Medical Concepts

 HOSPITAL ACQUIRED PNEUMONIA Definition: "HAP refers to a new episode of pneumonia occurring at least 2 days after the administration to hospital. It is the most common Hospital Acquired Infection (HAI) and leading cause of HAI-associated death". Predisposing factors: Aspiration of nasopharyngeal secretion Bacteria introduced into the lower GIT. Bacteriaemia Old age Mode of Spread:  Droplet infection Infecting agent: Bacteria: S.pneumonia , S.aureus , H.influenza Virus: Adenovirus, Corona virus, Herpes Simplex Clinical Features: Purulent sputum New radiological infiltrates Temperature > 38 degree Celsius Leukocytosis Investigations: Chest Pain:  to confirm the diagnosis and exclude complication. Pulse Oximetry : to monitor response to oxygen therapy, if SaO2 < 93% features of sever pneumonia, identify ventilatory failure or acidosis. Cell count:  ESR, Neutrophil leukocytosis Microbiological studies:  for severe CAP and those that do not respond to initial therapy (Gr

 COMMUNITY-ACQUIRED PNEUMONIA Definition: "It indicates pneumonia occurring in a person in a community (outside hospital)". Predisposing factors: Cigarette smoking Upper GIT infection Alcohol consumption Corticosteroid therapy Old age (pneumonia also called as Oldman's friend) Recent influenzae Indoor air pollution Mode of Spread: Droplet infection Infecting agents: S.pneumoniae S.aureus H.influenza Viruses - Influenza, Measles, Herpes simplex. Parainfluenza Clinical Features: Pulmonary symptoms such as : Breathlessness, cough (non-productive or productive with sputum), hemolysis, pleuritic chest pain, shortness of breath. Systemic symptoms such as : fever with chills, rigors, tachycardia, vomiting, Decreased appetite, headache, fatigue. In elderly: new onset/ progressive confusion In severely ill : Septic shock, organ failure, tachypnea, percussion note dull to flat, bronchial breathing with crackles. Investigations: Chest Pain: to confirm the diagnosis and exclude com

 DRUG-INDUCED OTOTOXICITY What is drug Induced Ototoxicity? Drug-Induced ototoxicity can affect hearing (auditory or cochlear function0, balance (vestibular function) depending on the drug. Drugs of almost every class have been reported to produce tinnitus (sounds in ear), as have placebos. The following agents are associated with measurable changes in hearing or vestibular defect when administered systemically. 1. AMINOGLYCOSIDES: Aminoglycosides antibiotics can cause cochlear or vestibular toxicities. Cochlear toxicity: occurs as progressive hear loss, starting with highest tones and advancing to lower tones. Thus, considerable damage can occur before the patient recognizes it. S ymptoms of Vestibular damage : include;  Dizziness Vertigo Ataxia Both forms of ototoxicity are bilateral and potentially reversible, but permanent damage is common and can progress even after discontinuation of aminoglycosides. Clinically detectable ototoxicity in as many as 5% patients. Most aminoglycosid

 GASTROINTESTINAL DECONTAMINATION AFTER POISONING GI-decontamination can be achieved by the administration of: Activated Charcoal Gastric Lavage Ipecac-induced Emesis Whole-Bowel Irrigation Indication for GI-decontamination: Ingestion of a known toxic dose Ingestion of an unknown dose of a known toxic substance Ingestion of a substance of known toxicity * For all methods of GI-decontamination, the value of the procedure diminishes with time. Some investigators now question the usefulness of gastric lavage, or ipecac-induced emesis more than 1 hr after ingestion.* *In general, activated charcoal is the most useful agent for preventing absorption of ingested toxic substance. Other methods may be considered if the ingested substance is not adsorbed by activated charcoal or if circumstances do not permit its prompt  administration. * 1.Activated Charcoal: Activated charcoal is a non-specific absorbent that binds unabsorbed toxins within the GIT.  Activated charcoal is not effective for abs

  MEDICAL EMERGENCY- CARDIAC ARREST AND BASIC LIFE SUPPORT Definition: " Cardiac Arrest is a medical emergency requiring a systematic approach". Early recognition must be followed by prompt, effective application of Basic Life Support (BLS) techniques to sustain the patient until Advanced Life Support (ALS) capabilities are available. Management: The management of Cardiac Arrest is a 4-step approach: Recognition and Assessment BLS Advanced Cardiovascular Life Support (ACLS) Post-resuscitation Care 1. RECOGNITION AND ASSESMENT Verify that the respiration and circulation have ceased: Loss of consciousness Loss of functional ventilation (respiratory arrest or inadequate respiratory effort) Loss of functional perfusion (No pulse). 2. BASIC LIFE SUUPORT (BLS) The goal in cardiac arrest is the restoration of spontaneous circulation (ROSC). The first step towards achieving this ROSC goal is prompt initiation of BLS, where the goal is to rapidly and effectively perfuse the tissues wi

  MEDICAL EMERGENCY- ANAPHYLAXIS Definition: " Anaphylaxis is a systemic response to exposure to an allergen caused by rapid, IgE-mediatd release of histamine and other mediators from tissue mast cells and circulating basophils". Symptoms: Symptoms usually occur within a few seconds or minutes of exposure but can be delayed or recur many hours after apparent resolution (exposure). Causes: Upper airway obstruction Cardiovascular collapse are the most common causes of death in anaphylaxis. Treatment: The treatment of anaphylaxis is directed towards its three Major Presentations : Skin Manifestations: Angioedema, Urticaria Respiratory distress: Wheezing, Stridor, Dyspnea from laryngeal edema, laryngospasm and bronchospasm Hypotension All specific treatment measures should be accompanied by basic resuscitative measures including clear airway, supplemented oxygen and IV access. General Therapy and Skin Manifestations: 1. Epinephrine HCl, IM or SC, 0.3-0.5mg ; may repeat q(every)