NSTEMI vs STEMI

NSTEMI (Non–ST-segment elevation myocardial infarction) and STEMI (ST-segment elevation myocardial infarction) are commonly known as heart attack. But they are different from each other in some extent. NSTEMI account for about 30% and STEMI about 70% of all heart attack (myocardial infarction).

• NSTEMI (Non–ST-segment elevation myocardial infarction)
• STEMI (ST-segment elevation myocardial infarction)

Pathophysiology of NSTEMI vs STEMI:

Pathophysiologically, NSTEMI is somewhat different from STEMI. NSTEMI occurs by developing a complete occlusion of a minor coronary artery or a partial occlusion of a major coronary artery previously affected by atherosclerosis. This causes a partial thickness damage of heart muscle.

STEMI occurs by developing a complete occlusion of a major coronary artery previously affected by atherosclerosis. This causes a full thickness damage of heart muscle.

Diagram: NSTEMI vs STEMI

Symptoms of NSTEMI vs STEMI:

There is no difference between NSTEMI and STEMI in clinical presentation. In both cases, patients usually present with similar type of symptoms such as chest pain, nausea, vomiting, sweating, breathing difficulty.

• Chest Pain, 
• Nausea, 
• Vomiting, 
• Sweating, 
• Breathing difficulty.

ECG of NSTEMI vs STEMI:

The usual ECG findings of NSTEMI are ST-segment depression or T-wave inversion. NSTEMI does not show ST segment elevation in ECG (due to partial thickness injury of heart muscle) and later does not progress to a Q-wave. For this reason, it is also called a non–Q-wave myocardial infarction (NQMI).

On the other hand, STEMI shows ST segment elevation in ECG (due to full thickness injury of heart muscle) and later progress to a Q-wave.  For this reason, it is also called a Q-wave myocardial infarction (QWMI). The ultimate ECG findings of STEMI are ST-segment elevation, pathological Q-wave formation and T-wave inversion.

nstemi vs stemi ECG

Figure: ECG findings of nstemi and stemi

Cardiac markers of NSTEMI vs STEMI:

Cardiac markers including CK-MB (creatine kinase myocardial band), troponin I and troponin T, all elevate both in cases. But the elevation of these markers is often mild in NSTEMI compared with STEMI.
Diagnosis of NSTEMI vs STEMI:

The diagnosis of a NSTEMI is based on a typical history of chest pain, no ST segment elevation in ECG plus elevation of cardiac markers in serum, and the diagnosis of a STEMI is based on a typical history of chest pain, ST segment elevation in ECG plus elevation of cardiac markers in serum.
Complications of NSTEMI vs STEMI:

Complications occur both in cases. But some complications like cardiogenic shock, left ventricular failure, severe mitral regurgitation due to papillary muscle rupture, cardiac tamponade due to ventricular wall rupture are more in STEMI (due to full thickness heart muscle damage) than NSTEMI.
Treatment of NSTEMI vs STEMI:

Antiplatelets (Aspirin, Clopidogrel, Ticagrelor), anticoagulants (Enoxaparin, Dalteparin, Fondaparinux), beta-blockers (atenolol, metoprolol, bisoprolol), nitrates (isosorbide dinitrate, glyceryl trinitrate), statins (atorvastatin, rosuvastatin, simvastatin, pitavastatin), ACE inhibitors (ramipril, enalapril, captopril, lisinopril) or ARBs (valsartan, candesartan, losartan, olmesartan) are given both in NSTEMI and STEMI.

In case of reperfusion therapy, primary PCI (percutaneous coronary intervention) is the treatment of choice for STEMI. Where primary PCI cannot be achieved within 120 minutes of diagnosis or PCI is not available, thrombolytic therapy such as streptokinase, tenecteplase, alteplase or reteplase should be given. On the other hand, early coronary angiography and revascularization, either by PCI or by CABG (coronary artery bypass grafting) is the treatment of choice for medium to high risk patients with NSTEMI. Drug treatment is appropriate in low risk patients with NSTEMI, and coronary angiography and revascularization reserved for those who fail to settle with drug treatment (low, medium and high risk patients are categorized in nstemi by GRACE score) . Thrombolytic therapy is harmful in NSTEMI. The aggregate data suggest that patients with NSTEMI may be put at risk of reinfarction if thrombolytic therapy is used.
Prognosis of NSTEMI vs STEMI:

