The document discusses fluid resuscitation strategies for trauma patients experiencing hemorrhagic shock. It summarizes several key studies that have compared immediate versus delayed fluid resuscitation and larger versus smaller volume resuscitation. However, the studies have shown mixed results and limitations. There remains uncertainty around the optimal timing and volume of fluid administration due to lack of large, high-quality randomized controlled trials in this area.
Basics of Shock and its management. Compentency and SLO based learning for undergraduate medical training (MBBS)
Check out the lecture by clicking on the link below
https://www.youtube.com/watch?v=J5m4kh4FO7k
Basics of Shock and its management. Compentency and SLO based learning for undergraduate medical training (MBBS)
Check out the lecture by clicking on the link below
https://www.youtube.com/watch?v=J5m4kh4FO7k
Heart Disease & Chest Pain Treatment At NT Cardiovascular Center Georgiamelvillejackson
http://www.ntcardiovascularcenter.com NT Cardiovascular Center providing latest cutting edge and comprehensive technology for heart disease, chest pain treatments, congestive heart failure, coronary artery disease monitoring, or any critical heart condition.
Shock is a state of acute circulatory failure leading to decreased organ perfusion, with inadequate delivery of oxygenated blood to tissues and resultant end-organ dysfunction. The mechanisms that can result in shock are divided into 4 categories: (1) hypovolemic, (2) distributive, (3) cardiogenic, and (4) obstructive. While much is known regarding treatment of patients in shock, several controversies continue in the literature. Assessment begins with identifying the need for critical interventions such as intubation, mechanical ventilation, or obtaining vascular access. Prompt workup should be initiated with laboratory testing (especially of serum lactate levels) and imaging, as indicated. Determining the intravascular volume status of patients in shock is critical and aids in categorizing and informing treatment decisions. This issue reviews the 4 primary categories of shock as well as special categories, including shock in pregnancy, traumatic shock, septic shock, and cardiogenic shock in myocardial infarction. Adherence to evidence-based care of the specific causes of shock can optimize a patient's chances of surviving this life-threatening condition.
Heart Disease & Chest Pain Treatment At NT Cardiovascular Center Georgiamelvillejackson
http://www.ntcardiovascularcenter.com NT Cardiovascular Center providing latest cutting edge and comprehensive technology for heart disease, chest pain treatments, congestive heart failure, coronary artery disease monitoring, or any critical heart condition.
Shock is a state of acute circulatory failure leading to decreased organ perfusion, with inadequate delivery of oxygenated blood to tissues and resultant end-organ dysfunction. The mechanisms that can result in shock are divided into 4 categories: (1) hypovolemic, (2) distributive, (3) cardiogenic, and (4) obstructive. While much is known regarding treatment of patients in shock, several controversies continue in the literature. Assessment begins with identifying the need for critical interventions such as intubation, mechanical ventilation, or obtaining vascular access. Prompt workup should be initiated with laboratory testing (especially of serum lactate levels) and imaging, as indicated. Determining the intravascular volume status of patients in shock is critical and aids in categorizing and informing treatment decisions. This issue reviews the 4 primary categories of shock as well as special categories, including shock in pregnancy, traumatic shock, septic shock, and cardiogenic shock in myocardial infarction. Adherence to evidence-based care of the specific causes of shock can optimize a patient's chances of surviving this life-threatening condition.
My presentation slides during the 1st National Symposium in Emergency and Acute Care (S.E.M.A.C). I presented some of the obstacles and challenges in scientific writing in emergency medicine within the Malaysia context as academic emergency medicine is still progressing in Malaysia,
Managing Cardiovascular Emergencies In A Malaysian Hospital - Challenges and ...Chew Keng Sheng
This is the talk I gave during ICEM 2010 under the International Experience of Cardiology Track. In this presentation, I highlighted some of the challenges I see within the Malaysian setting, I focus mainly on prehospital and A&E setting. Issues that are conventionally under the care of the cardiologists are not discussed.
A Free Paper Presentation in the 16th International Symposium in Critical Care and Emergency Medicine, Grand Hyatt, Bali, Indonesia (30th July - 1st August 2009). Won one of the best paper awards.
An introduction to the rationale and the two types (Write-in and Select-Menu) of Key Feature Questions. This presentation is based on an original article by Page and Bordage (1995).
My talk in April 2015 in Malaysia on Best Practices and Resuscitation Workflow. The new 2015 resuscitation guidelines is expected to be released in Oct 2015.
Holley analyses the cascade of events in bleeding trauma patients leading to Australia's latest evidenced-based guidelines on transfusion protocols in critical bleeding.
Debemos cambiar el paradigma! Para la reanimación del paciente politraumatizado en shock hemorrágico, debemos ser tremendamente cuidadosos y conservadores con el aporte de cristaloides o coloides!
