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By H. Will. New Mexico State University.

Resuscitation  LactateLactate  Dunham (1991)Dunham (1991)  Predictive value of lactate levels and mortality inPredictive value of lactate levels and mortality in hemorrhaged dogs 25mg clomid visa womens health magazine march 2014. Resuscitation  LactateLactate  Abramson (1993)Abramson (1993)  76 consecutive patients discount clomid 25mg overnight delivery women's health clinic redding ca; normalization of lactate76 consecutive patients; normalization of lactate (<2mmol/L)(<2mmol/L)  Normalization within 24 hours: 100% survivalNormalization within 24 hours: 100% survival  24-48 hours: 78% survival24-48 hours: 78% survival  > 48 hours: 14 % survival> 48 hours: 14 % survival  Of note: 40% of nonsurvivors achievedOf note: 40% of nonsurvivors achieved supernormal O2 transport values and 29% ofsupernormal O2 transport values and 29% of survivors did not. Resuscitation  Base DeficitBase Deficit  It is the amount of base, in millimoles, requiredIt is the amount of base, in millimoles, required to titrate 1 liter of whole arterial blood to a pHto titrate 1 liter of whole arterial blood to a pH of 7. Resuscitation  Base DeficitBase Deficit  Davis (1988)Davis (1988)  Base deficit correlated with ongoing hemorrhage. Resuscitation  Base DeficitBase Deficit  Rutherford (1992)Rutherford (1992)  3,791 consecutive trauma patients, retrospective. Resuscitation  SummarySummary  Supernormal Oxygen Transport VariablesSupernormal Oxygen Transport Variables ? Predictor of outcome, not an end point  Lactate/Base DeficitLactate/Base Deficit  Global markersGlobal markers  Should be used routinely! The Red Trauma Light Sounds Torn Thoracic Aorta Sharp Objects Careful Playing With The Toy Doctor’s Kit Multiple Stab Wounds, Once Just Isn’t Enough Dart Catching Contest Always Cut The Bagel Away From Your Face. Think Mechanism of Injury  Well Healed Scar From a Prior FemurWell Healed Scar From a Prior Femur Fracture. Be Careful Climbing Trees More Wood Those Telephone Polls Tend To Jump Out In Front Of You Only Grind The Sausage Sunny Day, All’s Well. Notes t facial mask with oxygen reservoir • provides O2concentrations of > 60% • 6 L/min = 60%, each increase of 1L/min increases the inspired O2concentration by 10% t Venturi mask - high flow system, with mixed O2concentrations • provides many O2concentrations, e. Your first weeks and months as an anesthesia resident are exciting, challenging, stressful, and rewarding. Regardless how much or how little experience you have in the field of anesthesiology, the learning curve for the next few months will be very steep. In addition to structured lectures and independent study, you will be primarily responsible for patients as they undergo anesthesia and surgery. While there were regular intra-operative and didactic lectures, the nuts and bolts of anesthesiology were taught with little continuity. In addition, a tutorial curriculum was refined to give structure to the intra-operative teaching and avoid redundancy in lectures. There is so much material to cover in your first couple months of residency that independent study is a must. While you review the tutorial with your mentor, use each lecture as a starting point for conversation or questions. By the end of this month, we hope you attain a basic knowledge and skill-set that will allow you to understand your environment, know when to ask for help, and determine how to direct self-study. Sprinkled throughout this book, you’ll find some light-hearted resident anecdotes from all the good times you’ll soon have, too. If you have any questions about the mentor program, booklet, or lectures, please direct them to one of us: Becky Wong, Katie Ellerbrock, or Dr. Topics covered include basic pharmacology of anesthetics, basic physiology, and various clinical skills and topics. There will be lecture on Thurs, July 8, and then ii every subsequent Tuesday, Wednesday, and Thursday at 4pm in July. Jaffe’s book Anesthesiologist’s Manual of Surgical Procedures is an invaluable resource for understanding the surgical aspects of your anesthetic. Despite being a new mom, she has worked tirelessly to prepare for your arrival, organizing this mentorship program and lecture series months in advance. Goldhaber-Fiebert (she’ll probably have you call her “Sara”) for her dedication to developing and improving the cognitive aids you’ll see in this book and in the laminated cards you’ll receive. Macario, Residency Program Director, who will be one of the first attendings to know all of you by your first names. Acquiring the fundamental knowledge, as well as cognitive and technical skills necessary to provide safe anesthesia, are essential early on in your training. Understand the proper use of laboratory testing and how abnormalities could impact overall anesthetic management. Exam ple Traces • Time delay exists due to length and volume of sample tube as wellas samplingrate (50-500 A. Ph iladelph ia:L ippincottW illiams& W ilkins, correlationwith tympanicandesoph agealtemperatures 2003.

