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There are no studies documenting effectiveness and only anecdotal accounts in the literature blood pressure 9860 cheap lopressor 12.5mg free shipping. The management of anaphylaxis also requires hospitalization or observation for 24 hours because of the possibility of biphasic anaphylaxis. All patients require at least observation since one cannot predict which patient will develop the biphasic response of anaphylaxis. However, if the parents are reliable observers and they are able to get to the hospital quickly, then the observation time in the emergency department can be shortened. The patient should be instructed on epinephrine use and dispensed an epinephrine syringe. Physicians should be responsible for demonstrating and training patients on the use of epinephrine syringes. However, considering the practical consideration that this epinephrine injector is not likely to be available. Patients should also be prescribed an oral antihistamine, which should be taken immediately. Lastly, the management of anaphylaxis should be directed toward avoiding the offending agent and education of where the offending agent can be hidden (especially if it is a food item). For example, patients who are allergic to peanuts will probably react to foods cooked in peanut oil and patients with dairy product allergy may need to avoid butter and foods cooked with butter. This can be extremely challenging and almost impossible to avoid, especially at restaurants. An instruction to the waiter of "no peanut oil", will often translate to "use corn oil instead" to the cooks in the back. However, if the pan used had some peanut oil on it for the previous dish that was cooked, this may still be sufficient to cause a reaction in the patient. Allergy testing may be useful to determine the cause of the allergy and desensitization therapy may be useful for some types of allergies. Urticaria, also commonly known as hives, are raised erythematous, circumscribed, pruritic lesions. Urticaria occurs from focal mast cell degranulation causing the release of histamine and other mediators. Individual lesions of urticaria generally do not remain in the same place for greater than 24 hours. Acute urticaria is more common in children and young adults, while the peak incidence of chronic urticaria is during the third and fourth decades (4). Urticaria can occur from food allergies, collagen vascular disease, infections, environmental factors such as heat, cold or pressure, and medications. H1 blockers, such as diphenhydramine or the newer non drowsy antihistamines such as loratadine, are the standard therapy, but H2 blockers, such as ranitidine and cimetidine, have variable degrees of success so routine use is controversial (8). Avoidance of known triggers of urticaria is probably the most important aspect in chronic management. Angioedema is a similar process that occurs in the deeper subcutaneous layers of the skin or mucus membranes, giving rise to nonpitting, stretched, colorless, well demarcated skin lesions. There are fewer mast cells and sensory nerve endings in the deeper layers of skin involved. Most frequently, angioedema affects the scalp, lips, face, eyes, extremities and genitalia. Otherwise, angioedema is similar to urticaria with the main distinguishing feature of involvement into the dermis. This condition occurs because of the absence or abnormally functioning C1 esterase inhibitor. Treatment involves the use of androgens, which causes the production of sufficient amount of C1 esterase inhibitor to prevent C1 activation. The lesions are varying in size and shape (multiformed) and some lesions have a target appearance with a rim of urticaria surrounding a central depression (target lesion). The most common presenting complaint is that of "hives" which has not responded to an antihistamine. Withdrawing the allergic substance is a good idea, but it is usually not possible to determine what the inciting cause was. What is the primary treatment of severe anaphylaxis and what is the appropriate dose Two weeks following a viral illness, a teenage boy breaks out in an evolving rash that is remarkable for target lesions. A girl is brought to her pediatrician by her mother because of recurrent bouts of non-pitting, non pruritic facial swelling that have occurred three times prior. Improved outcomes in patients with acute allergic syndromes who are treated with combined H1 and H2 antagonist. Adjunctive therapies includes antihistamines, bronchodilators, and perhaps glucagon and corticosteroids. His mother reports that he has had this rash since 6 months of life when bottle feeding started. The skin rash did not respond to 1% hydrocortisone treatment and it has worsened in the past few weeks. On exam, he is noted to have generalized dry skin with subacute eczematous lesions on both cheeks and the extensor surfaces of his extremities without other abnormal findings. His skin rash is controlled well within 2 weeks and this totally disappears after 1 year of age. Exam findings reveal normal vital signs, generalized expiratory wheezing and generalized urticaria. The symptoms respond well to diphenhydramine, subcutaneous epinephrine and an albuterol nebulizer treatment. In pre-school, she develops difficulty breathing and urticaria after eating a cookie given to her by another child. At age 10, while on a school field trip, she develops urticaria, wheezing and she passes out after eating chili for lunch. Case 3 A 16 year old female with seasonal allergic rhinitis is referred to see an allergist for evaluation of recurrent itching and swelling of her lips and tongue after eating bananas. The symptoms develop immediately after eating bananas and spontaneously resolve in 45 minutes. A skin test with a commercial extract yields a negative result; however, a skin test with fresh banana gives a positive result which confirms a diagnosis of oral allergy syndrome. His parents feed him some scrambled eggs two days later and he immediately develops hives and wheezing. He is treated with diphenhydramine, subcutaneous epinephrine and albuterol in an emergency department, where his parents are informed that he is probably allergic to eggs. The four case scenarios illustrate common presentations, diagnostic work up approaches and management of food allergies. Although an unpleasant reaction to food is often thought to be a food allergic reaction, only 8% of children under 3 years of age and roughly 2% of the adult population are affected by food allergies, which are mediated by an allergic/immune mechanism. An adverse food reaction is a general term for a clinically abnormal response to an ingested food or food additive. Adverse food reactions may be caused by food hypersensitivity (allergy) or food intolerance. Food intolerance is a descriptive term of an abnormal physiologic response to an ingested food or food additive. The response is not immunologic in nature and it may be caused by many factors such as a toxic contaminant (such as histamine in scombroid fish poisoning or toxins secreted by Salmonella or Shigella), pharmacologic properties of the food (such as caffeine in coffee or tyramine in aged cheese) and idiosyncratic responses or host factors (such as lactase deficiency). Acute urticaria and angioedema are the most common food allergic reactions, but the reaction may be a severe, life threatening event, such as anaphylactic shock. In fact, food allergies account for a large proportion of anaphylaxis cases in the United States. Other forms of acute presentations include: oral allergy syndrome, immediate gastrointestinal reaction (nausea, emesis, and diarrhea), anaphylaxis, rhinitis, asthma, and exercise-induced anaphylaxis. Delayed onset of food allergy symptoms includes atopic dermatitis, eosinophilic gastroenteropathies, dietary protein enterocolitis, dietary protein proctitis, dietary protein enteropathy, celiac disease and dermatitis herpetiformis. There is substantial evidence indicating that food allergies cause many cases of atopic dermatitis in children, although food allergy is rarely a trigger of atopic dermatitis in adults. In a study, food allergies were found in 35% of children with moderate-severe atopic dermatitis (4). The skin lesions are generally provoked by an oral food challenge and are resolved by avoidance of the causal foods. The pattern of food allergy in children is somewhat different from that in adults.

