The document discusses therapeutic hypothermia, or inducing a mild cooling of the body temperature, as a medical treatment. It explains that cooling the body by only a few degrees during events like heart attacks or brain injuries can significantly improve outcomes. It describes different methods for inducing therapeutic hypothermia, such as infusing cold saline or using external cooling pads, catheters, or even intranasal sprays. While research is still ongoing to determine the best protocols, therapeutic hypothermia is becoming a standard treatment in emergency medicine and critical care situations.
Therapeutic hypothermia - current evidenceSCGH ED CME
This document summarizes current evidence on therapeutic hypothermia after cardiac arrest. It discusses two key trials from 2002 that found improved outcomes with targeted temperature management between 32-34°C. However, these trials were small. A large recent randomized controlled trial found no difference in outcomes between a target temperature of 33°C versus 36°C. While therapeutic hypothermia remains recommended, the study challenges its widespread adoption based on only two small trials. Further research is still needed to determine the optimal target temperature range.
Heat stroke occurs when the body's temperature regulation system fails and body temperature rises to dangerous levels. It represents a failure of the body's ability to maintain thermoregulatory homeostasis. Symptoms include headache, nausea, confusion and loss of consciousness. Treatment involves rapid cooling of the body, typically using evaporative cooling techniques, to lower the core temperature and prevent irreversible organ damage. Aggressive rehydration and treatment of complications such as seizures, arrhythmias or hypotension are also important for management. Rapid cooling is crucial to improving outcomes in heat stroke patients.
Exposure to extreme heat or cold can cause hyperthermia or hypothermia in the human body. Hyperthermia refers to high body temperature from heat exposure and can cause heat exhaustion or heat stroke. Hypothermia is low body temperature from cold exposure and can lead to frostbite. Symptoms of hyperthermia include dizziness, nausea, and rapid breathing. Symptoms of hypothermia include shivering, impaired movement, and confusion. Management techniques for hyperthermia involve moving to a cool place, loosening clothing, and giving cool fluids. For hypothermia, techniques include preventing further cooling, replacing wet clothes, and gradually rewarming with blankets or body heat.
This document discusses heat illness in athletes. It defines heat illness and its forms, including heat cramps, heat exhaustion, and heat stroke. Symptoms and treatments are provided for each. The document emphasizes prevention through proper hydration, acclimation, clothing, and monitoring athletes for symptoms. It notes that heat illness is preventable but can be life-threatening if left untreated.
This document discusses heat stroke, including its definition, recent statistics in Pakistan, causes, symptoms, vulnerable groups, preventive measures, basic treatment, and the roles of individuals and the government. It aims to educate learners about heat stroke by having them define it, review statistics, list causes, recognize symptoms, identify at-risk groups, discuss prevention, and explain treatment. Key points covered include staying hydrated, avoiding strenuous activity in heat, recognizing symptoms like high fever and seizures, and quickly cooling the body if heat stroke is suspected.
This document summarizes first aid procedures for heat exhaustion, heatstroke, hypothermia, and frostbite. It outlines signs and symptoms of each condition and provides guidance on first aid management. For heat illnesses like heat exhaustion and heatstroke, first aid includes removing the person from heat, cooling their body, and providing fluids. For hypothermia, treatment ranges from removing wet clothing and adding dry layers for mild cases to calling emergency services and performing CPR if needed for severe cases. Frostbite treatment involves gently warming affected areas and seeking medical help.
Therapeutic hypothermia has been suggested as a treatment for severe traumatic brain injury (TBI) to reduce secondary brain injury. It can be used prophylactically in the early phases after injury or to control elevated intracranial pressure in the intermediate phase. While prophylactic hypothermia's efficacy is still unclear from conflicting studies, hypothermia for refractory intracranial hypertension has shown promise in reducing pressure and improving outcomes based on clinical trials. Optimal temperatures, duration, and rewarming rates need further study to maximize benefits and minimize complications of this therapeutic approach for TBI.
Heat-related illnesses range from mild conditions like heat syncope to life-threatening heatstroke. The body normally cools itself through sweating and other mechanisms, but high humidity or dehydration can interfere with cooling. Heatstroke occurs when thermoregulation fails and the core body temperature exceeds 40.5°C. Symptoms include confusion, seizures, and organ damage. Treatment involves rapid cooling through cold fluids, ice packs, and fans before complications develop. Proper hydration and acclimatization can prevent exertional heat illnesses.
Heat stress can occur when the body is unable to cool itself through normal processes like sweating and increased blood flow to the skin. There are different types of heat transfer and heat-related illnesses ranging from heat rash to heat stroke, a medical emergency. Risk factors include age, weight, medical conditions and medications. Treatment depends on the type and severity but involves stopping activity, cooling the body, and seeking medical help for severe cases like heat stroke. Proper hydration and acclimation are important for preventing heat stress.
Heat illness can grab anyone in most every industry and out-of-work activities. Presenter is a coach outside of work, a Safety, Health and Wellness professional, and has seen both athletes and workers fall victim to heat. This presentation uses facts from a variety of sources along with his first-hand experience.
Hyperthermia and heat stroke are conditions caused by the body failing to regulate its core temperature. Hyperthermia occurs when the body gains too much heat or loses too little, while fever is a regulated increase in temperature by the hypothalamus in response to infection. Heat illnesses form a spectrum from mild heat cramps to the most severe, heat stroke, defined as a core temperature over 40°C with neurological dysfunction. Heat stroke results from a failure of thermoregulation during heat exposure that leads to systemic inflammatory response and multi-organ damage.
