An oropharyngeal airway is a medical device called an airway adjunct used to maintain or open a patient's airway. It does this by preventing the tongue from covering the epiglottis, which could prevent the person from breathing; when a person becomes unconscious, the muscles in their jaw relax and allow the tongue to obstruct the airway. The oropharyngeal airway was designed by Arthur Guedel. Oropharyngeal airways come in a variety of sizes, from infant to adult, are used in pre-hospital emergency care and for short term airway management post anaesthetic or when manual methods are inadequate to maintain an open airway; this piece of equipment is utilized by certified first responders, emergency medical technicians and other health professionals when tracheal intubation is either not available, not advisable or the problem is of short term duration. Oropharyngeal airways are indicated only in unconscious people, because of the likelihood that the device would stimulate a gag reflex in conscious or semi-conscious persons.
This could result in vomit and lead to an obstructed airway. Nasopharyngeal airways are used instead as they do not stimulate a gag reflex. In general, oropharyngeal airways need to be sized and inserted to maximize effectiveness and minimize possible complications, such as oral trauma; the correct size OPA is chosen by measuring from the first incisors to the angle of the jaw. The airway is inserted into the person's mouth upside down. Once contact is made with the back of the throat, the airway is rotated 180 degrees, allowing for easy insertion, assuring that the tongue is secured. An alternative method for insertion, the method, recommended for OPA use in children and infants, involves holding the tongue forward with a tongue depressor and inserting the airway right side up; the device is removed when the person regains swallow reflex and can protect their own airway, or it is substituted for an advanced airway. It is removed by pulling on it without rotation. Use of an OPA does not remove the need for the recovery position and ongoing assessment of the airway and it does not prevent obstruction by liquids or the closing of the glottis.
It can, facilitate ventilation during CPR and for persons with a large tongue. The main risks of its use are: if the person has a gag reflex, they may vomit when it is too large, it can close the glottis and thus close the airway improper sizing can cause bleeding in the airway Airway management Bag valve mask Guedel's classification of stages of anesthesia Endotracheal tube Laryngeal mask airway Nasopharyngeal airway Photographs Sizing
Magnesium sulfate is an inorganic salt with the formula MgSO4x where 0≤x≤7. It is encountered as the heptahydrate sulfate mineral epsomite called Epsom salt; the overall global annual usage in the mid-1970s of the monohydrate was 2.3 million tons, of which the majority was used in agriculture. Epsom salt has been traditionally used as a component of bath salts. Epsom salt can be used as a beauty product. Athletes use it to soothe sore muscles, it has a variety of other uses: for example, Epsom salt is effective in the removal of splinters. A variety of hydrates are known; the heptahydrate loses one equivalent of water to form the hexahydrate. Epsom salt takes its name from a bitter saline spring in Epsom in Surrey, where the salt was produced from the springs that arise where the porous chalk of the North Downs meets non-porous London clay; the monohydrate, MgSO4·H2O is found as the mineral kieserite. It can be prepared by heating the hexahydrate to 150 °C. Further heating to 200 °C gives anhydrous magnesium sulfate.
Upon further heating, the anhydrous salt decomposes into magnesium sulfur trioxide. The heptahydrate can be prepared by neutralizing sulfuric acid with magnesium carbonate or oxide, but it is obtained directly from natural sources, it is on the WHO Model List of Essential Medicines, the most important medications needed in a basic health system. Magnesium sulfate is a common mineral pharmaceutical preparation of magnesium known as Epsom salt, used both externally and internally. Magnesium sulfate is water-soluble and solubility is inhibited with lipids used in lotions. Lotions employ the use of emulsions or suspensions to include both oil and water-soluble ingredients. Hence, magnesium sulfate in a lotion may not be as available to migrate to the skin nor to be absorbed through the skin, hence both studies may properly suggest absorption or lack thereof as a function of the carrier. Temperature and concentration gradients may be contributing factors to absorption. Externally, magnesium sulfate paste is used to treat skin inflammations such as small boils or localised infections.