These individuals should be extremely careful not to contract even minor injuries like trauma or extraction of tooth 100 mg clomid visa women's health center bismarck nd, since this may result in severe hemorrhage ( blood loss ) purchase 25 mg clomid visa breast cancer financial assistance. The defect is in the enzyme tyrosinase which is responsible for the biosynthesis of the pigment and hence the individual appears bleached. In this condition, melanin is not synthesized in the melanocytes and affects the skin, hair, sclera and choroids etc. Cause The disease is characterised by the defciency of homogentisate oxidase which catalyses the conversion of tyrosine to acetyl coA and acetate. In this reaction sequence homogentisic acid (homogentisate) is an intermediate which is oxidised by the enzyme homogentisate oxidase. In long standing cases, deposition of homogentisic acid derivatives in cartilages of ears and other exposed places leading to generalized pigmentation of connective tissues and deposition in joints leading to arthritis, a condition is called ochronosis. This is due to the of oxidation homogentisate by polyphenol oxidase, forming benzoquinone acetate, which polymerizes and binds to connective tissue macromolecules. Generally, the carbohydrate segments of glycolipids are removed by lysosomal hydrolases in the early phases of the turn over of these compounds. The amount sometimes exceeds 100 - 300 times the normal content causing degeneration of the nervous system. Symptoms Muscle weakness, retardation in development and diffculty in eating are typical early symptoms. Taysach’s disease can be diagnosed by taking amniotic fuid from the mother and assaying the hexosaminidase A activity. Cancer cells are characterized by three properties: 1) diminished or unrestrained control of growth and cell division; 2) invasion of local tissue; and 3) spread or metastasis to other parts of the body. Most of the tumours are localized without spread and so without risk to the host, they are called benign tumours. Sometimes they start interfering with normal tissues and secreting excessive amount of some hormones or other biologically active substances. Elevated levels of alkaline phosphatase is observed in malignancy of bone, liver and carcinoma of bronchus. Tumours become life threatening , when their cells instead of being localized spread throught the body. Changes in growth properties of cells and their subsequent ability to form malignant tumours are collectively referred to as transformation. Cancers that do not ft into either of these broad categories include leukemias , lymphomas and cancer of the cells of central nervous system. Nearly 90% of human cancers are carcinomas 110 Causes of cancer Agents causing cancer fall into 3 categories: a) radiant energy, b) chemical compounds and c) viruses. Examples of organic carcinogens are Benzopyrene, Dimethylbenzanthracene, Dimethylnitrosamine and Afatoxin B. For example Epstein - Barr virus cause Burkitt’s lymphoma and nasopharyngeal carcinoma and Herpes simplex virus cause cancer in the cervix in humans. Some changes that have been detected at the surface of malignant cells are alteration in transport properties, permeability, surface charge, diminished adhesion, appearance of new antigens, changes of glycolipid constituents and alterations of the oligosaccharide chains of glycoproteins. The metabolite that accumulates in Tay Sachs disease is i) galactose ii) tyrosine iii) ganglioside iv) glucose 2. Defciency of glucose 6-phosphatase is seen in i) Von Gierks disease ii) galactosemia iii) albinism iv) alkaptonuria 3. Liver cells are loaded with glycogen in i) hemophilia ii) galactosemia iii) albinism iv) Von-Gierkes disease 4. Hypopigmentation in skin and sclera is observed in i) albinism ii) alkaptonuria iii) hemophilia iv) galactosemia. Hence, any biological oxidation taking place at tissue level is associated with 2 the uptake of oxygen and release of carbon dioxide and rapidly liberates energy. This biological oxidation accompanied by specifc enzymes and coenzymes in a step wise fashion involves the union between hydrogen atoms with oxygen atom to form water. Oxidation involving phosphorylation is a very vital process and it is a continuous process and any disturbance of its function is incompatible with life.