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By N. Kayor. Embry-Riddle Aeronautical University. 2018.

If no air is entering the lungs then the most likely cause is that the tip of the tracheal tube is lying in the oesophagus generic doxazosin 1mg online. If this is suspected cheap 2mg doxazosin with visa, remove the tube immediately and oxygenate with a mask system generic 1 mg doxazosin amex. If auscultation shows that gas is entering one lung only purchase doxazosin 2mg, usually the right discount doxazosin 1mg on-line, withdraw the tube by 1cm while listening over the lungs. If this leads to improvement, the tip of the tracheal tube was lying in the main bronchus. If no improvement is seen then the possible causes include pneumothorax, diaphragmatic hernia, or pleural effusion. Severe bradycardia If the heart rate falls below 60 beats/min, chest compression must be started by pressing with the tips of two fingers over sternum at a point that is one finger’s breadth below an imaginary line joining the nipples. If there are two rescuers it is preferable for one to encircle the chest with the hands and compress the same point with the thumbs, while the other carries out ventilation. The chest should be compressed by about Bag mask for neonatal resuscitation one third of its diameter. Give one inflation for every three chest compressions at a rate of about 120 “events” per minute. If no improvement is seen within 10-15 seconds the umbilical vein should be catheterised with a 5 French gauge catheter. This is best achieved by transecting the cord 2-3cm away from the abdominal skin and inserting a catheter until blood flows freely up the catheter. The same dose of adrenaline (epinephrine) can then be given directly into the circulation. Although evidence shows that sodium bicarbonate can make intracellular acidosis worse, its use can often lead to improvement, and the current recommendation is that the baby should then be given 1-2mmol/kg of body weight over two to three minutes. Those who fail to respond, or who are in asystole, require further doses of adrenaline (epinephrine) (10-30mcg/kg). This can be given either intravenously or injected down the tracheal tube. It is reasonable to continue with alternate doses of adrenaline (epinephrine) and sodium bicarbonate for 20 minutes, even in those who are born in apparent asystole, Paediatric face masks. Resuscitation efforts should not be continued beyond 20 minutes unless the baby is making at least intermittent respiratory efforts. Pharyngeal suction Naloxone therapy ● Rarely necessary unless amniotic fluid Intravenous or intramuscular naloxone (100 mcg/kg) should stained with meconium or blood and the be given to all babies who become pink and have an obviously baby asphyxiated satisfactory circulation after positive pressure ventilation but fail ● Can delay onset of spontaneous respiration for a long time if suction is aggressive to start spontaneous respiratory efforts. Often the mothers have ● Not recommended by direct mouth suction a history of recent opiate sedation. Alternatively, naloxone can or oral mucus extractors because of be given down the tracheal tube. If naloxone is effective then congenital infection an additional 200 micrograms/kg may be given intramuscularly to prevent relapse. Naloxone must not be given to infants of mothers addicted to opiates because this will provoke severe withdrawal symptoms. Meconium aspiration A recent large, multicentre, randomised trial has shown that vigorous babies born through meconium should be treated conservatively. The advice for babies with central nervous system depression and thick meconium staining of the liquor remains—that direct laryngoscopy should be carried out immediately after birth. If this shows meconium in the pharynx and trachea, the baby should be intubated immediately and suction applied directly to the tracheal tube, which should then be withdrawn. Provided the baby’s heart rate remains above 60 beats/min this procedure can be repeated until meconium is no longer recovered. Hypovolaemia Acute blood loss from the baby during delivery may complicate resuscitation. It is not always clear that the baby has bled, so it is important to consider this possibility in any baby who remains pale with rapid small-volume pulses after adequate gas The goal of all deliveries—a healthy new born baby. Most babies respond well to a Steve Percival/Science Photo Library bolus (20-25ml/kg) of an isotonic saline solution. It is rarely necessary to provide the baby with blood in the labour suite.