Short-term (in-hospital or one month) mortality is lower in NSTEMI (3-5%) compared to STEMI (10-15%). Re-infarction rate (further heart attack) is higher in NSTEMI (15-25%) after hospital discharge compared to STEMI (5-8%). Long-term mortality is similar or higher in NSTEMI compared to STEMI (two year mortality is approximately 30% in both cases).


referral >> http://nstemi.org/nstemi-vs-stemi/#sthash.eFG1TDS1.dpuf

Yeast infections during pregnancy : Online Medical Help

What is a yeast infection?

Yeast infections are a common type of vaginal infection that are particularly common in pregnant women. These infections — also called monilial vaginitis or vaginal candidiasis — are caused by microscopic fungi in the Candida family, most commonly Candida albicans.

Video

Inside pregnancy: Weeks 15 to 20

 

A 3D animated look at a baby in the second trimester of pregnancy.

It's not uncommon to have a certain amount of yeast in your vagina, as well as in your intestinal tract. Yeast only becomes a problem when it grows so fast that it overwhelms other competing microorganisms.
Your higher level of estrogen during pregnancy causes your vagina to produce more glycogen, making it even easier for yeast to grow there. Some researchers think estrogen may also have a direct effect on yeast, causing it to grow faster and stick more easily to the walls of the vagina.
You're also more likely to get a yeast infection when you take antibiotics, particularly if you take them frequently or for a long time. That's because in addition to killing off the bacteria they're targeting, these drugs may affect the normal protective bacteria in your vagina, allowing yeast to overgrow.

What are the symptoms?

If you develop symptoms from a yeast infection, they're likely to plague you (and may get worse) until you treat the infection, though sometimes they come and go on their own. Symptoms may include:

• Itchiness, irritation, soreness, burning, and redness in your vagina and labia (and sometimes swelling)
• An odorless vaginal discharge that's often white, creamy, or cottage-cheesy
• Discomfort or pain during sex
• Burning when you urinate (when the urine hits your already irritated genitals)

What should I do if I think I have a yeast infection?

If you think you have a yeast infection, see your practitioner. She'll take a sample of your vaginal discharge and check it to confirm the diagnosis and rule out other things that may be causing your symptoms.
By the way, although antifungal medication is available over the counter, it's not a good idea to try to diagnose and treat yourself without seeing a practitioner. Your symptoms may be caused by something else, such as a sexually transmitted infection, instead of or along with yeast.
Studies show that the majority of women who treat themselves for a presumed yeast infection miss the real cause. As a result, they often delay getting proper treatment.
If you do have a yeast infection, your practitioner will give you a prescription or recommend a specific over-the-counter antifungal vaginal cream or suppository that's safe during pregnancy.
For most yeast infections, creams and suppositories with clotrimazole are more effective than those containing nystatin.
You'll need to insert the cream or suppository into your vagina seven days in a row, preferably at bedtime so it won't leak out. (The shorter-course regimens that you might have used before aren't as effective when you're pregnant.) It's also a good idea to apply some of the antifungal cream to the area just outside your vagina.
It may take a few days of treatment before you begin to feel some relief. In the meantime, you can soothe the itching with an ice pack or by soaking for ten minutes in a cool bath.
If you find the medication irritating or it doesn't seem to be working, let your practitioner know. She may have to switch you to another medication. Be sure to complete the full course of treatment to make sure the infection is gone.

Will a yeast infection affect my baby?

No, a yeast infection won't hurt or affect your developing baby. If you have an infection when you go into labor, though, there's a chance that your newborn will contract it as he passes through the birth canal. If he does, he may develop a yeast infection in his mouth, known as thrush.
Thrush is characterized by white patches on the sides and roof of the mouth and sometimes on the tongue. This condition isn't serious and is easily treated. (By the way, babies can get thrush even if you don't have a yeast infection.)

How can I reduce my chances of getting a yeast infection?