This document discusses heat exhaustion, including its causes, symptoms, treatment, and how to prevent it. It defines heat exhaustion as when the body is unable to cool itself and if left untreated can lead to heat stroke. The document outlines the key symptoms of heat exhaustion as headache, dizziness, sweating, nausea and cramps. It provides steps for treatment, which include rehydration, cooling the person, and monitoring their condition. Prevention tips emphasize hydration, rest, and avoiding overexertion in hot weather.
Basic data about heat stroke uncluding: Definition, forms, exertional and non exertional, epidemiology, risk factors, characteristics, ettiology, pathophysiology, clinical presentation in all body systems, management, cooling tools, assisting procedures, complications, prevention, and patient education
Extreme heat can cause heat-related illnesses and death if the body is unable to cool itself. Heat exhaustion occurs when the body's cooling mechanisms fail, causing symptoms like clammy skin, dizziness, and nausea. Heat stroke is the most severe form and is a medical emergency, with symptoms like confusion, lack of sweating, and body temperature over 105 degrees. To prevent heat illness, spend time in air conditioning, drink fluids, and monitor for symptoms in yourself and others during periods of high heat.
This document discusses heat emergencies ranging from minor issues like heat cramps and heat rash to life-threatening heat stroke. The body cools itself through sweating and blood flow changes but may become overwhelmed in extreme heat. Heat stroke is a medical emergency defined by a core temperature over 104°F and altered mental status. Treatment involves rapid cooling through methods like evaporative cooling, immersion, or ice packs while providing IV fluids and monitoring for complications like hypotension, hypokalemia, or renal failure. High risk groups include the elderly, young, chronically ill, and those engaged in strenuous activity in hot conditions.
This simple Presentation highlights Sunstroke by giving:
General description about Sunstroke.
Symptoms of sunstroke.
Medications the raise the risk of Sunstroke
How to prevén and treat Sunstroke.
What to wear to avoid Sunstroke.
Heat related illnesses simply explained, spectrum of hyper and hypothermia related clinical scenarios with symptoms, diagnosis, management and prognosis.
Dr. Ruhul Amin discusses heat stroke, which is a life-threatening illness caused by the body overheating. It is associated with a systemic inflammatory response and multi-organ dysfunction, predominantly affecting the central nervous system. Heat stroke is defined clinically as a core body temperature over 40°C accompanied by hot, dry skin and neurological issues. Treatment involves rapidly cooling the body to under 39°C and treating complications which can include multi-organ failure. Prevention emphasizes acclimatization to heat, scheduling activities for cooler times, drinking fluids, and avoiding overexertion in hot conditions.
This document discusses targeted temperature management (TTM), previously known as therapeutic hypothermia. It provides background on the mechanisms, history, recommendations and methods for TTM. Key points include that inducing mild hypothermia (32-36°C) for 24 hours after cardiac arrest can reduce neurological injury and improve outcomes. Several methods are described for cooling patients, including surface cooling with blankets/pads and internal cooling via intravenous fluids or catheters. Guidelines recommend TTM for comatose cardiac arrest patients with return of spontaneous circulation.
A presentation for EMS personnel about prehospital cooling of patients with return of spontaneous circulation in the field post cardiac arrest; research and application
cryogenics is the production and behaviour of materials at very low temperatures. It is an effort to save lives by using temperatures so cold that a person beyond help by today's medicine can be preserved for decades or centuries until a future medical technology can restore that person to full health. Cryonics sounds like science fiction, but is based on modern science.
The document discusses the Adult ICECAP trial, which aims to study early, high-quality hypothermic temperature management for out-of-hospital cardiac arrest. It notes that no devices are FDA-approved for inducing hypothermia in adults, so the trial is using an investigational device exemption. The goal of the trial is to take better care of patients through new knowledge and design future trials to accomplish this. It then provides rationales for inducing hypothermia to 33°C rather than just controlling fever, and argues for cooling patients early and deeply to give them the best chances of survival based on previous study results.
Hypothermia, Electro Anesthesia & Acu puncture ,DR.MUDASIR BASHIRguestafb98a0
Hypothermia is artificially lowering the body or body part temperature, commonly used in heart and brain surgery to reduce oxygen needs and protect organs during reduced blood flow. It can be induced through surface cooling by immersion in ice water or cold saline cavity irrigation. Best control is with extracorporeal cooling by circulating blood through a cold-water heat exchanger. Precautions must be taken to prevent complications like irregular heart rhythms, low blood pressure, prolonged clotting times and organ damage during prolonged hypothermia. Rewarming is carefully controlled to avoid rapid rewarming shock.
Heat stroke is a life-threatening condition that occurs when the body becomes unable to regulate its core temperature, causing it to rise rapidly. Left untreated, it can cause damage to the brain, organs and other body systems. The main symptoms include a core body temperature above 104°F, altered mental state, and hot, dry skin. First aid involves rapidly cooling the body through methods like cold water immersion or ice packs while seeking immediate medical help, as rapid cooling is key to preventing complications. Risk factors include high heat and humidity, dehydration, strenuous physical activity, and age. Proper prevention focuses on staying hydrated, limiting time outdoors in extreme heat, and wearing loose-fitting, light clothing.