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If more time to listen and think you are working with a new group it may be useful to indicate x Handouts should provide a scaffold on which students can build the ground rules for the session—for example buy 4mg doxazosin mastercard, “switch off their understanding of a topic x Handouts should provide a summary of the major themes while mobile phones discount doxazosin 4mg otc,” or “ask questions at any time buy discount doxazosin 2mg on line. However order 1 mg doxazosin, you can use various methods to encourage students to take a more active part in the learning process order 2 mg doxazosin fast delivery. Students’ attention (and recall) is best at the beginning and Better Lecture without student activity end of a lecture. Recall can be improved by changing the format of your lecture part way through. It is also important Lecture with student activity when planning a lecture to think about activities and exercises that will break up the presentation. Ask questions It is useful to ask questions of the group at various stages in the lecture, to check comprehension and promote discussion. Many lecturers are intimidated by the silence following a question and fall into the trap of answering it themselves. It takes time for students to move from Start of lecture End of lecture listening to thinking mode. A simple tip is to count slowly to 10 Student activity Time in your head—a question is almost certain to arrive. Graph showing effect of students’ interaction on their ability to recall what Get students to ask you questions they have heard in a lecture. Adapted from Bligh, 2000 (see “Recommended An alternative to getting students to answer questions is to ask reading” box) them to direct questions at you. A good way of overcoming students’ normal fear of embarrassment is to ask them to prepare questions in groups of two or three. When asked a question, you Involve me, and I understand” should repeat it out loud to ensure that the whole group is Chinese proverb aware of what was asked. Seeking answers to the question from other students, before adding your own views, can increase the level of interaction further. The lecturer invites answers to a question or problem from the audience and writes them, without comment, on a board or overhead. After a short period, usually about two or three minutes, the lecturer reviews the list of “answers” with the class. The answers can be used to provide material for the next part of the lecture or to give students an idea of where they are before they move on. By writing answers in a way that can be seen by everyone in the audience, you allow the students to learn from each other. They consist of groups of two to five students working for a few minutes on a question, problem, or exercise set by the lecturer. Buzz group activity is a useful means of getting students to process and use new information to solve problems. At the end of the buzz group session, the teacher can either continue with the lecture or check the results of the exercise by asking one or two groups to present their views. Remember that in an amphitheatre lecture hall, students can sit on their own desks to interact with the students behind them. Brief assessments can also Lecture title: allow the lecturer to measure how well the messages are being Directions: Take a moment to think about the lecture you have just attended, understood. Students could be asked, for example, to complete and then answer the following questions. An assessment of prior learning would be best at the start of a lecture, whereas an estimate of learning from the current session might be best carried out towards the end of the 2. At the end of a lecture it is important to summarise the key points and direct students toward further learning. Students are Example of a one-minute paper encouraged to learn more about a subject if they are set tasks or exercises that will require them to look further than the lecture notes for answers and ideas. Students may find the use of a one-minute paper a useful tool to help them to identify concepts and impressions that need clarification. Please rate the lecture on the following items Strongly Slightly Slightly Strongly Evaluating your lecture agree agree disagree disagree Clear Practice does make perfect, but the process of developing as a lecturer is greatly helped if some effort is made to evaluate Interesting performance. If the students Well organised are to be used as a source of feedback, the following methods are useful: Relevant to x Ask a sample of the students if you can read their lecture the course notes—this exercise gives some insight into what students have learned and understood x Ask for verbal feedback from individual students Example of an evaluation form focusing on the lecture. Adapted from x Ask the students to complete a one-minute paper Brown et al, 2001 (see “Recommended reading” box) 17 x Ask the students to complete an evaluation questionnaire. If you want to evaluate your teaching style and delivery, Please rate the lecturer on the following items peers can be a useful source of feedback: x Ask a colleague to observe part or all of a lecture and provide Strongly Slightly Slightly Strongly feedback afterwards. It is important to inform the observer what agree agree disagree disagree aspects of the lecturing process you want evaluated—for Was example, clarity, logical flow, effectiveness of the media used enthusiastic x Videotape the lecture for private viewing, and arrange a joint Was clearly viewing with a colleague later.

