#hbpm

[natb00]

Ronda Cx general:

Berta, 51 años.

Dx: Desnutrición proteicocalorica. Intestino corto. ***Falla intestinal Tipo III (Continuidad intestinal 70 cm de yeyuno + colon completo).

Tratamiento: NPT ciclada a 12 (el día de ayer) + enoxaparina 40 mg cada 12 horas + glargina 10 UI SC cada 24 h + Cristalina esquema de corrección + esomeprazol 20 mg cada 24 horas + metoclopramida 10 mg cada 8 horas.

Antecedentes personales:

Patológicos: trombosis venosa mesentérica superior con isquemia mesentérica aguda con necrosis segmentaria de yeyuno-íleon y válvula ileocecal con síndrome de intestino ultracorto desde Julio 2022 secundario, diabetes?, HTA, Desnutrición grave, sepsis de origen abdominal por isquemia mesentérica con peritonitis secundaria polimicrobiana: K. pneumoniae, E. coli, Enterococcus gallinarum y Candida albicans (julio 2022).

Quirurgicos: (05/07/2022) Lavado peritoneal y anastomosis yeyunocolonica, eventrorrafia (03/07/2022) Drenaje de peritonitis residual, resección de intestino delgado (queda cabo ligado con hiladilla), laparostomía doble bolsa (Queda con yeyuno 10 centímetros, transverso y descendente), Laparotomía, drenaje peritonitis, resección segmentaria intestino delgado, hemicolectomía derecha (cirugía control daño extremos ligados), abdomen abierto.

Alérgicos: niega.

Toxicológicos: niega.

Subjetivo: paciente refiere sentirse bien, logró conciliar sueño en la noche, tolerando líquidos por VO, diuresis y deambulación espontanea, deposiciones presentes. Refiere que no ha vuelvo a presentar episodios eméticos, mejoría de las nauseas.

EF: Paciente en buenas condiciones generales, estable hemodinamicamente, orientada en las 3 esferas mentales, colaboradora al momento del interrogatorio. Mucosas rosadas, anictéricas. Murmullo vesicular conservado sin sobreagregados. Abdomen blando, depresible, sin distensión, no doloroso a la palpación, sin signos de irritación peritoneal. Extremidades sin edema.

Paraclínicos: 25/08/2023: Cr 0.34, Sodio 139, Potasio 4.48, Hb 9.3, Hto 28.2, Plaq 243.000, Leucos 4800, Neu 1790. 23/08/2023: ALT 159, AST 183, Btotal 2. 08, Bdirecta 1. 46, Calcio 8. 1, Cloro 109. 1, Sodio 138, Potasio 5. 04, Cr 0. 44, FA 109, GGT 354, fOSFORO 4. 6. BUN 11. 9. Albumina 2. 5. Hb 8. 2, Hto 24. 4, Leucos N 2029.

Imágenes: 13/08/2023: TAC de abdomen con contraste: Cambios postquirúrgicos intestinales. No se identifican cambios obstructivos ni inflamatorios. No hay líquido libre ni neumoperitoneo. Hepatomegalia y esteatosis hepática difusa significativa. Quistes simples renales bilaterales.

Paciente de 51 años, hospitalizada en contexto de recuperación nutricional por desnutrición proteicocalorica por intestino corto (Falla intestinal Tipo III) secundario a trombosis venosa mesentérica superior con isquemia mesentérica aguda en julio del 2022. NPT ciclada a 12 horas. Paciente se encuentra en buenas condiciones generales, tolerando líquidos por VO, resolución de náuseas y episodios eméticos, deposiciones presentes. Hemoglobina de control del día de ayer estable. Pendiente concepto de grupo de soporte nutricional para definir plan de egreso con NPT ambulatoria.

****

Análisis y Plan de manejo: Mujer de 51 años con intestino corto (70 cm de yeyuno) por trombosis mesentérica que se diagnosticó en el HPTU julio 2022, en ese momento se fue con HBPM, ambulatoriamente fue evaluada por cirugia vascular en enero 2023 que hizo cambio a warfarina + ASA, los ac anti fosfolipidos fueron negativos. En casa fue dificil ajustar la dosis de warfarina, hacía INR supra con epistaxis e infraterapeuticos, al ingreso subterapéutico. Tuvo NPT ambulatoriamente que se suspendió porque logró recuperación nutricional, pero nuevamente perdió peso y está con intolerancia a la alimentación. Estuvo hospitalizada de abril a mayo en otro hospital por pérdida de peso e intolerancia a la alimentación, estudios endoscopicos normales.