Perinatal asphyxia is an insult to the fetus or the newborn due to lack of oxygen (hypoxia) and or a lack of perfusion (ischemia) to various organs. Hypoxia ischemia remains a significant cause of neonatal mortality and morbidity and adverse neurodevelopmental outcome. Therapeutic hypothermia found to improve neurodevelopmental outcome in asphyxiated babies.
The document discusses human thermoregulation and metabolism. It describes how the hypothalamus controls thermoregulation through peripheral thermoreceptors to maintain core body temperature within a narrow range. It outlines the mechanisms used to increase or decrease body temperature, such as vasoconstriction/vasodilation, shivering, and sweating. Disorders like hypothermia and hyperthermia are also examined, along with their causes, symptoms, and treatment approaches.
This document provides information about exercising in cold conditions and discusses hypothermia. It covers topics like how the body generates and loses heat, factors that influence heat loss, signs and symptoms of hypothermia, and treatment approaches for mild, moderate, and severe hypothermia. Guidelines are provided for exercising safely in cold weather, such as dressing in layers, keeping extremities warm, and monitoring for signs of cold stress. The effects of cold on exercise performance are outlined, noting that activities like swimming are higher risk due to increased heat loss through water conduction and convection.
Cryonics involves the freezing of humans or pets at death in hopes that future science can revive them. It derives from the Greek word for cold. Those who undergo cryonics have their blood replaced with cryoprotectants before being cooled to very low temperatures. Major obstacles include damage from freezing and lack of oxygen during the process. Several institutes in the US and elsewhere offer cryonics, but revival is not currently scientifically possible. Costs range from $28,000 to $155,000 depending on the organization and plan. Payment is often via life insurance spread over years. Ethical debates center on whether cryonics constitutes medicine or burial given current scientific limitations.
Cryosurgery, also known as cryotherapy, involves using intensely cold temperatures to destroy diseased or damaged tissue. It works by forming ice crystals inside cells when exposed to freezing temperatures, which can tear the cells apart. More damage occurs when blood vessels supplying the diseased tissue freeze as well. Liquid nitrogen is commonly used to rapidly freeze the tissue through direct application with probes, sprays, or swabs. The freezing damages cells through several mechanisms including ice crystal formation, thermal shock, electrolyte disruption, and enzyme inhibition. Precise control of factors like temperature, cooling and thawing rates, freeze duration, and repetitive cycles is important for effective treatment.
GEMC- Alterations in Body Temperature: The Adult Patient with a Fever- Reside...Open.Michigan
This is a lecture by Joe Lex, MD from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
The document discusses therapeutic hypothermia for survivors of cardiac arrest. It provides an overview of incidence rates, pathophysiology after arrest, historical context and supportive data for therapeutic hypothermia. It describes physiological changes during cooling and Kaiser's hypothermia protocol, including cooling techniques, effects on cardiovascular, metabolic and hematological systems, and increased risk of infection.
Safety guidelines by ec 16.1 notes for referenceMumbai Hiker
The document discusses acclimatization to high altitudes and provides information on how the body adjusts as it gains altitude. It notes that as altitude increases, atmospheric pressure and oxygen levels decrease. The body starts acclimatizing as soon as a person gains altitude through processes like increased heart and breathing rates. It recommends ways for people to support their body's adjustment, such as staying hydrated, eating well, resting adequately, and pacing activity levels. It also discusses dehydration, hypothermia, and blister prevention.
This document provides information on hypothermia and frostbite treatment. It discusses thermoregulation and the mechanisms of heat loss in the body. Hypothermia is defined as a core body temperature below 95°F and can be primary from direct cold exposure or secondary from underlying conditions. Treatment involves gentle rewarming, removing wet clothes, and warming with blankets and heated fluids/air. Factors like age, medications, and medical conditions can predispose people to hypothermia. Frostbite causes ice crystal formation in tissues which damages cells. Proper treatment is gradual rewarming without refreezing or rubbing of affected areas.
Heatstroke is a life-threatening condition caused by an inability to regulate body temperature, leading to hyperthermia. There are two types: classic, caused by environmental heat exposure without adequate cooling; and exertional, caused by strenuous physical activity overwhelming the body's ability to dissipate heat. Heatstroke causes central nervous system dysfunction, multi-organ failure, and temperatures over 40.5°C. Treatment involves rapid cooling and supportive care, while prevention focuses on avoiding overexertion in hot conditions, staying cool, and protecting vulnerable groups.
Therapeutic hypothermia involves cooling infants to 33-35°C for 72 hours to reduce brain injury from perinatal asphyxia. Hypothermia aims to slow the secondary phase of cell death that begins 6-24 hours after injury. Several randomized controlled trials found hypothermia reduced death and disability rates compared to normothermia. A meta-analysis of these trials found hypothermia reduced the risk of death or severe disability by 19% and increased the chance of normal neurological outcomes by 53%. Hypothermia is now standard care for infants with moderate to severe hypoxic-ischemic encephalopathy.
This document discusses several myths regarding therapeutic modalities. It addresses myths such as ice not removing swelling but preventing it, ultrasound penetration depth depending on frequency not intensity, and pulsed ultrasound still causing thermal effects depending on parameters. Key points are provided on proper ice application and precautions, differences between heat modalities, ultrasound guidelines, and emphasizing modalities are not required to be a successful athletic trainer. References are included for further information.