It's less likely you'll get a yeast infection if you keep your genital area dry (yeast thrives in a warm, humid environment) and your vaginal flora in balance. Not all of the following suggestions are supported by hard evidence, but they're easy enough and worth a try:

• Wear breathable cotton underwear and avoid pantyhose and tight pants, particularly synthetic ones.
• Get out of your wet bathing suit promptly after swimming, and change your underwear after exercising if you break a sweat.
• Try sleeping without underwear at night to allow air to get to your genital area. If you prefer to wear something to bed, a nightgown without underwear allows more air circulation than pajama bottoms.
• Avoid bubble baths, perfumed soaps, scented laundry detergent, and feminine hygiene sprays. While it's not clear whether these items contribute to yeast infections, they can cause bothersome genital irritation so are best avoided.
• Clean your genital area gently with warm water. (Never douche during pregnancy – or any other time.)
• Always wipe from front to back.
• Eat yogurt that contains a live culture of Lactobacillus acidophilus, which can theoretically help maintain the proper bacterial balance in your gut and vagina. There's conflicting evidence as to whether yogurt helps prevent yeast infections, but many women swear by it. And in any case, it's a good source of protein and calcium!

KALAIDENG OSCAR 3 SERIES For Samsung Galaxy Note 2

Spinal Nerve Function : Online Medical Help

Spinal Nerve Function

The term spinal nerve generally refers to a mixed spinal nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body. Humans have 31 left-right pairs of spinal nerves, each roughly corresponding to a segment of the vertebral column: 8 cervical spinal nerve pairs (C1-C8), 12 thoracic pairs (T1-T12), 5 lumbar pairs (L1-L5), 5 sacral pairs (S1-S5), and 1 coccygeal pair. The spinal nerves are part of theperipheral nervous system (PNS).

Normal Blood Gases : Arterial Blood Gases : Online Medical Help

Arterial Blood Gases Arterial blood gas analysis provides information on the following: 1] Oxygenation of blood through gas exchange in the lungs.  2] Carbon dioxide (CO2) elimination through respiration.  3] Acid-base balance or imbalance in extra-cellular fluid (ECF).   Normal Blood Gases
	Arterial	Venous
pH	7.35 - 7.45	7.32 - 7.42
Not a gas, but a measurement of acidity or alkalinity, based on the hydrogen (H+) ions present. The pH of a solution is equal to the negative log of the hydrogen ion concentration in that solution: pH = - log [H+].
PaO2	80 to 100 mm Hg.	28 - 48 mm Hg
The partial pressure of oxygen that is dissolved in arterial blood. New Born – Acceptable range 40-70 mm Hg.  Elderly: Subtract 1 mm Hg from the minimal 80 mm Hg level for every year over 60 years of age:  80 - (age- 60)  (Note: up to age 90)
HCO3	22 to 26 mEq/liter (21–28 mEq/L)	19 to 25 mEq/liter
The calculated value of the amount of bicarbonate in the bloodstream. Not a blood gas but the anion of carbonic acid.
PaCO2	35-45 mm Hg	38-52 mm Hg
The amount of carbon dioxide dissolved in arterial blood.  Measured.  Partial pressure of arterial CO2.  (Note: Large A= alveolor CO2).  CO2 is called a “volatile acid” because it can combine reversibly with H2O to yield a strongly acidic H+ ion and a weak basic bicarbonate ion (HCO3 -) according to the following equation: CO2 + H2O <--- --> H+  +  HCO3
B.E.	–2 to +2 mEq/liter Other sources:  normal reference range is between -5 to +3.
The base excess indicates the amount of excess or insufficient level of bicarbonate in the system.  (A negative base excess indicates a base deficit in the blood.) A negative base excess is equivalent to an acid excess. A value outside of the normal range (-2 to +2 mEq) suggests a metabolic cause for the abnormality.  Calculated value.  The base excess is defined as the amount of H+ ions that would be required to return the pH of the blood to 7.35 if the pCO2 were adjusted to normal.  It can be estimated by the equation: Base excess = 0.93 (HCO3 - 24.4 + 14.8(pH - 7.4)) Alternatively: Base excess = 0.93×HCO3 + 13.77×pH - 124.58 A base excess > +3 = metabolic alkalosis a base excess < -3 = metabolic acidosis
SaO2	95% to 100%	50 - 70%
The arterial oxygen saturation.