Neurology 1993; 43: 2145-2146 Cross References Polyopia Environmental Dependency Syndrome - see IMITATION BEHAVIOR; UTILIZATION BEHAVIOR Environmental Tilt Environmental tilt generic doxazosin 4 mg without prescription, also known as tortopia buy doxazosin 1 mg on line, is the sensation that visual space is tilted on its side or even upside down (“floor-on-ceiling” phe- nomenon doxazosin 2mg without a prescription, “upside-down” reversal of vision discount doxazosin 4 mg line, verkehrtsehen) generic 1 mg doxazosin with visa. The temptation to dismiss such bizarre symp- toms as functional should be resisted, since environmental tilt is pre- sumed to reflect damage to connections between cerebellar and central vestibular-otolith pathways. It has been reported in the following situations: Lateral medullary syndrome of Wallenberg Transient ischemic attacks in basilar artery territory - 111 - E Epiphora Demyelinating disease Head injury Encephalitis Following third ventriculostomy for hydrocephalus Cross References Lateral medullary syndrome; Vertigo; Vestibulo-ocular reflexes Epiphora Epiphora is overflow of tears down the cheek. This may be due to a blocked nasolacrimal duct, or irritation to the cornea causing increased lacrimation, but it may also be neurological in origin, e. Lacrimation is also a feature of trigeminal autonomic cephalalgias, such as cluster headache. Cross References Bell’s palsy; Crocodile tears Epley Maneuver - see HALLPIKE MANEUVER, HALLPIKE TEST; VERTIGO Erythropsia This name has been given to a temporary distortion of color vision in which objects take on an abnormal reddish hue. There are various causes, including drug use, visual diseases, and pseudophakia. Cross References Illusion; “Monochromatopsia”; Phantom chromatopsia Esophoria Esophoria is a variety of heterophoria in which there is a tendency for the visual axes to deviate inward (latent convergent strabismus). Clinically this may be observed using the cover-uncover test as an out- ward movement of the covered eye as it is uncovered. Cross References Cover tests; Exophoria; Heterophoria Esotropia Esotropia is a variety of heterotropia in which there is manifest inward turning of the visual axis of one eye; the term is synonymous with con- vergent strabismus. It may be demonstrated using the cover test as an outward movement of the eye which is forced to assume fixation by occlusion of the other eye. Acute esotropia has been described following contralateral thalamic infarction. Cross References Amblyopia; Cover tests; Diplopia; Exotropia; Heterotropia; Nystagmus Ewart Phenomenon This is the elevation of ptotic eyelid on swallowing, a synkinetic move- ment. The mechanism is said to be aberrant regeneration of fibers from the facial (VII) nerve to the oculomotor (III) nerve innervating the levator palpebrae superioris muscle. Cross References Ptosis; Synkinesia, Synkinesis Exophoria Exophoria is a variety of heterophoria in which there is a tendency for the visual axes to deviate outward (latent divergent strabismus). Clinically this may be observed in the cover-uncover test as an inward movement as the covered eye is uncovered. Exophoria may occur in individuals with myopia, and may be physiological in many subjects because of the alignment of the orbits. Cross References Cover tests; Esophoria; Heterophoria Exophthalmos Exophthalmos is forward displacement of the eyeball. Cross References Lid retraction; Proptosis Exotropia Exotropia is a variety of heterotropia in which there is manifest out- ward turning of the visual axis of an eye; the term is synonymous with divergent strabismus. It may be demonstrated using the cover test as an inward movement of the eye which is forced to assume fixation by occlusion of the other eye. When the medial rectus muscle is paralyzed, the eyes are exotropic (wall-eyed) on attempted lateral gaze toward the paralyzed side, and the images are crossed. Cross References Cover tests; Esotropia; Heterotropia Extensor Posturing - see DECEREBRATE RIGIDITY External Malleolar Sign - see CHADDOCK’S SIGN - 113 - E External Ophthalmoplegia External Ophthalmoplegia - see OPHTHALMOPARESIS, OPHTHALMOPLEGIA Extinction Extinction is the failure to respond to a novel or meaningful sensory stimulus on one side when a homologous stimulus is given simultane- ously to the contralateral side (i. It is important to show that the patient responds appropriately to each hand being touched individually, but then neglects one side when both are touched simultaneously. More subtle defects may be tested using simultaneous bilateral heterologous (asymmetrical) stimuli, although it has been shown that some normal individuals may show extinction in this situation. A motor form of extinction has been postulated, manifesting as increased limb akinesia when the contralateral limb is used simultane- ously. The presence of extinction is one of the behavioral manifestations of neglect, and most usually follows nondominant (right) hemisphere lesions. There is evidence for physiological interhemispheric rivalry or competition in detecting stimuli from both hemifields, which may account for the emergence of extinction following brain injury. Neural conse- quences of competing stimuli in both visual hemifields: a physiologi- cal basis for visual extinction. Annals of Neurology 2000; 47: 440-446 Cross References Akinesia; Hemiakinesia; Neglect; Visual extinction Extrapyramidal Signs - see PARKINSONISM Eyelid Apraxia Eyelid apraxia is an inability to open the eyelids at will, although they may open spontaneously at other times (i. The term has been criticized on the grounds that this may not always be a true “apraxia,” in which case the term “levator inhibition” may be preferred since the open eyelid position is normally maintained by tonic activity of the levator palpebrae superioris. Clinically there is no visible contraction of orbicularis oculi, which distinguishes eyelid apraxia from blepharospasm (however, perhaps paradoxically, the majority of cases of eyelid apraxia occur in association with ble- pharospasm). Electrophysiological studies do in fact show abnormal muscle contraction in the pre-tarsal portion of orbicularis oculi, which - 114 - Eyelid Apraxia E has prompted the suggestion that “focal eyelid dystonia” may be a more appropriate term. Although the phenomenon may occur in isolation, associations have been reported with: Progressive supranuclear palsy (Steele-Richardson-Olszewski syn- drome) Parkinson’s disease Huntington’s disease Multiple system atrophy MPTP intoxication Motor neurone disease Acute phase of nondominant hemisphere cerebrovascular event Wilson’s disease Neuroacanthocytosis.