Consideraciones por medicina interna -Anticoagulación con HBPM, iremos ajustando dosis a medida que aumente de peso. -Hiperglucemias con la NPT, por lo que se inició insulina basal. Ya está recibiendo 12 h en la noche con glucometrias en metas, por ahora sin cambios. Vigilaremos estrechamente porque antes hizo hipoglucemias.

Hemoglobina aumentó, ha estado con cifras tensionales limites bajas. Dejo controles para mañana incluyendo labs de hemólisis. Nueva evaluación por medicina interna mañana 26/08/23.

[penguinsomadagascar]

So I’ve been reading other people’s Madagascar headcannons. It’s fun, and interesting, and I try to be open to different ideas and ships. But I just can’t get behind any Kowalski related ships and I was wondering why...

But then I remembered...... a tpom fanfic I wrote back in high school.... where I Kowalski had a relationship with an OC... and I think she’s still my OTP for Kowalski... :/

Obviously I’m not valid here, that’s not the question.

What I’m wondering is if I should reread my 30k+ fanfic from 7 years ago. Good idea, bad idea?

[high-bpm]

#np # Daniel Kandi & Exolight - Remember (Summer With You) (Extended Mix) [Future Tendence] #Listen in @youtube @hearthis.at @mixcloud #trance #trancemusic #tranceenergy #trancefamily #trancelife #trancehits #dj #tranceislife #trancenation #tranceaddict #thisistrance #trance4life  #HBPM #progressive #summerhits #edm #summer #euphoric #puretrance #upliftingtrance #summerinthecity #vocaltrance #emotional_sens #melodictrance #topsummer #trancelovers #hïibiza https://www.instagram.com/p/BqnuaNFh4n7/?utm_source=ig_tumblr_share&igshid=14b77r3sxwns

[enfernal-by-rober]

Nuevo protocolo de administración de heparinas de bajo peso molecular para evitar transmisiones por contacto.

[marcopolorules]

"Cuando los fantasmas duermen, las nubes son blancas; vuelan despacio para no despertarlos. Los mecen y los llevan lejos. Cuando los fantasmas despiertan, las nubes se vuelven grises y se agazapan en el horizonte. Cuando los fantasmas se enfurecen, entonces las nubes se tornan negras, se agrietan y estallan."⠀ ⠀ "When ghosts sleep, the clouds are white; they fly slowly so as not to wake them up. They rock them and carry them away. When the ghosts awaken, the clouds turn gray and lurk on the horizon. When the ghosts are enraged, then the clouds turn black, crack and burst."⠀ ⠀ Ermilo Abreu Gómez⠀ & Welder Wings @welderwings (artists)⠀ ⠀ ⠀ #surrealportrait #surreal #surrealart #surrealism #surrealismartcommunity #popsurrealism #popsurreal #popsurrealist #lowbrowart #weirdart #lowbrowpopsurrealists #digitalcollageart #collageart #collagework #collageartist #surrealcollage #surrealismo #collageillustration #beautifulbizarre #darkart #darkartist #darksurrealism #gothicart #skull #skulls #skullart #vagabondwho #marcopolorules #jesuislesurrealisme #welderwings https://www.instagram.com/p/CQOi2o-HBpM/?utm_medium=tumblr

[mcatmemoranda]

The new guideline encourages physicians to confirm the diagnosis of hypertension and to titrate medication therapy through the use of out-of-office blood pressure readings. This can be achieved via either:

Ambulatory Blood Pressure Monitoring (ABPM) - formal 24-hour blood pressure measurements using a provider-provided device, or

Home Blood Pressure Monitoring (HBPM) - blood pressure readings taken by a patient at home.

The meta-analysis conducted for the 2017 guideline found that clinical trials of self-measured blood pressure led to a significant, but transient (six-month) improvement in SBP compared to patients having office-based blood pressure measurements5. While ABPM and HBPM are increasing in frequency, many existing practices do not have well-developed systems in place to implement this particular recommendation.

* For all groups, the target blood pressure is 130/80 mmHg

** Only consider medications for such patients with Stage 1 or 2 hypertension (i.e. BP >= 130/80)

[poonamcmi]

Can a tight Blood Pressure Monitoring Testing cuff cause a high reading?

