ATLS is two days course for those who manage trauma patients. These protocols have been followed by hospitals all over the world to treat trauma patients quickly and efficiently.
ATLS is two days course for those who manage trauma patients. These protocols have been followed by hospitals all over the world to treat trauma patients quickly and efficiently.
This is a presentation which contains basics of polytrauma management,ATLS, triage, critical decision making skills, application of Glasgow coma scale and complications of different management strategies, if not applied properly.
Seminar presentation by 4th year medical student of Lincoln University College, supervised by HRPZ Orthopedic's specialist.
Reference were from reliable medical websites and also from texttbook; Apley and Solomon's Concise System of Orthopaedics and Trauma, 4th Ed.
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
Fluid and electrolyte management in surgical patients.KETAN VAGHOLKAR
Fluid and electrolyte management has to be aggressive. It is pivitol in speedy recovery in GI surgery. Changes should be anticipated and treated promptly. A detailed knowledge of this is essential for optimum management especially in the ICU.
This is a presentation which contains basics of polytrauma management,ATLS, triage, critical decision making skills, application of Glasgow coma scale and complications of different management strategies, if not applied properly.
Seminar presentation by 4th year medical student of Lincoln University College, supervised by HRPZ Orthopedic's specialist.
Reference were from reliable medical websites and also from texttbook; Apley and Solomon's Concise System of Orthopaedics and Trauma, 4th Ed.
Seminar present the Upper Gastrointestinal Bleeding problems
Edited by : Dr. Inzar Yassen & Dr. Ammar L. Aldwaf
in Hawler Medical Uni. collage of medicine in 14/01/2014
Iraq - Kurdistan - Erbil
Fluid and electrolyte management in surgical patients.KETAN VAGHOLKAR
Fluid and electrolyte management has to be aggressive. It is pivitol in speedy recovery in GI surgery. Changes should be anticipated and treated promptly. A detailed knowledge of this is essential for optimum management especially in the ICU.
Awareness Anesthesia occurs when a patient becomes conscious during a surgical procedure performed under general anesthesia and subsequently has recall of these events
Successful management of Polytrauma must achieve the following goals, 1- Keep someone alive that would be dead without you 2- Prioritize treatment to prevent killing someone 3- Treat extremity injuries to return the patient to a functional life. The Priorities are 1- Life threatening, 2- Limb threatening, 3- Function threatening. The question about the best strategy in the management Polytrauma and the choice between an Early Total Care (ETC) vs. Damage Control Orthopedics (DCO) will be answered in this presentation.
“Trauma” = Injury of one or more systems,that results in excessive bleeding and mayaffect the normal body functioning.
Defined as cellular disruption caused by anexchange with environmental energy that isbeyond the body's resilience.
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.
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!
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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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.
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
2. Advance Trauma Life Support
• Simultaneous diagnostic and therapeutic activities
intended to identify and treat life and limb-
threatening injuries, beginning with the most
immediate.
• This focus on urgent problems is first captured by the
‘Golden hour’ catch phrase and is one of the most
important lessons of ATLS.
• The GOLDEN HOUR, the first hour after a traumatic
injury, when emergency treatment is most likely to be
successful.
3. Basics of Trauma Assessment
Preparation
Triage
Primary Survey (A,B,C,D and E)
Resuscitation
Secondary Survey
Monitoring and Evaluation, Secondary
adjuncts
Transfer to Definitive Care
4. TRIAGE
• The process of categorizing victims or
mass casualties based on their need for
treatment and the resources available.
• GOALS:
1. Prevent avoidable deaths.
2. Ensure proper initial treatment within a minimal time frame.
3. Avoid misusing assets on hopeless cases
5. PRIMARY SURVEY
• First, most important thing when you
encounter a trauma patient is to speak to
him!
• A complete sentence spoken by the
patient tell us:
1. Airway is patent.
2. Breathing is intact.
3. Good cerebral circulation
6. PRIMARY SURVEY
Airway and Protection of Spinal Cord
Breathing and Ventilation
Circulation
Disability
Exposure and Control of the Environment
7. AIRWAY MANAGEMENT
Why first in the algorithm?
– Loss of airway can result in death in < 3 minutes.
– Prolonged hypoxia means Inadequate perfusion, End-
organ damage.
