A primer on lower extremity regional anesthesia, including instructions for sciatic, parasacral, lumbar plexus, femoral, saphenous, popliteal, lateral femoral cutaneous, obturator, and ankle blocks
Trunk Blocks - Plan A Blocks - Royal College of Anaesthetists & Regional Anae...Amit Pawa
These are slides from a Joint Webinar between RA-UK and RCOA held on the 10th November 2020.
This was part of a meeting where the Plan A blocks were discussed.
A primer on lower extremity regional anesthesia, including instructions for sciatic, parasacral, lumbar plexus, femoral, saphenous, popliteal, lateral femoral cutaneous, obturator, and ankle blocks
Trunk Blocks - Plan A Blocks - Royal College of Anaesthetists & Regional Anae...Amit Pawa
These are slides from a Joint Webinar between RA-UK and RCOA held on the 10th November 2020.
This was part of a meeting where the Plan A blocks were discussed.
new technique for pain management ,described by dr forero ,it can replace epidural anesthesia,paravertebral anesthesia and other regional blocks.it can be used for both acute and chronic painful conditions
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
Neuraxial and Truncal Regional AnesthesiaBrian Allen
A step by step lecture explaining thoracic epidural, lumbar epidural, spinal, paravertebral, TAP, and Rectus Sheath blocks. Additional focus on spine anatomy, test dosing.
The transversus abdominis plane, more commonly referred to as the TAP block,
Places local anesthetic in the lateral abdominal wall in a plane between the internal oblique and the transversus abdominis muscles.
Here, the local anesthetic block can block many of the abdominal nerves as they pass to the abdominal structures.
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
Thyroid and its pathology (Hypothyroidism).Vikas Reddy
GREEK :- THYREOS – SHIELD ; EIDOS – FORM
1.LOCATION:- Anterior to trachea in between the cricoid cartilage and the suprasternal notch.
2.SHAPE:- It has 2 lobes connected with an isthmus, each lobe in turn has two poles.
3.Weighs around 10-20 gm, highly vascular and soft in consistency.
4. 4 Parathyroid glands which secrete PTH are located posterior to each pole of thyroid
The RLN traverse the lateral border of thyroid gland and must be identified during thyroid surgery to avoid injury and vocal cord paralysis.
Develops from the floor of primitive pharynx during the 3rd week of gestation.
Fetal cells in which developmental transcription factors TTF-1,TTF-2 & PAX-8 are expressed selectively form the thyroid gland ,secondly they result in induction of thyroid specific genes
Tg,TPO,NIS,TSH-R.
Mutations-THYROID AGENESIS & DYSHORMONOGENESIS(CONG. HYPOTHYROIDISM).
The developing gland migrates along the thyroglossal duct to reach its final location in the neck.
LINGUAL THYROID AND THYROGLOSSAL DUCT CYST.
Thyroid hormone synthesis begins at about 11 weeks of gestation.
Until 11 week of gestation and even later, it is the maternal thyroid hormones which cross the placenta to reach the fetus and aid its development.
Therefore a child born to a hypothyroid mother would suffer from features of congenital hypothyroidism.
Secondly if the mother has TSH-R blocking antibodies or has received anti thyroid therapy during pregnancy, might lead to transient congenital hypothyroidism.
new technique for pain management ,described by dr forero ,it can replace epidural anesthesia,paravertebral anesthesia and other regional blocks.it can be used for both acute and chronic painful conditions
Intro to Hypoxic pulmonary vasoconstriction Arun Shetty
Hypoxic pulmonary vasoconstriction, a seldom heard phenomenon but very effective physiologic property which helps lungs utilise ventilation to the maximum
Neuraxial and Truncal Regional AnesthesiaBrian Allen
A step by step lecture explaining thoracic epidural, lumbar epidural, spinal, paravertebral, TAP, and Rectus Sheath blocks. Additional focus on spine anatomy, test dosing.
The transversus abdominis plane, more commonly referred to as the TAP block,
Places local anesthetic in the lateral abdominal wall in a plane between the internal oblique and the transversus abdominis muscles.
Here, the local anesthetic block can block many of the abdominal nerves as they pass to the abdominal structures.