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Ninety-eight articles In 1913 Albee designed a special fracture table were on bone-graft surgery safe doxazosin 4mg, 19 of which were on that became a most useful addition to the the use of the bone-peg graft for fractures of the armamentarium of the orthopedic surgeon buy discount doxazosin 4 mg on-line. In hip cheap 2 mg doxazosin fast delivery, 16 on bacteriophages generic doxazosin 4 mg mastercard, 14 on arthroplasty discount 2 mg doxazosin amex, 12 1936 the table was modified by the use of a on rehabilitation, 11 on World War I surgery, eight central hydraulic hoist and became known as the on the reconstruction of the hip, seven on Albee–Comper table. Also in 1913 he first per- sional accomplishments in the order in which the formed a bone-peg operation for ununited frac- work was started. Later he reported 90% good In 1909 he did his original bone-graft operation results. This operation, it is said, was a great stim- for fusion of a tuberculous spine. Just 13 days the US Army, organized and became the surgeon- later, on May 28, Dr. Hibbs, of the New in-chief and director of an orthopedic hospital at York Orthopedic Hospital, published a descrip- Colonia, NJ. It was a model of its kind and the tion of another type of spinal fusion that has since first reconstruction rehabilitation hospital this borne his name. Albee more firmly convinced than ever before that in showed how the power-driven machine tools of many ways it was more important to restore a the mechanics’ trade could be used in bone patient to normal mental and spiritual health than surgery as precision instruments, thus increasing to physical health, and that in so doing the patient tremendously the scope of orthopedics. With this must also be restored to his place in the economic system a new era of surgery commenced. From this experience came During 1912 Albee did many bone-graft Albee’s deep and lasting interest in rehabilitation experiments on dogs at Cornell University School as we know it today. He demonstrated to his own satis- were taught that their work was no longer con- faction that rigid cortical bone was much better fined to the sick room and the operating theatre, for transplantation than cancellous bone. Today but that it was related closely to the economic many think differently. He also showed that of all scheme of things in the very fabric of society the types of transplants, the autogenous graft had itself. In the field of so-called social orthopedics, the greatest measure of success. In 1912 he published his first work on bone Because of his keen interest, the first state reha- grafting in ununited fractures. It was in this type bilitation commission was established in New of surgery that his tools were most useful and Jersey in 1919. This was quite different from any in London, at the International Congress of Med- other type that had been done before. It was a V- icine at the Royal National Orthopedic Hospital, shaped fore-and-aft wedge. Albee felt strongly he demonstrated his bone-grafting techniques that, since one could not duplicate in the human with his motor-driven saw. In 1914, 4 months knee the normal gliding mechanism of the 6 Who’s Who in Orthopedics articular bone surfaces, a wedge type of arthro- plasty that provided both mobility and stability was to be preferred. As an interposing membrane in arthroplasties, he always used the facial fat graft advocated by Murphy. Winnett Orr, in Lincoln, NE, Albee became very much interested in osteomyelitis. He was convinced that the reason for the success of the closed plaster method of Orr in the infected com- pound fracture and the old osteomyelitic case was the spontaneous development within the host of a substance that thrived on virulent pathogenic bacteria and completely destroyed them. This substance, in 1921, had been called a “bacteriophage” by D’Herelle, of Yale. Albee was able to show a phage appearing in 94% of 100 cases of acute and chronic osteomyelitis. His Lewis ANDERSON treatment was to clean the infected material out of the wound completely and then inject a bacteri- 1930–1997 ophage solution into osteomyelitic wounds. In 1933 Albee described a rather ingenious Lewis Anderson was born in Greensboro, arthroplasty of the elbow in which, after he had Alabama, on October 13, 1930. He attended reconstructed the joint, he lengthened the olecra- Emory University in Atlanta from 1947 through non with its triceps attached—in some ways a 1949 and received his MD degree from the Uni- comparable operation with his kinesiology lever versity of Pennsylvania in Philadelphia in 1953.

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