Known in the UK as "drawing paste", it is used to remove splinters. The standard British Pharmacopoeia composition is dried Magnesium Sulfate 47.76 % w/w, Phenol 0.49 % w/w. and glycerol. Epsom salt is used for isolation tanks. Magnesium sulfate is the main preparation of intravenous magnesium. Internal uses include: Oral magnesium sulfate is used as a saline laxative or osmotic purgative. Replacement therapy for hypomagnesemia Magnesium sulfate is a antiarrhythmic agent for torsades de pointes in cardiac arrest under the ECC guidelines and for managing quinidine-induced arrhythmias; as a bronchodilator after beta-agonist and anticholinergic agents have been tried, e.g. in severe exacerbations of asthma, magnesium sulfate can be nebulized to reduce the symptoms of acute asthma. It is administered via the intravenous route for the management of severe asthma attacks. Magnesium sulfate is effective in decreasing the risk. IV magnesium sulfate is used to treat seizures of eclampsia, it reduces the systolic blood pressure but doesn't alter the diastolic blood pressure, so the blood perfusion to the fetus isn't compromised.
It is commonly used for eclampsia where compared to diazepam or phenytoin it results in better outcomes. In agriculture, magnesium sulfate is used to increase sulfur content in soil, it is most applied to potted plants, or to magnesium-hungry crops, such as potatoes, tomatoes, lemon trees and peppers. The advantage of magnesium sulfate over other magnesium soil amendments is its high solubility, which allows the option of foliar feeding. Solutions of magnesium sulfate are nearly neutral, compared with alkaline salts of magnesium as found in limestone. Magnesium sulfate is used as a brewing salt in making beer, it may be used as a coagulant for making tofu. Anhydrous magnesium sulfate is used as a desiccant in organic synthesis due to its affinity for water. During work-up, an organic phase is treated with anhydrous magnesium sulfate; the hydrated solid is removed with filtration or decantation. Other inorganic sulfate salts such as sodium sulfate and calcium sulfate may be used in the same way. Magnesium sulfate heptahydrate is used to maintain the magnesium concentration in marine aquaria which contain large amounts of stony corals, as it is depleted in their calcification process.
In a magnesium-deficient marine aquarium and alkalinity concentrations are difficult to control because not enough magnesium is present to stabilize these ions in the saltwater and prevent their spontaneous precipitation into calcium carbonate. Magnesium sulfates are common minerals in geological environments, their occurrence is connected with supergene processes. Some of them are important constituents of evaporitic potassium-magnesium salts deposits. Bright spots observed by the Dawn Spacecraft in Occator Crater on the dwarf planet Ceres are most consistent with reflected light from magnesium sulfate hexahydrate. All known mineralogical forms of MgSO4 are hydrates. Epsomite is the natural analogue of "Epsom salt". Another heptahydrate, the copper-containing mineral alpersite SO4·7H2O, was recognized. Both are, not the highest known hydrates of MgSO4, du
Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, psychosis, violence or other rapid changes in behavior. Psychiatric emergency services are rendered by professionals in the fields of medicine, nursing and social work; the demand for emergency psychiatric services has increased throughout the world since the 1960s in urban areas. Care for patients in situations involving emergency psychiatry is complex. Individuals may arrive in psychiatric emergency service settings through their own voluntary request, a referral from another health professional, or through involuntary commitment. Care of patients requiring psychiatric intervention encompasses crisis stabilization of many serious and life-threatening conditions which could include acute or chronic mental disorders or symptoms similar to those conditions. Symptoms and conditions behind psychiatric emergencies may include attempted suicide, substance dependence, alcohol intoxication, acute depression, presence of delusions, panic attacks, significant, rapid changes in behavior.
