00:00:00 intro
00:02:00 PROF MICHELLE CHEW -BASIC PHYSIOLOGY
00:18:00 CASE PRESENTATION
00:45:00 DISCUSSION
Understanding Blood Pressure and Flow
Prof Michelle Chew discussed the importance of understanding both blood pressure and flow in cardiovascular physiology, emphasizing that both are necessary for optimal perfusion. She explained that perfusion pressure is determined by mean arterial pressure minus outflow pressure, which varies depending on the body part. She also highlighted the significance of cardiac output in oxygen delivery to tissues. The meeting was briefly interrupted due to technical issues with the presentation slides, which were eventually resolved. No questions were raised during the discussion.
Organ Perfusion, Blood Flow, and Monitoring
Michelle discussed the principles of organ perfusion and blood flow, focusing on stroke volume, cardiac output, and the determinants of these factors. She emphasized the importance of assessing cardiac output, not just in numbers, but in response to treatments and fluid responsiveness. Michelle also highlighted the role of echocardiography in assessing cardiac contractility and preload, and the challenges of measuring afterload and venous return. She stressed the importance of monitoring central venous pressure (CVP) and the potential adverse effects of fluid infusion, such as lung edema and increased intra-abdominal pressure. Michelle concluded by mentioning the utility of various methods, including the tidal volume challenge, in assessing fluid responsiveness and the balance between oxygen demand and delivery.
CASE
Michelle initiated a discussion about a case . DR Ahmed presented a case of a patient, Mr. John, who was admitted to the emergency department with a five-day history of lethargy, fatigue, and abdominal pain. Ahmed discussed the patient's medical background, including type 2 diabetes, hypertension, and his current condition. Ahmed also shared the patient's clinical parameters, blood test results, and the actions taken in the intensive care unit. The discussion aimed to understand the patient's condition and the possible causes, with Ahmed emphasizing the importance of asking questions about the patient's condition, such as "what's happening, and why is it happening?"
Hypovolemia, Pneumothorax, and Hemodynamic Monitoring
Ahmed discussed a patient's clinical condition, focusing on the possibility of hypovolemia or pneumothorax. He mentioned the patient's heart rate and blood pressure, noting a swing in the latter. Ahmed also discussed the use of advanced hemodynamic monitoring, such as stroke volume variation, to assess the patient's volume status. Michelle asked about the patient's intubation status, and Dr. Bansal suggested that the patient might be fluid responsive based on the stroke volume variation. However, Michelle cautioned against interpreting this without considering the patient's acidosis and spontaneous breathing, which could generate negative intrathoracic pressures.
Medical Parameters and Fluid Management
Ahmed discusses various medical parameters and measurements related to fluid management, hemodynamics, and respiratory function. He mentions assessing fluid responsiveness through techniques like fluid challenges and monitoring indicators like pulse pressure variation, extravascular lung water, and cardiac output. Ahmed also talks about adjusting ventilator settings like tidal volume and considering interventions like raising the head of the bed to optimize respiratory function. The discussion covers the importance of evaluating these parameters to guide clinical management.
Balancing Demand and Consumption in Health
Ahmed discussed the balance between demand and consumption, emphasizing the importance of understanding the context of these factors. He highlighted the need to consider the impact of increased demand or new oxygen availability, as well as reduced or tear of improvement. Ahmed also touched on the potential for elevated or normal Venus sizes, and the importance of monitoring cardiac function and overall health, particularly in patients with sepsis. He stressed the need for a thorough clinical examination and the use of surrogate markers, while also cautioning against relying solely on these tools.
Clinical Examination and Hemodynamic Monitoring
In the meeting, Ahmed discussed the importance of clinical examination over hemodynamic monitoring and the balance between oxygen delivery and consumption. He also emphasized the need to ask why something is happening during a clinical examination. Michelle added that the diastolic blood pressure can be a useful indicator of vasoplegia, and that fluid responsiveness should not be assessed using blood pressure. She also highlighted the importance of vigilance in diagnosing sepsis in postoperative patients and managing fluid balance to prevent acute kidney injury.
Информация по комментариям в разработке