A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
Anesthetic consideration in smokers,alcoholics and addictsAftab Hussain
Anaesthetic consideration in smokers alcoholic and drug addicts. As an anaesthesiologist we must be aware with the problems associated with their management and interaction with anaesthetics.
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
Anesthetic consideration in smokers,alcoholics and addictsAftab Hussain
Anaesthetic consideration in smokers alcoholic and drug addicts. As an anaesthesiologist we must be aware with the problems associated with their management and interaction with anaesthetics.
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 power point is a master piece ,dedicated to give inclusive knowledge on history, indications,types, modes,alarms and troubleshooting,Complicatons,weaning of mechanical ventilation
Differences between Paediatric and Adult airway gourav_singh
These slides contain a brief discussion about what all common differences between pediatric and adult airway can be found if you are in an ENT OPD or during Anesthesia.
Just a brief discussion.
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).
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 power point is a master piece ,dedicated to give inclusive knowledge on history, indications,types, modes,alarms and troubleshooting,Complicatons,weaning of mechanical ventilation
Differences between Paediatric and Adult airway gourav_singh
These slides contain a brief discussion about what all common differences between pediatric and adult airway can be found if you are in an ENT OPD or during Anesthesia.
Just a brief discussion.
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).
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.
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
Do Not Forget To Visit Our Pages On Facebook on the following Links:
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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.
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.
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.
COPD; a chronic, progressive airway obstruction; is directly linked with persistent inflammation and high oxidative stress. Airway obstruction is added on by plugging of airways with thick mucus. Role and efficacy of N-acetyl cysteine is reviewed with clinical cases.
Works Cited Milne, Anne C., Alison Avenell, and Jan Potter. Meta-.docxkeilenettie
Works Cited
Milne, Anne C., Alison Avenell, and Jan Potter. "Meta-Analysis: Protein and Energy Supplementation in Older People."
Annals of Internal Medicine
144.1 (2006): 37-48.
ProQuest.
Web. 1 Oct. 2014.
Meta-Analysis: Protein and Energy Supplementation in Older People Anne C. Milne, MSc; Alison Avenell, MD; and Jan Potter, MBChB Background: Protein and energy undernutrition is common in older people, and further deterioration may occur during illness. Purpose: To assess whether oral protein and energy supplementa tion improves clinical and
nutritional outcomes for older people in the hospital, in an institution, or in the community. Data Sources: Cochrane Central Register of Controlled Trials (CEN TRAL), MEDLINE, EMBASE,
HealthStar, CINAHL, BIOSIS, and CAB abstracts. The authors included English- and non-English-language studies and hand-searched journals, contacted manufacturers, and sought information from trialists. The date of the most recent search of CENTRAL and MEDLINE is June 2005. Study Selection: Randomized and quasi-randomized controlled tri als of oral protein and energy
supplementation compared with placebo or control treatment in older people. Data Extraction: Two reviewers independently assessed trials for inclusion, extracted data, and assessed trial quality. Differences were resolved by consensus. Data Synthesis: Fifty-five trials were included (n = 9187 randomly tions (Peto odds ratio, 0.72 [95% Cl, 0.53 to 0.97]) and reduced mortality (Peto odds ratio, 0.66 [CI, 0.49 to 0.90]) for those un dernourished at baseline. Few studies reported evidence that suggested any change in mortality, morbidity, or function for those given supplements at home. Ten trials reported gastrointestinal disturbances, such as nausea, vomiting, and diarrhea, with oral supplements. Limitations: The quality of most studies, as reported, was poor, particularly for concealment of allocation and blinding of outcome assessors. Many studies were too small or the follow-up time was too short to detect a statistically significant change in clinical out come. The clinical results are dominated by 1 very large recent trial in patients with stroke. Although this was a high-quality trial, few participants were undernourished at baseline. Conclusions: Oral nutritional supplements can improve nutritional status and seem to reduce mortality and complications for under nourished elderly patients in the hospital. Current evidence does not support routine supplementation for older people at home or for well-nourished older patients in any setting. assigned participants). For patients in short-term care hospitals who were given oral supplements, evidence suggested fewer complica-Ann Intern Med. 2006:144:37-48. For author affiliations, see end of text.
www.annals.OIJ
ndernutrition among older people is a continuing source of concern (1, 2). Older people have longer periods of illness and longer hospital stays (3), and data show tha.
Effect of Continuous Infusion of Hypertonic Saline vs Standard Care on 6-Mont...Khaled Ali Ghanayem
Effect of Continuous Infusion of Hypertonic Saline vs Standard Care on 6-Month Neurological Outcomes in Patients With Traumatic Brain Injury The COBI Randomized Clinical Trial - Journal club.
JAMA. 2021;325(20):2056-2066. doi:10.1001/jama.2021.5561
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.