Emergency psychiatry treat these symptoms and psychiatric conditions. In addition, several lethal medical conditions present themselves with common psychiatric symptoms. A physician's or a nurse's ability to identify and intervene with these and other medical conditions is critical; the place where emergency psychiatric services are delivered are most referred to as Psychiatric Emergency Services, Psychiatric Emergency Care Centers, or Comprehensive Psychiatric Emergency Programs. Mental health professionals from a wide area of disciplines, including medicine, nursing and social work in these settings alongside psychiatrists and emergency physicians; the facilities, sometimes housed in a psychiatric hospital, psychiatric ward, or emergency department, provide immediate treatment to both voluntary and involuntary patients 24 hours a day, 7 days a week. Within a protected environment, psychiatric emergency services exist to provide brief stay of two or three days to gain a diagnostic clarity, find appropriate alternatives to psychiatric hospitalization for the patient, to treat those patients whose symptoms can be improved within that brief period of time.
Precise psychiatric diagnoses are a secondary priority compared with interventions in a crisis setting. The functions of psychiatric emergency services are to assess patients' problems, implement a short-term treatment consisting of no more than ten meetings with the patient, procure a 24-hour holding area, mobilize teams to carry out interventions at patients' residences, utilize emergency management services to prevent further crises, be aware of inpatient and outpatient psychiatric resources, provide 24/7 telephone counseling. Since the 1960s, the demand for emergency psychiatric services has endured a rapid growth due to deinstitutionalization both in Europe and the United States. Deinstitutionalization, in some locations, has resulted in a larger number of mentally ill people living in the community. There have been increases in the number of medical specialties, the multiplication of transitory treatment options, such as psychiatric medication; the actual number of psychiatric emergencies has increased especially in psychiatric emergency service settings located in urban areas.
Emergency psychiatry has involved the evaluation and treatment of unemployed and other disenfranchised populations. Emergency psychiatry services have sometimes been able to offer accessibility and anonymity. While many of the patients who have used psychiatric emergency services shared common sociological and demographic characteristics, the symptoms and needs expressed have not conformed to any single psychiatric profile; the individualized care needed for patients utilizing psychiatric emergency services is evolving, requiring an always changing and sometimes complex treatment approach. As of 2000, the World Health Organization estimated one million suicides in the world each year. There are countless more suicide attempts. Psychiatric emergency service settings exist to treat the mental disorders associated with an increased risk of completed suicide or suicide attempts. Mental health professionals in these settings are expected to predict acts of violence patients may commit against themselves though the complex factors leading to a suicide can stem from many sources, including psychosocial, interpersonal and religious.
These mental health professionals will use any resources available to them to determine risk factors, make an overall assessment, decide on any necessary treatment. Aggression can be the result of both internal and external factors that create a measurable activation in the autonomic nervous system; this activation can become evident through symptoms such as the clenching of fists or jaw, slamming doors, hitting palms of hands with fists, or being startled. It is estimated that 17% of visits to psychiatric emergency service settings are homicidal in origin and an additional 5% involve both suicide and homicide. Violence is associated with many conditions such as acute intoxication, acute psychosis, paranoid personality disorder, antisocial personality disorder, narcissistic personality disorder and borderline personality disorder. Additional risk factors have been identified which may lead to violent behavior; such risk factors may include prior arrests, presence of hallucinations, delusions or other neurological impairment, being uneducated, etc. Mental health professionals complete violence risk ass
Dopamine is an organic chemical of the catecholamine and phenethylamine families. It functions both as a hormone and a neurotransmitter, plays several important roles in the brain and body, it is an amine synthesized by removing a carboxyl group from a molecule of its precursor chemical L-DOPA, synthesized in the brain and kidneys. Dopamine is synthesized in plants and most animals. In the brain, dopamine functions as a neurotransmitter—a chemical released by neurons to send signals to other nerve cells; the brain includes several distinct dopamine pathways, one of which plays a major role in the motivational component of reward-motivated behavior. The anticipation of most types of rewards increases the level of dopamine in the brain, many addictive drugs increase dopamine release or block its reuptake into neurons following release. Other brain dopamine pathways are involved in motor control and in controlling the release of various hormones; these pathways and cell groups form a dopamine system, neuromodulatory.
