0.88 CME

आपातकालीन स्थिति में हृदयाघात और उसका प्रबंधन

वक्ता: डॉ.विशांत शर्मा

मैक्स सुपर स्पेशियलिटी हॉस्पिटल गुरुग्राम में आपातकालीन चिकित्सा

लॉगिन करें प्रारंभ करें

विवरण

 In recent years, significant advances have been made in the treatment of rheumatoid arthritis (RA), a chronic autoimmune disease that primarily affects the joints. These advancements have revolutionized the management of RA, providing new hope and improved outcomes for patients. Biologic drugs have emerged as a game-changer in RA treatment. These medications specifically target molecules and pathways involved in the immune response, such as tumor necrosis factor (TNF), interleukin-6 (IL-6), and Janus kinase (JAK) enzymes. Biologics have shown remarkable efficacy in reducing inflammation, slowing disease progression, and improving overall joint function. The concept of personalized medicine has gained prominence in RA treatment. Genetic testing and biomarker analysis help identify specific characteristics and disease mechanisms in individual patients. This information enables physicians to tailor treatment strategies, selecting the most appropriate medications and dosages for each person, leading to better outcomes. In cases where joint damage is severe and non-responsive to medical therapy, surgical interventions have also seen advancements. Joint replacement surgeries, such as total hip or knee replacements, have become increasingly sophisticated and durable, relieving pain and restoring mobility for individuals with advanced RA.

सारांश

  • Acute Coronary Syndrome (ACS) involves an imbalance between myocardial oxygen supply and demand, often due to coronary artery blockage. Symptoms include central chest pain or pressure, radiating pain, shortness of breath, and diaphoresis. Subtypes include unstable angina, NSTEMI, and STEMI, diagnosed using ECG and biomarkers.
  • Unstable angina presents as new or worsening chest pain, especially at rest. Diagnosis involves biomarkers and ECGs, though ECGs may be normal. STEMI shows ST segment elevation on ECG. Differential diagnoses for chest pain include aortic dissection, pulmonary embolism, and perforated ulcer.
  • Initial ACS management focuses on rapid assessment, ECG, and immediate pain relief. Treatment includes oxygen, aspirin, and nitroglycerin, with considerations for blood pressure and contraindications. Invasive or conservative strategies are chosen based on patient risk factors.
  • Cardiac arrest results from a sudden cessation of heart pumping, leading to unresponsiveness and absent pulse and breathing. Rapid intervention is critical, as survival rates decrease significantly with each minute of delay.
  • CPR begins with CAB (circulation, airway, breathing), emphasizing uninterrupted chest compressions. Defibrillation is used if required. Airway management includes head-tilt-chin-lift and potentially airway devices. Proper ventilation involves high-flow oxygen and appropriate breath rate.
  • High-quality CPR involves compressions at a rate of 100-120 per minute with adequate depth and full chest recoil. Scene safety is paramount. AEDs automate defibrillation. It's essential to differentiate between shockable (VF, VT) and non-shockable rhythms.
  • Drug therapy in cardiac arrest includes epinephrine (1mg every 3-5 minutes) and amiodarone or lidocaine for persistent VT/VF. Five Hs (hypovolemia, hypoxia, hydrogen ion excess, hypo-/hyperkalemia, hypothermia) and 5Ts (tension pneumothorax, tamponade, toxins, thrombosis) reversible causes are identified during ongoing resuscitation.
  • Team dynamics in cardiac arrest emphasize coordinated roles, with a team leader, nurses for airway management and medication, and trained personnel for chest compressions. Post-ROSC care involves ECG, avoiding overheating, and transport to facilities with cardiac catheterization.
  • Arrhythmia management priorities include CAB and determining if the patient is stable or unstable. Stable arrhythmias may not require treatment, while unstable arrhythmias necessitate immediate stabilization and expert consultation. Bradicardia treatment begins with identifying reversible causes atropin.

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