An aortic dissection occurs when blood tears the inner layer of the aorta, separating it from the middle layer. It is classified by location and timing of symptoms. Risk factors include hypertension, connective tissue disorders, and family history. Treatment depends on location but may include surgery, endovascular stent grafting, or medical management of blood pressure. Prognosis depends on type and treatment, with mortality rates declining with advances in surgical and endovascular techniques.
CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
Kindly leave your comment if you found this helpful ;)
Some of the slides, i hide it from my real presentations for my own reference. Download to see all of them.
CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
Kindly leave your comment if you found this helpful ;)
Some of the slides, i hide it from my real presentations for my own reference. Download to see all of them.
commonly used for medical students, and helpful to use this ppt to study for them, and also a common man can understand very easily what is coarctation of aorta.
Neha diwan presentation on aortic aneurysmNEHAADIWAN
An aortic dissection is a serious condition in which a tear occurs in the inner layer of the body's main artery (aorta).Aortic rupture is when all the layers of the aorta wall tear, causing blood to leak out from the aorta often due to a large aortic aneurysm that bursts. This will stop blood being pumped around the body and is life threatening. Ideally an aortic aneurysm will be repaired before a rupture can occur.
Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiot...Crimsonpublisherssmoaj
Acute type A aortic dissection is a catastrophic event in which blood exits the vascular lumen and dissects the media, creating a false lumen. Surgery is the best possible treatment but it is complex. The surgical team needs to understand the anatomy and physiopathology before dealing with the repair. While there are just a few surgical solutions for the repair of the dissected ascending aorta, debate is still ongoing about the best surgical option for the disease involving the arch and the descending aorta. Late reoperations are relatively common on the aortic valve and/or the distal aorta after primary repair. Results are excellent in specialized centers with high volume and complexity. Lifelong follow-up is required in survivors.
Fatal Condition of Aortic Dissection Produces Symptoms of Sudden and Tearing ...semualkaira
Aortic dissection is a very difficult condition in which the inner
sheath of the aortic wall is torn without tearing the outer sheath.
This causes blood to enter the aortic wall through the tear, which
further splits the mediastinum and creates a new channel in the
aortic wall. The serious and often fatal condition of aortic dissection produces symptoms of sudden and tearing chest pain. Although aortic dissection mostly occurs in people around the age of
60, the peak incidence in people with Marfan syndrome is between
20 and 40 years of age.
Fatal Condition of Aortic Dissection Produces Symptoms of Sudden and Tearing ...semualkaira
Aortic dissection is a very difficult condition in which the inner
sheath of the aortic wall is torn without tearing the outer sheath.
This causes blood to enter the aortic wall through the tear, which
further splits the mediastinum and creates a new channel in the
aortic wall. The serious and often fatal condition of aortic dissection produces symptoms of sudden and tearing chest pain. Although aortic dissection mostly occurs in people around the age of
60, the peak incidence in people with Marfan syndrome is between
20 and 40 years of age.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
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Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
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Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
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Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
2. INTRODUCTION
Aortic dissection is a serious condition in which there
is a tear in the wall of aorta.
Aortic dissection is the surging of blood through a tear
in the aortic intima with separation of the intima and
media and creation of a false lumen (channel).
During an aortic dissection the inner layer of aorta
tears, letting blood in where it usually doesn’t go.
This causes the inner and middle layers to separate,
or dissect.
If the blood bursts through the outer wall of aorta, it’s
life-threatening and needs immediate repair.
3. It occurs when blood enters the medial layer
of the aortic wall through a tear or penetrating
ulcer in the intima and tracks along the media,
forming a second blood-filled channel within
the wall.
4.
5. DEFINITION
Aortic dissection is the tearing
in the innermost lining of the
arterial wall of aorta that
allows blood to enter between
the intima and media , thus
creating a false lumen.
6. INCIDENCE
Aortic dissection affect men 2 to 5 times
more often than women.
Occurs most frequently in the sixth and
seventh decades of the life.
8. DEBAKEY CLASSIFICATION
SYSTEM
type I: involves ascending and
descending aorta (= Stanford A)
type II: involves ascending aorta only
(= Stanford A)
type III: involves descending aorta
only, commencing after the origin of
the left subclavian artery (= Stanford
B)
9. STANFORD SYSTEM
TYPE A: A affects ascending aorta and arch
accounts for ~60% of aortic dissections & start before left
subclavian artery.
surgical management
may result in:
coronary artery occlusion
aortic incompetence
rupture into pericardial sac with resulting cardiac tamponade
TYPE B: B affects descending aorta.
accounts for ~40% of aortic dissections
dissection commences distal to the left subclavian artery
medical management with blood pressure control
10.
11.
12.
13. BASED ON SYMPTOM ONSET
Acute(First 14 days).
Subacute( 14-90 days).
Chronic( greater than 90
days)
14. Approximately two third of dissections involve
the ascending aorta and are acute in onset.
Chronic dissections are almost type B.
15. ETIOLOGY
There are numerous factors that will increase the
risk of aortic dissection. Some factors are :
Chronic Hypertension.
Atherosclerosis, or hardening of the aortic walls
Hypercholesterolemia
Rare: traumatic injury to chest area( Blunt or
Iatrogenic).
Sex. Men have about double the incidence of
aortic dissection.
Connective tissue disorders( Marfan’s or
Ehlers-Danlos) Syndrome.
16. Age. The incidence of aortic dissection peaks in the
60s and 70s.
Cocaine use.
Aortic diseases( aortitis, coarctation ).
A history of aortic aneurysm
Family history
Congenital heart disease( Bicuspid aortic valve)
History of heart surgery
Pregnancy
High-intensity weightlifting
17. Chronic Hypertension usually degenerate
elastic fibers in the arterial wall.