If the cuff you're wearing is excessively tight, it could cause your skin to fold over and pinch. Not only that, but an ill-fitting cuff might cause error codes on your blood pressure monitor or inaccurate — and often dangerously high — blood pressure readings.

There are a few major cautions to HBPM, notwithstanding its importance as a preventive measure. It's impossible to measure the pressure of the entire body at once without running the danger of misdiagnosis. As a result, it's critical to pick a cuff size that fits comfortably around the arm. On the market, there are various different types of blood pressure monitoring testing equipment, each with its own set of benefits and drawbacks. A continuous Blood Pressure Monitoring Testing is the most prevalent. While a blood pressure monitor's accuracy is dependent on its precision, it can also be effective in preventing white coat hypertension. Blood pressure measurements taken in a doctor's office could be higher than those taken at home.

Read More @ https://cmiinfopiece.blogspot.com/2022/02/blood-pressure-monitoring-testing.html

[natb00]

B0951 - Yaqueline Astrid Martinez Molina (1589685).

Ronda Cx general.

Yaqueline, 42 años.

Dx:

Isquemia intestinal por trombosis venosa. **Trombosis aguda de la vena mesentérica superior + trombosis aguda de la vena porta. -Peritonitis bacteriana.

Trombofilia en estudio.

Deficiencia de vitamina B12.

Tratamiento:

Ciprofloxacina 400 mg cada 12 horas (FI 08/08/2023, Dia 3/5).

Metronidazol 500 mg cada 8 horas (FI 08/08/2023, Dia 3/5).

Enoxaparina 60 mg SC cada 24 horas.

Procedimientos:

04/08/2023: Laparotomía, resección de segmento intestino delgado, cabos ligados, abdomen abierto. ** Hallazgos operatorios: isquemia intestinal de aproximadamente 50 cms de intestino delgado a 90 cms de la valvula ileocecal por trombosis venosa, abundantes trombos en el meso del intestino delgado, congestión de asas de yeyunoterminal e ileon proximal

07/08/2023: Lavado peritoneal, anastomosis de intestino delgado a intestino delgado, eventrorrafia simple. ** Hallazgos operatorios: cavidad abdominal limpia, líquido seroso escaso, viabilidad de intestino en su totalidad, bordes de intestino delgado ligados, sin sangrado ni fugas.

Aislamientos:

05/08/2023: Líquido abdominal: Klebsiella variicola multisensible, Enterobacter hormaechei multisensible.

Antecedentes personales: Patológicos: EAP leve, higado graso? Farmacológicos: omeprazol 20 mg cada 24 horas, ACO. Quirúrgicos: niega. Tóxicos: alcohol ocasional, niega consumo de tabaco y sustancias psicoactivas. Alérgicos: niega.

S: paciente refiere pasar una buena noche, sin dolor, afebril, sin dificultad respiratoria, diuresis espontánea, tolerando dieta blanda y deambulación, no ha presentado nuevos episodios emeticos. Refiere sentir mejoría de la sintomatología. Ya presentó deposición.

EF: PA /, FC lpm, FR rpm, Sp02 % ambiente. Paciente alerta, orientada en las 3 esferas, colaboradora al momento de la evaluación. Cabeza y cuello: normocéfalo, escleras anictéricas, mucosas hidratadas. Tórax: expansible, simétrico, murmullo vesicular conservado en ambos campos pulmonares, sin agregados, ruidos cardiacos rítmicos, sin soplos. Abdomen: blando, distendido, leve dolor a la palpación generalizada, sin signos de irritación peritoneal, peristaltismo (+). Herida quirúrgica cubierta con apósitos. Extremidades: móviles, simétricas, sin edemas, pulsos periféricos conservados (++/++++) y simétricos, llenado capilar < 2 seg.

Paraclinicos:

09/08/2023: Calcio 7. 7, Cloro 107. 8, Sodio 140, Potasio 3. 24, Cr 0. 42, Mg 1. 74, BUN 5. 3.

08/08/2023: Calcio 7. 5, Cloro 109. 3, Sodio 140, Potasio 3. 28, PCR 19. 83. Hb 11. 9, Hto 34. 8, Plaq 335. 000. Leucos 8400. Neu 6552.