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Navigational Note: Hair texture abnormal Present Definition:A disorder characterized by a change in the way the hair feels arrhythmia symptoms buy generic lopressor 100 mg. Navigational Note: Hirsutism In women, increase in length, In women, increase in length, thickness or density of hair in thickness or density of hair in a male distribution that the a male distribution that patient is able to camouflage requires daily shaving or by periodic shaving, bleaching, consistent destructive means or removal of hair of hair removal to camouflage; associated with psychosocial impact Definition:A disorder characterized by the presence of excess hair growth in women in anatomic sites where growth is considered to be a secondary male characteristic and under androgen control (beard, moustache, chest, abdomen). Navigational Note: Hypertrichosis Increase in length, thickness Increase in length, thickness or density of hair that the or density of hair at least on patient is either able to the usual exposed areas of the camouflage by periodic body [face (not limited to shaving or removal of hairs or beard/moustache area) is not concerned enough plus/minus arms] that about the overgrowth to use requires frequent shaving or any form of hair removal use of destructive means of hair removal to camouflage; associated with psychosocial impact Definition:A disorder characterized by hair density or length beyond the accepted limits of normal in a particular body region, for a particular age or race. Navigational Note: Nail changes Present Definition:A disorder characterized by a change in the nails. Navigational Note: Nail ridging Asymptomatic; clinical or diagnostic observations only; intervention not indicated Definition:A disorder characterized by vertical or horizontal ridges on the nails. Older lesions are usually a darker purple color and eventually become a brownish-yellow color. Also known as morbillform rash, it is one of the most common cutaneous adverse events, frequently affecting the upper trunk, spreading centripetally and associated with pruritis. Navigational Note: Skin ulceration Combined area of ulcers <1 Combined area of ulcers 1 2 Combined area of ulcers >2 Any size ulcer with extensive Death cm; nonblanchable erythema cm; partial thickness skin loss cm; full-thickness skin loss destruction, tissue necrosis, or of intact skin with associated involving skin or involving damage to or damage to muscle, bone, or warmth or edema subcutaneous fat necrosis of subcutaneous supporting structures with or tissue that may extend down without full thickness skin loss to fascia Definition:A disorder characterized by a circumscribed, erosive lesion on the skin. The syndrome is thought to be a hypersensitivity complex affecting the skin and the mucous membranes. This syndrome is observed in patients who demonstrate a state of generalized leaky capillaries following shock syndromes, low-flow states, ischemia-reperfusion injuries, toxemias, medications, or poisoning. Navigational Note: Hematoma Mild symptoms; intervention Minimally invasive evacuation Transfusion; invasive Life-threatening Death not indicated or aspiration indicated intervention indicated consequences; urgent intervention indicated Definition:A disorder characterized by a localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. Navigational Note: Hypotension Asymptomatic, intervention Non-urgent medical Medical intervention Life-threatening Death not indicated intervention indicated indicated; hospitalization consequences and urgent indicated intervention indicated Definition:A disorder characterized by a blood pressure that is below the normal expected for an individual in a given environment. Navigational Note: Lymph leakage Symptomatic; medical Severe symptoms; invasive Life-threatening Death intervention indicated intervention indicated consequences; urgent intervention indicated Definition:A disorder characterized by the loss of lymph fluid into the surrounding tissue or body cavity. Navigational Note: Lymphocele Asymptomatic; clinical or Symptomatic; medical Severe symptoms; invasive diagnostic observations only; intervention indicated intervention indicated intervention not indicated Definition:A disorder characterized by a cystic lesion containing lymph. Navigational Note: Peripheral ischemia Brief (<24 hrs) episode of Prolonged (>=24 hrs) or Life-threatening Death ischemia managed medically recurring symptoms and/or consequences; evidence of and without permanent invasive intervention end organ damage; urgent deficit indicated operative intervention indicated Definition:A disorder characterized by impaired circulation to an extremity. Navigational Note: Phlebitis Present Definition:A disorder characterized by inflammation of the wall of a vein. Navigational Note: Superficial thrombophlebitis Present Definition:A disorder characterized by a blood clot and inflammation involving a superficial vein of the extremities. Signs and symptoms include swelling and cyanosis of the face, neck, and upper arms, cough, orthopnea and headache. Vasculitis Asymptomatic, intervention Moderate symptoms, medical Severe symptoms, medical Life-threatening Death not indicated intervention indicated intervention indicated. The sponsor maintains an updated list of principal investigators, sites and institutions and Contract Research Organizations (if applicable). Signature of Principal Investigator Date Printed Name of Principal Investigator Biosense Webster, Inc. Atrial fibrillation secondary to electrolyte imbalance, thyroid disease, or reversible or non-cardiac cause. Presence of intracardiac thrombus, myxoma, tumor, interatrial baffle or patch or other abnormality that precludes catheter introduction or manipulation. Significant congenital anomaly or a medical problem that in the opinion of the investigator would preclude enrollment in this trial. Currently enrolled in an investigational study evaluating another device, biologics, or drug. Women of child bearing potential whom are pregnant, lactating, or planning to become pregnant during the course of the clinical investigation (as evidenced by pregnancy test if of child bearing potential). Presenting contra-indication for the devices used in the study, as indicated in the respective instructions for use. A small spring connects the ablation tip electrode to the catheter shaft with a magnetic transmitter and sensors to measure deflection of the spring. The catheter has a high torque shaft with a bi-directional deflectable tip section containing an array of electrodes which may be used for recording and stimulation purposes. At the proximal end of the catheter, a saline input port with a standard Luer fitting terminates from the open lumen. This saline port serves to permit the injection of normal saline to irrigate the tip electrode. During ablation, heparinized saline is passed through the internal lumen of the catheter and through the tip electrode, to irrigate and cool the ablation site as well as the electrode tip. Serious adverse events related to atrial esophageal fistula/tamponade/perforation have occurred at 9% of sites where the product has been distributed. A summary of risks associated with catheter ablation, including analysis of and plans to minimize these risks is provided below: 4. Experience at numerous clinical sites/centers suggests that the risk of coronary occlusion is less than 0. The thrombus could become dislodged and embolize to produce a stroke, myocardial infarction, or other ischemic injury. The risk of an embolus is reduced by quickly terminating the application of current after an impedance rise, which limits the size of the coagulum on the electrode. This risk may be reduced by the use of aspirin or other anticoagulant therapy, at the discretion of the investigator. An increased risk of cardiac perforation during ablation may be associated with the use of saline-irrigated electrode catheter due to its ability to create a larger, deeper lesion. Risks associated with the general procedure Radiation exposure during the fluoroscopic imaging of the catheters may result in an increase in the lifetime risk of developing a fatal malignancy (0. The risk of serious complications is generally related to the severity of cardiac disease. The degree of risk of the electrophysiological and catheter ablation procedures and the potential benefit of the treatment of persistent or recurrent arrhythmia should be determined by a qualified physician. Cardiac catheterization and electrophysiological procedures should be performed by qualified and appropriately trained personnel in an electrophysiology laboratory. The laboratory should contain sufficient resuscitative equipment and facilities to manage any potential complication. Failure to observe any of the contraindications, warnings, and precautions in these instructions may result