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Laryngoscopy may damage teeth erectile dysfunction natural remedies diabetes buy line malegra dxt plus, particularly the upper front incisors erectile dysfunction and causes purchase genuine malegra dxt plus, if they are used as a fulcrum on which to erectile dysfunction medication risks order malegra dxt plus 160 mg with mastercard lever the laryngoscope. It is safer to remove a loose tooth deliberately because, if dislodged by accident, it may be inhaled and result in a lung abscess. Peripheral nerves Certain peripheral nerves, such as the ulnar nerve at the elbow, may be damaged by prolonged pressure. Tourniquets, if used, must be carefully applied with padding and must never be left inflated for more than 90 minutes as ischaemic nerve damage may occur. Make sure that the surgeon or assistant is not leaning on the chest wall or upper abdomen. Steep, head-down positions restrict movement of the diaphragm, especially in obese patients, and controlled ventilation may therefore be necessary. If a patient is placed in the prone position, insert pillows under the upper chest and pelvis to allow free movement of the abdominal wall during respiration. Beware of inflammable skin cleaning solutions that can be ignited by surgical diathermy. To prevent diathermy burns, apply the neutral diathermy electrode firmly and evenly to a large area of skin over the back, buttock or thigh. If other electrical apparatus is in use, beware of the risk of electrocuting or electrically burning the patient. Hypothermia Keep unconscious patients as warm as possible by covering them and keeping them out of draughts. Most general and regional anaesthetics cause skin vasodilatation, which increases heat loss from the body. Hypothermia during anaesthesia has two harmful effects: It increases and prolongs the effects of certain drugs, such as muscle relaxants By causing the patient to shiver during the recovery period, it increases oxygen demand, leading to hypoxia. The term "monitoring" has been extended to mean "actively looking for abnormal patient events". In other words, the major part of this job lies with the person doing the measurement who must actively seek the information. In the past 20 years, more technological progress has been made in the field of monitoring during resuscitation and anaesthesia than in most other fields of medicine. These developments have made it possible to conduct a case almost without laying a hand on the patient, yet remain informed of the pulse, blood pressure, respiration, oxygen saturation, skin temperature or other physiological change. However, the prohibitive training and equipment costs involved (both in capital outlay and maintenance) to sustain this advanced technology mean that anaesthetists in the developing world will usually not have more than the basic traditional monitoring tools (blood pressure cuff and stethoscope) with perhaps the chance of a pulse oximeter if they are lucky. Thus, the sensory system of the anaesthetist him/herself becomes the most important monitoring device. It is a fundamental rule in anaesthesia that you must never leave your patient unattended. Such a person fails to act logically to react to changes, and is undoubtedly the greatest hazard for the patient under anaesthesia. Sophisticated monitoring devices sometimes act as a distraction to an anaesthetist who would do a better job with a manual blood pressure cuff and a finger on the pulse. It is usually more important to look at the patient than the equipment but the alert anaesthetist pays constant attention to both. Expand this space outward so that it meets and interacts with the equivalent zones of other people in the operating room and you communicate with them. Sometimes two or more anaesthetists organise themselves into a "group anaesthetist" to conduct anaesthesia, perhaps for a difficult case. This can be very dangerous for the patient because, firstly, no one person is in charge and, secondly, communications within the group may be poor. It is often necessary to have one or more assistants for a case, but remember that there must always be only one person in charge of anaesthesia. If, for example, the blood pressure is found to be low and halothane is on 3%, the person taking the blood pressure should inform the anaesthetist in charge who then decides what to do about it, rather like the captain of a ship who ultimately has responsibility for that ship. If the person in charge goes off duty while the patient is still on the table, he or she must hand over to another person in charge.

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The dorsal and lateral borders of the posterior process serve the insertion of the dilator laryngeus muscle erectile dysfunction medication muse cheap malegra dxt plus on line. The caudal surface has an oval impotence quad hoc malegra dxt plus 160 mg free shipping, concave condyle which articulates with the condyle of the cricothyroid cartilage impotence curse purchase malegra dxt plus once a day. The medial border i s concave and forms the border of the posterior limb of the glottis. The apices of the arytenoid cartilages a r e covered by thickened fibrocartilaginous plugs of connective tissue. These plugs, which a r e not discrete cartilages, perfect the closure of the glottis. Ligaments of Larynx the ligaments of the larynx may be divided into intrinsic and extrinsic groups. One of these membranes, the aryepiglottic fold, is composed of two layers of epithelium separated by a thin layer of fibroelastic connective tissue. It extends from the lateral border of the arytenoid cartilage to the lateral border of the epiglottic. The other, the cricothyroid membrane, is a thin sheet of fibroelastic connective tissue connecting the lateral limbs of the dorsal cricothyroid from the level of the third tracheal ring to the arytenoid cartilage. The third intrinsic ligament, the articular capsule, is a continuous membrane encircling the articulation of the arytenoid with the cricothyroid cartilage. It controls the position of the larynx in relation to that of the hyoid apparatus. Muscles of Larynx In lizards there a r e two pairs of muscles that function in the larynx. Its fibers pass anterolaterally, fan out, and insert into the dorsolateral part of the posterior process of the arytenoid cartilage. Some of these fibers traverse the fibers of the constrictor muscle, both dorsally and laterally, to insert into the anterior process of the arytenoid cartilage. Its fibers extend laterally around the cartilage, follow the semilunar groove and the dorsal surface of the arytenoid cartilage, and insert with their fellows into the dorsal mid-line raphe. It lies in the mid-line ventral to the pharynx and in the lower cervical region ventral to the esophagus. Covering it ventrally a r e the posterior parts of the hypohyal cartilage, the hyoid body, and both second ceratobranchial cartilages with their attached sternohyoideus and omohyoideus muscles. Lying lateral to the trachea, usually on the right, though occasionally on both sides, is the tracheal vein; on the left, a t the caudal end of the cervical region, a r e the ultimobranchial bodies. In the mid-cervical region, the thyroid gland lies across the ventral surface of the trachea; the inferior laryngeal nerve and the laryngotracheal artery lie along its lateral surface. It extends ventrally from the larynx to the body of the hyoid bone, turns dorsad to the esophagus, and then caudad into the thorax. The trachea is formed of a s e r i e s of complete cartilaginous rings, linked together by fibroelastic membranes. At the larynx the rings a r e circular; however, in the c e r vical region they a r e dorsoventrally flattened. The blood supply to the trachea is through the laryngotracheal and glossopharyngeal arteries. It is lined by mucous membrane which is characterized throughout by parallel longitudinal folds. The folds a r e confined to the epithelium and the lamina propria and cannot be reduced by stretching. The pharynx is covered by a thin layer of circularly arranged smooth muscle which increases in thickness toward the esophagus. The last attachments of the pharynx to the skull a r e on the coronoid process of the mandible ventrally and on the transverse processes of the pterygoid and ectopterygoid dorsally. Ventrally the pharynx lies on the trachea and hyoid musculature, and dorsally it i s continuous in the mid-line with the pyriform r e c e s s and the auditory space.

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Cultural imposition - tendency to erectile dysfunction drugs from canada order malegra dxt plus 160mg line impose your beliefs impotence means malegra dxt plus 160mg mastercard, values erectile dysfunction no xplode buy 160mg malegra dxt plus amex, and patterns of behavior on individuals from another culture 5. Space between the paramedic and the patient is important and varies among different cultures a. Social distance (1) 4 to 12 feet (2) Used for impersonal business transactions, perceptual information much less detailed (3) Much of a patient interview will occur at this distance d. Vital signs a) Heart rate 100 to 160 beats per minute during first 30 minutes (1) (2) Settling around 120 beats per minute b) Respiratory (1) Rate (a) Initially 40 - 60 (b) Dropping to 30 - 40 after first few minutes of life (c) Slowing to 20 - 30 by one year (2) Tidal volume (a) 6 - 8 mil kg initially Increasing to 10 - 15 mil kg by 1 year (b) c) d) 2. Blood pressure (1) Average systolic blood pressure increases from 70 at birth to 90 at 1 year Temperature ranges (1) 98 to 100 degrees Fahrenheit is the thermoneutral range 3. Immune system a) Passive immunity retained through the first 6 months of life b) Based on matemal antibodies Nervous system a) Movements (1) Strong, coordinated suck and gag (2) Well flexed extremities (3) Extremities move equally when infant is stimulated b) Reflexes (1) Moro reflex (2) Palmar grasp (3) Sucking reflex (4) Rooting reflex Fontanelles c) (1) Posterior fontanelle closes at 3 months (2) Anterior fontanelle closes between 9 to 18 months (3) Fontanelles may provide an indirect estimate of hydration Sleep d) (1) Initially sleeps 16-18 hours per day with sleep and wakefulness evenly distributed over 24 hours. Gradually decreases to 14-16 hours per day with 9-10 hour concentration at (2) night (3) Sleeps through the night at 2-4 months (4) Normal infant is easily arousable Musculoskeletal system a) Bone growth (1) Epiphyseal plate - length (2) Growth in thickness occurs by deposition of new bone on existing bone Is influenced by (3) (a) Growth hormone (b) Genetic factors (c) Thyroid hormone (d) General health b) Muscle weight is about 25% in infants Dental system a) Teeth begin to erupt at 5-7 months Growth and development in infants a) Rapid changes over first year (1) 2 months (a) Tracks objects with eyes (b) Recognizes familiar faces (2) 3 months (a) Moves objects to mouth with hands Displays primary emotions with distinct facial expressions (b) (3) 4 months (a) Drools without swallowing (b) Reaches out to people (4) 5 months Sleeps throughout night without food (a) (b) Discriminates between family and strangers United Stated Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 3 Preparatory: 1 Life Span Development: 10 B. Family processes - reciprocal socialization Scaffolding a) b) Attachment c) Trust versus mistrust d) Secure attachment 2. Temperament - infants may be a) Easy child b) Difficult child c) Slow to warm-up child 3. Situational crisis - parental separation reactions a) Protest b) Despair Withdrawal c) 6. Vital signs a) Heart rate (1) Toddlers - 80 to 130 beats per minute United Stated Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 4 Preparatory: 1 Life Span Development: 10 b) c) 2. Cardiovascular system a) Capillary beds better developed to assist in thermoregulation b) Hemoglobin levels approach normal adult levels 4. Pulmonary system a) Terminal airways continue to branch b) Alveoli increase in number 5. Renal system a) Kidneys are well developed in toddler years b) Specific gravity and other urine findings similar to adults 6. Immune system a) Passive immunity lost, more susceptible to minor respiratory and gastrointestinal infections b) Develops immunity to common pathogens as exposure occurs 7. Nervous system a) Brain 90% of adult weight b) Myelination increases cognitive development c) Development allows effortless walking and other basic motor skills d) Fine motor skills developing 8. Elimination patterns a) Toilet training (1) Physiologically capable by 12 to 15 months (2) Psychologically ready between 18 and 30 months (3) Average age for completion - 28 months 11. Sensory a) Visual acuity - 20/ 30 during the toddler years b) Hearing - essential maturity at 3 to 4 years Psychosocial 1. Cognitive a) Basics of language mastered by approximately 36 months, with continued refinement throughout childhood b) Understands cause and effect between 18-24 months c) Develops separation anxiety - approximately 18 months d) Develops magical thinking - between 24 and 36 months 2. Play (2) Preschoolers - 80 to 120 beats per minute Respiratory rate (1) Toddlers - 20 to 30 (2) Preschoolers- 20 to 30 Systolic blood pressure (1) Toddlers -70 to 100 mmHg (2) Preschools - 80 to 110 mmHg Temperature - 96. Exploratory behavior accelerates Able to play simple games and follow basic rules Begin to display competitiveness Observation of play may uncover frustrations otherwise unexpressed relationships Sibling rivalry First born children (1) Usually maintain special relationship with parents (2) Expected to exercise self-control and show responsibility in interacting with younger siblings Peer group functions a) Children about the same age and maturity levels b) Provide a source of information about the outside world and other families Become more important to the child throughout childhood c) Parenting styles and its effect on children 6. Vital signs a) Heart rate - 70 to 110 beats per minute b) Respiratory rate - 20 to 30 c) Systolic blood pressure - 80 to 120 mmHg d) Temperature - 98. Bodily functions a) Most reach adult levels during this period b) Lymph tissues proportionately larger than adult c) Brain function increases in both hemispheres d) Loss of primary teeth and replacement with permanent teeth begins B. Families a) Children allowed more self regulation United Stated Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 6 Preparatory: 1 Life Span Development: 10 2. Vital signs a) Heart rate - 55 to 105 beats per minute b) Respiratory rate - 12 to 20 breaths per minute Blood pressure - 100 to 120 c) d) Temperature- 98. Family a) Conflicts arise (1) Adolescents strive for autonomy (2) Biological changes associated with puberty (3) Increased idealism (4) Independence and identity changes 2. Develop identity a) Self-consciousness increases b) Peer pressure increases c) Interest in the opposite sex increases d) Want to be treated like adults e) Progress through various stages based on how they handle crisis, etc. Vital signs a) Heart rate - average 70 beats per minute b) Respiratory rate - average 16 to 20 c) Blood pressure - average 120/80 mmHg d) Temperature - 98. Childbirth most common in this age group United Stated Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 8 Preparatory: 1 Life Span Development: 10 4.

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Direct or indirect injury (1) Edema United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 18 Trauma: 4 Head and Facial Trauma: 5 2 smoking and erectile dysfunction causes malegra dxt plus 160mg. Glasgow coma scale - method to erectile dysfunction medication online pharmacy trusted malegra dxt plus 160mg assess level of consciousness (1) Three independent measurements (a) Eye opening (b) Verbal response (c) Motor response (2) Numerical score - 3 to impotence natural remedy order malegra dxt plus online now lS (3) Head injury classified according to score (a) Mild - 13 to lS (b) Moderate - 8 to 12 (c) Severe - < 8 d. Airway and ventilation - oxygenate to 9S% -100% saturations (1) Oxygenation does not always require hyperventilation (2) Hyperventilate with signs and symptoms of increased rcp i) United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 20 Trauma: 4 Head and Facial Trauma: 5 I. Pharmacology (1) Osmotic diuretics (a) Mannitol and/ or furosemide (2) Paralytics/ sedation (3) Avoid glucose unless hypoglycemia confirmed f. Psychological support/ communication strategies Specific Injuries - diffuse axonal injury and focal injuries 1. Diffuse axonal injury - shearing, stretching or tearing of nerve fibers with subsequent axonal damage a. Assessment - may result in immediate unconsciousness or persistent confusion, disorientation and amnesia of the event extending to amnesia of moment-to-moment events; may have focal deficit; residual cognitive (inability to concentrate), psychologic (frequent periods of anxiety, uncharacteristic mood swings) and sensorimotor deficits (sense of smell altered) may persist c. Assessment - unconsciousness for prolonged period, posturing common, other signs of increased Iep occur depending on various degrees of damage c. Purpose of helmet (1) Protect head (2) Protect the brain (3) Cervical spine remains vulnerable b. Controversy regarding removal, at scene versus hospital (1) Priori ties (a) Airway management (b) Spinal immobilization (2) Factors determining need for immediate removal (a) Access to airway United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 26 Trauma: 4 Head and Facial Trauma: 5 d. Prone United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 2 Trauma: 4 Spinal Trauma: 6 3. Paresthesias United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 4 Trauma: 4 Spinal Trauma: 6 E. Priapism Not always practical to immobilize every "motion" injury Most suspected injuries were moved to a normal anatomical position 1. Anterior longitudinal ligament (1) Runs on anterior portion of the body (2) Major source of stability (3) Protects against hyperextension b. Posterior longitudinal ligament (1) Runs along posterior body within the vertebral canal (2) Prevents hyperflexion (3) Can be a major source of injury c. Other ligaments (1) Cruciform ligament (2) Accessory atlantoaxial ligament (3) Add to strength, stability, and articulation 6. Increase in size when moving from cervical to sacral region for support of the trunk Vertebral foramen 1. When all vertebrae are in place forms opening for spinal cord (vertebral canal) 2. Pedicles (1) Projecting posteriorly from vertebral Laminae (1) Arise from pedicles and fuse into spinous process (2) Failure of the laminae to unite during fetal development causes spina bifida (a) Most commonly in the lumbosacral region Transverse process 1. United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 6 Trauma: 4 Spinal Trauma: 6 K. Located within the vertebral canal (1) Begins at foramen magnum (2) Ending near L-2 b. Carries impulses from body parts and sensory information to the brain United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 7 Trauma: 4 Spinal Trauma: 6 7. Mixed nerves (1) Carries both sensation and motor function (2) Provides two-way communication between spinal cord and body parts c. Named according to level of spine from which they arise (1) Cervical 1-8 (2) Thoracic 1-12 (3) Lumbar 1-5 (4) Sacral 1-5 (5) Coccygeal 1 set of nerves d. Spinal nerve (1) Emerges from the cord (2) Two short branches or roots (3) Dorsal root (a) Carries sensory impulses to the cord (4) Ventral root (a) Carries motor impulses from the cord to the body Motor and sensory dermatomes a. Dermatome is the particular area in which the spinal nerves travels or controls b. Does not require spinal immobilization United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 10 Trauma: 4 Spinal Trauma: 6 3. Clinical criteria used for a basis of whether to employ spinal immobilization (1) Examples (a) Person trips over garden hose, falling to the ground and hitting their head (b) Fall from 2-4 feet (c) Low speed motor vehicle crash (fender bender) Clinical criteria versus mechanism of injury a. In some non-traumatic spinal conditions immobilization may be necessary/ indicated f. If specific criteria cannot be clearly satisfied; complete spine immobilization undertaken 4. Specific criteria United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 11 Trauma: 4 Spinal Trauma: 6 1. Prevent motion of the spine by assistant maintaining stabilization throughout the exam Reliable patients/ exam a.

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A hinge joint allows movement in only one plane such as either flexion or extension erectile dysfunction vacuum pump cheap malegra dxt plus. A pivot joint allows rotational movement around a fixed point such as the movement of the radial head depression and erectile dysfunction causes buy discount malegra dxt plus 160mg on line. When an oval head or condyle articulates with an elliptic cavity erectile dysfunction treatment doctors in hyderabad buy malegra dxt plus 160 mg with amex, movement such as flexion, extension adduction, abduction, and circumduction is possible. The movement of the thumb is provided by a saddle joint which is similar to an ellipsoidal or condyloid joint 10 in its range of motion. The hip has movement in three axes that include flexion, extension, adduction, abduction, and rotation. Part Hand Bones Proximal end of 1 metacarpal with the trapezium Scaphoid, lunate, and triquetral bones articulate with the radius and articular disk Trochlea of the humerus with the semilunar notch of the ulna; head of the radius with the capitulum of the humerus and head of the radius in the radial notch of the ulna the head of the humerus in the glenoid cavity of the scapula Between the tarsals Between the metatarsals and phalanges st Type Saddle Movement Flexion, extension, abduction, adduction, and circumduction of the thumb Flexion, extension, abduction, and adduction of the hand Flexion and extension Wrist Condyloid Elbow Hinge type Shoulder Ball-andsocket Gliding Foot Flexion, extension, abduction, adduction, rotation, and circumduction of the upper arm Gliding; inversion and eversion Flexion, extension, slight abduction, and adduction Flexion and extension Hinge Between the phalanges Hinge Ankle Knee the distal ends of the tibia and fibula with the talus Between the distal end of the femur and proximal end of the tibia. Constitute the largest joint in the body Head of the femur in the acetabulum Gliding Hinge Flexion and extension Flexion and extension with slight rotation of the tibia Flexion, extension, abduction, adduction, rotation Hip Ball-andsocket. The mechanics of constant movement along with factors associated with aging, genetics, and environmental impacts all contribute to destruction of the hyaline articular cartilage within the joint capsule. Terminology Associated with Bony Parts and Prominences the production of high quality radiography images requires that the radiographer perform many tasks properly. One of the most important tasks that the radiographer must perform is proper placement and positioning of the anatomic structure being examined. To do so requires that radiographers be intimately familiar with the terminology used to describe or name various bony parts and prominences located on each of the 206 bones in the human skeleton. These structures are referred to as 11 anatomical landmarks and are commonly used by radiographers in positioning for various imaging examinations. Ala, Body, Crest, Spine, and Process the ilium, a bone in the pelvic girdle, has 3 descriptive anatomic landmarks. The ala or wing is the upper flat curved part of the body or main portion of the ilium. The term body is also used when referring to the main portion of the body of the scapula. A crest refers to the upper border of an ala or wing such as the crest of the ilium. A pointed process on a bone is referred to as a spine and the term is often used when referring to a portion of the ischium. Condyle, Epicondyle, Head, Capitulum, Neck and Capitellum the term condyle is used to describe a rounded projection on a bone. A condyle helps to form an articulation such as the ones located on the distal ends of the femur, helping to form the knee joint, and the condyle at the distal end of the humerus, helping to form the elbow joint. An epicondyle is a rounded projection on a bone and is located above its companion condyle. An epicondyle usually has a roughened surface to allow for the attachment of muscles and ligaments. The term that is often used to describe the rounded upper end of a bone is the head. When the term neck is used in relationship to a bony landmark it means the elongated portion. The term capitellum refers to a rounded eminence such as the one at the lower end of the humerus. Foramen, Fossa, Sulcus, Lumen, and Meatus A fissure is a groove or natural division, cleft, or slit in a bone and the term used to describe an ulcer or cleft-like sore. A foramen is a perforation or opening (usually in a bone) through which nerves or blood vessels pass. An example of a foramen within a bone is the foramen magnum located within the occipital bone of the cranium. Another example of a foramen is the large opening in the lower part of the innominate bone, which is the largest foramen in the human skeleton. A fossa refers to a pit or depression in bone and the term sulcus is used to describe a furrow, groove, or slight depression. Sesamoid bone, Symphysis, and Trochanter A sesamoid bone is an oval nodule of bone or fibrocartilage located within a tendon playing over a bony surface.

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