Airway Assessment
– Initial airway assessment involves evaluating for airway
obstruction or patency which can be determined by
assessing for snoring, stridor, drooling, hoarseness,
edema, and facial trauma or burns.
8. PROTECTION OF SPINAL CORD
• General Principle:
• Protect the entire spinal cord until injury has been excluded by
radiography or clinical physical exam in patients with potential spinal cord
injury.
• Spinal Protection
• Rigid Cervical Spinal Collar = Cervical Spine
• Long rigid spinal board or immobilization on flat surface such as stretcher
= T/L Spine
• Clinical Pearls
• Treatment (Immobilization) before diagnosis.
• Return head to neutral position.
• Do not apply traction.
• Diagnosis of spinal cord injury should not precede resuscitation.
• Motor vehicle crashes and falls are most commonly associated with spinal
cord injuries.
10. AIRWAY MANAGEMENT
• The head-tilt chin-lift maneuver, a
maneuver that gently extends the head
slightly into the "sniffing position“ and lifts the
tongue from the back of the throat, is the most
reliable method of opening the airway when
cervical spine injury is not suspected.
• The oropharyngeal airway comes in a
variety of adult and pediatric sizes and is
sized from the corner of the mouth to the
earlobe. With a tongue blade to depress the
tongue, the OPA is inserted over the tongue.
• The Jaw Thrust in which mandible is pushed
forward via index fingers. When the mandible
is displaced forward, it pulls the tongue
forward and prevents it from obstructing the
entrance to the trachea.
11. AIRWAY MANAGEMENT
• A bag valve mask, abbreviated to BVM and
sometimes generically as a manual
resuscitator or "self-inflating bag", is a hand-
held device commonly used to provide
positive pressure ventilation to patients who
are not breathing or not breathing adequately.
• The non-rebreather mask is utilized for
patients with physical trauma, chronic airway
limitation, cluster headache, smoke
inhalation, and carbon monoxide poisoning,
or any other patients who require high-
concentration oxygen, but do not require
breathing assistance.
12. AIRWAY MANAGEMENT
• Tracheal intubations, usually simply referred to as intubations, is the placement
of a flexible plastic tube into the trachea to maintain airway, procedures commonly
used are Direct Laryngoscopy, Video Laryngoscopy, Digital Intubations etc,
patient needs to be preoxygenated, sedated and paralyzed before performing
intubations!
13. AIRWAY MANAGEMENT
• Cricothyroidotomy, also
known as cricothyrotomy, is
an important emergency
procedure that is used to
obtain an airway when
other, more routine methods
are ineffective or
contraindicated. It is
specially indicated in
Maxillofacial Injuries and if
the cervical spine is
immobilized. Only
contraindication is AGE!
• Tracheostomy is an
operative procedure that
creates a surgical airway in
the cervical trachea.
14. Breathing and Ventilation
Breathing/Ventilation Assessment:
– Exposure of chest
– General Inspection (LOOK)
Tracheal Deviation
Accessory Muscle Use
Retractions
Absence of spontaneous breathing
Paradoxical chest wall movement
– Auscultation to assess for gas exchange (LISTEN)
Equal Bilaterally
Diminished or Absent breath sounds
– Palpation (FEEL)
Deviated Trachea
Broken ribs
Injuries to chest wall
15. BREATHING AND VENTILATION
Identify Life Threatening Injuries
–Massive hemothorax
–Flail chest
–Rib fractures
–Open pneumothorax
–Pulmonary contusion
–Tension Pneumothorax
16. BREATHING AND VENTILATION
Tension Pneumothorax
Air trapping in the pleural space between the lung and
chest wall
Sufficient pressure builds up and pressure to compress the
lungs and shift the mediastinum
Physical exam
– Absent breath sounds
– Air hunger
– Distended neck veins
– Tracheal shift
Treatment
– Needle Decompression
2nd
Intercostals space, Midclavicular line
– Tube Thoracostomy
5th
Intercostals space, Anterior axillary line
18. BREATHING AND VENTILATION
Hemothorax
– Blood collecting in the pleural space
and is common after penetrating and
blunt chest trauma
– Source of bleeding = Lung, Chest wall
(intercostal arteries), heart, great
vessels (Aorta), Diaphragm
– Physical Exam
Absent or diminished breath sounds
Dullness to percussion over chest
Hemodynamic instability
– Treatment = Large Caliber Tube
Thoracostomy
10-20% of cases will require Thoracostomy for
control of bleeding
19. BREATHING AND VENTILATION
Flail Chest
– Direct injury to the chest resulting in an unstable segment of
the chest wall that moves separately from remainder of
thoracic cage
– Physical exam = paradoxical movement of chest segment
– Treatment = improve abnormalities in gas exchange
Early intubation for patients with respiratory distress
Avoidance of overaggressive fluid resuscitation
20. BREATHING AND VENTILATION
TUBE THORACOSTOMY
Insertion site
– 5th
intercostal space,
– Anterior axillary line.