Similar to Therapeutic hypothermia - catching your death of warm | Insight, issue 3 (20)
Team Consulting won the Design Project of the Year award for their work developing an emergency ventilator called EVA 1.5 to address the urgent need for additional ventilators during the COVID-19 pandemic. They were asked to develop, manufacture, and deliver safety critical ventilators in just six weeks, when it usually takes years. By identifying an existing ventilator design from Diamedica and adapting it, along with an agile development process, they were able to design, test, and transfer the EVA 1.5 ventilator to manufacture within the tight six week timeframe. This unprecedented effort to develop a critical medical device from scratch so quickly through collaborative work was a remarkable technical success given the urgent situation
The advantages of a connected device can be explored through the different categories of needs, by trialling a range of solutions and considering a framework of manageable steps.
The document discusses surgical haemostats, which are used to manage bleeding during surgery. It describes both passive haemostats that rely on physical processes like absorption to stop bleeding, as well as active haemostats that exploit the body's clotting cascade. Newer generations of haemostats are improving formulation and delivery methods. Powder-based products are increasing due to advantages like ease of use. Delivery devices are also advancing, such as spray devices that can target bleeding sites accurately while avoiding risks of air embolisms. Further innovations are expected to improve safety, efficacy and convenience of haemostats.
The document discusses "Design Drivers", which are provocative headings and imagery used to define aspirations and provide a vision for product design. Design Drivers help structure ideas generated during brainstorming and provide goals to measure designs against. They describe what is wanted from a product in an emotive way to inspire divergent thinking beyond just meeting requirements. Examples discussed include drivers for a wearable injector like "invisible beneath clothing" and for a device worn on the skin like "comfortable against the skin". Design Drivers are useful for agreeing on a design vision, establishing design direction, and keeping projects on track.
The document summarizes lessons learned from failures in medical device design and development. It discusses several examples of medical device failures that led to major improvements, including the sinking of the Titanic which improved maritime safety regulations. The document outlines seven key lessons for engineers based on case studies of medical device failures: 1) conduct extensive background research; 2) establish and understand user requirements; 3) don't rush the device development process; 4) design for ease of manufacturing and assembly; 5) take a risk based approach; 6) plan for post-market evaluation; and 7) promote a culture of learning from failures.
Three documents discuss superstitions related to the number 13 and bad luck. The first discusses a study finding higher transport accident injuries on Friday the 13th despite fewer vehicles. The second describes the superstition of crossing fingers for good luck. The third discusses cyclists wearing the number 13 upside down to avoid bad karma if assigned that number in a race.
The document discusses the blood-brain barrier (BBB), which protects the brain from harmful substances in the bloodstream. It describes how the BBB is formed by tightly joined endothelial cells that line brain capillaries and only allow certain molecules like oxygen and nutrients to pass through. While this protects the brain, it also makes it difficult to deliver drugs to treat neurological diseases. New strategies are being explored to trick or temporarily alter the BBB to allow drug molecules to cross into the brain, but effectively delivering drugs remains a major challenge.
The document discusses the important role that excipients play in drug formulations. Excipients make up the majority of a drug's composition and are responsible for functions like improving drug stability, delivery, and absorption. Some key points made include:
- Excipients can improve drug heat or freeze resistance to eliminate the need for cold storage of vaccines. Excipients are also used to modify drug release and targeting.
- Viral vectors modified to deliver growth factors could treat neurodegenerative diseases by reaching specific brain cells, though challenges remain in regulating therapeutic actions.
- Nanoparticle drug carriers using excipients like albumin or chitosan can improve targeted delivery of chemotherapy or statins to tumors or
- The document discusses various prototyping methods and advises seeking expert advice from a prototyping company rather than relying solely on 3D printing.
- It describes traditional prototyping methods like vacuum casting and CNC machining that can produce prototypes closer to the final product than 3D printing alone by adding details like colors, finishes, and mechanical functions.
- The author argues that while 3D printing enables quick prototypes, other methods from experienced prototyping companies are still needed to fully evaluate design aspects like colors, finishes, interactions, and durability testing before final production.
Analytical engineering uses both theoretical and empirical methods to inform product design decisions. Theoretical methods include mathematical modeling and simulation, while empirical methods involve physical testing and measurement. Early in design, theoretical tolerance analysis is used, while later empirical metrology data from prototypes is combined with simulation to validate models. For complex issues like component deflection under load, a hybrid approach using initial modeling followed by targeted physical testing and model validation is most effective. Combining methods alleviates limitations of any single approach and ensures high quality data at all stages of design.
The document discusses the process of industrialization, which is the stage of product development where prototypes are transformed into commercial products ready for mass production. Industrialization involves developing manufacturing methods, processes, and ensuring production specifications accurately translate functional requirements. It is a complex stage that requires coordination between design, manufacturing, and quality teams. The resources and time needed for industrialization are often underestimated. The document provides several rules of thumb for successful industrialization, including following quality management systems, documenting a manufacturing strategy plan, involving manufacturing teams early in the design process, and focusing on high-risk components.
Thinking Human by Julian Dixon, PMPS Inhalation Technology SupplementTeam Consulting Ltd
As medical device companies strive to make their products more user-friendly, it becomes clear that listening to the end user is an important part of the process. Through small-scale studies and human factor analysis, inhalers can be developed that are simple and easy to use.
ONdrugDelivery - The advantages of designing high-resistance swirl chambers f...Team Consulting Ltd
In this article, David Harris, Head of Respiratory Drug Delivery, Team Consulting, taps into a powerful combination of detailed anatomical and functional understanding of the human respiratory system, pulmonary drug delivery technology and formulation expertise, and mathematical modelling techniques, in order to put forward the case for high-resistance swirl chambers in dry-powder inhalers, and a rational strategy for optimising the design and thus maximising therapeutic efficacy.
