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At Super Specialty Facility in Metro location where higher-end technology is available Facilities required 1 buy cheap butenafine 15mg online. The team should consist of a trauma surgeon or a general surgeon generic 15 mg butenafine free shipping, intensive care or emergency medicine physician butenafine 15 mg with mastercard, Neurosurgical team buy butenafine 15mg on line, cardiothoracic team, orthopedician& anaesthesiologist. Trauma protocol to guide management The principles followed in clinical diagnosis, investigations & treatment are same as above. In multiple casualty incidents, the number of patients and the severity of their injuries do not exceed the ability of the trauma care facility. In mass casualty incidents, the number of patients and the severity of their injuries exceed the capacity of the trauma care facility. The life threatening conditions are identified and treatment priorities are established based on their injuries, vital signs and injury mechanisms. Chin-lift or Jaw-thrust maneuver may be used to achieve airway patency simultaneously protecting the cervical spine. A definitive airway is warranted in a patient with an altered level of consciousness or a Glasgow Coma Score of 8 or less. Breathing and Ventilation The patient’s chest should be exposed to adequately assess chest wall excursion. Auscultation to detect adequate air entry, percussion to exclude air or blood in chest and visual inspection and palpation to detect injuries to chest wall should be carried out. Specific life threatening problems 116 such as tension pneumothorax, massive hemorrhage, flail chest and cardiac tamponade should be identified immediately and addressed during the primary survey Circulation with Hemorrhage Control Hemorrhage is the primary cause of shock in trauma patients. Rapid and accurate assessment of the patient’s hemodynamic status and identification of the site of hemorrhage is therefore essential. While the primary survey is going on, two intravenous lines should be established with short broad gauge cannula, preferably in the upper extremities, and resuscitation started with crystalloids. Disability / Neurological Status A rapid neurological evaluation is carried out at the end of primary survey after the resuscitation and before rapid sequence intubation. This assesses the patient’s level of consciousness, papillary size and reaction and focal neurological deficit. Exposure / Environmental Control The patient should be completely undressed to facilitate thorough examination and assessment. Pulseless electrical activity, the presence of cardiac rhythm without peripheral pulse may indicate cardiac tamponade, tension pneumothorax or profound hypovolemia. All trauma victims should be catheterized to enable monitoring of the urine output and plan intravenous fluid therapy. It should be passed via the orogastric route in patients with head injury and suspected base skull fracture. Secondary Survey Once the primary survey is accomplished, life- threatening conditions are managed and resuscitative efforts are underway, secondary survey is carried out. This is head to toe evaluation of trauma patient, which includes a complete history and physical examination and reassessment of all the vital signs. The care continues with regular re-evaluation of the patient for any deterioration and new findings, so that appropriate measures can be taken. Constant monitoring of the severely injured patient is required and may necessitate rapid transfer to the surgical intensive care unit, operating room or to another centre having better specialized facilities. Advanced trauma life support th program for doctors, 8 ed, chapter1, Initial assessment and management. In situations where the history is not forthcoming any injury or mishap associated with the change in the level of consciousness of the individual should be deemed to be associated with brain injury unless proved otherwise. Incidence of the condition in our country Incidence of road traffic accidents in India is amongst the highest in the world, and is rising. As per the report of the National Crime Records Bureau 2001, 2,710,019 accidental deaths, 108,506 suicidal deaths and 44,394 violence-related deaths were reported in India. Facial, chest, abdominal and limb injuries were documented in 48%, 3%, 1% and 10% of cases, respectively. Differential Diagnosis: The differential diagnosis of traumatic brain injury is generally straight forward. However, the use of pharmacoprophylaxis might be associated with a higher chance of intra cranial bleeding. However, monitoring patients on hypothermia regimen needs core temperature monitoring and may not be available in resource limited settings. If patients are considered fit for transport, it is advisable to transfer them to a centre with the facilities and experience in using hypothermia. Notes Diagnosis t findings suggesting a toxic-metabolic cause • dysfunction at lower levels of the brainstem (e. M etabolic Com a Structural Toxic-M etabolic pupillary asymmetric pupils equal, round, regular reaction or absent reaction to light (see Table 3) extraocular asymmetric symmetric m ovem ents or absent or absent m otor asymmetric symmetric findings or absent or absent Table 3.