in procedural complications. Risks include: cardiovascular injury or perforation with or without cardiac tamponade, pulmonary embolus, tricuspid regurgitation, myocardial infarction, bleeding at the catheter insertion site, sepsis, and death. Additional contraindications for device use include: hemodynamic instability, bacteremia, coagulopathy, prosthetic tricuspid valve, intra-atrial or venous thrombosis, and pregnancy. Further reference can be made to the User manual and addendum, for more information. A protocol Amendment will be submitted for approval if any additional significant risks would be identified in newly released software versions. Further reference can be made to the pre-clinical testing reports and Investigator Brochure for more information. Subjects will be screened carefully prior to enrollment in the study to ensure compliance with the inclusion and exclusion criteria. The exclusion criteria have been developed to exclude subjects with a medical history or condition that increases their risk of adverse events (refer to Section 8. Should occlusion of a coronary artery occur for any reason, the physician will attempt to restore coronary blood flow through pharmacological, catheter and/or surgical intervention as medically indicated. Additionally, safety data will be evaluated periodically during enrollment and follow up by medical safety officer or designee. The investigational device may allow cardiac ablation procedures to be done with greater efficiency, safety, and effectiveness. All information and data sent to the sponsor concerning subjects or their participation in this clinical investigation will be considered confidential and transmitted anonymously. Only authorized sponsor personnel or designee, or local government authorities acting in their official capacities will have access to these confidential files. All data used in the analysis and reporting of this evaluation will be without identifiable reference to the subject.

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Before the anatomy of the infranodal conduction system was understood hypertension 28 years old purchase 50 mg lopressor visa, the fascicular blocks were called peri-infarction block. The presumed mechanism is massive catecholamine discharge caused by the acute bleed, leading to severe vasoconstriction, and subendocardial ischemia. Pathologic studies have shown subendocardial myolysis and an absence of coronary obstructive disease. She is able to raise her heart rate with exercise, and atrial contraction is preserved. If there is doubt about pericarditis, angioplasty would be safer than thrombolytic therapy. Comment: I have mentioned that conduction across an accessory pathway may be intermittent. Note the T wave changes that appear with the delta wave; it should be no surprise that changing the sequence of ventricular activation may also change the sequence of repolarization. The node usually recovers, either because of good collateral flow or because of relaxation of vagal tone. Comment: Patients with pre-excitation may have multiple accessory pathways; this patient has switched from one to another with the change in heart rate. With cardiogenic shock, the prognosis is poor unless reperfusion therapy can be accomplished quickly. For reperfusion therapy to work, the infarct artery should be opened within 6 hours of the onset of pain. Move in the direction of the cardiac catheterization laboratory as soon as you make the diagnosis of cardiogenic shock. The key to the diagnosis is the sedimentation rate, which is usually above 100mm/hr. Her emergency angiogram showed acute occlusion of the left anterior descending artery (to the anterior wall). She had chronic, asymptomatic occlusion of the right coronary artery (to the inferior wall), and the distal vessel was supplied by collaterals from the left anterior descending. Interpretation: Possibly accelerated idioventricular rhythm, although nodal rhythm is possible, 70/min. Comment: this is a relatively common occurrence (we staged it for this purpose with one of the technicians). Another common lead misplacement involves the V leads and bizarre R wave progres sion across the precordium. Index Page numbers in italics refer to figures and those in bold to tables, but note that figures and tables are only indicated when they are separated from their text references. A test will be given that will require you to recognize cardiac arrest rhythms and the most common bradycardias & tachycardias. Arrhythmias will be reviewed in teaching and skills stations in order to improve your skills. The instructors will assist you in developing skills to differentiate the rhythms required for successful completion. Ventricular Fibrillation $ Chaotic, disorganized electrical depolarization of the ventricles 4. Atrial Flutter $ No definable P waves; "sawtooth" appearing flutter waves from atrial depolarization. This example is regular due to it dropping every other beat (2:1 conduction nd ratio). This example is irregular due to it dropping every so often (variable conduction ratio). This project was made possible by unrestricted educational grants from the Boston Scientific, Medtronic, and St. No part of this publication may be reproduced in any form or by any means without written permission from the publisher. Adrenaline re common arrhythmia in cardiac arrest is ventricular leased during intense physical or athletic activ fibrillation. Prevention of arrest among those known after a heart attack is a particularly high-risk to be at risk is a significant cornerstone in saving period for sudden cardiac arrest in patients lives. Intended for physician reference, Part I of this v Sudden Cardiac Arrest: Meeting the Challenge publication presents the condensed, evidence-based Follow-up care. Those who are successfully resusci guidelines of the American College of Cardiology/ tated from sudden cardiac arrest require excellence in American Heart Association/European Society of care from hospitals and from supportive entities in Cardiology formulated in 2006, and the guidelines the community. Abstracted from the American Heart Association Web site, curs, whether in the hospital or in the community. Placement of automated external de this publication is not intended to offer fibrillators, and training in their use, has been shown medical advice; it is intended as a reference to save lives. Guidelines for Management of Patients with Ventricu lar Arrhythmias and the Prevention of Sudden Cardiac Incidence. The event rate management of heart failure, insertion and use of for adults is 100 per 100,000 patient years. We recognize that, in the ular fibrillation, the most common rhythm associ general sense, all cardiac care has a goal of preven ated with cardiac arrest. Recent literature reports indi among African-Americans and whites have yielded cate that, increasingly, cities such as Boston, Seattle, conflicting findings but some studies have demon and New York are requiring rescue personnel to take strated excess risk among African-Americans. Risk profiling for coronary artery dis Populations: Subgroups and Risk Prediction. In gen Hemodynamically Unstable Ventricular Tachycardia: eral, treatment is indicated to prevent potential mor the term hemodynamically unstable has not been bidity. Level of Evidence B: Data derived from a single randomized trial or nonrandomized studies. A thorough drug history including With the exception of beta blockers, at the present dosages used must be included in the evaluation of time the use of antiarrhythmic drugs to abolish exer patients suspected of having ventricular arrhythmias. Physical Although the safety of supervised exercise testing is examination is often unrevealing in patients sus well established, less data are available in patients at pected of having ventricular arrhythmias unless the risk for serious ventricular arrhythmias. In one series, arrhythmia occurs while the patient is being exam exercise testing in patients with life-threatening ven ined. Its most com monitors are more appropriate because they can mon application is for detection of silent ischemia in record over extended periods of time. Persistent inducibility while receiv ischemia and who are unable to exercise or have rest ing antiarrhythmic drugs predicts a worse prognosis. Management of the manifest arrhyth varies greatly with the selected patient populations. As a general rule, antiarrhyth mic agents may be effective as adjunctive therapy in When ventricular tachycardia is suspected: Syncope the management of arrhythmia-prone patients under 10 Sudden Cardiac Arrest: Meeting the Challenge special circumstances. The mechanism of antiarrhythmic efficacy darone or sotalol can be tried with monitoring for of this class of drugs involves competitive adrenergic adverse effects during administration. Sotalol is effective in suppressing atrial polarization