National Integrated Medical Association
Pathardi Branch

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This Month's CME


MANAGEMENT OF POISONING CASES AT GENERAL PRACTITIONER LEVEL

While practicing in rural   area we have to counter poisoning cases many times. May it be accidental or suicidal timely & proper intervention can save many lives. For that we should know proper management of poisoning cases i.e. ABC OF POISIONING MANAGEMENT.

                We should know the concept of TOXIDROMES, common procedures in poisoning management & DO'S & DO NOT'S at GP level.

in this article we will study detailed aspects of poisoning managagement. Let us first see/download the slide show

APPROACH TO A PATIENT  WITH POISONING & SNAKE BITE on SLIDEWORLD

 

Let us see  now the video clipping of NASO GASTRIC INTUBATION

 

Now  read/download the PDF on slde world : ABC OF POSIONING MANAGEMENT

I think you have understood the topic, always remember we are treating patient as PRIMARY CARE PROVIDERS..

Always remember our limitations & enhance your knowldege. This will  save LIVES..

Thanx..

DR.SURESH AVHAD

SHOCK:Dr.B.B.Sheikh,Nandurbar

 SHOCK:Dr.B.B.Sheikh,Nandurbar

INTRODUCTION

Shock is a state of severe systemic reduction in tissue perfusion characterized by decreased cellular oxygen delivery and utilization as well as decreased removal of waste byproducts of metabolism. Hypotension, although common in shock, is not synonymous to shock. One can have hypotension and normal perfusion, or shock without hypotension in a patient who is usually very hypertensive. Shock is the final preterminal event in many diseases. Progressive tissue hypoxia results in loss of cellular membrane integrity, a reversion to a catabolic state of anaerobic metabolism, and a loss of energy-dependent ion pumps and chemical and electrical gradients. Mitochondrial energy production begins to fail. Multiple organ dysfunction follows localized cellular death, and organism death follows. Despite recent advances in treatment, mortality remains high: >60% in cardiogenic shock and >35% in septic shock

PATHOPHYSIOLOGY OF SHOCK

One method of evaluating shock is to recall the determinants of systemic blood pressure. Blood pressure is determined by the formula BP = systemic vascular resistance (SVR) × cardiac output (CO), where CO = heart rate (HR) × stroke volume (SV). SV = end diastolic volume (EDV)-end systolic volume (ESV). EDV is the filled ventricular volume prior to systolic contraction averaging about 100 cc in many adults. ESV is residual blood left in the ventricle after emptying during systole averaging about 40 cc. Therefore, the determinants of blood pressure are vascular resistance, HR, preload volume, and contractility (see Figure 9-1). SVR is the vascular "tone" and is a large determinant of diastolic blood pressure. EDV is largely determined by a preload volume that augments SV via Frank-Starling curves where increases in diastolic filling volumes increase CO. ESV is determined largely by cardiac contractility and it decreases as the heart ejects a greater percentage of its diastolic volume. For example, one can increase SV by increasing preload (EDV) with volume or decreasing ESV with increased contractility. The ejection fraction ((EDV - ESV)/EDV) thus increases

The initial derangement precipitating a state of shock might be (1) vasodilation (causing a decreased SVR) from sepsis, anaphylaxis, drugs, or cervical cord lesion, (2) extremes of HR, (3) loss of preload volume (causing decreased EDV) from blood or volume loss, or (4) loss of contractility (increasing the ESV) from heart failure. Compensatory mechanisms come into play and provide many of the clinical clues to early shock

The initial insult of vasodilation from loss of SVR generally causes a compensatory tachycardia and thirst. Despite systemic tissue hypoxemia, the skin remains perfused and is warm initially. Blood or fluid loss (decreasing EDV) causes a reflex increase in SVR, which increases diastolic BP, narrowing the pulse pressure; increases sympathetic cholinergic sweating; and makes the patient pale, thirsty, and cool. As

volume loss increases, tachycardia and hypotension ensue. Loss of contractility also is compensated by increases in SVR to maintain blood pressure with similar symptoms

Once compensatory mechanisms fail, irreversible shock occurs with irreversible cell death, microcirculation plugging, and free radical generation. There is loss of autonomic regulation due to local nitric oxide vasodilator generation, and even with complete correction of blood volume (for example, in hypovolemic shock), tissue function and organ function are not restored, causing eventual death 

CLASSIFICATION OF SHOCK

The major classical classification of shock includes (1) hypovolemic, (2)cardiogenic, (3)distributive, and (4)obstructive shock.

For details of shock, Defination,Types,Patho-Phisiology & Management Click Here 

Dr.B.B.Sheikh,

President,

NIMA NANDURBAR

ASTHMA MANAGEMENT

Allergic bronchial asthma both in adults & pediatrics is prevalent in India. General practitioner have key role in diagnosis & management of asthma in proper way.

The slide-shows & videos will help to understand the underlying patho-phisiology  of asthma & help general practitioners to diagnose the asthma and manage it properly.

Proper management & patient education is key to asthma treatment, & that will encourage the patient to live healthy lives

Click the following links for complete understanding of the subject

Asthma Management Slide Show

Asthma Management Video

Real Deal With Asthm-Video

More On Asthma

DR.YOGIRAJ DESHMUKH

BAMS,PGCEMS

EMERGENCY MEDICINE : BASICS OF AIRWAY MANAGEMENT

AIRWAY IS VERY IMPORTANT IN BASIC LIFE SUPPORT(BLS) & ADVANCED LIFE SUPPORT(ACLS)

BASICS OF AIRWAY MANAGEMENNT

 

KNOW BASICS OF ECG INTERPRETATION

ECG BASICS & INTERPRETATION OF RHYTHM

ON WORLD HEART DAY-

WHAT WILL YOU DO WHEN YOU SUFFER FROM HERAT ATTACK WHEN ALONE

www.slideworld.org/viewslides.aspx?link=http://www.globalhealthandfitness.com/HeartAttack.pps

VERY USEFUL PRESENTATION FOR PATIENT EDUCATION IN MARATHI BY DR.PRADIP TALWALKAR

 FOR RECENT MEDICAL EDUCATION MATERIAL CONTACT

FOR MORE SLIDE SHOWS VISIT

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