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
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
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
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.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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.
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
1. Updates
on
Asthma
and
COPD
Keng
Sheng
Chew
School
of
Medical
Sciences
Universi6
Sains
Malaysia
1
2. Conflict
of
Interest
• I
declare
I
have
received
educa6onal
grants
from
Astra-‐Zeneca
(M)
Sdn
Bhd
2
3. Outlines
•
•
•
•
•
•
•
•
In
asthma:
Con6nuous
neb?
IV
B2-‐agonist?
IV
steroids?
An6cholinergics?
Magnesium
sulphate?
NIPPV?
When
intubate?
What
to
look
for?
3
4. Outlines
•
•
•
•
•
•
In
COPD:
Recent
concepts
B2-‐agonists
vs
an6cholinergics?
NIPPV?
Issues
of
mechanical
ven6la6on
Hypoxic
drive
–how
true
is
this
fear?
4
8. “Rules
of
2”
in
asthma
• AXacks
>2
6mes
per
week
or
• Needs
rescuer
inhaler
>2
6mes
per
week
• Awakening
due
to
nocturnal
symptoms
>2
6mes
per
month
• Use
>2
canisters
of
relievers
per
year
• If
yes
to
any
=
uncontrolled,
needs
steroids
• (Adapted
from
GINA
guideline)
8
9. Con@nuous
neb
vs
intermiCent
neb?
• “Con6nuous”
neb
=
con6nuous
aerosol
delivery
or
sufficient
frequency
of
at
least
1
neb
q15
min
or
>
4
neb/hour
• In
a
Cochrane
systema6c
review,
Camargo
et
al
(2009),
8
trials,
n
=
461
• Con@nuous
neb
– Benefits
in
severe
disease
– Significant
lung
improvement
at
2
–
3
hours
– Similar
side
effects
(tremors,
increased
K+,
HR)
– Well
tolerated
9
10. IV
Beta-‐2
agonists
vs
inhaled
Beta-‐2
agonists?
• Travers
et
al
(2001),
in
a
Cochrane
systema6c
review,
15
trials,
n
=
583
• IV
beta
agonists
offer
no
therapeu6c
advantage
over
inhaled
forms
of
the
drugs.
• However,
no
difference
in
autonomic
side
effects
10
11. Early
IV
steroids
use?
• Rowe
et
al
(2009),
Cochrane
systema6c
review,
12
trials,
n
=
863
• IV
steroids
given
within
1
hour:
• significantly
reduced
admission
rates
(OR
=
0.40,
95%
CI:
0.21
to
0.78)
• Benefits
most
pronounced
among
those
with
severe
asthma
and
in
those
who
have
not
yet
been
on
systemic
steroids
prior
to
ED
presenta6on
11
12. An@cholinergics
• An6cholinergics
–
not
to
be
used
alone
• Teoh
et
al
(2012),
in
a
Cochrane
review,
4
trials,
n
=
171
– An6cholinergics
alone
less
efficacious
and
more
likely
to
fail
• An6cholinergics
combined
with
SABA?
– Griffiths
et
al
(2013),
in
a
systema6c
review,
15
trials,
n
=
2497
(pediatrics),
found
– combining
an6cholinergic
and
SABA
significantly
reduces
the
risk
for
hospital
admission
12
13. Magnesium
sulphate
• Blocks
calcium
channel
• Relaxes
bronchial
smooth
muscle
• Inhibits
contrac6le
response
to
endogenous
bronchoconstrictors
• Rowe
et
al
(2009):
• 7
trials,
n
=
665
• Overall
no
improvement
in
lung
func6on,
no
improvement
in
adm
rate
• BUT
reduce
admission
rate
in
severe
asthma
subgroup
13
14. NIPPV
in
Asthma?
• Lim
et
al
(2012)
in
a
Cochrane
review,
5
trials,
n
=
206,
preliminary
results
show
NIPPV
has
benefit
of
– Reduced
hospitaliza6on
rate
– Reduced
6me
to
discharge
from
ED
– Improves
lung
func6on
• But
s6ll
lack
of
good
evidence,
remains
controversial;
NOT
for
rou6ne
use
• Two
of
the
studies:
2
intuba6ons
needed
in
45
par6cipants
on
NPPV
vs
no
intuba6ons
in
41
control
pa6ents
(risk
ra6o
4.48;
95%
CI
0.23
to
89.13)
14
15. Mechanical
ven@la@on
• 4
indica6ons
for
intuba6on
(Brenner
et
al,
2009
in
Proceedings
of
the
ATS)
– cardiac
arrest
– respiratory
arrest
or
profound
bradypnea
– physical
exhaus6on
– AMS
(agitated
pa6ent,
interfering
with
oxygen
delivery)
• Hypercapnia
per
se
without
evidence
of
physical
exhaus6on
or
mental
changes
IS
NOT
an
indica6on
• Persistent
hypercapnia
despite
treatment
+/-‐
AMS
is
an
indica6on
(PaCO2
increase
~
5mmHg/Hr
or
more
than
55
–
70
mmHg)
15
16. Mechanical
ven@la@on
• Permissive
hypercapnia
-‐
minimize
risk
of
increased
intrathoracic
pressure.