currents that can inhibit or terminate and ventricular arrhythmias; the combination of ventricular arrhythmias by increasing the wavelength beta blockers and amiodarone is an alternative ap for reentry. A few blockers rather than sotalol can be the first-line ther studies and one meta-analysis of several large studies apy for defibrillator storm. Findings indicate that statins reduce the occurrence of life-threatening ven Wearable Automatic Defibrillator: the wearable tricular arrhythmias in high-risk cardiac patients automatic defibrillator has been approved in the with electrical instability. Coronary revascularization vide palliation but will not eliminate the need for involving either percutaneous balloon/stent angio device or antiarrhythmic therapy. Possible reversible tial 2 minutes from the onset of cardiac arrest, so causes, particularly for bradyarrhythmia and asystole, that by 4 to 5 minutes survivability may be 25% or should be considered and excluded (or treated) less, and by 10 minutes it is less than 10%. The mechanisms of tachyarrhythmias, led to the generation of complex these arrhythmias may be different from those seen protocols to guide responders. Arrhythmias rithms to these various circumstances are complex during acute ischemia may be related to re-entry, and these documents are classified as Level of Evi abnormal automaticity, or triggered activity and are dence: C, but they are derived from a combination affected by a variety of endogenous factors such as of varied studies and opinion from Levels of Evi potassium levels and autonomic states.

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Her role in this regard has been overstated arrhythmia symptoms in children order lopressor with mastercard, and the history of the word itself is far more complex than has been previously understood. Prince did describe herself with such terms as transgenderal as early as 1969 and transgenderist as early as 1978, as a means to name the specic behavior of living full time in a chosen social gender role different from that typically asso ciated with birth-assigned sex, without undergoing genital sex-reassignment surgery (see Ekins and King 2006). Cristan Williams is the founder of the Transgender Archives in Houston, Texas, and is the executive director of the Transgender Foundation of America. Transition thus weighs especially heavily on people who lack the resources or the wish to conform to its polarized denitions of sexed embodiment, such as poor and/or uninsured people and those whose gender expression is not formed in relation to dominant white European American conventions. In dance, transitions are strategies for redirecting embodied energies; they can change the quality or the direction of movement, increase or decrease momentum, cover space, and/or occupy time. In parturition, transition names the shift from active labor to pushing the baby out. Like birth, like writing, gender transition is when hopes take material form and in doing so take on a life of their own. Transition is thousands of little gestures of protest and presence, adding up and getting some momentum behind them so that you nally achieve escape velocity from the category you were stuck in all those years ago. At some point, for many people, changes become less pronounced, less socially and affectively intense. Still when we pass, if we are unlucky in our relatives, Downloaded from read. When we are not aware of the days getting longer, have the seasons stopped changing This is the promise of transition, as the term continues to expand from its psychiatric and surgical usage: that we can live in the time of our own becoming and that possible change is not restricted to the narrow sphere of our conscious intention. Julian Carter is associate professor of critical studies at California College of the Arts in Oakland and San Francisco. Given that the prex trans is used to indicate individuals who might have migrated (or whose family histories might include migration) and who might have transnational connections, it acquires a double valence, referring Downloaded from read. In my own work, I have also used the term translocas but embraced the alternate, vernacular, Downloaded from read. He is the author of Queer Ricans: Cultures and Sexualities in the Diaspora (2009), Unas pintadas de azul/Blue Fingernails (2009), and Abolicion del pato(2013). Roger Lancaster (1998) discusses the wide variety and heterogeneity of trans categories and practices in Latin America. Sandy Stone, a founder of trans studies, tells this story: it is 1972 at the Stanford Gender Dysphoria Clinic, and Sandy is waiting for her appointment, one of many that she hopes will establish her eligibility for sex reassignment support. In a world in which gay, queer, and transgender all comingle with imperialist insti tutions, translators carry the burden of destruction and creation. In Mandarin, tongzhi conventionally means common cause, commitment, or comrade; it carries a con cept of affinity across Chinese socio-temporal contexts, specically using the tensions of homosexual in/visibilities to arrive at a new meaning commonly translated into English as gay. Perhaps few things point out the failure of words to convey our arrival in this social body quite so well as transgender. As a term, transgender translates an innite multi plicity into a single disciplinary body. Transgender demands above all the need for more context, more story, and thus the translation into transgender never arrives and rests. Instead, it begs that we continuously translate from transgender, provide new contextual elaborations that include time and place and all the disciplinary regimes through we which have named and been named, the names that are the precondition of our passing. Translation like pronoun fails becomes interpretation, imposition, the transposition of one body on to an other not one, not two: it multiplies with each border crossed or not crossed. Kang, Tobaron Waxman, the Electronic Disturbance Theater, Chris Vargas, Cayden Mak, and Jacolby Satterwhite, have created works that express dimensions of transgender and gender-nonconforming experience while also transforming the relationship between the aesthetics, politics, and technol ogies of cultural representation. In their transmedia productions, bodies, images, sounds, materialities, politics, and informatics offer points of social contact and expressive meaning making rather than static representations and theories. In the War of Desire and Technology at the Close of the Mechanical Age (1996), Stone explains how the act of listening to a public lecture by Stephen Hawking, amplied through microphone, computer, and speakers, can create a communicative intimacy that trespasses the presumed boundaries of the body and internal self. In response to the epistemic violence of academic knowledge production, Stone has turned to performance as her primary medium of knowledge transmission, emphasizing the impact of sharing space, time, and physical presence in specic contexts (Stone 2010). As a com mercial concept, transmedia describes contemporary media products that are created through models of production and for models of consumption that differ from mass industrial modes. They are produced, circulated, and consumed across interconnected media industries and tech nologies within the United States and transnationally. New Zealand was an outsourced and economically incentivized lming location for Avatar. The location was also a source of labor and an ecological resource (the basis for the virtual world of Pandora) for the lm. The interpenetration of media industries and technologies produces phantasmago rias, or simulated sensory connections between products that overload and alienate the senses so that consumption becomes passive (Buck-Morss 1991). A reclaimed transmedia approach recognizes that commercial intoxication relies on sustaining the out-of-world feeling of having been transported across space and time. Trans and genderqueer rebels mobilize transmedia to recover the deleted material conditions that have enabled the current technological and economic network ing of media. Lissette Olivares is a PhD candidate in the History of Consciousness Department at the University of California, Santa Cruz, where she investigates the role of new media in social movements from a transnational and transhistorical perspective. And there is documented evidence of sexual violence, physical violence, and verbal harassment of trans people, and at least the self-reports of trans people indicate that such behavior often arises from hostile attitudes toward them as trans. While it is clear transphobia exists, however, it is far from evident what transphobia is. Provisionally, the term can be dened to mean any negative attitudes (hate, contempt, disapproval) directed toward trans people because of their being trans.