We think it is important to think ahead and to consider what issues the medical industry will be facing in the future.
As we near 2015 we’ve decided to use this as a half-way point. In this infographic we’ve reflected on significant global changes over the last 15 years and looked at the forecasts for the next 15. The result is a glimpse of what challenges healthcare will face in 2030. Can we do anything today to change the future? Or if we accept this vision of the future what do we need to do now to best prepare?
In an issue of IPT (Innovations in Pharmaceutical Technology) magazine, Team Consulting's David Harris explores the benefits of dry powder inhalers for a range of new therapeutic areas, outside of traditional asthma and COPD treatments.
If you were to tell some people that one of the most frustrating aspects of the development of a drug delivery device would be the little clicks that it makes as part of its operation, they would probably think you had lost your sense of priority.
Device developers know this - whether human factors experts or industrial designers, mechanical engineers, or risk analysis teams - yet this aspect of device design, like many others, is frequently not given the attention it deserves. So why is a click so important?
Designing for battery-powered and battery-packed medical devices, EPD&T, Dec ...Team Consulting Ltd
Team's Jonathan Oakley writes about designing the 'graceful shutdown'. When power starts to run out in a medical device it is important to think about which parts of the system are affected and at what stage.
First published in EPD&T in December 2013 http://www.epdtonthenet.net/
The document discusses using mathematical modeling and sensitivity analysis to troubleshoot product design issues. It describes how sensitivity analysis can help identify which design aspects most impact performance when physical testing all design variations is impractical. It provides an example of using these methods to investigate failures in an auto-injector device late in production. Combining mathematical modeling, finite element analysis, and Taguchi experimental design principles allowed efficiently conducting a sensitivity analysis to determine potential causes and solutions.
Interventional radiology is a medical specialty that uses imaging techniques, such as X-rays, CT scans, and ultrasound, to guide minimally invasive procedures to diagnose and treat a variety of conditions. These procedures can be an alternative to open surgery, often resulting in shorter recovery times for patients.
Regenerative Medicine in Chronic Pain ManagementReza Aminnejad
Regenerative technologies are the future of medicine. The current clinical strategy focuses primarily on treating the symptoms but regenerative medicine seeks to replace tissue or organs that have been damaged by age, disease, trauma, or congenital issues.
Definition of mental health nursing, terminology, classification of mental disorder, ICD-10, Indian Classification, Personality development, defense mechanism, etiology of bio psychosocial factors,
All the information you need to know about Hypothyroidism - Introduction,
Etiology, clinical manifestations, complications, pathophysiology,
diagnosis, treatment, precautions.
CASE PRESENTATION ON ACUTE GASTROENTERITIS.Bhavana
This is a case presentation of a 72 year old female patient who was admitted in the hospital with the chief complaints of loose stools since 6 Days and generalised weakness and history of one episode of vomiting (one day back).
As a leading rheumatologist in Chandigarh, Dr. Aseem specializes in the diagnosis and management of a wide range of rheumatic conditions, including but not limited to:
Rheumatoid Arthritis: An autoimmune disorder that causes chronic inflammation of the joints.
Osteoarthritis: A degenerative joint disease characterized by the breakdown of cartilage.
Lupus: A systemic autoimmune disease that can affect the skin, joints, kidneys, and other organs.
Ankylosing Spondylitis: A type of arthritis that primarily affects the spine, causing pain and stiffness.
Gout: A form of arthritis characterized by sudden, severe attacks of pain, redness, and tenderness in the joints.
Psoriatic Arthritis: A type of arthritis that affects some people with psoriasis.
Vasculitis: An inflammation of the blood vessels that can cause a variety of symptoms.
Sjogren’s Syndrome: An autoimmune disorder characterized by dry eyes and mouth.
Accurate diagnosis is crucial for effective treatment. Dr. Aseem Goyal utilizes advanced diagnostic techniques to identify the underlying causes of rheumatic conditions. Our state-of-the-art facility is equipped with the latest technology to provide comprehensive diagnostic services, including:
Blood Tests: To check for markers of inflammation and autoimmune activity.
Imaging Studies: Such as X-rays, MRI, and ultrasound to assess joint and soft tissue damage.
Joint Fluid Analysis: To examine the fluid in the joints for signs of inflammation or infection.
Biopsy: In certain cases, a small tissue sample may be taken for further examination.
Treatment Approaches
Dr. Aseem Goyal adopts a holistic and patient-centered approach to treatment. Depending on the specific condition and its severity, treatment options may include:
Medications
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): To reduce inflammation and relieve pain.
Disease-Modifying Antirheumatic Drugs (DMARDs): To slow the progression of rheumatic diseases.
Biologic Agents: Targeted therapies that block specific pathways in the immune system.
Corticosteroids: To control severe inflammation quickly.
A medical treatment that uses high doses of radiation to kill cancer cells or shrink tumors by damaging their DNA. When the DNA is damaged, cancer cells can no longer divide and grow, and they eventually die.
An exciting session emphasizing the timely intervention and management of obstetric sepsis for better patient outcomes.
This presentation highlights risk factors, diagnosis, management, and some interesting cases of obstetric sepsis.
Periodontal disease is a disease, or more likely a number of diseases of the periodontal tissues that results in attachment loss and destruction of alveolar bone. The natural history of periodontal disease, in some but not all patients, results in tooth loss. Periodontal disease, however, encompasses a wider spectrum of diseases than just periodontitis and the recognition of these diseases requires a diagnosis be made.