The fibers are interwoven so the stimulation that causes the contraction of one fiber results in the contraction of the whole group generic butenafine 15 mg with visa. As more blood enters the heart butenafine 15mg cheap, as occurs during exercise buy butenafine 15 mg, the muscle contracts buy butenafine 15 mg amex, with greater strength so push the larger volume of blood out into the blood vessels. It is determined by the volume of blood ejected from the ventricle with each beat−the stroke 265 Human Anatomy and Physiology volume−and the number of beats of the heart per minute−the heart rate. The Conduction System of the Heart The cardiac cycle is regulated by specialized areas in the heart wall that forms the conduction system of the heart. Two of these areas are tissue mass called nodes; the third is a group of fibers called the atrioventricular bundle. The sinoatrial node, which is located I the upper wall of the right atrium an initiates the heart beat, is called the pacemaker. The second node, located in the ineratrial septum at the bottom of the right atrium, is called the atrioventricular node. The atrioventricular bundle, also known as the bundle of His, is located at the top of the interventricular septum; it has branches that extend to all parts of the ventricle walls. Fibers travel first down both sides of the interventricular septum in groups called the right and left bundle branches. Smaller Purkinje fibers then travel in a branching network throughout the myocardium of the ventricles (Figure 9- 6). The relatively slower conduction through this node allows time for the atria to contract and complete the filling of the ventricles. The excitation wave travels rapidly through the bundle of His and then throughout the ventricular walls by means of the bundle branches and Purkinje fibers. As a safety measure, a region of the conduction system other than the sinoatrial node fails, but it does so at a slower rate. Recall from chapter 7 that stimulation from the sympathetic nervous system increases the heart rate and the stimulation from the parasympathetic nervous system decreases the heartrate. During rest and sleep, the heart may beat less than 60 beats/minute but usually does not fall below 50 beats/minute. Sinus arrhythmia is a regular variation in heart rate due to changes in the rate and depth of breathing. Premature beats, also called extrasystoles are beats that come in before the the expected normal beats. It occurs at the beginning of ventricular relaxation and is due in large part to sudden closure of the semilunar valves. The many conditions that can cause abnormal heart sounds include congenital defects, disease, and physiological variations. A murmur due to rapid filling of the ventricles is called a functional (flow) murmur; such a murmur is not abnormal. An abnormal sound caused by any structural change in the heart or the vessels connected with the heart is called an organic murmur. Blood Vessels Functional classification The blood vessels, together with the four chambers of the heart, from a closed system for the flow of blood; only if there 269 Human Anatomy and Physiology is an injury to some part of the wall of this system does any blood escape. Arteries carry blood from the ventricles (pumping chambers) of the heart out to the capillaries in organs and tissue. Capillaries allow for exchanges between the blood and body cells, or between the blood and air in the lung tissues. Because the thicker muscle layer in the artery wall is able to resist great pressures generated by ventricular systole. In arteries, the tunica medial plays a critical role in maintaining blood pressure and controlling blood distribution in the body. This is 270 Human Anatomy and Physiology a smooth muscle, so it is controlled by the autonomic nervous system. A thin layer of elastic and white fibrous tissue covers an inner layer of endothelial cells called the tunica interna in arteries and veins. The tunica interna is actually a single layer of squamous epithelial cells called endothelium that lines the inner surface of the entire circulatory system. The most important structural feature of capillaries is their extreme thinness−only one layer of flat, endothelial cells composes the capillary membrane. Substances such as glucose, oxygen, and wastes can quickly pass through it on their way to or from the cells. Smooth muscle cells that are called precapillary sphincters guard the entrance to the capillary and determine into which capillary blood will flow. It continues down behind the heart just in front of the vertebral column, through the diaphragm, and into the abdomen (Figure 9-8 and 9-9). The thoracic aorta lies just in front of the vertebral column behind the heart and in the space behind the pleura. The thoracic and abdominal aorta together makes up the descending aorta 272 Human Anatomy and Physiology Figure 9-7. Sections of small blood vessels showing the thick arterial walls and the thin walls of veins and capillaries. Branches of the Aortic Arch The arch of aorta, located immediately beyond the ascending aorta, gives off three large branches.