Intravenous Paracetamol : Online Medical Help

1 Intravenous (IV) paracetamol should be prescribed carefully, according to the weight, age and co-morbidities
of the patient. The upper dose limit for each single dose and in each 24-hour period should not be exceeded.
2 50ml vials of IV paracetamol should be used for patients less than 33kg. In infants and small children, doses
should be measured accurately using a syringe.
3 Enquiry about recent paracetamol ingestion should form part of routine pre-operative assessment. All doses
of paracetamol administered in the operating theatre should be recorded on the ward drug administration
chart and in the anaesthetic record.
4 Advice should be sought from the local poisons information service in all cases of overdose of intravenous
paracetamol. Treatment with acetylcysteine is suggested following a single dose greater than 60mg/kg.
5 Intravenous paracetamol (Perfalgan®) remains under intensive monitoring by the MHRA. All suspected
adverse reactions to IV paracetamol should be reported to the Yellow Card Scheme and discussed with the
local poisons information service.

 Background
A Fatal Accident Inquiry in Scotland in 2011 concluded that a young adult died from liver failure due to an overdose
of paracetamol. The Sheriff found ‘there was, at the time of the death, a prevailing culture of assumed familiarity with
the administration of IV paracetamol, a familiarity derived from the common use of oral paracetamol’. The patient,
who weighed 35kg, died nine days after receiving paracetamol 1g IV on a sustained and regular basis.1
Intravenous paracetamol was licensed in the UK in 2004 and is used routinely in anaesthetic practice. Since
introduction, there have been concerns about accidental overdose of IV paracetamol due to errors in drug prescription
and administration, particularly in children, small adults, the elderly, alcoholics and those with pre-existing
hepatocellular insufficiency.
Reported errors include incorrect dose in adults with high or low body mass index; accidental overdose in children
associated with use of 100ml-vials; 10-fold drug calculation errors; confusion between dose volume in millilitres and
dose of drug in milligrams; errors when setting up infusion pumps; and duplication of doses between the ward and
the operating theatre or recovery.2-5
Examples of recent reports to the NRLS include:
➤ Patient had a dose of paracetamol before going to theatre and then was given another dose whilst in theatre. Fifth
dose in 24 hours.
➤ Paracetamol not given on the ward post op due to double dose given in theatre...
➤ Patient was given the prescribed 1gram paracetamol on the ward at 08:13hrs as part of pre-med. On return to ward
after procedure it was noted on the anaesthetic chart that 1gram of IV paracetamol had been given at 09:30 hrs...
The MHRA issued a Patient Safety Update in 2010 that raised concerns about accidental overdose of IV paracetamol
(Perfalgan®), especially in infants and neonates. Perfalgan® is presented in a concentration of 10mg/ml, and in
most cases, a 10-fold overdose was reported. The MHRA advised vigilance when prescribing and administering
Perfalgan®, to adhere to recommended doses and dose intervals, to avoid concomitant administration by different
routes, and to use 50ml vials for infants and children who weighed less than 33kg.3
The NPSA issued a Signal alert in 2010 that raised concern about the risk of inadvertent overdose of IV paracetamol
in children, and described 206 incidents relating to IV paracetamol, two associated with severe harm and 14 with
moderate harm.5

recoMMended dose of iv paracetaMol
The dose of IV paracetamol recommended by the MHRA for children and adults is shown in the table below.
Paracetamol should be given by infusion over 15 minutes, and the minimum dose interval should not be less than four
hours (six hours in patients with renal impairment).

*The dose of IV paracetamol is controversial in neonates and infants. The BNF for Children (BNFC) suggests a dose of
7.5mg/kg every 8 hours (maximum 25mg/kg daily) in preterm neonates over 32 weeks postmenstrual age, 10mg/kg
every 4-6 hours (maximum 30mg/kg daily) in neonates.6
**The British National Formulary (BNF) suggests caution in patients with hepatocellular insufficiency, chronic
alcoholism, chronic malnutrition or dehydration, and to administer a maximum daily infusion dose of 3g in adults in
these patient groups.