Shock hemorrágico en el paciente politraumatizado, no debe tratarse con fisiológico, Ringer o gelatinas! Mientras más de estos productos reciban, peor pronóstico tiene nuestro paciente.
En este contexto, no debe administrarse nada que no aporte a transportar oxigeno o que colabore con la coagulación!
No más reanimación tipo ATLS, donde se recomendaba 2lt de suero fisiológico y solicitar exámenes para evaluar coagulación y ver necesidad de productos sanguíneos... NO MÁS!!!
Conceptos Claves:
- politraumatizado + shock = hemorrágico (abdomen, tórax, extremidades)
- control anatómico del sangrado es vital!
- no reanimar contra presión arterial, reanimar contra perfusión
- si necesita volumen; aportar fluidos que aporten a la coagulación o a transportar oxígeno
- recuerden calcio y ácido tranexámico
- hosp pequeño, o 1rio o 2ndario: esfuerzos en traslado
- hospital cuidado definitivo: protocolo transfusión masiva, hipotensión permisiva, cirugía control de daño, UCI
Disaster and Mass Casualty Incidents (updated 7th July 2020)Chew Keng Sheng
A new updated slide on an overview of disaster management in Malaysia, including the formation of NADMA as the dedicated agency to coordinate disaster management in Malaysia.
Predatory publishing is a relatively recent phenomenon that seems to be exploiting some key features of the open access publishing model, sustained by collecting APCs that are far less than those found in legitimate open access journals. This CME aims to introduce to the participants on the phenomenon of predatory journals, why they continue to thrive, characteristics that are suggestive of a predatory journal, and how one can take step to minimize the risk of faling into predatory journal publication
A short sharing on doctor-patient communication to First year medical students in Universiti Malaysia Sarawak, to be supplemented with anecdotal accounts.
This slide was first presented during the Malaysian 1st Emergency Medicine Annual Scientific Meeting, in conjunction with the Academy of Medicine Malaysia, Academy of Medicine Singapore and the Academy of Medicine Hong Kong Tripartite Meeting in Aug 2016.
Sensitivity, specificity and likelihood ratiosChew Keng Sheng
A short tutorial on sensitivity, specificity and likelihood ratios. In this presentation, I demonstrate why likelihood ratios are better parameters compared to sensitivity and specificity in real world setting.
ACLS 2015 Updates - The Malaysian PerspectiveChew Keng Sheng
This set of slide was presented during the Kelantan Resuscitation Update 22 Nov 2015 in accordance to the latest ACLS/ILCOR 2015 Guidelines. However, I have emphasized on certain important aspects relevant within the Malaysian context. Nonetheless, in general, there are no major changes for this year 2015
My talk in April 2015 Malaysia on Best Practices and Resuscitation Workflow. The new 2015 resuscitation guidelines is expected to be released in Oct 2015.
New or Presumed New LBBB To Be Treated As a STEMI Equivalent? A Contra Argume...Chew Keng Sheng
My 6-page notes to go along with the "debate" of whether new or presumed new LBBB per se (without any other qualification) should be treated as STEMI equivalent
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.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
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
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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.
2. According to ATLS, shock in trauma to
be treated with fluid replacement pre‐
opera&vely
Is this consensus driven rather than
randomized controlled trials?
Concept of Low Volume Resuscita&on/
Permission Hypotension?
Early versus delayed?
Larger versus smaller volume?
6. Permissive Hypotension?
• The study by Bickell et al, 1994 seems to
suggest that resuscita&on should be less
aggressive
• Allowing for permissive hypotension
• Decrease &me to defini&ve treatment in OR
• Decrease risk of dislodging clot forma&on
• RR death reduced by 1.26
Bickell, W. H., Wall, M. J., Jr., Pepe, P. E., Mar&n, R. R., Ginger, V. F., Allen, M. K. &
MaUox, K. L. (1994). Immediate versus delayed fluid resuscita&on for hypotensive
pa&ents with penetra&ng torso injuries. N Engl J Med, 331 (17), 1105‐9.
7. Problems
• The study by Bickell et al is only on
penetra&ng torso injuries
– Extrapola&on to include all types of trauma??
• Single ter&ary care center
• Short prehospital transport &me
• Poor randomiza&on, bias poten&al, lack of
blinding
8. • In a larger study by Turner et al in
2000 to assess early versus no/
delayed fluid resuscita&on in pre‐
hospital sejng showed
– no significant mortality difference (RR
of death = 1.07) with
– adequate randomiza&on, and
assessed both blunt and penetra&ng
trauma collec&vely
Turner, J., Nicholl, J., Webber, L., Cox, H., Dixon, S. & Yates, D. (2000). A randomised controlled
trial of prehospital intravenous fluid replacement therapy in serious trauma. Health Technol
Assess, 4 (31), 1‐57.