Classification is the process of identifying and grouping objects or ideas into predetermined categories.
Osvaldo Bernardo Muchanga- MALE CIRCUMCISION, ITS Vs SOCIOCULTURAL BELIEFS (C...Osvaldo Bernardo Muchanga
MALE CIRCUMCISION consists of the surgical act of removing the foreskin (skin that covers the glans of the penis), leaving the glans more prominent and better cleanable.
MALE CIRCUMCISION itself has medical as well as sociocultural implications, as it has been proven to be an act that can minimize SEXUALLY TRANSMITTED INFECTIONS (STIs), especially HIV, but it also represents the SOCIOCULTURAL IDENTITY of some people, respectively.
Now, in a SERO-EPIDEMIOLOGICAL PROFILE like that of Mozambique where the prevalence of HIV is around 12.5% which corresponds to approximately 2 million people living with HIV, where the province of GAZA is the most seroprevalent with a positivity rate of 21% (INSIDA, 2021), it is extremely necessary to THOROUGHLY scrutinize all possibilities for preventing or minimizing the spread of HIV and other STIs.
STRATEGIES FOR RATIONALISING/REDUCING CAESAREAN SECTION RATE BY USE OF "SION ...Niranjan Chavan
The journey to reduce/rationalise the C-section rate started in June 2023 and it’s an ongoing study been carried out at #SionHospital #LTMMC Mumbai.
It’s going to revolutionise the journey of motherhood for safer, predictable maternal and fetal outcome.
The SION model is a structured and networked approach to promoting vaginal deliveries.
By integrating education, support, policy implementation, and continuous improvement, it aims to enhance maternity care and reduce unnecessary C-sections through collaborative efforts among healthcare providers and patients.
Encouraging trials of labor after previous C-sections (TOLAC) and fostering a multidisciplinary team approach in maternity care are crucial.
Regular training for healthcare providers and establishing supportive hospital policies further promote vaginal births.
Heart Valves and Heart Sounds -Congenital & valvular heart disease.pdfMedicoseAcademics
This presentation, authored by Dr. Faiza, Assistant Professor of Physiology at CIMS Multan, delivers an in-depth analysis of heart valves, heart sounds, valvular heart diseases, and congenital heart defects. It begins by distinguishing between normal and abnormal heart sounds, elucidating the timing and causes of the four heart sounds—S1, S2, S3, and S4—and their clinical significance. Detailed explanations are provided on the auscultation sounds that define conditions such as mitral stenosis, mitral insufficiency, aortic stenosis, and aortic insufficiency, with a focus on how these pathological changes affect cardiac mechanics and blood pressure.
The presentation delves into abnormal heart sounds, known as murmurs, categorizing them by their causes, which include valvular lesions, rheumatic fever, aging, congenital heart diseases, viral infections during pregnancy, and hereditary factors. It explores the various types of murmurs, their timing within the cardiac cycle, and their association with specific valvular heart diseases such as stenosis and regurgitation. The intricate relationship between systolic and diastolic murmurs and conditions like anemia and ventricular septal defects is also highlighted.
Further, the presentation covers the pathophysiology of congenital heart diseases, offering a comprehensive review of conditions such as Tetralogy of Fallot and Patent Ductus Arteriosus. It explains the mechanisms of these diseases, their impact on cardiac function, and the clinical manifestations observed in affected individuals. The physiological adjustments of the circulatory system during exercise in patients with valvular lesions are discussed, emphasizing the reduced cardiac reserve and the risk of acute pulmonary edema.
Special attention is given to the compensatory mechanisms of the heart in response to valvular diseases, including the development of concentric and eccentric hypertrophy, increased venous return, and the eventual progression to heart failure. The presentation also examines rheumatic valvular lesions, aging-related aortic stenosis, and the specific challenges posed by these conditions, such as reduced stroke volume and increased metabolic demand.
This thorough exploration of heart sounds, valvular diseases, and congenital defects is designed to enhance understanding and clinical acumen, making it a valuable resource for medical students, healthcare professionals, and educators in the field of cardiology and physiology.
General Endocrinology and mechanism of action of hormonesMedicoseAcademics
This presentation, given by Dr. Faiza, Assistant Professor of Physiology, delves into the foundational concepts of general endocrinology. It covers the various types of chemical messengers in the body, including neuroendocrine hormones, neurotransmitters, cytokines, and traditional hormones. Dr. Faiza explains how these messengers are secreted and their modes of action, distinguishing between autocrine, paracrine, and endocrine effects.
The presentation provides detailed examples of glands and specialized cells involved in hormone secretion, such as the pituitary gland, pancreas, parathyroid gland, adrenal medulla, thyroid gland, adrenal cortex, ovaries, and testis. It outlines the special features of hormones, differentiating between peptides and proteins based on their amino acid composition.
Key principles of endocrinology are discussed, including hormone secretion in response to stimuli, the duration of hormone action, hormone concentrations in the blood, and secretion rates. Dr. Faiza highlights the importance of feedback control in hormone secretion, the occurrence of hormonal surges due to positive feedback, and the role of the suprachiasmatic nucleus (SCN) of the hypothalamus as the master clock regulating rhythmic patterns in biological clocks of neuroendocrine cells and endocrine glands.