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
Thyroid and its pathology (Hypothyroidism).Vikas Reddy
GREEK :- THYREOS – SHIELD ; EIDOS – FORM
1.LOCATION:- Anterior to trachea in between the cricoid cartilage and the suprasternal notch.
2.SHAPE:- It has 2 lobes connected with an isthmus, each lobe in turn has two poles.
3.Weighs around 10-20 gm, highly vascular and soft in consistency.
4. 4 Parathyroid glands which secrete PTH are located posterior to each pole of thyroid
The RLN traverse the lateral border of thyroid gland and must be identified during thyroid surgery to avoid injury and vocal cord paralysis.
Develops from the floor of primitive pharynx during the 3rd week of gestation.
Fetal cells in which developmental transcription factors TTF-1,TTF-2 & PAX-8 are expressed selectively form the thyroid gland ,secondly they result in induction of thyroid specific genes
Tg,TPO,NIS,TSH-R.
Mutations-THYROID AGENESIS & DYSHORMONOGENESIS(CONG. HYPOTHYROIDISM).
The developing gland migrates along the thyroglossal duct to reach its final location in the neck.
LINGUAL THYROID AND THYROGLOSSAL DUCT CYST.
Thyroid hormone synthesis begins at about 11 weeks of gestation.
Until 11 week of gestation and even later, it is the maternal thyroid hormones which cross the placenta to reach the fetus and aid its development.
Therefore a child born to a hypothyroid mother would suffer from features of congenital hypothyroidism.
Secondly if the mother has TSH-R blocking antibodies or has received anti thyroid therapy during pregnancy, might lead to transient congenital hypothyroidism.
Perioperative management of patients on corticosteroidsTerry Shaneyfelt
In these annotated PowerPoints I discuss the evaluation and perioperative management of patient taking or who have taken steroids. I discuss how to determine if the adrenal axis is suppressed and how to provide supplemental glucocorticoids if needed. Remember to download these slides to see the annotations for each slide.
Hyperthyroidism is a disorder that occurs when the thyroid gland makes more thyroid hormone than the body needs. Hyperthyroidism is sometimes called thyrotoxicosis, the technical term for too much thyroid hormone in the blood. Thyroid hormones circulate throughout the body in the bloodstream and act on virtually every tissue and cell in the body. Hyperthyroidism causes many of the body’s functions to speed up.
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.
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
- 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
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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!
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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
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
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.
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Upper Extremity Regional Anesthesia
1. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Upper Extremity Regional
Anesthesia
Brian Allen
06/2014
2. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Scalp* (U,P){2}
Interscalene (S,L){2}
Transgluteal Sciatic (L,P){4,6}
Paravertebral (U,L){4,6}
Thoracic Epidural (U,L){4,6}
Lumbar Plexus† (L){4,6}
TAP (S){4}
Superficial Cervical Plexus* (S){2}
Axillary* (S,A){2}
Infraclavicular (S,A){4}
Supraclavicular (S){2}
Lumbar Epidural (U,L){4,6}
Infragluteal Sciatic (S,L,P){4,6}
Ankle* (S){2}
Lat Fem Cut* (S){2,4}
Popliteal Sciatic (S,U,L){4}
Femoral (S){2,4}
Obturator* (S){4}
Saphenous (S,P){4}
HEENT*{2}
Wrist* (S){2}
Legend:
* = Only Single Shot
Bold = May Place Catheter
Underline = uncommonly done
† = Nerve Stimulator always used
Positioning ( ):
S = Supine
U = Sitting Up
P = Prone
L = Lateral Decubitus or Simms
