves lower
lung( perfused) to less compliant part of
the compliance curve
• PPV favors the upper lung (Compliant)
• Neuromuscular blockade: abdominal
contents rise up against dependent
hemidiaphragm
• Rigid bean bag
INDUCTION AND PPV
9. . The Open Pneumothorax :
• The lungs are kept expanded by the
negative pleural pressure .When chest is
opened the –ve pleural pressure is lost
and the lung is collapsed
• Spontaneous ventilation with open
pneumothorax in the lateral position
results in paradoxical respiration &
mediastinal shift
15. 3. One Lung Ventilation:
• Intentional collapse of the lung on the
operative side greatly facilitates most
thoracic procedures but complicates
anesthetic management
• The collapsed lung continues to be perfused
and no longer ventilated
16. • So the patient develops RT to LT
intrapulmonary shunt hypoxia
• Widens alveolar to arterial gradient
hypoxia
20. • Techniques for one lung ventilation:
1. Use of double lumen BT
2. Use of single lumen ET + bronchial blocker
3. Use of single lumen EBT
• Double lumen endobronchial tube is often
used
22. • Indications for one lung ventilation:
-CONFINED INFECTION TO ONE LUNG
-CONFINED BLEEDING TO ONE LUNG
-SEPARATE LUNG VENTILATION:
*large cyst or bulla *BPF *tracheobron. disruption
PATIENT
RELATED:
-LUNG RESECTION:
*pneumonectomy *lobectomy *segmental resection
-THORACOSCOPY
-ANT. APPROACH TO THORACIC SPINE
-ESOPHAGEAL SURGERY -B.A. LAVAGE
PROCEDURE
RELATED:
23. Absolute indication for OLV
– Isolation of one lung from the other to avoid
spillage or contamination
• Infection
• Massive hemorrhage
– Control of the distribution of ventilation
• Bronchopleural / - cutaneous fistula
• Surgical opening of a major conducting airway
• giant unilateral lung cyst or bulla
• Tracheobronchial tree disruption
• Life-threatening hypoxemia due to unilateral lung
disease
29. • Advantage:
– Can suction lungs independently
– Quality of suctioning better
– Can apply CPAP to nonventilated lung
• Disadvantage:
– Difficult to insert.
– Needs change of tube if postoperative
ventilation is considered
– Needs determination of appropriate size
– Potential for tracheobronchial injury
30. How is the size of the DLT
determined for each patient?
31. • An ideally placed DLT should pass easily
through the glottis and should enter the
intended main bronchus without causing
trauma
• Single-use PVC DLTs : 26 F, 28 F, 32 F,
35 F, 37 F, 39 F, 41 F
• 35 F and 37 F - small and large females
• 39 F and 41 F for small and large males
34. • The right upper lobe bronchus takes off
from the right main bronchus 0.5 to 1 cm
below the carina
• When right sided DLT is placed, there
are high chances that the right upper
lobe bronchus may be occluded
• Left mainstem bronchus is much longer
than the right one (50 mm as compared
to 20 mm)
• Margin of safety while positioning a left
sided DLT is more
37. • ƒDetailed medical history : coexisting disease
• Optimal treatment and control of associated
medical conditions
• Patient’s functional capacity should be assessed
• History of smoking, symptoms suggestive of COPD
elicited
• Preoperative cardiologic evaluation
• Airway evaluation
• Patients may receive chemotherapy
preoperatively, and should be evaluated for
chemotherapy related toxicity
39. Investigations
• CBC : Polycythemia - COPD or leucocytosis -
active pulmonary infection
• Sputum cultures and sensitivity to guide
appropriate antibiotic therapy
• Renal function test
• Liver function test
• X-ray Chest : tracheal deviation or
obstruction, mediastinal mass, superior vena
cava syndrome, pleural effusions,
consolidation
40. • Pulmonary function tests : obstructive or
restrictive abnormalities, to assess
responsiveness to bronchodilators and to
confirm suitability for resection
• ECG : For signs of left or right heart
dysfunction
• TTE : to rule out pulmonary hypertension
• Further cardiopulmonary testing may be
indicate if warranted by the history/above
investigations
41. Describe the 3 legged stool
test of prethoracotomy
respiratory assessment ?