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No other organic blood pressure cuff walgreens purchase cheapest lopressor and lopressor, functional, or structural disease, defect, or limitation that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds (1). May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges. Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or (2). The average blood pressure while sitting should not exceed 155 mm mercury systolic and 95 mm mercury diastolic maximum pressure for all classes. A medical assessment is specified for all applicants who need or use antihypertensive medication to control blood pressure. Examination Techniques In accordance with accepted clinical procedures, routine blood pressure should be taken with the applicant in the seated position. An applicant should not be denied or deferred first-, second-, or third-class certification unless subsequent recumbent blood pressure readings exceed those contained in this Guide. An applicant whose pressure does not exceed 155 mm mercury systolic and 95 mm mercury diastolic maximum pressure, who has not used antihypertensive medication for 30 days, and who is otherwise qualified should be issued a medical certificate by the Examiner. Pulse (Resting) the medical standards do not specify pulse rates that, per se, are disqualifying for medical certification. These tests are used, however, to determine the status and responsiveness of the cardiovascular system. Aerospace Medical Disposition If there is bradycardia, tachycardia, or arrhythmia, further evaluation is warranted and deferral may be indicated (see Item 36. Aerospace Medical Disposition Glycosuria or proteinuria is cause for deferral of medical certificate issuance until additional studies determine the status of the endocrine and/or urinary systems. If the glycosuria has been determined not to be due to carbohydrate intolerance, the Examiner may issue the certificate. Trace or 1+ proteinuria in the absence of a history of renal disease is not cause for denial. The Examiner may request additional urinary tests when they are indicated by history or examination. Regardless of who performs the tests, the Examiner is responsible for the accuracy of the findings, and this responsibility may not be delegated. If the form is complete and accurate, the Examiner should add final comments, make qualification decision statements, and certify the examination. Comments on History and Findings Comments on all positive history or medical examination findings must be reported by Item Number. Item 60 provides the Examiner an opportunity to report observations and/or findings that are not asked for on the application form. If there are no significant medical history items or abnormal physical findings, the Examiner should indicate this by checking the appropriate block. When advised by an Examiner that further examination and/or medical records are needed, the applicant may elect not to proceed. Use of this form will provide the applicant with the reason for the denial and with appeal rights and procedures. If the Examiner denies the applicant, the Examiner must issue a Letter of Denial, to the applicant, and report the issuance of the denial in Item 60. The worksheets provide detailed instructions to the examiner and outline condition specific requirements for the applicant. Copies of all records regarding prior psychiatric or substance-related hospitalizations, observations, or treatment. If the neuropsychologist believes there are any concerns* with the evaluation results, a Supplemental Battery must also be conducted. Possible interview of collateral sources of information such as parent, school counselor/teacher, employer, flight instructor, etc. The sample must be collected at the conclusion of the neurocognitive testing or within 24 hours after testing. See Report Requirements for items that must be covered as well as additional items that must be submitted. To promote test security, itemized lists of tests comprising psychological/neuropsychological test batteries have been moved to this secure site. If records were not clear or did not provide sufficient detail to permit a clear evaluation of the nature and extent of any previous mental disorders, that should be stated. Current substance use and substance use/abuse history including treatment and quality of recovery, if applicable; c. All medication use history; 245 Guide for Aviation Medical Examiners i. You should report if there are other conditions or a learning disorder present; and ii. If pilot norms are not available for a particular test or inappropriate for a specific applicant, then the normative data/comparison group relied upon for interpretation. In that event, authorization for release of the data (by the airman to the expert reviewer) is required. This report must attest to stable visual acuity and refractive error, absence of significant side effects/complications, need of medications, and freedom from any glare, flares or other visual phenomena that could affect visual performance and impact aviation safety Visual Acuity Standards: o As listed below or better; o Each eye separately; o Snellen equivalent; and o With or without correction. Current 24-hour Holter monitor evaluation to include select representative tracings. Examples include epinephrine injection, cardiac trauma, complications of catheterization, blood clotting disorders. Required documentation for all pilots with any of the remaining conditions above: a. Additional required documentation for first and unlimited* second class airmen a. The applicant should indicate if a lower class medical certificate is acceptable (if they are found ineligible for the class sought) E. Note: If cardiac catheterization and/or coronary angiography have been performed, all reports and actual films (if films are requested) must be submitted for review. At a minimum: A review of all available records, including academic records, records of prior psychiatric hospitalizations, and records of periods of observation or treatment. Applicants with a diagnosis of diabetes mellitus controlled by diet alone are considered eligible for all classes of medical certificates under the medical standards, provided they have no evidence of associated disqualifying cardiovascular, neurological, renal, or ophthalmological disease. Specialized examinations need not be performed unless indicated by history or clinical findings. The report must contain a statement regarding the medication used, dosage, the absence or presence of side effects and clinically significant hypoglycemic episodes, and an indication of satisfactory control of the diabetes. The results of an A1C hemoglobin determination within the past 30 days must be included. Note must also be made of the presence of cardiovascular, neurological, renal, and/or ophthalmological disease. Re-issuance of a medical certificate under the provisions of an Authorization will also be made on the basis of reports from the treating physician. The applicant should be informed of the potential for hypoglycemic reactions and cautioned to remain under close medical surveillance by his or her treating physician. Hemoglobin A1C lab value and date (A1C lab value must be taken more than 30 days after medication change and within 90 days of re/certification) 5. Any evidence of progressive diabetes induced end organ disease Cardiac. Yes No Treating Provider Signature Date Note: Acceptable Combinations of Diabetes Medications and copies of this form for future follow-ups can be found at Individuals certificated under this policy will be required to provide medical documentation regarding their history of treatment, accidents, and current medical status. For details of what specific information must be included for each requirement/report (Items #1-7), see the following pages.