The presentation also addresses the metabolic clearance of hormones from the blood, explaining the mechanisms involved, such as metabolic destruction by tissues, binding with tissues, and excretion by the liver and kidneys. The differences in half-life between hydrophilic and hydrophobic hormones are explored.
The mechanism of hormone action is thoroughly covered, detailing hormone receptors located on the cell membrane, in the cell cytoplasm, and in the cell nucleus. The processes of upregulation and downregulation of receptors are explained, along with various types of hormone receptors, including ligand-gated ion channels, G protein–linked hormone receptors, and enzyme-linked hormone receptors. The presentation elaborates on second messenger systems such as adenylyl cyclase, cell membrane phospholipid systems, and calcium-calmodulin linked systems.
Finally, the methods for measuring hormone concentrations in the blood, such as radioimmunoassay and enzyme-linked immunosorbent assays (ELISA), are discussed, providing a comprehensive understanding of the tools used in endocrinology research and clinical practice.
General Endocrinology and mechanism of action of hormones
Therapeutic hypothermia - catching your death of warm | Insight, issue 3
1. www.team-consulting.com
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Therapeutic
Hypothermia –
catching your
death of warm
BY BEN W ICKS
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The use of hypothermia in medicine
isn’t a new idea. In the 4th Century BC
Hippocrates described putting snow on
an injured person, and the benefits of
chilling patients was also tried during
the Napoleonic wars. However, medical
science embraced some fairly crazy
ideas back then so it isn’t surprising
that proper investigation of therapeutic
hypothermia didn’t begin in earnest until
the second half of the 20th century. Even
then there were some fatalities because
the clinicians got carried away and cooled
people too much - only in the 1980s did
clinicians begin to realise that cooling a
patient by just a few degrees could have a
significant benefit. >
37
Strange as it may seem, the cold may
actually help Steve make a full recovery.
Over the last few years the deliberate
use of therapeutic hypothermia in the
treatment of heart attack and several
other acute conditions has become
more and more widespread, and is now
almost routine.
8
It’s February, it’s snowing and 56 year
old Steve Grinstan has collapsed outside
the delicatessen on the corner of 7th
and 55th in New York suffering from a
heart attack. The attending paramedics
re-establish his normal heart rhythm
within a few minutes, but Steve remains
lying on the ground looking very cold.
Next, the paramedics start infusing him
with ice cold saline before putting him
in the ambulance. The small group of
bystanders stamp their feet in the cold
and wander off discussing whether the
unfortunate man may survive the heart
attack, only to die of cold.
2. Team / insight.
How can cold be good?
Most of your body is designed to work
optimally at 37°C. All of your cells and
enzymes are geared up to do their
work at this temperature. If your core
temperature drops below 37°C then
your physiology begins to slow down,
your cells work more slowly, consume
less energy and need less oxygen. This
fact has been exploited for several
decades to help protect the brain during
heart transplant or cardiopulmonary
bypass (CPB) surgery when blood flow
to the brain is slowed and sometimes
briefly stopped.
MOST OF YOUR
BODY IS DESIGNED
TO WORK OPTIMALLY
AT 37ºC
In 2002, two landmark clinical studies
reported that mild hypothermia
(cooling to 32-34°C) could improve
the neurological outcomes of heart
attack patients. Since then a great
deal more clinical investigation has
been carried out, and whilst there
have been differences in the clinical
protocols and measured outcomes, a
picture is emerging which unequivocally
shows that therapeutic hypothermia
can improve survival and neurological
function of heart attack patients. Direct
brain injury can also be treated with
therapeutic hypothermia, with several
studies also strongly suggesting that
cooling the brain can help prevent
damage following traumatic brain
injury. Interestingly, it’s not just the
brain which may benefit from being
cooled. Preliminary evidence also
suggests that cooling may even help
protect the heart muscle itself which is
starved of oxygen during a heart attack.
What does cooling actually do?
The influence of cooling on cellular and
biochemical mechanisms within the
brain is fairly complex.
All cells are normally regulated by a
complex series of biochemical feedback
systems which keep everything in
balance within the cell (homeostasis).
Damage caused by lack of oxygen can
upset these mechanisms and can cause
cells to spiral out of control and even
push cells into a programmed selfdestruct mode (known as apoptosis).
Cooling helps to dampen the severity
of these swings and reduces the risk of
a cascade resulting in cell damage or
death.
Nerve cells constantly send signals
to one another by producing special
chemicals known as neurotransmitters.
When nerve cells are damaged they can
give out toxic levels of these chemicals
which can kill the transmitting cells and
their neighbours; hypothermia helps
reduce this level of neurotransmitter
release.
How much chilling is helpful?
The clinical community is working
hard to determine the optimum way to
use therapeutic hypothermia, but as
the process of clinical trialling is time
consuming and difficult, there are as yet
few hard and fast rules.
The first question is ‘how quickly should
cooling be initiated after the injury’?
This subject is hotly debated (sorry)
but most people agree that cooling
should start as early as possible after
a heart attack or brain injury, and there
is evidence that shows that it may still
be worthwhile cooling a patient up to 12
hours after the injury or event.
The second question is ‘how cold’?
Whilst cardiopulmonary bypass patients
are sometimes cooled to temperatures
as low as 15°C, it appears that cooling
by only 3-5°C is probably sufficient for
treatment after heart attack or brain
injury. Even a few degrees of cooling has
a significant effect, as brain metabolism
decreases by around six percent for every
one degree decrease in temperature
below 37°C.
The last question is ‘how long’?