Nursing

Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life.

Nurses may be differentiated from other health care providers by their approach to patient care, training, and scope of practice. Nurses practice in a wide diversity of practice areas with a different scope of practice and level of prescriber authority in each. Many nurses provide care within the ordering scope of physicians, and this traditional role has come to shape the historic public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.

The American Nurses Association (ANA) states nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations

Homonymous hemianopsia : Online Medical Help

Homonymous hemianopsia

Hemianopsia or hemianopia is visual field loss on the left or right side of the vertical midline. It can affect one eye but usually affects both eyes. Homonymous hemianopsia, or homonymous hemianopia, is hemianopic visual field loss on the same side of both eyes. Hemianopias occur because the right half of the brain has visual pathways for the left hemifield of both eyes, and the left half of the brain has visual pathways for the right hemifield of both eyes. When one of these pathways is damaged, the corresponding visual field is lost.

INTUBATION And VENTILATION : Online Medical Help

INTUBATION  And VENTILATION

Preparation...

Intubation - Elective or Emergency

Elective: for patients undergoing GA

Emergency indications

Rapid Sequence Induction

The Essentials...

Monitoring - SPO2, BP, PR, ECG (Cardiac monitor)

Glove, Mask

Oxygen Source

Ambu-bag with mask/GA Machine/Endotracheal Tube/Laryngoscope/Different blade size (Mac 3-4 adult/Mac 2 for paediatrics). McCoy blade/Bougie if anticipated difficult airway/Glidescope

Drugs: Resuscitation, Opioid, Induction agent, Relaxants

make sure...

Oxygen source: wall, tank, GA Machine

Suction: Yaunker and suction tube, suction apparatus functioning

Airways: oropharyngeal airway or nasopharyngeal airway

Laryngoscope with functioning light bulb

Endotracheal tube of approriate sizes(7.5/8 for male, 7-7.5for female, 6.5-7 for gravid women/ Age/4 +4 for children with one size smaller and bigger as standby)

Lubricating jelly, Syringe 10-20mls

Good assistants

Tip and Tricks

Securing ETT

plaster - trouser like

string tie

Reason-risk of dislodgement

Male-20-23cm

Female-18-21cm

Paediatric-Age/2+12

Airway Physical Exam

Assessment of possibility of difficult airway;

Obesity

Short Neck

Large tongue

Loose teeth/Buck teeth

Poor mouth opening-<2FB

Limited neck movement

Beard

Receding chin/Small chin

The 4Ds of Difficult Intubation

Distortion: laryngeal oedema, blood, vomitus, tumour mass, abscess

Dysmobility of joints: TMJ, atlanto occipital, suspected cervical trauma on hard collar

Disproportion: thyromental distance <6cm, Mallampati scoring

Dentition: buck teeth

Mallampati Classes

Class 1: Faucillar pillars, soft palate, uvula

Class 2: Faucillar pillars, soft palate

Class 3: Soft palate

Class 4: Soft palate not seen

Positioning during intubation

Positioning...

Cricoid Pressure

How to perform intubation

Endotracheal Suctioning...

Importance

The proper method

Type of endotracheal suctioning - Open, Closed

Setting Ventilator... the basic

Contents

History

Basic Physiology

Pressure Control

Volume Control

Ventilators...

History...

“ … an opening must be attempted in the trunk of the trachea, into which a tube of reed or cane should be put; you will then blow into this, so that the lung may rise again … and the heart becomes strong…”

                                                 Andreas Vesalius (1555)

First description of positive pressure ventilation.

Took 400 years to apply on patient care.