In popular culture and media, dopamine is seen as the main chemical of pleasure, but the current opinion in pharmacology is that dopamine instead confers motivational salience. Outside the central nervous system, dopamine functions as a local paracrine messenger. In blood vessels, it acts as a vasodilator. With the exception of the blood vessels, dopamine in each of these peripheral systems is synthesized locally and exerts its effects near the cells that release it. Several important diseases of the nervous system are associated with dysfunctions of the dopamine system, some of the key medications used to treat them work by altering the effects of dopamine. Parkinson's disease, a degenerative condition causing tremor and motor impairment, is caused by a loss of dopamine-secreting neurons in an area of the midbrain called the substantia nigra, its metabolic precursor L-DOPA can be manufactured. There is evidence that schizophrenia involves altered levels of dopamine activity, most antipsychotic drugs used to treat this are dopamine antagonists which reduce dopamine activity.
Similar dopamine antagonist drugs are some of the most effective anti-nausea agents. Restless legs syndrome and attention deficit hyperactivity disorder are associated with decreased dopamine activity. Dopaminergic stimulants can be addictive in high doses, but some are used at lower doses to treat ADHD. Dopamine itself is available as a manufactured medication for intravenous injection: although it cannot reach the brain from the bloodstream, its peripheral effects make it useful in the treatment of heart failure or shock in newborn babies. A dopamine molecule consists of a catechol structure with one amine group attached via an ethyl chain; as such, dopamine is the simplest possible catecholamine, a family that includes the neurotransmitters norepinephrine and epinephrine. The presence of a benzene ring with this amine attachment makes it a substituted phenethylamine, a family that includes numerous psychoactive drugs. Like most amines, dopamine is an organic base; as a base, it is protonated in acidic environments.
The protonated form is water-soluble and stable, but can become oxidized if exposed to oxygen or other oxidants. In basic environments, dopamine is not protonated. In this free base form, it is less water-soluble and more reactive; because of the increased stability and water-solubility of the protonated form, dopamine is supplied for chemical or pharmaceutical use as dopamine hydrochloride—that is, the hydrochloride salt, created when dopamine is combined with hydrochloric acid. In dry form, dopamine hydrochloride is a fine colorless powder. Dopamine is synthesized in a restricted set of cell types neurons and cells in the medulla of the adrenal glands; the primary and minor metabolic pathways are: Primary: L-Phenylalanine → L-Tyrosine → L-DOPA → Dopamine Minor: L-Phenylalanine → L-Tyrosine → p-Tyramine → Dopamine Minor: L-Phenylalanine → m-Tyrosine → m-Tyramine → DopamineThe direct precursor of dopamine, L-DOPA, can be synthesized indirectly from the essential amino acid phenylalanine or directly from the non-essential amino acid tyrosine.
These amino acids are found in nearly every protein and so are available in food, with tyrosine being the most common. Although dopamine is found in many types of food, it is incapable of crossing the blood–brain barrier that surrounds and protects the brain, it must therefore be synthesized inside the brain to perform its neuronal activity. L-Phenylalanine is converted into L-tyrosine by the enzyme phenylalanine hydroxylase, with molecular oxygen and tetrahydrobiopterin as cofactors. L-Tyrosine is converted into L-DOPA by the enzyme tyrosine hydroxylase, with tetrahydrobiopterin, O2, iron as cofactors. L-DOPA is converted into dopamine by the enzyme aromatic L-amino acid decarboxylase, with pyridoxal phosphate as the cofactor. Dopamine itself is used as precursor in the synthesis o
International emergency medicine
International emergency medicine is a subspecialty of emergency medicine that focuses not only on the global practice of emergency medicine but on efforts to promote the growth of emergency care as a branch of medicine throughout the world. The term international emergency medicine refers to the transfer of skills and knowledge—including knowledge of ambulance operations and other aspects of prehospital care—from developed emergency medical systems to those systems which are less developed. However, this definition has been criticized as oxymoronic, given the international nature of medicine and the number of physicians working internationally. From this point of view, international emergency medicine is better described as the training required for and the reality of practicing the specialty outside of one's native country. Emergency medicine has been a recognized medical specialty in the United States and other developed countries for nearly forty years, although these countries' EMSs did not become mature until the early 1990s.