Cooling is normally applied for 24
hours, sometimes longer. The process
of rewarming the patient is usually
controlled to make sure that it occurs
gradually over a period of several hours,
typically at 0.25 - 0.5°C per hour. Most
of the cooling systems and devices on
the market can be used to help rewarm
the patient.
The science of cooling
We live in an age of amazing medical
technology where we can see inside
the brain using MRI, or visualise the
beating heart of a baby in its mother’s
womb using ultrasound. The challenge
of rapidly cooling a person by a few
degrees therefore seems trivial – surely
you’d think there was some kind of
wireless technology which could be
applied? Disappointingly, the physics of
cooling is rather mundane and clunky,
and you can’t avoid the need to create
a close physical coupling between the
cooling system and the warm inside of
the patient. You’ve just got to get the
cold in and the heat out, and there’s a
lot of heat to get out. Cooling someone
by 5°C requires the same dissipation
of heat as cooling three kettles full of
boiling water down to room temperature
( ~1700kJ or ~half a kilowatt hour).
One of the quickest and easiest ways of
chilling someone is to infuse them with
several litres of ice cold saline. This
only cools the body by around half a
degree, but it can be done quickly and is
a good start. Many health providers are
already advocating this intervention for
heart attack treatment since it can be
administered easily and requires little
additional infrastructure, just a fridge
in the ambulance.
Chilling out
Although you might think that it’s very
easy to get cold, the human body is
amazingly good at keeping itself warm.
A series of physiological systems make
sure your core temperature doesn’t vary
significantly - shivering is an obvious
example - and so it is quite difficult
to quickly get someone cold. Despite
its relative infancy, there are already
therapeutic hypothermia products on
the market and the medical device
3. www.team-consulting.com
industry has come up with some quite
creative, and at times bizarre, methods
to induce and maintain hypothermia.
Therapeutic hypothermia systems
fall into three main categories:
•
•
•
Extracorporeal (which cool the
outside of the body)
Natural orifice (yes, you’ve
guessed it!)
Intravascular (which cool from
within the bloodstream)
Extracorporeal systems are the
simplest, cheapest and most
widespread. The normal format uses
cold pads which are placed onto the
patient’s skin, and a refrigeration unit
circulates cold water through the pads,
with the most efficient pads having a
gel coating to ensure maximal thermal
conductivity between the coolant circuit
and the skin.
The major disadvantages of
extracorporeal systems are their limited
cooling rate of ~1.5°C per hour, and the
fact that a relatively large area of skin
needs to be covered with the pads. The
skin is quite a good insulation layer and
vasoconstriction limits the amount of
core blood which circulates near the skin.
Natural orifice systems, as the name
suggests, use the body’s orifices as
a cooling interface (you’re probably
wincing as you read this). Theoretically,
cooling should be quicker and more
efficient since mucus membranes are
thinner and less insulating than normal
skin. Whilst almost all the imaginable
orifices have been tried, the ‘RhinoChill
Intranasal Cooling System’ deserves
particular mention. Designed for
out-of-hospital use on heart attack
patients, the product squirts a rapidly
evaporating coolant into the nasal cavity
of the patient, cooling the blood and
the nearby brain. If you get a headache
eating ice-cream too quickly then you
can imagine what the RhinoChill feels
like! The product FAQ includes the
incongruous question “What should be
done if the patient’s nose turns white?”
As you might expect, there are practical
08 — 09
issues with almost all natural orifice
systems and they are unlikely to capture
much of the market without significant
advances in usability and performance.
WHATEVER
HAPPENS, THE
FUTURE FOR
THERAPEUTIC
HYPOTHERMIA
WITHIN EMERGENCY
MEDICINE AND
CRITICAL CARE
SEEMS FAIRLY
ASSURED
(a ‘chill pill’) will ever be found which
has the ability to influence the myriad of
complex intracellular and extracellular
mechanisms which can be dampened by
simple cooling.
What’s the future?
Expect to see more novel cooling
products and technologies emerging
in the next few years, particularly for
the out-of-hospital / emergency care
setting. Cold, breathable gas mixtures
may have some potential in this regard.
Mixtures of oxygen and inert gases with
a higher thermal capacity than air have
been explored for some time but some
new approaches, including frozen mists,
might make this approach feasible.
Whatever happens, the future for
therapeutic hypothermia within
emergency medicine and critical care
seems fairly assured. The growing body
of clinical evidence means that it will
become adopted as standard for the
treatment of heart attack and traumatic
brain injury.
Intravascular systems use specially
designed large-bore catheters which
are inserted into the femoral vein. Cold
saline is constantly circulated through
the hollow catheter which, in turn, cools
the blood. The catheter is sealed at one
end so no coolant comes into contact
with blood. The advantage of systems
such as the Zoll Thermogard XP and
Philips’ InnerCool RTx is that they can
achieve very high cooling rates in excess
of 2°C per hour. The downside is that the
procedure to insert a catheter is fairly
invasive, carries some risks, requires a
well-qualified clinician and in practice,
the fast cooling rate may be offset by the
time required to place the catheter.
Surface cooling, extracorporeal products
seem likely to become the widely used
technology but no one type of cooling
technology is likely to dominate the
entire market, and all three main types
of cooling products are likely to find their
own particular niche. There seems little
chance that a pharmaceutical approach
— ben.wicks@team-consulting.com
Ben is Head of Critical Care and
joined Team from Sagentia and
Sphere Medical in 2012. His focus
is on building on our success in
this area.