Respiratory System...

a balloon connected to a tube

balloon = elastic element                  (lungs and chest wall)

tube = the resistive element (conducting airways)

Ventilation Simplified

Respiratory Pump = Mechanical Ventilator

Generate sufficient pressure to overcome both the resistance and compliance of the lung to allow gas exchange between the environment and the pulmonary capillary bed

Indications for Mechanical Ventilation

inadequate ventilation to maintain pH(raised CO2)

inadequate oxygenation

excessive breathing workload

congestive failure

circulatory shock

Goals of Mechanical Ventilation

Maintain appropriate levels of partial pressure of O2 and CO2 in arterial blood

Unload/reduce the workload of the ventilatory muscles

Protect the lung from overdistention and recruitment-derecruitment injury

Main Determinants

Mean Airway Pressure

refers to the mean pressure across the entire respiratory cycle, both inspiration and expiration

The most obvious method of increasing the pressure is to increase the tidal volume, this also will increase the PEAK and PLATEAU airway pressure. High risk of ventilator induced lung injury

Prolonging the Inspiratory Time increase the mean pressure

Inspiratory Time

Set as

% of respiratory cycle

I:E ratio

Expiratory time not set

remaining time after inspiration before next breathing

Increased inspiratory time

improved oxygenation

unnatural

increase risk of gas trapping

PEEP

-Increasing the FRC

-Re-inflating atelectatic lung areas and recruitment of collapsed alveoli

-Optimizing the V/Q ratio

-Reducing the right-left shunt

-Avoiding end expiratory alveolar collapse

Standard Parameter

Following settings are for all patients admitted into ICU for mechanical ventilation unless stated otherwise by doctor in charge of ICU

Mode: SIMV (Volume) or SIMV (Pressure 10-20)

Rate: 8-12 breaths/min

Tidal Volume(amount of air delivered for each breath: 6-10mls/kg

PBW Males= 50 + 2.3 [height (inches) - 60]

Females= 45.5 + 2.3 [height (inches) -60]

Start with fiO2 1.0 and titrate down with serial ABGs

Oxygen toxicity (eg. pulmonary fibrosis) does not usually occur if a FiO₂ of 1.0 is used for < 24 hours.

 The goal is to keep PaO₂ within 83-100 mmHg or SaO₂ within > 92% (try to avoid FiO₂ > 60%)

FiO₂ requirement can further be reduced by adding PEEP (positive end-expiratory pressure)

PEEP                                 :           5 - 20 cmH₂O.

 As a result, FiO2 can be kept at a minimum to avoid oxygen toxicity.

 In some situations higher levels of PEEP may be required but unless indicated levels of 5cmH2O is deem adequate.

FiO₂/PEEP Combination

Pressure Support

10cmH₂0

Helps decrease patient's work of breathing.

 A level of 10cmH₂O is deem necessary to overcome the ventilator circuit resistance (e.g. the demand valves that are triggered open with each breath, and the resistance of breathing through the small diameter of the endotracheal tube).

 Adequacy of pressure support (PS) can actually be gauge by increasing PS by 1 - 2 cmH₂O while assessing patient comfort and  RR < 30 or normal TV (500mL) is achieved.

Keep PS < 35 to avoid barotrauma and hemodynamic compromise secondary to a decrease in cardiac output.

Inspiratory:Expiratory

During spontaneous breathing, the normal I:E ratio is 1:2, indicating that for normal patients the exhalation time is about twice as long as inhalation time.

If exhalation time is too short “breath stacking” occurs resulting in an increase in end-expiratory pressure also called auto-PEEP.

Depending on the disease process, such as in ARDS, the I:E ratio can be changed to improve ventilation

Sensitivity - Trigger

When pressure triggering is used, a ventilator-delivered breath is initiated if the demand valve senses a negative airway pressure deflection (generated by the patient trying to initiate a breath) greater than the trigger sensitivity.

When flow-by triggering is used, a continuous flow of gas through the ventilator circuit is monitored. A ventilator-delivered breath is initiated when the return flow is less than the delivered flow, a consequence of the patient's effort to initiate a breath

Peak Flow Rate: 50 LPM, max flow delivered by ventilator during inspiration

Alarm Parameters: +/- 20% set parameters

Humidification: Activate

Ideal Breath Types of Mechanical Ventilation

synchronize with patient’s spontaneous breathing effort

maintain adequate & consistent VT & VE at low airway pressure

responds to rapid changes of pulmonary mechanics or patient’s demand

provide lowest possible work of breathing

Basic Classification:

Control:

