Medical Concepts

 IV DRUG THERAPY- SELECTION OF EQUIPMENTS AND INSERTION OF CATHETER Equipment: Canula selection: Select cannula based on purpose and duration of use and age of patient. Consider risk of infection and extravasation. Cannula made from polyurethanes are associated with decreased risk of phlebitis. Steel needles have higher risk of extravasation and should be avoided where tissue necrosis is likely if extravasation occurs.       2. Skin Prep: Antiseptic solution, use an aqueous based alternative if there is a known allergy to alcohol.       3. Other Equipment: Intravenous solution as ordered, torniquet, giving set, IV stand/pole, infusion pump, transparent occlusive dressing, tape or similar to secure cannula, gloves, paper bag.       4. Additional Equipment which may be required: Syring (5mL), sterile sodium chloride 0.9%, local anesthetics (in children), 3-way tap or triflow, short extension tube. Selection Of the Catheter Site: Generally speaking, the vein section with the straightest a

 INTRAVENOUS THERAPY Definition: "Intravenous therapy or IV therapy is the giving of liquid substances into vein".  It can be intermittent or continuous; continuous administration called an Intravenous drip.  The word intravenous simply means "within vein" but is most commonly used to refer to IV therapy. Compared to other routes of administration, the intravenous route is the fastest way to deliver fluids and medications throughout the body. Some medications, as well as blood transfusions and lethal injections can only be given intravenously. The simplest form of intravenous access is a syringe with an attached hole in needle. The needle is inserted through the skin into a vein, and the contents of the syringe are injected through the needle into the bloodstream. This is easily done with an arm vein, especially one of the metacarpal veins. Usually, it is necessary to use a constricting band first to make the vein bulge; once needle is in place, it is common to dra

 DRUG-INDUCED HEPATOTOXICITY "Hepatotoxicity is the injury or liver damage caused by exposure to certain drugs, when taken in overdoses and sometimes when administered at therapeutic ranges, may injure the organ". Drug-induced hepatotoxicity is also referred to as the Drug-Induced Liver Injury (DILI). Physiological functions of liver: Formation and sensation of bile. Nutrient and vitamin metabolism (amino acid, lipid). Detoxification and inactivation of various substances (toxin drugs). Synthesis of plasma proteins (Albumin, clotting factors). Immune systems (Kupffer cells). Hepatotoxicity is most prevalent in older patients especially in those with pre-existing hepatic impairment. The few examples of drugs that cause hepatotoxicity are listed below: 1. ACE Inhibitors: Hepatic injury occurs occasionally with ACE-Inhibitors. Captopril and Enalapril are implicated in most reported cases, but others also have similar hepatotoxic potential. Most cases show cholestatic injury, b

 DRUG-INDUCED OCULOTOXICITY Occasionally, non-specific blurred vision occurs with almost all the drugs. The drugs listed below are associated with a specific pattern of drug-induced oculotoxicity when administered systemically: 1. Allopurinol: Despite the discovery of Allopurinol in cataractous lenses taken from patients on long term (>2 years) therapy, there is no clinical evidence for an increased risk of cataracts in allopurinol-treated patients. 2. Beta-Adrenergic Blocking Agents: A reduction in tear production occurs, which can produce a hot, dry, gritty sensation in the eyes. This is rapidly reversible with drug discontinuation. 3. Contraceptives, (Oral): A variety of retinal vascular disorders have been occurred due to oral contraceptives, but the association remains unproved. Some oral contraceptives users cannot tolerate contact lenses, possibly because of ocular edema or dryness. However, a prospective study failed to show any difference in lens tolerance between oral cont

  LIVER AND THE COMPLICATIONS ASSOCIATED WITH THE PROGRESSION OF DISEASE! Liver: The liver weighs up to 1.5kg in adults and is the 2nd largest organ in the body. Hepatocytes are the functioning unit of liver. Impairment of liver may lead to: Acute liver diseases Chronic liver diseases Liver cirrhosis Acute Liver Disease (ALD): ALD is a self-limiting episode of hepatocyte damage which in most cases spontaneously without clinical sequelae, but acute liver failure (ALF) may develop. This is a rare condition in which there is a rapid deterioration in liver function with associated encephalopathy and coagulopathy. ALF carries significant morbidity and mortality and may require emergency liver transplant. Chronic Liver Disease (CLD): CLD occurs when the longstanding cell damage causes permanent structural changes within the liver, with the loss of normal liver structure and functions. In many cases, this may lead to cirrhosis where fibrosis sears divide the liver cells into areas of regenera

SUPPURATIVE PNEUMONIA (ASPIRATION PNEUMONIA) AND PNEUMONIA IN IMMUNOCOMPROMOISED PATIENTS  SUPPURATIVE PNEUMONIA Definition: "Suppurative pneumonia is characterized by destruction of the lung parenchyma by inflammatory process and although microabscessation formation is characteristic histological feature, pulmonary abscess" is usually taken to refer lesion which is a large, localized collection of pus or a cavity lined by chronic inflammatory tissue from which pus has escaped by rupture into bronchus". Etiology: Inhalation of septic material during operations on the nose, mouth, throat under general anesthesia Bulbar Vocal cord palsy Esophageal reflux Alcoholism Infecting Organism: Bacterioder melaninogenicus Anaerobic/microaerophilic cocci B. fragilis S. aureus (most common) K.pneumoniae S.pneumonia. *Leimerres Syndrome is a rare cause of pulmonary abscesses. Usually, causative agent is F.secrophorum . Illness signs include sore throat, painful swollen neck, fever, ri

 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

 PNEUMONIA Definition: "Pneumonia is an infection of pulmonary parenchyma". (Harrison)                                                    OR "Pneumonia is defined as an acute respiratory illness associated with recently developed radiological pulmonary shadowing which may be segmental, lobar or multilobar". (Davidson) Etiology: Microorganisms gain excess to the lower respiratory tract in several ways: Aspiration from the oropharynx (most common). Inhalation of contaminated droplets. Hematogenous spread. Contiguous extension. Pathophysiology of Pneumonia: Pneumonia results from proliferation of microbial pathogens at the alveolar level and the hosts response to these microorganisms.  Defensive Mechanisms against Pneumonia: The defensive mechanism against pneumonia involve: Branching architecture of tracheobronchial tree. Muco-ciliary clearance. Local antibacterial factors. Gag Reflex. Cough mechanism. Normal flora adhering to mucosal cells of oropharynx. Alveolar mac

 DRUG-INDUCED NEPHROTOXICITY Drug-Induced Nephrotoxicity is increasingly recognized as a significant contributor to kidney disease including Acute Kidney Injury (KI) and chronic kidney disease (CKD). Nephrotoxicity has a wide spectrum, reflecting damage to different nephron segments based upon individual drug-mechanisms. 1. ACE-INHIBITORS: ACE-Inhibitors are frequently associated with Proteinuria and Renal Insufficiency. The prevalence of Proteinuria in Captopril treated patient is estimated to be 1%. The risk of Renal Insufficiency is greater with long-acting ACE Inhibitors such as Lisinopril or Enalapril than with Captopril. Immune complex glomerulopathy is a major contribute to ACE Inhibitor nephrotoxicity. Predisposing factors include: Hyponatremia Diuretic therapy Pre-existing renal impairment Congestive Heart Failure (CHF) Diabetes Mellitus Recovery of renal function usually follows ACE-Inhibitor discontinuation. 2. CEPHLOSPORIN: The cephalosporin antibiotics are capable of pro