Imágenes:

04/08/2023: TAC de abdomen contrastado: Trombosis aguda de la vena mesenterica superior, trombosis aguda de la vena porta, isquemia mesentérica, ascitis, no hay signos de apendicitis aguda.

Análisis y Plan de manejo: Paciente de 42 años, en POP del 07/08/2023 donde fue llevada a lavado peritoneal, anastomosis de intestino delgado a intestino delgado y eventrorrafia simple, en contexto de isquemia intestinal por trombosis venosa (Trombosis aguda de la vena mesentérica superior + trombosis aguda de la vena porta). Paciente valorada en conjunto con medicina interna-vascular periferico quien define completar 6-12 semanas con HBPM, para luego pasar a warfarina de forma ambulatoria. El día de hoy encontramoa paciente estable hemodinamicamente, afebril, dolor controlado, tolerando dieta blanda, buena evolución, continuamos vigilancia.

[coolreviewnews]

Reason Why Most Men Die Suddenly During Sexual Act

Reason Why Most Men Die Suddenly During Sexual Act

Beyond the pleasure, Sex is an activity that is demanding physically, in other words, sex is a physicall activity. One thing u must do before any demanding physical activity is to check your blood pressure and your blood sugar, and HBPM, heart beat per minute. Before you carry out any physical activity, u need to prepare your body for it. Thats y u need to engage your body with light exercises…

[penguinsomadagascar]

Thanks for tagging me @just4penguins this is a fun little question thing! (All questions are made by just4penguins, and they all relate to the Madagascar fandom) Questions: What is your favourite movie: Madagascar 
What is your favourite TV series: The Penguins of Madagascar 
In Madagascar, what is your favourite scene: The scene where the penguins take over the boat 
In Madagascar 2, what is your favourite scene: the dance number at the beginning 
In Madagascar 3, what is your favourite scene: the circus performance with Firework playing 
In Penguins of Madagascar, what is your favourite scene: The prologue 
In The Penguins of Madagascar, what is your favourite episode: Brain Drain 
In All Hail King Julien, what is your favourite episode: I don’t remember. The coffee one from S1? 
In the Madagascar movies, who is your favourite character: Gloria 
In Penguins of Madagascar, who is your favourite character: Kowalski 
In The Penguins of Madagascar, who is your favourite character: Kowalski. Among minor characters, my favorites are Alice and Dr. Blowhole In All Hail King Julien, who is your favourite character: Maurice 
And last but not the least, what is your favourite day in the Madagascar Week 2017: Fanart Day!!!

[high-bpm]

https://plus.google.com/+EricksonFarias/posts/JdTR2Ssoasz?_utm_source=1-2-2

[beautifulstudentprince-blog]

Reason Why Most Men Die Suddenly During Sexual Act

Reason Why Most Men Die Suddenly During Sexual Act

Beyond the pleasure, Sex is an activity that is demanding physically, in other words, sex is a physicall activity. One thing u must do before any demanding physical activity is to check your blood pressure and your blood sugar, and HBPM, heart beat per minute. Before you carry out any physical activity, u need to prepare your body for it. Thats y u need to engage your body with light exercises…

[raysconsultancyservices]

#SIP #mutualfunds #financialgoals (at Mumbai, Maharashtra) https://www.instagram.com/p/CXyulO-hbPm/?utm_medium=tumblr

[vaikunthholidays]

at Delhi, India https://www.instagram.com/p/CUKZJd-hbpM/?utm_medium=tumblr

[blogkemenag]

Dalam rangka mensukseskan program #PrafromHome Kemenag, maka sampaikan sbb: 1. Bahwa besok Sabtu 10 Juli 2021 ada dilaksanakan Hening Cipta secara serentak se Nusantara oleh Kemenag tepat pada Jam 11.07 wita, selama 1 (satu) menit di tempat masing2. 2. Hening Cipta ini dimaksudkan sebagai permohonan Doa dengan mengetuk langit untuk keselamatan Bangsa dan kesehatan kita bersama agar Pandemi Covid19 ini berakhir. 3. Agar pelaksanaan Hening cipta ini massif dilakukan bersama, maka dimohon kepada kita semua untuk mengajak keluarga/handetolan/tetangga/masyarakat sekitar untuk ikut berpartisipasi bersama melakukan hening cipta. 4. Dimohon pelaksanaan hening cipta ini didokumentasikan dan diaplod di media sosial masing2. Demikian kami sampaikan, sebagai salah satu ikhtiar dan doa kita untuk mengetuk Yang Maha Pencipta agar kita tetap diberi kesehatan dan keselamatan, Pandemi ini Berakhir, Amin Wassalam Maros, Jumat 9/7/2021 Kepala Kemenag Maros Muh. Tonang https://www.instagram.com/p/CRG9c-hBPMs/?utm_medium=tumblr

