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Vice Chair, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University
Corticosteroids Herpes Simplex • Orolabial Herpes (fever blisters or cold sores) –clusters of grouped vesicles on the lips gastritis pepto bismol discount pantoprazole 20mg without prescription. Nondermatophyte Infections Candidiasis • Yeast fungal infection • Glistening gastritis y reflujo discount pantoprazole 20mg with mastercard, fiery red or moist pink gastritis diet list order pantoprazole 20mg on line, beefy red with satellite pustules, severe itching/burning • Sites: skin folds/groin area, oral-thrush, diaper rash • Teach prevention and management –Disposable diapers or cloth diapers without rubber pants, Change as soon as soiled –Exposure to open air, apply ointments (zinc oxide), avoid over washing, caution with perfumed soaps 281 Psoriasis • Chronic hereditary disorder • Light-skinned race • Environmental factors that trigger –Skin injury –Infections –Hormone changes –Stress –Drugs –Alcohol –Smoking –obesity • Erythematous plaque with sharp well defined borders and silvery white scales. Inflammatory Disorders of the Skin: Dermatitis/Eczema • In current usage, eczema has almost become synonymous with dermatitis, although eczema tends to be used most often to refer to chronic forms of dermatitis. It is a chronic superficial inflammation that evolves into pruritic, red, weeping, crusted lesions. Strategies for Avoiding Contact Dermatitis • Avoid contact with causative materials. Extent of injury depends on the type of current, the pathway of flow, local tissue resistance, and duration of contact 288 4. Radiation Result from radiant energy being transferred to the body resulting in production of cellular toxins Burn Wound Assessment • Classified according to depth of injury and extent of body surface area involved • Burn wounds differentiated depending on the level of dermis and subcutaneous tissue involved 1. Full thickness (third and fourth degree) The depth of the injury depends on the temperature of the burning agent and the duration of contact with the agent. For example, in the case of scald burns in adults, 1 second of contact with hot tap water at 68. Hypokalemia (potassium depletion) may occur later with fluid shifts and inadequate potassium replacement. Fluid Remobilization • Occurs after 24 hours • Capillary leak stops • See diuretic stage where edema fluid shifts from the interstitial spaces into the vascular space 294 • Blood volume increases leading to increased renal blood flow and diuresis • Body weight returns to normal •? Hypokalemia if no potassium replacement Effects on blood volume • At the time of burn injury, some red blood cells may be destroyed and other damaged, resulting in anemia • Despite this the hematocrit may be elevated due to plasma loss • Blood loss during surgical procedures, wound care, diagnostic studies and ongoing hemolysis further contribute to anemia • Blood transfusions are required periodically to maintain adequate hemoglobin levels for oxygen delivery • Abnormalities in coagulation, including a decrease in platelets (thrombocytopenia) and prolonged clotting and prothrombin times occur with burn injury Pulmonary Alterations • Inhalation injury is the leading cause of death in fire victims • Half of these deaths could have been prevented with use of a smoke detector • Burn victims make it out of a burning home safely • Once they are outside they may realize that loved ones or valuable items are still inside the burning home • They then reenter the burning home and are overcome with toxic smoke and fumes and become disoriented or unconcious Pulmonary response • Pulmonary imjuries fall into several categories, upper airway injury, inhalational injury, including carbon monoxide poisining, and restrictive defects • Upper air way injury results from direct heat or edema • It is manifested by mechanical obstruction of the upper airway, including the pharynx and larynx • Upper airway injury is treated by early nasotracheal or endotracheal intubation • Inhalation injury below the glottis results from inhaling products of incomplete combustion (Burning) or noxious gases: carbon monoxide, sulfer oxide, nitrogen oxide, & benzene 295 • The injury results directly from chemical irritation of the pulmonary tisues at the alveolar level • Inhalation injuries below glottis cause loss of ciliary action, hypersecretion, severe mucosal edema and bronchospasm • The pulmonary surfactant is reduced, resulting in atelectasis (collapse of alveoli) • Expectoration of carbon particles in the sputum is the cardinal sign of this injury • The pathophysiology effects are due to tissue hypoxia a result of carbon monoxide combining with hemoglobin to form carboxyhemoglobin which competes with oxygen for available hemoglobin sites • The effinity of hemoglobin for carbon monoxide is 200 times greater than that for oxygen • Treatment usually consists of ealy intubation and mechnical ventilation with 100% oxygen • Administering 100% O2 is essential to accelerate the removal of carbon monoxide from the hemoglobin molecule • restrictive defects arise when edema develops under full-thickness burns encircling the neck and thorax • Chest expansion may be greatly restricted resulting in decreased tidal volume • In such situation escharotomy is necessary • More than half of all burn victims with pulmonary involvement do not initially demonstrate pulmonary signs and symptoms • Any pat with possible inhalation injury must be observed for at least 24 h for respiratory complications Pulmonary response • Airway obstruction may occur very rapidly in hours • Decreased lung compliance, decreased arterial oxygen levels and respiratory acidosis may occur gradually over the first 5 days after a burn Indication of possible pulmonary damages include • History indicating that the burn occured in an enclosed area • Burns