12. Cochrane Review
• Not able to conduct meta‐analysis or data‐
pooling because of considerable clinical and
sta&s&cal heterogeneity of available trials
• Un&l higher quality studies examining more
homogenous popula&ons and resuscita&on
strategies are produced, a clear set of
evidence‐based physiological goals for
trauma&c shock remain elusive
16. Favorable Unfavorable
Physiological
Crystalloids Familiar, experience in Poor plasma expander (e.g.
usage 40 ml plasma expansion per
500 ml NS)
Minimal side effects or drug Inters&&al expansion,
interac&ons worsen lung oxygena&on
Large volume of NS cause
hyperchloremic NAGMA
Colloids Onco&c pressure >30 Coagulopathy
mOsm/l
Good plasma expander Reduced renal excre&on in
renal impaired pa&ents
Low risk of inters&&al Anaphylaxis/allergic
edema reac&on
Administra1on/cost
Crystalloid Cheap; usually no max dose
Colloids Up to 50 &mes cost; dose
depends on types & BW
17. Use of Hypertonic Saline?
• HS 7.5% has been used in trauma&c brain injury but
with equivocal results from different studies
• Cooper, D. J., Myles, P. S., McDermoU, F. T., Murray, L. J., Laidlaw, J.,
Cooper, G., Tremayne, A. B., Bernard, S. S. & Ponsford, J. (2004).
Prehospital hypertonic saline resuscita&on of pa&ents with
hypotension and severe trauma&c brain injury: a randomized
controlled trial. JAMA, 291 (11), 1350‐7.
• Bajson, C., Andrews, P. J., Graham, C. & PeUy, T. (2005).
Randomized, controlled trial on the effect of a 20% mannitol
solu&on and a 7.5% saline/6% dextran solu&on on increased
intracranial pressure ater brain injury. Crit Care Med, 33 (1),
196‐202; discussion 257‐8.
18. Hypertonic (7.5%) Saline
Theore&cal benefits Reduced need to carry large fluid volumes (in disaster, developing
na&on, war, etc)
Reduced need for blood donors
Reduced need for refrigera&on (e.g. in disasters)
Reduced &me required to infuse volume (e.g. in war, disasters,
etc)
Clinical Data Decreased inters&&al edema and intracranial pressure
Increases plasma volume up to 10 &mes the equivalent volume of
NS
Trends towards improved survival in hemorrhagic shock
Poten&al side effects Hyperosmolarity, hypernatremia, central pon&ne myelinolysis
Vassar, M. J., Fischer, R. P., O'Brien, P. E., Bachulis, B. L., Chambers, J. A., Hoyt, D. B. & Holcrot, J.
W. (1993). A mul¢er trial for resuscita&on of injured pa&ents with 7.5% sodium chloride.
The effect of added dextran 70. The Mul¢er Group for the Study of Hypertonic Saline in
Trauma Pa&ents. Arch Surg, 128 (9), 1003‐11; discussion 1011‐3.
19. Use of Hypertonic Saline?
• A meta‐analysis compared HS vs NS in 230
pa&ents with hemorrhagic shock following
penetra&ng torso trauma
• Found a non‐significant trends towards
improved survival in HS (HS = 82.5%, NS =
75.5%, p=0.19)
• Among those requiring surgery, improved
survival in HS group (HS = 84.5% vs NS = 0.01)
Wade, C. E., Grady, J. J. & Kramer, G. C. (2003). Efficacy of hypertonic saline dextran fluid
resuscita&on for pa&ents with hypotension from penetra&ng trauma. J Trauma, 54 (5 Suppl),
S144‐8.
20. Conclusion
• While evidence seems to
suggest that HS is not
harmful, and may have
large applica&on in a
variety of clinical
situa&ons, there is s&ll
lack of larger clinical
studies
23. Recombinant ac&vated Factor VII
• Binds to exposed &ssue factor to create a
thrombin burst
• Risk of thomboembolic events – myocardial
infarc&on, cerebral infarc&on, etc due to &ssue
factor exposure at sites other than &ssue
injury (e.g. unstable coronary plaques)
• Not for first line treatment – only as an
adjunct
25. Recombinant ac&vated Factor VII
• The focus of recombinant ac&vated factor VII
is to reduce the need for blood products
rather than &me to bleeding cessa&on
• No consistent mortality benefit has yet been
shown
• Its volume of distribu&on and clearance is
variable; therefore op&mal dosing unclear
(range 40 mcg/kg – 200 mcg/kg)
Spahn, D. R., Cerny, V., Coats, T. J., Duranteau, J., Fernandez‐Mondejar, E., Gordini, G., Stahel, P.
F., Hunt, B. J., Komadina, R., Neugebauer, E., Ozier, Y., Riddez, L., Schultz, A., Vincent, J. L. &
Rossaint, R. (2007). Management of bleeding following major trauma: a European guideline. Crit
Care, 11 (1), R17.