Volume Controlled: Volume limited, volume targeted and pressure variable

Pressure Controlled: Pressure limited, pressure targeted and volume variable

Volume Control: Adv

Constant flow rate

Guaranteed tidal volume delivered

Variable peak pressure is dependent on the compliance of the lung

Less atelectasis

Precise control of PaCO2

Volume Control: Disadv

Pressure variable & difficult to control

Resultant high peak pressure: barotrauma, volutrauma, acute lung injury

Uneven distribution of ventilation

Increased muscle workload

Flow rate may not match demand

Pressure Control: Adv

Constant inspiratory pressure

Decelerating variable inspiratory flow rate-improved gas exchange

Improves gas distribution & reduce work of breathing

Better tolerance, less sedation needed

More homogenous ventilation

Reduction of peak pressure and risk of barotraumas

Pressure Control: Disadv

Variable tidal volume sec to changes in lung compliance & resistance-hypoventilation

Potentially excessive tidal volume as compliance improves

SIMV ( Synchronized Intermittent Mandatory Ventilation )

Mandatory breaths are delivered at set rate with VC or PC in synchrony with patient’s inspiratory effort

If no inspiratory effort detected, the ventilator delivers a mandatory breath at the scheduled time.

Between mandatory breath, patient is allowed to breath spontaneously.

Spontaneous breaths – pressure support

CPAP ( Continuous Positive Airway Pressure )

Spontaneous breathing mode: no mandatory breath delivered

Most commonly used mode to evaluate extubation readiness

Trouble Shooting

Patient

Machine

9 Spices for Super Health : Online Medical Help

There is no doubt that spices enhance the flavor and aroma of the food, but there are several that can also contribute to the overall health of our body. Some accelerate metabolism, others reduce cholesterol levels, and still others manage stress, as well as being powerful antioxidants with natural healing ability. Here then the seven major beneficial properties:


GINGER

If your muscles are sore after a hard workout at the gym, you may want to add a little ginger fresh or ground in food. A search of the University of Georgia has shown that daily consumption of ginger face decline of 25% muscle pain from exercise during the day. It is a spice -inflammatory that also helps against stomach ache and the common cold. Eating quotidiamente the ginger bread also soothes the pain caused by arthritis.

CINNAMON

This spice contains fiber, calcium, iron and manganese, reduces bad cholesterol and helps help maintain balance in the levels of sugar in the blood. It is said to work miracles for mood swings, reducing anxiety and stress . It also improves memory and attention.

TURMERIC

Used in Indian dishes, is known as detoxifying the liver and anti-inflammatory. It is a natural antibacterial agent, used to disinfect cuts and burns but it is also a powerful antioxidant and can slow the progression of Alzheimer's disease.

OREGANO

Dr. Bazilian considers oregano a mini salad because "one teaspoon has as much antioxidant power as three cups of chopped broccoli (but don't ditch the broccoli – have both!)." Oregano is among the highest in antioxidants of the dried herbs.

SAFFRON

Helps fight depression and is beneficial for the eyes . An Australian research has shown that saffron may help women with menstrual cramps.

CUMIN

A teaspoon of ground cumin provides a 4 milligrams of iron , contributing to the prevention of anemia. Cumin improves digestion and sleep and its antiseptic properties, in combination with vitamin C and iron, they help to strengthen the system immune . Rich in vitamin E, it tends to keep the skin healthy.

CAYENNE PEPPER 

Give energy and speeds up the metabolism, making a valuable contribution in weight loss. The cayenne pepper boosts the immune system and two teaspoons provide 47 percent of the daily value of vitamin A . So the next time you have a stuffy nose, we assume the cayenne pepper that will relieve nasal congestion .

CLOVE

For a long time the cloves are used to fight infections, colds and bacteria, as well as to relieve cough and help heal the toothache . This spice is also used to soothe sore throats and asthma but also helps prevent gas and bloating.

ROSEMARY

Rich source of antioxidants and anti-inflammatory compounds- these are thought to help boost the immune system and improve blood circulation. Laboratory studies have shown rosemary to be rich in antioxidants, which play an important role in neutralizing harmful particles called free radicals. Rosemary is a good source of iron, calcium, and vitamin B6. It is typically prepared as a dried whole herb or a dried powdered extract, while teas and liquid extracts are made from fresh or dried leaves.