21. CIRCULATION
Shock
Impaired tissue perfusion
Tissue oxygenation is inadequate to meet metabolic
demand
Prolonged shock state leads to multi-organ system failure
and cell death
Clinical Signs of Shock
– Altered mental status
– Tachycardia (HR > 100) = Most common sign
– Arterial Hypotension (SBP < 120)
– Inadequate Tissue Perfusion
Pale skin color
Cool clammy skin
Delayed cap refill (> 3 seconds)
Altered LOC
Decreased Urine Output (UOP < 0.5 ml/kg/hr)
22. CIRCULATION
Types of Shock in Trauma
– Hemorrhagic
Assume hemorrhagic shock in all trauma patients until proven otherwise
Results from Internal or External Bleeding
– Obstructive
Cardiac Tamponade
Tension Pneumothorax
– Neurogenic
Spinal Cord injury
Sources of Bleeding
– Chest
– Abdomen
– Pelvis
– Bilateral Femur Fractures
23. CIRCULATION
General Treatment Principles
• Stop the bleeding
Apply direct pressure
Temporarily close scalp lacerations
– Close open-book pelvic fractures
Abdominal pelvic binder/bed sheet
– Restore circulating volume
Crystalloid Resuscitation (2L)
Administer Blood Products
– Immobilize fractures
Responders vs. Non-responders
– Transient response to volume resuscitation = sign of ongoing blood
loss
– Non-responders = consider other source for shock state or operating
room for control of massive hemorrhage
24. CIRCULATION
Pericardial Tamponade
– Pericardium or sac
around heart fills with
blood due to
penetrating or blunt
injury to chest.
– Treatment
Rapid evacuation of
pericardial space
Performed through a
Pericardiocentesis
(temporizing measure)
Open thoracotomy.
26. DISABILITY
Baseline Neurological Exam
– Pupillary Exam
Dilated pupil – suggests transtentorial herniation
on ipsilateral side
– AVPU Scale
Alert
Responds to verbal stimulation
Responds to pain
Unresponsive
– Gross Neurological Exam – Extremity
Movement
Equal and symmetric
Normal gross sensation
– Glasgow Coma Scale: 3-15
– Rectal Exam
Normal Rectal Tone
27. DISABILITY
Key Principles
– Prevention of further injury and identification of
neurological injury is the goal.
– Maintenance of adequate cerebral perfusion is
key to prevention of further brain injury.
Adequate oxygenation
Avoid hypotension
– Involve neurosurgeon early for clear intracranial
lesions.
28. EXPOSURE
Remove all clothing
– Examine for other signs of injury
– Injuries cannot be diagnosed until seen by
provider
Logroll the patient to examine patient’s
back
– Maintain cervical spinal immobilization
– Palpate along thoracic and lumbar spine
– Minimum of 3 people, often more providers
required
Avoid hypothermia
– Apply warm blankets after removing clothes
– Hypothermia = Coagulopathy
Increases risk of hemorrhage
30. SECONDARY SURVEY
Secondary Survey is started after primary
survey is completed and patient has been
adequately resuscitated.
No patient with abnormal vital signs should
proceed to a secondary survey.
Secondary Survey includes a brief history
and complete physical exam!
33. DEFINITIVE CARE
Secondary Survey followed by radiographic
evaluation
– CatScan
– Consultation
Neurosurgery
Orthopedic Surgery
Vascular Surgery
Transfer to Definitive Care
– Operating Room
– ICU
– Higher level facility