A = Arm Over Head
Needle Length { in inches }
Common Regional
and Neuraxial
Blocks
Suprascapular* (U){2,4}
Spinal (U,L){3.5,6}
17. BFSA
Slide by Brian F S Allen
BFSA
BFSA
ISB Surface Anatomy
Image: Jaci Berkopec
18. BFSA
Slide by Brian F S Allen
BFSA
BFSA
ISB Surface Anatomy
Sterno-
cleido-
mastoid
Image: Jaci Berkopec
19. BFSA
Slide by Brian F S Allen
BFSA
BFSA
ISB Surface Anatomy
Anterior
Scalene
Middle
Scalene
Image: Jaci Berkopec
20. BFSA
Slide by Brian F S Allen
BFSA
BFSA
ISB Surface Anatomy
Brachial
Plexus
Image: Jaci Berkopec
21. BFSA
Slide by Brian F S Allen
BFSA
BFSA
ISB Surface Anatomy
Sterno-
cleido-
mastoid
Brachial
Plexus
Image: Jaci Berkopec
Anterior
Scalene
Middle
Scalene
22. BFSA
Slide by Brian F S Allen
BFSA
BFSA
ISB Surface Anatomy
Image: Jaci Berkopec
Ultrasound
Probe
23. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Interscalene
AnteriorPosterior
Image: Brian Allen
24. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Interscalene
Anterior ScaleneMiddle Scalene
SCM
AnteriorPosterior
Image: Brian Allen
25. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Interscalene
Anterior ScaleneMiddle Scalene
SCM
AnteriorPosterior
Interscalene Groove
Image: Brian Allen
26. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Interscalene
Anterior ScaleneMiddle Scalene
SCM
C5
C7
C6
C6
AnteriorPosterior
Image: Brian Allen
27. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Interscalene
C5
C7
C6
C6
“Traffic Light”
AnteriorPosterior
Image: Brian Allen
28. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Interscalene
“Traffic Light”
AnteriorPosterior
Image: Brian Allen
29. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Interscalene Side Effects,
Complications
Common
• Phrenic Nerve Block (100%)
• Horner’s Syndrome (25-
50%)
• Hoarseness (10-20%)
Rare
• Pneumothorax
• Cough
• Bronchospasm
Contraindications
• Severe Respiratory Disease
30. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Interscalene
Neurostimulation,
Block Success
Neurostimulation
• Expected: Deltoid, Biceps,
Pec
• Unfavorable:
– Trapezius (CN XI) – too
posterior
– Diaphragm (Phrenic) – too
anterior
Block Success
• Money Sign
• Deltoid Weakness
33. BFSA
Slide by Brian F S Allen
BFSA
BFSA
SCB Surface Anatomy
Clavicle
Axillary
Artery
Subclavian
Artery
34. BFSA
Slide by Brian F S Allen
BFSA
BFSA
SCB Surface Anatomy
Brachial
Plexus
MC
PC
LC
C5
C6
C7
C8
T1
35. BFSA
Slide by Brian F S Allen
BFSA
BFSA
SCB Surface Anatomy
Clavicle
Axillary
Artery
Subclavian
Artery
MC
PC
LC
Ultrasound
Probe
36. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Image: Brian Allen
Supraclavicular
Supero-
Lateral
Infero-
Medial
37. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Supraclavicular
Image: Brian Allen
Supero-
Lateral
Infero-
Medial
38. BFSA
Slide by Brian F S Allen
BFSA
BFSA
SCA
First Rib
Pleura
Pleura
Supraclavicular
Image: Brian Allen
Supero-
Lateral
Infero-
Medial
39. BFSA
Slide by Brian F S Allen
BFSA
BFSA
SCA
Brachial Plexus
Supraclavicular
Image: Brian Allen
Supero-
Lateral
Infero-
Medial
40. BFSA
Slide by Brian F S Allen
BFSA
BFSA
SCA
Brachial Plexus
Supraclavicular
Image: Brian Allen
Infero-
Medial
41. BFSA
Slide by Brian F S Allen
BFSA
BFSA
“Corner Pocket”
Supraclavicular
Image: Brian Allen
Supero-
Lateral
Infero-
Medial
42. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Supraclavicular Side Effects,
Complications
Common
• Phrenic Nerve Block (<50%)
Rare
• Pneumothorax
• Horner’s Syndrome
Contraindications
• Severe Respiratory Disease?
43. BFSA
Slide by Brian F S Allen
BFSA
BFSA
Neurostimulation
• Expected: Distal (Hand)
• Unfavorable: Proximal
(Deltoid, Biceps)
Block Success
• Push – Triceps, Elbow Extend
• Pull – Biceps, Elbow Flex
• Pinch – Pinch Thenar
• Pinch – Pinch Hypothenar
Supraclavicular
Neurostimulation,
Block Success