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The extrinsic muscles of the hands originate along the forearm and insert into the hand in order to facilitate crude movements of the wrists buy discount butenafine 15 mg on-line, hands purchase 15 mg butenafine free shipping, and fingers generic butenafine 15 mg without prescription. These muscles are the flexor carpi radialis buy butenafine 15mg on-line, palmaris longus, flexor carpi ulnaris, and the flexor digitorum superficialis. The extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris are the muscles found in the superficial posterior compartment. The deep posterior compartment includes the abductor longus, extensor pollicis brevis, extensor pollicis longus, and the extensor indicis. Finally, the intrinsic muscles of the hands allow our fingers to make precise movements, such as typing and writing. The thenar muscles, which are located on the lateral part of the palm, are the abductor pollicis brevis, opponens pollicis, flexor pollicis brevis, and adductor pollicis. The hypothenar muscles, which are located on the medial part of the palm, are the abductor digiti minimi, flexor digiti minimi brevis, and opponens digiti minimi. The intermediate muscles, located in the middle of the palm, are the lumbricals, palmar interossei, and dorsal interossei. The large and strong gluteus maximus, gluteus medius, and gluteus minimus extend and abduct the femur. The lateral rotators of the femur at the hip are the piriformis, obturator internus, obturator externus, superior gemellus, inferior gemellus, and quadratus femoris. On the medial part of the thigh, the adductor longus, adductor brevis, and adductor magnus adduct the thigh and medially rotate it. The thigh muscles that move the femur, tibia, and fibula are divided into medial, anterior, and posterior compartments. The anterior compartment comprises the quadriceps femoris, quadriceps tendon, patellar ligament, and the sartorius. The quadriceps femoris is made of four muscles: the rectus femoris, the vastus lateralis, the vastus medius, and the vastus intermedius, which together extend the knee. The posterior compartment of the thigh includes the hamstrings: the biceps femoris, semitendinosus, and the semimembranosus, which all flex the knee. The muscles of the leg that move the foot and toes are divided into anterior, lateral, superficial- and deep-posterior compartments. The anterior compartment includes the tibialis anterior, the extensor hallucis longus, the extensor digitorum longus, and the fibularis (peroneus) tertius. The superficial posterior compartment has the gastrocnemius, soleus, and plantaris; and the deep posterior compartment has the popliteus, tibialis posterior, flexor digitorum longus, and flexor hallucis longus. What are some similarities and differences between the muscles are arranged around the joints of the body. At some point in the future, will this type of technology lead to the ability to augment our nervous systems? Army/Wikimedia Commons) Introduction Chapter Objectives After studying this chapter, you will be able to: • Name the major divisions of the nervous system, both anatomical and functional • Describe the functional and structural differences between gray matter and white matter structures • Name the parts of the multipolar neuron in order of polarity 504 Chapter 12 | The Nervous System and Nervous Tissue • List the types of glial cells and assign each to the proper division of the nervous system, along with their function(s) • Distinguish the major functions of the nervous system: sensation, integration, and response • Describe the components of the membrane that establish the resting membrane potential • Describe the changes that occur to the membrane that result in the action potential • Explain the differences between types of graded potentials • Categorize the major neurotransmitters by chemical type and effect The nervous system is a very complex organ system. Kramer’s book Listening to Prozac, a pharmaceutical researcher is quoted as saying, “If the human brain were simple enough for us to understand, we would be too simple to understand it” (1994). That quote is from the early 1990s; in the two decades since, progress has continued at an amazing rate within the scientific disciplines of neuroscience. It is an interesting conundrum to consider that the complexity of the nervous system may be too complex for it (that is, for us) to completely unravel. One easy way to begin to understand the structure of the nervous system is to start with the large divisions and work through to a more in-depth understanding. In other chapters, the finer details of the nervous system will be explained, but first looking at an overview of the system will allow you to begin to understand how its parts work together. But before you learn about that, you will see a big picture of the system—actually, a few big pictures. That suggests it is made of two organs—and you may not even think of the spinal cord as an organ—but the nervous system is a very complex structure. Within the brain, many different and separate regions are responsible for many different and separate functions. It is as if the nervous system is composed of many organs that all look similar and can only be differentiated using tools such as the microscope or electrophysiology. In comparison, it is easy to see that the stomach is different than the esophagus or the liver, so you can imagine the digestive system as a collection of specific organs. The Central and Peripheral Nervous Systems The nervous system can be divided into two major regions: the central and peripheral nervous systems. The brain is contained within the cranial cavity of the skull, and the spinal cord is contained within the vertebral cavity of the vertebral column. In actuality, there are some elements of the peripheral nervous system that are within the cranial or vertebral cavities. The peripheral nervous system is so named because it is on the periphery—meaning beyond the brain and spinal cord. Depending on different aspects of the nervous system, the dividing line between central and peripheral is not necessarily universal. A glial cell is one of a variety of cells that provide a framework of tissue that supports the neurons and their activities.