[ganeshwalagaurav]

Home blood pressure monitoring and BP control-1

In a healthy person, blood pressure rises and falls throughout the day. But pressure higher than normal for a long time can damage health and cause health problems. In India, hypertension is poorly controlled and many hypertensive patients are living with a disability or affected with cardiovascular disease.

Current data suggest that efforts are needed to support self-monitoring in hypertensive patients because it plays important role in the management of hypertension along with medical therapy.

Why self-monitoring at home is needed?

Hypertension for a longer period can damage the heart, kidney, and brain. Patients with high blood pressure are at higher risk of complications like heart attack, heart failure, stroke, kidney failure, and many others. Hence to avoid these complications regular BP monitoring is very important. Some of the hypertensive patients check their blood pressure by visiting doctors. But, it is not always possible for patients to visit doctors and check-up their blood pressure. Hence, most often we advise patients to self-monitoring of their BP levels.

How self-monitoring can be done at home?

Firstly, understand the correct way to take a blood pressure reading. It can be done by using home blood pressure monitoring (HBPM) devices, typically known as sphygmomanometers. It records blood pressure across different points in a time outside of a clinical or community setting, mainly at home.

A blood pressure reading involves two numbers as 120/80 mmHg for a normal healthy person:

(1) The top number 120 indicates systolic blood pressure; it is the pressure in the blood vessels when the heart beats.

(2) The bottom number 80 represents diastolic pressure; it is the pressure in the blood vessels when the heart rests between the beats.

The blood pressure level for a hypertensive person is 140/90 mmHg. If a person has greater BP than this, then he/she might be at risk of developing heart diseases. Blood pressure varies during the day: it is highest after waking for short time and lowest at night. Therefore, when comparing results, it is important to compare readings that were taken at the same time of day.

Benefits of self-monitoring

Self-monitoring helps a person to measure BP at different times throughout the day and over a longer period. It also assists a doctor to get a more complete picture of a person’s blood pressure readings at different times. It can better predict cardiovascular morbidity and mortality rather than single, routine blood pressure measures that occur during a clinical visit. Let me brief some more benefits of home blood pressure monitoring.

Avoiding false diagnosis

Ø Research involving 24-hour ambulatory blood pressure monitoring indicates that most people experience two peaks in their blood pressure each day, typically between 6 and 8 AM and later between 5 and 8 PM.

Ø Blood pressure is typically elevated by 30 to 50 mmHg during these peak periods.

Ø Some patients with early hypertension may only experience higher blood pressure during one of the peak periods.

Ø Because these peak periods fall outside of normal schedules of doctor’s appointment times, could go without a diagnosis.

Ø Thus, self-testing provides the opportunity to measure BP during these peak periods and helps the doctor identify early-onset hypertension.

Identifying white coat hypertension

Ø Some of the individuals experience higher BP, when in a medical setting due to the stress of being in the doctor’s clinic or hospital.

Ø Self-testing is an effective way to rule out such type of situational high blood pressure known as “white coat hypertension”.

Ø At-home testing helps to identify the situational elevation in BP, and also helps to track daily blood pressure readings.

Monitoring treatment outcomes

Many individuals experience various symptoms when dealing with hypertension. Regular monitoring at home practically helps to create a baseline for such symptoms and provides valuable information regarding treatment outcomes which help doctors in drug and dosage adjustment.

Observing complications and emergency treatment

Home-based monitoring can also help in detecting complications and delivering needed emergency treatment. Individuals with hypertension may suffer from different complications, including diabetes, heart disease, hyperlipidemia, kidney disease, hyperthyroidism, etc. If the hypertensive patient is present with such other complications, then strict BP control is required. For example, If a person has general hypertension, then needs to regulate blood pressure at 140/90mmHg; however, if the hypertensive person also has diabetes or kidney disease, then needs to control at 130/80mmHg levels.