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Lessons from CRITICOEN.pptx

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Lessons from CRITICOEN.pptx

  1. 1. Tips on using my ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. 7. See notes for bibliography.
  2. 2. CRITICON2017 •
  3. 3. CRITICON2017 • CRITICON2017 was held in Raipur on 24th and 25th of June 2017
  4. 4. Topics Covered
  5. 5. Topics Covered 1. Acute Pancreatitis. 2. Antibiotic use dos and donts 3. Ventilators 4. Sepsis update2016 5. Fluid resuscitation 6. Management of ARDS 7. ECMO 8. Hyponatremia 9. Brain trauma 10. Diabetic ketoacidosis 11. ARDS
  6. 6. Diabetic ketoacidosis
  7. 7. Diabetic ketoacidosis Triad of • Ketosis • Hyperglycemia • Acidosis – IV Fluid Only NS – Give Sodabicarb only if pH is <6.9 – Insulin- Plain 0.1 units/kg/hour infusion – Potassium if <3.3 mEq/l. hold insulin first give KCL 20-30 mEq/hour.
  8. 8. Save You Kidneys
  9. 9. Save You Kidneys • E-Book by Dr. Sanjay Pandya
  10. 10. Acute Pancreatitis.
  11. 11. Acute Pancreatitis. • Autodigestion of pancreas • Presents as acute abdomen with raised Amylase and Lipase. • Treat with analgesics and RL/NS • Early enteral feeding • PPIs, octride and antibiotics are not indicated. • Use antibiotics only proven infection
  12. 12. Sepsis update2016
  13. 13. Sepsis update2016 • SIRS term is dropped. • Only two terms- – Sepsis – Septic shock. • SOFA (Sequential Organ Failure Assessment)Score • BP <100 • GCS <15 • Respiratory rate >22 2 of 3 +nt + infection – Sepsis Need for Vasopressors/Lactate >2 – Septic Shok
  14. 14. Sepsis update2016 Management • RL 30ml/kg. in 3hours. • Multiple blood cultures • 7-10 days antibiotic
  15. 15. Sepsis update2016 Management • Vasopressors Preferred • Nor Ad>Vasopressin>Adrenaline>Phenylnephri ne • Dopamine not useful. • No Steroids, Parenteral nutrition,FFP,immunoglobulins
  16. 16. ARDS
  17. 17. ARDS • Severe Hypoxemia + BL Patchy shadows • Berlin definition 1. Timing- Within 1week 2. Imaging 3. Origin of oedema 4. Oxygenation PF ratio.
  18. 18. ARDS • Pathophysiology damaged oedematous alveolar membrane leads to BABY LUNG. • Causses 1. Sepsis 2. Trauma 3. Aspiration 4. Pneumonia 5. TRALI-Transfusion Related Lung Injury
  19. 19. Management of ARDS
  20. 20. Management of ARDS 1. Treat the cause- don’t wait for ARDS to resolve. 2. Supportive care- 1. Prone position 2. Early invasive ventilatory support. 3. Low tidal volume 4 -6 ml./Kg. 4. Pharmacological support. sedatives and neuromuscular blockade,
  21. 21. IV Fluids in Critical Care
  22. 22. IV Fluids in Critical Care • Use only Crystalloids ( Albumin is better in septic shock). • Use only RL unless contraindicated- – Raised ICP – Hepatic dusfunction – Renal failure. – Hyperklemia is not contraindication for RL
  23. 23. ECMO
  24. 24. ECMO • Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is an extracorporealtechnique of providing both cardiac and respiratory support. • This intervention has mostly been used on children, but it is seeing more use in adults with cardiac and respiratory failure.
  25. 25. ECMO: Indications
  26. 26. ECMO: Indications • Criteria for the initiation of ECMO include acute severe cardiac or pulmonary failure that is potentially reversible and unresponsive to conventional management.
  27. 27. ECMO: Results
  28. 28. ECMO: Results • A registry of patients that have received ECMO is maintained by the Extracorporeal Life Support Organization (ELSO). The last publication of ELSO registry data reported outcomes on nearly 51,000 patients with 75% survival for neonatal respiratory failure, 56% survival for pediatric respiratory failure, and 55% survival for adult respiratory failure
  29. 29. ECMO:Contraindications
  30. 30. ECMO:Contraindications • Conditions incompatible with normal life if the person recovers • Preexisting conditions that affect the quality of life (CNS status, end-stage malignancy, risk of systemic bleeding with anticoagulation) • Age and size • Futility: those who are too sick, have been on conventional therapy too long, or have a fatal diagnosis.
  31. 31. ECMO:Types
  32. 32. ECMO:Types • There are several forms of ECMO, • The two most common are- – Veno-arterial (VA) – Veno-venous (VV).
  33. 33. Antibiotic use dos and donts
  34. 34. Antibiotic use dos and donts Dos • Use in susceptible established infection. – Fever/hypothermia – Tachycardia – Leukocytosis/Leukopenia • Use higher antibiotics only if indicated by culture & sensitivity tests.
  35. 35. Antibiotic use dos and donts Don’ts • Elective post operative patient • Abscesses • Viral fever • Diarrhoea, dysentery • Burns • Ureteric colick • Abdominal pain • Acute and chronic pancreatitis. • Open wounds.
  36. 36. Antibiotic use dos and donts Don’ts • Stitch abscess • Breast lump • Mastalgia • Anal fissure • Hemorrhoids • Cesarean section, hysterectomy, normal delivery, episiotomy
  37. 37. Get this ppt in mobile 1. Download Microsoft PowerPoint from play store. 2. Open Google assistant 3. Open Google lens. 4. Scan qr code from next slide.
  38. 38. Get this ppt in mobile
  39. 39. Get my ppt collection • https://www.slideshare.net/drpradeeppande/ edit_my_uploads • https://www.dropbox.com/sh/x600md3cvj8 5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl =0 • https://www.facebook.com/doctorpradeeppa nde/?ref=pages_you_manage

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