What other spices that are good for health? let's share ...

Benefits of Roselle : Online Medical Help

The roselle (Hibiscus sabdariffa) is a species of Hibiscus native to the Old World tropics, used for the production of bast fibre and as an infusion. It is an annual or perennial herb or woody-based subshrub, growing to 2–2.5 m (7–8 ft) tall. The leaves are deeply three- to five-lobed, 8–15 cm (3–6 in) long, arranged alternately on the stems.

The flowers are 8–10 cm (3–4 in) in diameter, white to pale yellow with a dark red spot at the base of each petal, and have a stout fleshy calyx at the base, 1–2 cm (0.39–0.79 in) wide, enlarging to 3–3.5 cm (1.2–1.4 in), fleshy and bright red as the fruit matures. It takes about six months to mature. 

The scientists from University Kebangsaan Malaysia (UKM) found certain varieties of roselle to contain high levels of organic acid called hydroxycitric acid (HCA) which is currently used in some weight loss products and supplements. This finding has added further value to the fruit which is already known to be rich in both vitamin C and anthocyanins (potent antioxidants).

Although the potential of HCA as a weight lowering compound has been recognised since 1970s, few clinical studies have been conducted with this compound. These few studies resulted in both positive and negative results, the negative ones are most likely due to HCA being poorly available in the cytosol of a target cell. Better HCA compounds, such as potassium HCA, are being developed to address this, i.e. to further improve the bioavailablity and the efficacy of HCA.

In any case roselle is already known as a health drink due to its high contents of vitamin C and anthocyanins (antioxidants). Vitamin C and anthocyanins found in roselle juice or tea drink are good for our health and can increase the level of resistance of our body to diseases. In some countries roselle is becoming increasingly popular for health purposes, for example its leaves and fruits are claimed to be effective in controlling high blood pressure.

Roselle, or Rosella Fruit, or Binomially speaking Hibiscus Sabdariffa. This annual or perennial herb is one of the species of Hibiscus. The fruit of Roselle plant become mature in about six months and that is when it gets beautiful bright red color. While still immature, this plant can have whitish or yellowish colors with a dark reddish spot at the bottom of each petal. The stem of the Roselle plant is cultivated for the production of Bast Fiber or Skin Fiber which is then used to make burlap (Woven Fabric, Gunny Cloth, or Coarse Fabric).

Roselle plant has been and still is considered as an AntiHypertensives (used to treat hypertension or high blood pressure), Mild Laxative (used to induce bowel movements), and Diuretic (used to elevate the rate of urination to treat drug overdose or poisoning). The Red Calyces or Sepals of this plant are used by some countries for food colorings, for flowers, for syrups, for jams, or for many different kinds of drinks. And the green leaves of Roselle can be used for salads, for curry, for teas, for lotions, for wounds, and for sores.

So, the Nutrients in one cup (57 grams) of Raw Roselle Plant without any refuse are:

- Vitamin A
- Vitamin B2, Riboflavin
- Vitamin B3, Niacin
- Vitamin C
- Protein
- Calcium
- Iron
- Magnesium
- Phosphorus
- Potassium
- Sodium
- Natural Fats
- Carbohydrates
- Calories

According to these Nutrients we can come up with these Health Benefits of Roselle Plant:

Vitamin C:
- Improves wound healing
- Prevents cells from damages
- Improves gums health
- Improves teeth health
- Improves Immune System
- Protects from free radicals
- Reduces Aging
- Lowers Risks of some Cancers
- Improves Iron absorption
- Improves Lung health
- Prevents from frequent colds
- Protects from frequent infections

Calcium:
- Maintains healthy bones
- Improves nerve function
- Improves muscle function
- Supports Healthy blood clotting
- Reduces feet tingling
- Reduces hand tingling
- Lowers chance of retardation in children
- Reduces chance of bone deformities
- Reduces feet numbness
- Reduces hand numbness
- Improves teeth health 

Assessment Of Nervous Emergencies : Online Medical Help