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Motivational interviewing techniques pulse pressure and exercise order generic lopressor pills, to assess desire for and barriers to change, can be helpful. Her lungs are clear to auscultation and her abdomen is nontender, with no organomegaly. A sore throat with fever in children and adolescents prompts many pediatric primary care visits. For the girl in the vignette, adenovirus is the most likely cause of her symptoms. Adenovirus commonly presents with pharyngoconjunctival fever, and the appropriate management is supportive care. Testing for adenovirus is not usually needed unless other conditions (eg, Kawasaki disease) are being considered. Although topical antihistamines can provide some relief for the symptoms of conjunctivitis, these can sometimes irritate the eyes further. Epstein-Barr virus is a common cause of pharyngitis, which is more severe in older children and adolescents. Heterophile antibodies are often not present in young children, thus, for the 7-year old child in the vignette, serologic testing would be required to make this diagnosis. There are several potentially serious causes of pharyngitis that require urgent evaluation and intervention. These include peritonsillar abscess, characterized by a unilaterally enlarged tonsil; and if the child is ill-appearing, a retropharyngeal abscess, epiglottitis, or Lemierre syndrome should be suspected. His mother reports that he has developed anxiety around eating and is not eating as much as he used to following an episode of food impaction several months ago. He was able to clear the impaction prior to evaluation in the emergency department. He now takes longer than the entire family to eat and is drinking large volumes of water with meals. This diagnosis is based on his history of food impaction, slow eating with excessive chewing and flushing his food down with large volumes of liquids, and atopy (asthma and eczema). He reports no dysphagia or odynophagia, which would be expected with esophageal stricture, achalasia, and nutcracker esophagus. Children with gastroesophageal reflux are not likely to experience food impactions. Eosinophilic esophagitis is an allergy/immune condition in which large numbers of eosinophils are found in the esophagus. Untreated gastroesophageal reflux can appear very similar to eosinophilic esophagitis with eosinophils on biopsy. Therefore, children should be placed on proton pump inhibitors for a minimum of 6 weeks prior to endoscopy. In children with eosinophilic esophagitis, the esophagus often demonstrates longitudinal furrows, white plaques, and pallor. Eosinophilic esophagitis is diagnosed if there are more than 15 eosinophils per high power field while on a proton pump inhibitor. Eosinophilic esophagitis in children and adolescents: epidemiology, clinical presentation and seasonal variation. His mother reports a 2-week history of polyuria, polydipsia, and nocturnal enuresis after being dry at night for the past 4 years. He also has evidence of significant volume depletion with tachycardia, prolonged capillary refill time, and elevated blood urea nitrogen and creatinine. Although care should be taken to not give excessive fluids, current consensus guidelines recommend initiation of fluid therapy before starting insulin. Hence, giving 10 mL/kg of intravenous normal saline over 1 hour is the most appropriate initial management step for this boy. Subsequent fluid administration should provide daily maintenance requirements plus the estimated fluid deficit given evenly over 48 hours. Isotonic fluid should be continued for at least the first 4 to 6 hours, and thereafter, fluid should be administered with 0. Administration of intravenous half-normal saline with potassium at twice-maintenance rate is appropriate after the first 4 to 6 hours, but is not the best initial management step. Starting insulin within the first hour of fluid therapy is associated with an increased risk of cerebral edema. Thus, starting intravenous insulin is not the best initial management step for the boy in the vignette nor is a bolus of intravenous insulin, which can also worsen hypokalemia. The glucose level corrects before the acidosis, and it is important to avoid hypoglycemia. Therefore, until the acidosis corrects, as the glucose level falls, dextrose should be added to the fluids rather than decreasing the insulin infusion rate. Cerebral edema has been associated with greater dehydration and acidosis at presentation, greater volumes of fluid given in the first 4 hours, and insulin administration during the first hour of fluid administration. A proposed mechanism is that cerebral hypoperfusion before treatment causes cytotoxic injury, predisposing the brain to reperfusion injury and subsequent edema during treatment. Rapid overhydration should be avoided to prevent reperfusion injury; however, underhydration or delayed hydration carries the risk of worsening the cerebral cytotoxic injury caused by dehydration and acidosis. Diabetic ketoacidosis may occur as the initial presentation of diabetes or with existing diabetes. Common presenting symptoms include polyuria, polydipsia, fatigue, weight loss, nausea, vomiting, abdominal pain, and rapid breathing. Symptoms can mimic gastroenteritis, viral syndromes (eg, influenza), acute abdomen, pneumonia, or asthma. Thus, a high index of suspicion for diabetes is necessary to avoid delayed diagnosis. Physical examination findings may be significant for signs of dehydration and altered mental status. Serum sodium will be low because of hyperglycemia, and should be assessed after correction for the plasma glucose level. It is associated with greater dehydration and acidosis at presentation, greater volumes of fluid given in the first 4 hours, insulin administration in the first hour of fluid treatment, and bicarbonate administration. He undergoes intubation and mechanical ventilation because of hypoxic and hypercapnic respiratory failure. Over the next 3 days, he requires high ventilator settings to maintain gas exchange. Breath sounds are decreased bilaterally, with mid to end-expiratory wheezes, crackles, and rhonchi evenly scattered throughout all lung fields. The most likely consequence of this respiratory acidosis, over the next several days, is renal compensation with increased renal absorption of bicarbonate. In the red blood cell, the hydrogen ion that is produced is buffered by intracellular proteins, further driving the reaction to the right and producing bicarbonate. The bicarbonate is then exchanged with chloride at the erythrocyte cell membrane, which increases the serum bicarbonate level. This acute compensation only raises the serum bicarbonate level by 1 mmol/L for every 10 mm Hg of increased partial pressure of carbon dioxide (Pco2). When respiratory acidosis continues for several days, increased absorption of bicarbonate then occurs at the level of the nephron. Increased arterial Pco2 causes the diffusion of carbon dioxide into proximal tubule cells where, because of the equilibrium of the carbonic anhydrase reaction, hydrogen ion is produced. As opposed to the mechanism in the erythrocyte, in the nephron, pH and electroneutrality are achieved by the increased secretion of hydrogen ion into the tubular lumen and urine. The consequence of this renal compensation for chronic respiratory acidosis is generally a rise in serum bicarbonate of 3. The expected changes in pH for the acute and chronic phases of respiratory acidosis would be: Acute respiratory acidosis: delta pH = 0. Although tachypnea, increased alveolar ventilation, and increased Pco2 diffusion can occur in response to an acute illness, the boy in the vignette demonstrates impaired alveolar ventilation as evidenced by his rise in Pco2.