46. THORACIC ANESTHESIA
• Preoperative management
ResultMeasures
HbCO2 decreases in 12-24h
so more O2 is available
Cessation of smoking
Select antibiotics according
to culture and sensitivity
Treat pulmonary infections
Beta-2 agonistsTreat bronchospasm
Hydration and chest
percussion
Thin and mobilize secretions
48. THORACIC ANESTHESIA
1) Preparation:
• Apart from basic airway management
• Multiple single and double tubes should be
available
• fiberoptic bronchoscope should be available
• Tube exchanger
• Cpap delivery system,bronchodilator
• Thoracic epidural catheter
49. THORACIC ANESTHESIA
2) Venous access:
• At least 2 large iv canula( 14-16 g) is
mandatory
• CV catheter, blood warmer ,rapid infusion
device are desired if blood loss is
anticipated
52. • GA with controlled ventilation with
thoracic epidural analgesia
• IV induction with propofol or
thiopentone
• Propofol : preferred since many of these
patients will have reactive airways and
use of thiopentone and tracheal
instrumentation in light plane can lead to
bronchospasm
• NDMR can be used
53. • Maintenance : halogenated agent + opiod
• Delivered in an oxygen/air or
oxygen/nitrous oxide mix
• During one-lung ventilation, anaesthesia
can be maintained intravenously with
propofol and an air/oxygen mix
55. • For sudden or severe desaturation:
–Convert to two-lung ventilation
• For gradual desaturation:
1. Increase FiO2 to 1.0
2. The position of DLT should be
rechecked using a fiberoptic
bronchoscope.
3. The hemodynamic status of the patient
should be optimized
4. Recruitment of the ventilated lung
56. 5. PEEP of 5-10 cm H2O: the dependent
lung
6. CPAP of 1-2 cm H2O: to the
nondependent lung, after a recruitment
maneuver
7. Intermittent two-lung ventilation.
8. Partial ventilation of the non-ventilated
lung using either low flow oxygen
insufflations or high frequency ventilation
9. If a pneumonectomy is being
performed, ligation of the pulmonary
artery : completely eliminate the shunt.
58. • Fluid restriction is generally advocated in lung
resections.
• The reasons for this are:
– Third spacing is not excessive in lung surgeries
– The dependent lung : high capillary hydrostatic
pressures
– Postoperative pulmonary edema
– Surgery may impair lymphatic drainage. It is
recommended that the total positive fluid
balance in the first 24 hours should not
exceed 20 mL/kg
62. • Most patients are extubated early to
reduce the risk of pulmonary
barotrauma, blowout of the bronchial
stump and pulmonary infection
• Pts with marginal reserve: Double lumen
tube is exchanged with regular
tube,extubated when criteria met
63. What are the available
techniques for pain relief in
this patient?
64. • Thoracic epidural analgesia:gold standard for
post-thoracotomy analgesia
– The epidural is most effective when placed at
the vertebral level corresponding with the
dermatomes of the surgical incision.
– Local anaesthetic solutions may be infused
continuously or via a patient controlled device
– Opiods can be added
• Parenteral opioids: Patient-controlled analgesia
(PCA) devices can be used to deliver opioids
67. • 1. Cardiovascular:
– a. Arrhythmias
– b. Right ventricular failure
– c. Cardiac herniation
– d. Hemorrhage
• 2. Pulmonary
– a. Pulmonary edema
– b. Respiratory insufficiency
– c. Pulmonary torsion
• 3. Pneumonectomy space
– a. Bronchopleural fistula
– b. Empyema
• 4. Neurological
– Recurrent laryngeal, vagus or phrenic nerve injury
69. • > 1.5 L once ICTD is placed.
• > 200ml/hr for consecutive 4 hrs
• Clotted hemothorax
• Persistent pneumothorax
70. What are the indications
of chest tube insertion
71. • Asymptomatic patients with minimal
pneumothorax (< 15–20% of hemithorax) :
conservative management
• Symptomatic or patients with larger
pneumothorax need aspiration or drainage
• ICTD indications :
1. Pneumothorax
a. In mechanically ventilated patient
b. Tension pneumothorax after initial
decompression by inserting a needle
c. Persistent or recurrent pneumothorax
after simple aspiration
72. 2. Large or symptomatic pleural
effusions
3. Other pleural collections
a. Pus (empyema)
b. Blood (hemothorax)
c. Chyle (chylothorax)
4. Postoperative—after thoracotomy
or thoracoscopy