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A tumor in the thoracic cavity may interrupt the output of the thoracic ganglia that project to the head and face buy 15 mg butenafine otc. There is no parasympathetic influence on blood pressure butenafine 15mg free shipping, so nicotine activation of autonomic ganglia will preferentially increase blood pressure purchase 15mg butenafine free shipping. Also best 15 mg butenafine, cardiac muscle tissue is only modulated by autonomic inputs, so the conflicting information from both sympathetic and parasympathetic postganglionic fibers will cause arrhythmias. Chapter 16 1 Coordination and gait were tested first, followed by mental status, motor, sensory, and reflexes. The fibers originating in each region are contained within the same spinal nerve, which relates to the perception of that localization. The cerebrocerebellum is related to controlling the appendicular muscles and keeps the legs moving to pedal the bike. The vestibulocerebellum receives input about equilibrium to help keep everything balanced as the bike is moving forward. Hormones are released from the endocrine cell into the extracellular environment, but then travel in the bloodstream to target tissues. At the axon terminal, the electrical signal prompts the release of a chemical signal called a neurotransmitter that carries the message across the synaptic cleft to elicit a response in the neighboring cell. Neurotransmitters can be classified as paracrines because, upon their release from a neuron’s axon terminals, they travel across a microscopically small cleft to exert their effect on a nearby neuron or muscle cell. A hydrophobic hormone diffuses through the cell membrane and binds to the intracellular hormone receptor, which may be in the cytosol or in the cell nucleus. This initiates the transcription of a target gene, the end 1380 Answer Key result of which is protein assembly and the hormonal response. This can raise blood calcium levels so excessively that calcium deposits begin to accumulate throughout the body, including in the kidney tubules, where they are referred to as kidney stones. Estrogens play an important role in the development of the female reproductive tract and secondary sex characteristics. All insulin-dependent cells of the body require insulin in order to take up glucose from the bloodstream. Destruction of the beta cells would result in an inability to produce and secrete insulin, leading to abnormally high blood glucose levels and the disease called type 1 diabetes mellitus. For example, gastrin is secreted in response to stomach distention and causes the release of hydrochloric acid in the stomach. Secretin is secreted when acidic chyme enters the small intestine, and stimulates the release of pancreatic bicarbonate. In contrast, andropause is a much more gradual and subtle decline in testosterone levels and functioning. A man typically maintains fertility until very old age, although the quantity, quality, and motility of the sperm he produces may be reduced. Chapter 18 1 There are values given for percent saturation, tension, and blood gas, and there are listings for different types of hemoglobin. Acute myelogenous leukemia impairs the production of erythrocytes and other mature formed elements of the myeloid stem cell lineage. A burn is especially likely to increase the proliferation of leukocytes in order to ward off infection, a significant risk when the barrier function of the skin is destroyed. Chapter 19 1 The pressure gradient between the atria and the ventricles is much greater than that between the ventricles and the pulmonary trunk and aorta. Without the presence of the chordae tendineae and papillary muscles, the valves would be blown back (prolapsed) into the atria and blood would regurgitate. However, the papillary muscles also contract, placing tension on the chordae tendineae and holding the atrioventricular valves (tricuspid and mitral) in place to prevent the valves from prolapsing and being forced back into the atria. The semilunar valves (pulmonary and aortic) lack chordae tendineae and papillary muscles, but do not face the same pressure gradients as do the atrioventricular valves. As the ventricles relax and pressure drops within the ventricles, there is a tendency for the blood to flow backward. However, the valves, consisting of reinforced endothelium and connective tissue, fill with blood and seal off the opening preventing the return of blood. Beginning with all chambers in diastole, blood flows passively from the veins into the atria and past the atrioventricular valves into the ventricles. When ventricular pressure rises above the pressure in the two major arteries, blood pushes open the two semilunar valves and moves into the pulmonary trunk and aorta in the ventricular ejection phase. When the pressure falls below that of the atria, blood moves from the atria into the ventricles, opening the atrioventricular valves and marking one complete heart cycle. In order for the heart to maintain adequate flow to overcome increasing afterload, it must pump more forcefully. From the head, these are the truncus arteriosus, bulbus cordis, primitive ventricle, primitive atrium, and sinus venosus. The bulbus cordis develops into the right ventricle, whereas the primitive ventricle becomes the left ventricle.