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In the figure above blood pressure chart 50 year old male purchase generic lopressor online, there is loss of the alpha activity in the seventh sec ond (arrow). Since more than 15 sec of this page has stage I sleep, this epoch is scored as sleep onset. Sleep latency is calculated by calculat ing the difference between lights off and sleep onset times. In addi Ftion to the loss of alpha rhythm, there is appearance of slow, rolling eye movements, mixed-frequency activity in the 2 to 7-Hz range, and finally vertex waves. In the figure above, rapid eye movements start in the seventh second (thin arrows). Sleep-related breathing disorders in adults: recommendations for syn drome definition and measurement techniques in clinical research. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects. A manual of standardized terminology, tech niques and scoring system for sleep stages of human subjects. Often the neurophysiologist is able to alert the surgeon of impending injury and potential neurologic sequelae, allowing the surgeon to modify or reverse the procedure. Several techniques can be used to monitor the integrity of the nervous system during surgery, and these are chosen depending on the part of the nervous system that is at risk and type of surgery. In this chapter, each modality is shown separately for illustration purposes, although in clinical practice many different types of monitoring tech niques are used simultaneously. Changes in the latencies and amplitudes of the wave I and wave V from baseline are observed. Notice the consistency with which the wave V falls on this line, indicating no significant change in latency. In the figure above, waves I (thin arrow) and V (thick arrow) are initially identified. Soon after placement of the cerebellar retractor, there is prolongation of the wave V latency (notice the dot placed on the peak of wave V at baseline). The surgeon is 226 Neurophysiologic Intraoperative Monitoring alerted, and he repositions the cerebellar retractor. When the retractor is removed, the wave V gradually returns to baseline (dash and dot arrow). A persistent 1 msec or wors ening latency shift is more likely to be associated with postoperative hearing loss. In the fig ure above, notice that the vertical line is over the wave V at baseline; at the time of tumor dissection, there is maximal shift of the wave V (thin arrow). By the end of the surgery, the latency of wave V is close to baseline signified by the vertical line (thick arrow). Presence of wave I at the time of maximal wave V shift verifies the adequacy of stimulation (dashed arrow). If it does not return by the end of the surgery, the patient is likely to have post operative hearing loss. However, the loss of the wave V is not incom patible with preserved hearing (false-positive). When complete loss of wave V occurs suddenly, it is usually due to interruption of the vascu lar supply of the vestibulocochlear nerve. If the loss is gradual, the eti ology is more likely to be either mechanical or thermal trauma to the nerve. In the figure above, there is a robust wave V at the start of the case (thin arrow); however, as dissection proceeds there is gradual loss of amplitude (thick arrow) and eventually complete loss of wave V (dashed arrow) that does not return by the end of the surgery. The preserved wave I (dotted arrow) confirms that this change is not due to technical reasons. In the figure above, wave V is noted at baseline (thin arrow); however, with cerebellar retraction there is gradual latency prolongation up to 0. When the surgeon is notified and the retractor is removed, there is a gradual return of wave V (dotted arrow). A relatively common cause is kinking or clamping of the tubing used to transmit the acoustic stimulus from the sound generator to the ear. After positioning the patient in the example above, the baseline response was obtained and revealed a robust wave V waveform (thin arrow). Soon after draping the patient, however, there was a sudden loss of the wave V (thick arrow) as well as wave I (dashed arrows). In the example above, there is gradual prolongation of latency and a drop in amplitude of the wave V waveform toward the end of the surgery (thin arrow). Note that as the wave V disappears, so does the wave I, indicating a peripheral etiology for the change (thick arrow). Subcortical (P14/N18 for upper, P31/N34 for lower) and cortical (N20 for upper, P37 for lower) waveforms are fol lowed during surgery. When no significant changes in the responses are noted, neurological morbidity is not anticipated. When such a change occurs, and technical and general physiological causes have been excluded, the surgeon should be alerted. At the start of the case, robust sub cortical (thin arrows) and cortical (thick arrows) responses are seen. As surgery continues, there is a gradual loss of amplitude of the sub cortical (dashed arrow) and cortical (dotted arrow) waveforms obtained after right-sided stimulation. The patient is likely to have postoperative dysfunction that involves the sensory pathways mediated by the dorsal columns of the right median nerve. In the figure above, cortical (P37) waveforms (thin arrows) are seen at the start of distraction from right tibial nerve stimulation. However, shortly thereafter, the cortical response has a decrease in amplitude and becomes difficult to identify (thick arrow), and the sur geon is alerted. Subcortical responses are more resilient to anesthetics and often can be followed in cases in which such anesthetics are required. Notice that the sub cortical responses persist despite the increase in anesthetics (dashed arrows). In the figure above, the first and third columns display the cortical (P37) waveforms, while the second and fourth columns display the subcor tical (P31/N34) waveforms. However, when the pressure drops to about 50 mm Hg, there is significant amplitude reduction of the wave forms (circles). Consequently, if patients are not given neuromuscular-blocking agents or higher doses of anesthetic gases during surgery, often the subcorti cal waveforms cannot be clearly seen. It has also been used for patients undergoing therapeutic stimulator implanta tions for facial pain. An N20 waveform is seen over the somatosen sory cortex, while a P22 (sometimes called the P20) waveform is seen over the motor cortex. In the figure above, there are robust N20 (thin arrow) and P22 (thick arrow) waveforms that phase reverse at contacts 7 and 8. The technologist checked the stimulating needles and found that they had been dis lodged. In this way,the corticospinal tracts are able to be monitored to help predict the like lihood of postoperative weakness. Usually, recordings are made 246 Neurophysiologic Intraoperative Monitoring from small hand and foot muscles. Spinal recordings (for D and I waves) are seldom used owing to the invasive methods required for recording. Using both modalities, both the anterior and posterior aspects of the spinal cord can be monitored. However, in patients in whom nerve roots as well as the spinal cord is at risk. This can allow detection of not only spinal cord injury but also injury to individual nerve roots.