Ini6al
sepng:
– TV
6
ml/kg
– Rate
6/min
– I:E
up
to
1:4
• Try
keep
Plateau
pressure
below
30
cm
H20.
• Pplat
(or
lung
distension
pressure)
gives
an
es6mate
of
average
of
end-‐insp
alveolar
P
(Brenner
et
al,
2009)
16
17. Induc@on
Agents
Ketamine
releases
of
catecholamines
bronchial
smooth
muscle
relaxa6on
Side
effects
–
hypersecre6on,
hypertension,
arrhythmias,
and
hallucina6ons
• rela6vely
contraindicated
in
pa6ents
with
ischemic
heart
disease,
hypertension,
increased
intracranial
pressure.
•
•
•
•
17
20. Basics
• COPD
is
a
systemic
disease,
not
just
pulmomary
(Agus6,
2005)
– systemic
inflamma6on,
systemic
oxida6ve
stress,
ac6va6on
of
circula6ng
inflammatory
cells,
e.g.
neutrophils,
macrphages,
and
augmented
levels
of
pro-‐
inflammatory
cytokines
• Extrapulmonary
associa6ons:
IHD,
osteopenia,
cachexia,
malnutri6on,
skeletal
was6ng
20
21. Bronchodilators
• Cochrane
systema6c
review
by
McCrory
et
al
(2005)
– No
significant
difference
in
changes
in
FEV1
between
b2-‐agonists
and
the
an6cholinergic
ipratropium
at
90
minutes
and
24
hours
and
– no
advantage
combining
• An6cholinergics
–
slower
onset
(15
min,
peak
60
to
90
min,
and
longer
6
to
8
hrs).
• General
consensus
(GOLD)
–
SABA
first,
then
an6cholinergics
21
22. NIPPV
in
COPD
• Ram
FSF
et
al
(2004)
in
a
Cochrane
systema6c
review,
14
trials
involving
n
=
622
(outcomes
of
treatment
failure),
n
=
541
(mortality)
• NIPPV
resulted
in
• decreased
mortality
• decreased
need
for
intuba6on
• reduc6on
in
treatment
failure
22
23. Mechanical
ven@la@ons
• Issues
with
mechanical
ven6la6on
in
COPD
(BruloXe
et
al,
2012):
• poorer
prognosis
(mortality
rates
between
20%
and
73%)
• a
mean
life
expectancy
of
1
year
• Barotrauma,
infec6ons
• Discuss
with
family
regarding
pros
and
cons
23
24. Hypoxic
Drive
in
COPD?
• How
real
is
this
fear?
• Started
off
with
a
paper
by
E.J.M
Campbell
in
1960
• Really
no
science
behind
it!
Consensus
opinion
• A
Cochrane
review
by
Aus6n
Wood-‐Baker
(2009)
– “No
relevant
trials
have
been
published
to
date,
so
there
is
no
evidence
to
indicate
whether
different
oxygen
therapies
in
the
pre-‐
hospital
se@ng
have
an
effect
on
outcome
for
people
with
acute
exacerbaBons
of
COPD”
24
25. Hypoxic
Drive
in
COPD?
• Plant
et
al
(2000)
shows
an
associa6on
between
increased
oxygen
with
hypercapnea,
respiratory
acidosis,
and
ICU
admission
but
this
does
not
occur
in
every
pa6ent
given
increased
FiO2.
• May
happen
• Careful
observa6on
of
this
pa6ent
• BUT
remember:
the
risks
of
withholding
oxygen
are
much
greater
than
giving
them
too
much!
25
26. Summary
•
•
•
•
•
•
•
•
In
asthma:
Con6nuous
neb?
IV
B2-‐agonist?
IV
steroids?
An6cholinergics?
Magnesium
sulphate?
NIPPV?
When
intubate?
What
to
look
for?
26
27. Summary
•
•
•
•
•
•
In
COPD:
Recent
concepts
B2-‐agonists
vs
an6cholinergics?
NIPPV?
Issues
of
mechanical
ven6la6on
Hypoxic
drive
-‐
controversials
27
28. References
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30. References
• Barry
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posi6ve
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ven6la6on
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to
exacerba6ons
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chronic
obstruc6ve
pulmonary
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Cochrane
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31
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• Teoh
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32