At that point, some of its practitioners turned their attention from developing the specialty at home to developing it abroad, leading to the birth of international emergency medicine. They began to support the growth of emergency medicine worldwide, doing so through conferences and regional emergency medicine organizations and development organizations, international emergency medicine fellowships, physician exchanges, information transfer, curriculum development. Most developing countries are taking steps to develop emergency medicine as a specialty, to develop accreditation mechanisms, to promote the development of emergency medicine training programs, their interest is a result of improved healthcare, increasing urbanization, aging populations, the rising number of traffic fatalities, heightened awareness of emergency medicine among their citizens. In addition, emergency medicine is useful in dealing with time-sensitive illnesses, as well as improving public health through vaccinations, interventions and data collection.
Countries that lack mature EMSs are developing emergency medicine as a specialty so that they will be able to set up training programs and encourage medical students to pursue residencies in emergency medicine. Some challenges faced in international emergency medicine include immature or non-existent training programs, a lack of adequate emergency transport, a shortage of resources to fund emergency medicine development, an absence of research that could inform developing countries how to best spend the resources they devote to emergency medicine. Additionally, the standards and methods used in countries with mature EMSs are not always suited for use in developing countries due to a lack of infrastructure, shortage of funds, or local demographics. Ambulances, the developed country standard, are costly and not practical for the road conditions present in many countries. Furthermore, in place of expensive medication and equipment, developing countries opt for cheaper if less effective alternatives.
Although it may seem that increasing availability to emergency medicine must improve health, there is little empirical evidence to directly support that claim or to point out which methods are most effective in improving patient health. Evidence-based medicine seeks to address this issue by rigorously studying the effects of different interventions instead of relying on logic or tradition; the most accepted definition of international emergency medicine is that it is "the area of emergency medicine concerned with the development of emergency medicine in other countries." In that definition, "other countries" refers to nations that do not have a mature emergency care system. Included in those nations are some that are otherwise quite developed but lack a complete emergency medical system, such as Armenia, Israel and the Philippines. Work in international emergency medicine can be broken down into two main categories: 1) the promotion of emergency medicine as a recognized and established specialty in other countries, 2) the provision of humanitarian assistance.
William Burdick, Mark Hauswald, Kenneth Iserson have criticized the above definition as oxymoronic, given the international nature of medicine and the number of physicians working internationally. From that point of view, international emergency medicine is not about development of emergency medical systems but is instead better described as the training required for and the reality of practicing the specialty outside of one's native country. Emergency medicine is a specialty, first developed in the United States in the 1960s. For the United States, the high number of traffic and other accident fatalities in the 1960s spurred a white paper from the National Academy of Sciences; the United Kingdom, Canada, Hong Kong, Singapore followed shortly thereafter, developing their respective emergency medicine systems in the 1970s and 1980s. By the early 1990s, the emergency medicine systems in the United States, the United Kingdom, Canada, Hong Kong, Singapore were mature, leading some practitioners to focus on developing the specialty in other countries.
Thus, international emergency medicine as a subspecialty began in the 1990s, although some isolated efforts to achieve some of its goals had taken place in the late 1980s. There were several reasons for the heightened interest these practitioners had in developing emergency medicine
In medicine, a nasopharyngeal airway known as an NPA, nasal trumpet, or nose hose, is a type of airway adjunct, is a tube, designed to be inserted into the nasal passageway to secure an open airway. When a patient becomes unconscious, the muscles in the jaw relax and can allow the tongue to slide back and obstruct the airway; this makes airway management necessary, an NPA is one of the available tools. The purpose of the flared end is to prevent the device from becoming lost inside the patient's nose; as with other catheters, NPAs are measured using the French catheter scale, but sizes are also quoted in millimeters. Typical sizes include: 6.5 mm/28FR, 7.0 mm/30FR, 7.5 mm/32FR, 8.0 mm/34FR, 8.5 mm/36FR. These devices are used by emergency care professionals such as EMTs and paramedics in situations where an artificial form of airway maintenance is necessary, but tracheal intubation is impossible, inadvisable, or outside the practitioner's scope of practice. An NPA is used in conscious patients where an oropharyngeal airway would trigger the gag reflex.
The correct size airway is chosen by measuring the device on the patient: the device should reach from the patient's nostril to the earlobe or the angle of the jaw. The outside of the tube is lubricated with a water-based lubricant so that it enters the nose more easily; the device is inserted until the flared end rests against the nostril
International Standard Serial Number
An International Standard Serial Number is an eight-digit serial number used to uniquely identify a serial publication, such as a magazine. The ISSN is helpful in distinguishing between serials with the same title. ISSN are used in ordering, interlibrary loans, other practices in connection with serial literature; the ISSN system was first drafted as an International Organization for Standardization international standard in 1971 and published as ISO 3297 in 1975. ISO subcommittee TC 46/SC 9 is responsible for maintaining the standard; when a serial with the same content is published in more than one media type, a different ISSN is assigned to each media type. For example, many serials are published both in electronic media; the ISSN system refers to these types as electronic ISSN, respectively. Conversely, as defined in ISO 3297:2007, every serial in the ISSN system is assigned a linking ISSN the same as the ISSN assigned to the serial in its first published medium, which links together all ISSNs assigned to the serial in every medium.
The format of the ISSN is an eight digit code, divided by a hyphen into two four-digit numbers. As an integer number, it can be represented by the first seven digits; the last code digit, which may be 0-9 or an X, is a check digit. Formally, the general form of the ISSN code can be expressed as follows: NNNN-NNNC where N is in the set, a digit character, C is in; the ISSN of the journal Hearing Research, for example, is 0378-5955, where the final 5 is the check digit, C=5. To calculate the check digit, the following algorithm may be used: Calculate the sum of the first seven digits of the ISSN multiplied by its position in the number, counting from the right—that is, 8, 7, 6, 5, 4, 3, 2, respectively: 0 ⋅ 8 + 3 ⋅ 7 + 7 ⋅ 6 + 8 ⋅ 5 + 5 ⋅ 4 + 9 ⋅ 3 + 5 ⋅ 2 = 0 + 21 + 42 + 40 + 20 + 27 + 10 = 160 The modulus 11 of this sum is calculated. For calculations, an upper case X in the check digit position indicates a check digit of 10. To confirm the check digit, calculate the sum of all eight digits of the ISSN multiplied by its position in the number, counting from the right.
The modulus 11 of the sum must be 0. There is an online ISSN checker. ISSN codes are assigned by a network of ISSN National Centres located at national libraries and coordinated by the ISSN International Centre based in Paris; the International Centre is an intergovernmental organization created in 1974 through an agreement between UNESCO and the French government. The International Centre maintains a database of all ISSNs assigned worldwide, the ISDS Register otherwise known as the ISSN Register. At the end of 2016, the ISSN Register contained records for 1,943,572 items. ISSN and ISBN codes are similar in concept. An ISBN might be assigned for particular issues of a serial, in addition to the ISSN code for the serial as a whole. An ISSN, unlike the ISBN code, is an anonymous identifier associated with a serial title, containing no information as to the publisher or its location. For this reason a new ISSN is assigned to a serial each time it undergoes a major title change. Since the ISSN applies to an entire serial a new identifier, the Serial Item and Contribution Identifier, was built on top of it to allow references to specific volumes, articles, or other identifiable components.
Separate ISSNs are needed for serials in different media. Thus, the print and electronic media versions of a serial need separate ISSNs. A CD-ROM version and a web version of a serial require different ISSNs since two different media are involved. However, the same ISSN can be used for different file formats of the same online serial; this "media-oriented identification" of serials made sense in the 1970s. In the 1990s and onward, with personal computers, better screens, the Web, it makes sense to consider only content, independent of media; this "content-oriented identification" of serials was a repressed demand during a decade, but no ISSN update or initiative occurred. A natural extension for ISSN, the unique-identification of the articles in the serials, was the main demand application. An alternative serials' contents model arrived with the indecs Content Model and its application, the digital object identifier, as ISSN-independent initiative, consolidated in the 2000s. Only in 2007, ISSN-L was defined in the