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Also cheap 15mg butenafine mastercard, the destruction of embryos to isolate embryonic stem cells raises considerable ethical and legal questions butenafine 15 mg without a prescription. In contrast butenafine 15 mg sale, adult stem cells isolated from a patient are not seen as foreign by the body buy butenafine 15 mg line, but they have a limited range of differentiation. Some individuals bank the cord blood or deciduous teeth of their child, storing away those sources of stem cells for future use, should their child need it. Induced pluripotent stem cells are considered a promising advance in the field because using them avoids the legal, ethical, and immunological pitfalls of embryonic stem cells. It is composed of a phospholipid bilayer, with hydrophobic internal lipid “tails” and hydrophilic external phosphate “heads. The cell membrane is selectively permeable, allowing only a limited number of materials to diffuse through its lipid bilayer. All materials that cross the membrane do so using passive (non energy-requiring) or active (energy-requiring) transport processes. During passive transport, materials move by simple diffusion or by facilitated diffusion through the membrane, down their concentration gradient. During active transport, energy is expended to assist material movement across the membrane in a direction against their concentration gradient. The cell contains an array of cellular organelles, each one performing a unique function and helping to maintain the health and activity of the cell. Some of these protein products are enzymes destined to break down unwanted material and are packaged as lysosomes for use inside the cell. Cells also contain mitochondria and peroxisomes, which are the organelles responsible for producing the cell’s energy supply and detoxifying certain chemicals, respectively. Peroxisomes contain enzymes that transform harmful substances such as free radicals into oxygen and water. Cells also contain a miniaturized “skeleton” of protein filaments that extend throughout its interior. Three different kinds of filaments compose this cytoskeleton (in order of increasing thickness): microfilaments, intermediate filaments, and microtubules. Each cytoskeletal component performs unique functions as well as provides a supportive framework for the cell. This nuclear envelope is studded with protein-lined pores that allow materials to be trafficked into and out of the nucleus. After a cell is born, it passes through an interphase before it is ready to replicate itself and produce daughter cells. The cell cycle is under precise regulation by chemical messengers both inside and outside the cell that provide “stop” and “go” signals for movement from one phase to the next. Failures of these signals can result in cells that continue to divide uncontrollably, which can lead to cancer. Once a cell has completed interphase and is ready for cell division, it proceeds through four separate stages of mitosis (prophase, metaphase, anaphase, and telophase). Telophase is followed by the division of the cytoplasm (cytokinesis), which generates two daughter cells. This process takes place in all normally dividing cells of the body except for the germ cells that produce eggs and sperm. A stem cell is an unspecialized cell that can divide without limit as needed and can, under specific conditions, differentiate into specialized cells. While all somatic cells contain the exact same genome, different cell types only express some of those genes at any given time. These differences in gene expression ultimately dictate a cell’s unique morphological and physiological characteristics. Through the action of these transcription factors, cells specialize into one of hundreds of different cell types in the human body. How does temperature proceeds simultaneously at several sites on the same affect diffusion rate, and why? What would happen if anaphase proceeded even though movement of ions away from like charge all have in the sister chromatids were not properly attached to their common? Explain how a transcription factor ultimately determines whether or not a protein will be present in a 35. These cells contain essentially the same internal structures yet they vary enormously in shape and function. The different types of cells are not randomly distributed throughout the body; rather they occur in organized layers, a level of organization referred to as tissue. The micrograph that opens this chapter shows the 136 Chapter 4 | The Tissue Level of Organization high degree of organization among different types of cells in the tissue of the cervix. You can also see how that organization breaks down when cancer takes over the regular mitotic functioning of a cell.

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