Half of the all acute aortic dissections in
patients younger than 40 years of age occur in
patients with Marfan’s syndrome.
20. CLINICAL MENIFESTATIONS
Severe chest pain often described as a tearing,
ripping or shearing sensation, that radiates to the
neck or down the back. It occurs in 80% of
patients with acute Type A aortic dissection.
Pain in the back, abdomen or legs . It occurs
more in clients with Type B aortic dissection.
Shortness of breath
Sudden difficulty speaking, loss of vision,
weakness, or paralysis of one side of body, such
as having a stroke.
Sweating
21. Neurological deficits : Altered level of
consciousness, weakened or absent carotid and
temporal pulses and dizziness or syncope( If
aortic arch involved)
Type A aortic disscetion: There is angina, M.I. A
new high pitched murmur sound. In severe
cases left sided heart failure, cardiogenic shock,
death.
Subclavian artery is involved radial, ulnar,
brachial pulse may be different the left and right
arms.
22. COMPLICATIONS
Cardiac tamponade.
Aortic rupture leads to hemorrhage into the
mediastinal, pleural or abdominal cavities.
Spinal cord ischemia.
Renal failure due to renal ischemia.
Abdominal ischemia.
Death due to internal bleeding.
Aortic regurgitation & Stroke.
23. DIAGNOSTIC EVALUATION
Health history.
Physical examination.
ECG may rule out cardiac ischemia.
Chest X ray may show widening of mediastinum
and pleural effusion.
CT scan & MRI provide information on severity
of aortic dissection.
Magnetic resonance angiography.
Transesophageal echocardiography : when
patient is very unstable or when CT & MRI are
contraindicated.
24. MANAGEMENT
. An aortic dissection is a medical emergency
requiring immediate treatment. Therapy may
include surgery or medications, depending on the
area of the aorta involved.
The initial goals of therapy without complications are
heart rate and BP control
General measures includes:
1) Bed rest.
2) ICU hospitalization.
3) Blood transfusion (if needed)
25. PHARAMACOLOGICAL
MANAGEMENT
I.V. Beta blocker(esmolol) to lower Blood
pressure & heart rate.
Calcium channel blockers(diltiazem) can
be used to lower heart rate when beta
blockers are contraindicated.
Morphine reduces pain through
decreasing sympathetic nervous system
stimulation.
26. CONSERVATIVE THERAPY
The patient with acute or chronic Type
B aortic dissection without
complication can be treated through:
1) Pain relief.
2) BP and Heart rate control.
3) CVD risk factor modification
4) Close surveillance imaging with CT or
MRI.
29. ENDOVASCULAR
DISSECTION REPAIR(EVAR)
It is indicated for acute & chronic
type B aortic dissection . Two
procedures are recommended under
these endovascular treatment:
A. Thoracic endovascular aortic
repair(TEVAR).
B. Endovascular Fenestration.
30. THORACIC ENDOVASCULAR
AORTIC REPAIR(TEVAR)
TEVAR or stent grafting is a minimally
invasive treatment for an aortic dissection.
A cloth-covered stent graft is used to seal
the tear in the aorta.
One or more uncovered stents may be
added to support and expand the true
lumen in order to improve blood flow to
your abdominal organs, pelvis and legs.
31. Complications are Major or minor stroke (up
to 5–7% of cases); insufficient blood supply to
the spinal cord, which can lead to leg paralysis
(up to 3%), and extension of the dissection (up
to 3%).
36. OPEN SURGICAL REPAIR
Indications of open surgery are:
I. Acute type A aortic dissection.
II. Chronic dissection with connective
tissue disorder.
III. A descending thoracic aortic diameter
greater than 5.5 cm.
37.
38. Once surgeon has found the tear, he or
she will use man-made (synthetic) grafts
to replace the damaged parts of the aorta.
If r aortic valve is damaged, surgeon may
also put in a replacement valve.
When surgeon has made all of the repairs,
he or she will remove the heart bypass
machine and close incision.
39. Surgeon will make a cut (incision) in
chest or belly (abdomen). The exact spot
will depend on where dissection is
located.
A heart bypass machine will take over
pumping blood around heart and lungs.
40.
41. NURSING DIAGNOSIS
Ineffective tissue perfusion related to
compromised arterial blood
flow secondary to blood extravasation via
aortic dissection.
42. NURSING INTERVENTION
Continuously monitor arterial BP during acute
phase to evaluate the patient’s response to
therapy.
Monitor hourly urine output because a drop in
output may indicate renal artery dissection or a
decrease in arterial blood flow.
Continuously monitor ECG for dysrythmia
formation, ST segment or T-wave changes,
suggesting coronary sequelae or a decrease in
arterial blood flow.
43. Assess neurologic status to evaluate the
course of dissection. Confusion or changes in
sensation and motor strength may indicate
compromised cerebral blood flow (CBF).
Auscultate for changes in heart sound
and signs and symptoms of heart failure,
which may indicate that the dissection involves
the aortic valve.
Compare BP and pulses in both arms and legs
to determine differences.
44. PROGNOSIS
About 20% of patients with aortic dissection die before
reaching the hospital. Without treatment, mortality
rate is 1 to 3%/h during the first 24 h, 30% at 1 wk,
80% at 2 wk, and 90% at 1 yr.
Hospital mortality rate for treated patients is about
30% for proximal dissection and 10% for distal. For
treated patients who survive the acute episode,
survival rate is about 60% at 5 yr and 40% at 10 yr.
About one third of late deaths are due to
complications of the dissection; the rest are due to
other disorders.
45. PREVENTION
Control blood pressure.
Don't smoke.
Maintain an ideal weight.
Wear a seat belt.
Work with your doctor: If Patient has
family history of aortic dissection or
bicuspid aortic valve.