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Ryan White Act Page 30 of 385 Anatomy and Physiology Paramedic Education Standard Integrates a complex depth and comprehensive breadth of knowledge of the anatomy and physiology of all human systems blood pressure 8855 generic lopressor 12.5mg line. Medulla and autonomic nervous system regulation of the diameter of the blood vessels 16. Location, Structure, and Function of the Stomach, Small intestine, Liver, Gallbladder, and Pancreas Page 48 of 385 J. Significance of caloric value of foods Page 53 of 385 Medical Terminology Medical Terminology Paramedic Education Standard Integrates comprehensive anatomical and medical terminology and abbreviations into the written and oral communication with colleagues and other health care professionals. Body Systems Page 54 of 385 Pathophysiology Pathophysiology Paramedic Education Standard Integrates comprehensive knowledge of pathophysiology of major human systems. Perform one function or act in concert with other cells to perform a more complex task C. Bacteria produce enzymes or toxins a) Toxins i) Exotoxins ii) Endotoxins b) Fever is caused pyrogens c) Inflammation d) Hypersensitivity e) Bacteremia or Septicemia c. Financial burdens Page 75 of 385 Public Health Public Health Paramedic Education Standard Applies fundamental knowledge of principles of public health and epidemiology including public health emergencies, health promotion, and illness and injury prevention. Individual training programs have the authority to add any medication used locally by paramedic. Thiamine Page 88 of 385 Airway Management, Respiration, and Artificial Ventilation Airway Management Paramedic Education Standard Integrates complex knowledge of anatomy, physiology, and pathophysiology into the assessment to develop and implement a treatment plan with the goal of assuring a patent airway, adequate mechanical ventilation, and respiration for patients of all ages. Cell and tissue beds and disruptions of membrane integrity, enzyme systems and acid-base balance. Disruptions in oxygen transport associated with diminished oxygen carrying capacity 1. Review of the physiologic differences between normal and positive pressure ventilation C. AgeRelated Variations in Pediatric and Geriatric Patients Page 100 of 385 Patient Assessment Scene Size-Up Paramedic Education Standard Integrates scene and patient assessment findings with knowledge of epidemiology and pathophysiology to form a field impression. If the paramedic cannot alleviate the conditions that represent a health or safety threat to the patient, move the patient to a safer environment 2. Paramedics should not enter a scene or approach a patient if the threat of violence exits. A variety of specialized protective equipment and gear is available for specialized situations. Chemical and biological suits can provide protection against hazardous materials and biological threats of varying degrees. Include a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any healthcare delivery setting c. The extent of standard precautions used is determined by the anticipated blood, body fluid, or pathogen exposure. Personal protective equipment includes clothing or specialized equipment that provides some protection to the wearer from substances that may pose a health or safety risk. Primary assessment: unstable Page 105 of 385 Patient Assessment History Taking Paramedic Education Standard Integrates scene and patient assessment findings with knowledge of epidemiology and pathophysiology to form a field impression. Requires use of knowledge of anatomy, physiology and pathophysiology to direct the questioning a. Clinical reasoning requires integrating the history with the physical assessment findings 2. Do not overlook the ability of these patients to provide you with adequate information 2. Be careful to announce yourself and to explain who you are and why you are there O. Physical examination techniques will vary from patient to patient depending on the chief complaint, present illness, and history A. Secondary trauma assessment order (see Trauma) Page 129 of 385 Patient Assessment Monitoring Devices Paramedic Education Standard Integrates scene and patient assessment findings with knowledge of epidemiology and pathophysiology to form a field impression. Rapidly becomes inactivated with use, therefore must be periodically replaced for continuous monitoring B. Geriatrics Page 132 of 385 Medicine Medical Overview Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. May not be appropriate to perform a complete secondary assessment on all medical patients 2. Patient presentation often leads to a recognizable pattern common to multiple conditions with similar presentations D. Specific Injuries/ illness: causes, assessment findings and management for each condition A. Patient education and prevention Page 149 of 385 Medicine Infectious Diseases Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. Standard Precautions, personal protective equipment, and cleaning and disposing of equipment and supplies. Introduction-Pathophysiology, incidence, risk factors, methods of transmission, complications 2. Chills, high-grade fevers, chest pain with respirations, tachypnea, and dyspnea b. Introduction-Pathophysiology, incidence, types, causes, risk factors, methods of transmission, complications b. Introduction- Pathophysiology, incidence, causes, risk factors, methods of transmission, complications Page 154 of 385 b. Introduction- Pathophysiology, incidence, causes, risk factors, methods of transmission, complications b. Pathophysiology, incidence, causes, risk factors, methods of transmission, complications for gastroenteritis caused by an infectious agent a. Pathophysiology, incidence, causes, risk factors, methods of transmission, complications for a patient with a drug resistant bacterial condition 2. Pathophysiology, incidence, causes, risk factors, methods of transmission, complications for a patient with a fungal infections 2. Progressive worsening of neurologic signs is characteristic of rabies and should be considered as a positive indicator for rabies Page 158 of 385 7. Legal requirements regarding reporting communicable or infectious diseases/conditions A. Required reporting to the health department or other heath care agency Page 161 of 385 Medicine Endocrine Disorders Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. Pathophysiology, causes, Incidence, morbidity, and mortality, assessment findings, management for endocrine conditions A. Patient education and prevention Page 164 of 385 Medicine Psychiatric Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. Transport decisions Page 167 of 385 Medicine Cardiovascular Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint. Abnormal lipid metabolism or excessive intake or saturated fats and cholesterol b. Defined as a brief discomfort, has predictable characteristics and is relieved promptly no change in this pattern b. Typical sudden onset of discomfort, usually of brief duration, lasting three to five minutes, maybe 5 to 15 minutes; never 30 minutes to 2 hours b. Defined as impaired diastolic filling of the heart caused by increased intrapericardiac pressure B. Resuscitation to provide efforts to return spontaneous pulse and breathing to the patient in full cardiac arrest b. Apply pathophysiological principles to the assessment of a patient with cardiovascular disease B. Quality assurance Page 201 of 385 Medicine Toxicology Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint.