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http://projects.csail.mit.edu/courseware/?term=respect-the-elderly-essay respect the elderly essay Upon stabilization, placement of a pulmonary artery (pa) catheter may be indicated based on the need for more extensive cardiovascular monitoring than is available from noninvasive measurements such as vital signs, cardiac rhythm, and urine output. 10,11 key measured parameters obtained from a pa catheter are the pulmonary artery occlusion pressure (paop), which is a measure of left ventricular preload, and co. From the co values and simultaneous measurement of hr and bp, one can calculate the left ventricular sv and svr. 11 placement of a pa catheter should be reserved for patients at high risk of death due to the severity of shock or preexisting medical conditions such as heart failure. 12 an alternative to the pa catheter is placement of a central venous catheter that typically resides in the superior vena cava to monitor central venous pressure (cvp). Although central venous catheters are less expensive and more readily placed, they are not particularly accurate in monitoring effective fluid resuscitation. 11 »» fluid therapy the use of fluids is the cornerstone of managing hypovolemic shock. 1,2 three major therapeutic options are available to clinicians for restoring circulating blood volume. Crystalloids (electrolyte-based solutions), colloids (large molecular weight solutions), and blood products. 13 blood products are used only in instances •• skin color. Pale to ashen. May be cyanotic in severe cases •• skin temperature. Cool to cold •• mental status. Confusion to coma •• pulmonary artery (pa) catheter measurements. Decreased co, decreased sv, increased svr, low pulmonary artery occlusion pressure (paop) •• organ dysfunction (see table 13–2) laboratory tests •• increased serum lactate •• decreased arterial ph •• decreased hemoglobin/hematocrit (hemorrhagic hypovolemic shock) •• hypernatremia •• elevated serum creatinine (scr) •• elevated blood urea nitrogen •• hyperglycemia involving hemorrhage (or severe preexisting anemia), thus leaving crystalloids and colloids as the mainstay of therapy in all types of hypovolemic shock, along with adjunctive vasopressor support. The aggressiveness of fluid resuscitation (rate and volume) is driven by the severity of the hypovolemic shock and the underlying cause. Warming of all fluids to 37°c (98. 6°f) prior to administration is an important consideration to prevent hypothermia, arrhythmias, and coagulopathy because these complications will have a negative impact on the success of the resuscitation effort. 14 crystalloids  conventional “balanced” crystalloids are fluids with (a) electrolyte composition that approximates plasma, such as lactated ringer (lr), or (b) a total calculated osmolality similar to that of plasma (280–295 mosm/kg or mmol/kg), such patient encounter, part 1 a 65-year-old woman is admitted to the trauma center after a robbery attempt in which she received two gunshot wounds. One to her right hip and one to her right thigh.

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http://projects.csail.mit.edu/courseware/?term=nail-polish-essay nail polish essay Wang cs, blindness with viagra fitzgerald jm, schulzer m, mak e, ayas n. Does this dyspneic patient in the emergency department have congestive heart ailure?. Jama. 2005;294(15). 1944-1956. He criteria committee o the new york heart association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston, ma. Little, brown & co. 1994:253-256. Worster a, balion cm, hill sa, et al. Diagnostic accuracy o bnp and n -probnp in patients presenting to acute care settings with dyspnea. A systematic review. Clin biochem. 2008;41(4-5):250-259. Jessup m, abraham w , casey de, et al. 2009 focused update. Accf/aha guidelines or the diagnosis and management o heart ailure in aadults. A report o the american college o cardiology foundation/american heart association ask force on practice guidelines. Developed in collaboration with the international society or heart and lung ransplantation. Circulation. 2009;119(14). 1977-2016. Heart failure society o america, linden eld j, albert nm, et al.

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thesis statement examples expository Not necessary or diagnosis but is o en positive blindness with viagra. Esr and crp. Not speci c, but elevated due to the in ammatory nature o as. Tissue. Mri. Should be per ormed with gadolinium. T is is the gold standard to identi y abscesses and pathologic enhancement. 642 c h apt er 39 imaging plain x-rays. Obtain x-rays o the entire spine and pelvis to look or radiographic evidence o sacro-iliitis and used vertebral segments. Mri. T is can be obtained i evaluation o the spinal canal and surrounding so tissues is needed. Bone scan. Will show increased uptake at si joint. T is can be obtained i the diagnosis remains ambiguous. Treatment as is primarily managed with medical therapy. Nsaids, sul asalazine, nf-alpha antagonists, and steroids are staples o as therapy. Fractures should be treated on the basis o stability. Those that are stable can be treated with a rigid brace, while unstable ractures require urgent surgical stabilization. Patients who develop neurologic de cits also are likely to require surgery. Rheumatoid arthritis xt background/causes rheumatoid arthritis (ra) is a chronic in ammatory condition that a ects multiple diarthrodial joints. Systemic involvement is variable and can cause signi cant morbidity i it does occur. Ra a ects women twice as o en as men, and the incidence peaks in the ourth and h decades. T e cervical region is the most commonly involved area o the spine in ra because o the large number o joints. Ra causes erosion o the joints and, in particular, the ligamentous attachments, which leads to ligamentous laxity and cervical instability. Atlantoaxial dislocation (aad) is the most common pathology, but there can also be basilar invagination and pannus granulation o the odontoid.33 as it pertains to the cervical spine, ra undergoes similar pathologic changes as seen in the hands. T ere is immunemediated destruction o the acets (these are synovial joints as well) that causes in ammation and rheumatoid pannus. T is granulation tissue produces collagenase and proteolytic enzymes that can destroy adjacent cartilage, tendons, and ligaments.34 signs/symptoms/examination ra mani ests clinically as symmetrical morning sti ness and arthritic changes o the proximal interphalangeal (pip), metacarpophalangeal (mcp), and metatarsophalangeal (m p) joints. Patients may have rheumatoid nodules on the extensor sur ace o their hands. Ra causes neck pain due to instability secondary to ligamentous laxity.

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