of the face and neck • Hoarseness, voice change, dry cough, stridor. Wound assessment and initial care Emergent phase/ at fire sceine • Extinguish the flames, switch off power source, remove chemical soaked clothes, etc… 298 • Assess and maintain an open airway • Cool the burn • Remove restrictive objects. Metabolic acidosis Loss of sodium depletes fixed base; relative carbon dioxide content increases. Wound cleaning • Hydrotherapy (whirl pool) –Antiseptics added to the water –Temp kept between 37-38º C –Warmth allow for easier movement of joints which will prevent contracture –Movement of water will remove dead tissue. Dressing the Burn Wound • After burn wounds are cleaned and debrided, topical antibiotics are reapplied to prevent infection 306 • Standard wound dressings are multiple layers of gauze applied over the topical agents on the burn wound Wound Débridement 1. Surgical Débridement Wound Grafting • coverage of the burn wound is necessary until coverage with a graft is possible. A combination of these approaches • The main areas for skin grafting include the face (for cosmetic and psychological reasons); functional areas, such as the hands and feet; and areas that involve joints. Homografts (or allografts): skin obtained from living or recently deceased humans or amniotic membrane. Heterografts (or xenografts): skin taken from Autografts • Graft taken from the same person • Graft care (goal: not to dislodge the graft) –Immobilize graft area (use splint) –Occlusive dressing, first dressing removed by Dr (usually after 2-5 days in there is no infection. Other care during acute phase • Pain management • Nutrition –Metabolic rate is very high because of anabolism –High caloric high protein diet. Disorders of Wound Healing • hypertrophic scars: characterized by an overabundant formation of matrix, especially collagen, in wounds that heal by granulation • Keloids: A large, heaped-up mass of scar tissue, a keloid, may develop and extend beyond the wound surface. Assess breath sounds, and oxygen provides dyspnea respiratory rate, rhythm, moisture to Respiratory depth, and symmetry. These signs within normal respiratory indicate possible limits secretions inhalation injury 4.
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Stay on the kidney cleanse for three to six weeks and repeat a one- week session every few months to keep removing deposits which may also choose these sick joints to settle in gastritis diet 3-2-1 buy pantoprazole 40 mg fast delivery. To summarize gastritis spanish discount 40mg pantoprazole fast delivery, do everything as for osteoarthritis gastritis help order 20 mg pantoprazole otc, empha- sizing the roundworm parasites for elimination. But we can easily triple and quadruple our benzoic acid intake by consuming commercial beverages and pastries where benzoic acid is used as a preservative. All of it must be detoxified, though, and this gives us way too much hippuric acid. The kidneys are unable to excrete such overloads of hippuric acid, so it distributes itself in our organs. It is only sensible for persons with chronic pain not to consume benzoic acid (or benzoate) preserved foods. Many vegetables, notably the cabbage family, contain such cyanides, giving them protection from insects, disease, and grazing animals. In fact, it is the chemical used as a general reactant with amino acids in the well known Edman degradation reaction. This suggests that the liver is capable, again, of detoxifying the cyanides for you in a reasonable time and you may eat them again. Joint pain, or arthritis, was known in antiquity long before dogs and cats were household pets and giving us their parasites. Pigs and horses harbor these roundworms too and may have been the source at that time. Homeopathic treatments, as well as massage, heat and electronic devices also help. With this wide range of effective treatments dating to the distant past, why is none of them a permanent cure? The common roundworms are everywhere about us, sanitation is poor, and our civilized lifestyle leads to deposit formation that invites bacteria. But knowing this, you can stop your pain and remove the causes to become one of the first hu- mans to achieve a permanent cure. The drugs were no longer effective and she would need to do something else very soon. She had the typical causes: her body was toxic with mercury and nickel from tooth fillings. She had numerous roundworm parasites including two kinds of Ascaris, two kinds of hookworm, Strongyloides and Tri- chinella. She started on the kidney herbs, killed parasites with a frequency gen- erator and in two months noticed her swelling was receding. She was given a diet change; onto milk, fruits and vegetables, off other beverages, less meat and grains. Thigh Pain Inner thigh pain often stems from the sciatic nerve which is suffering pressure at the lower back. The correct treatment, after killing bacteria electronically, is to clean up the entire kidney area using the kidney herb recipe. If the pain recurs after clearing it several times, there must be a chronic source of bacteria. Since the kidneys are already cleaned, consider the teeth, as well as recurring parasites, and the liver. Clean the liver every two weeks until 2000 or more stones have appeared and no more appear. In fact, these bacteria regularly come from two sources: the kidneys and the teeth.
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It is more active biochemically Microbiology/Apply knowledge of fundamental than the other species owing to ornithine biological characteristics/Gram-negative bacilli/2 decarboxylase and β-galactosidase activity gastritis diet 5 2 generic pantoprazole 40mg free shipping. Which of the following tests best differentiates enzymes lymphocytic gastritis symptoms treatment discount 40mg pantoprazole mastercard, found in most strains of S gastritis diet best 20 mg pantoprazole. Microbiology/Evaluate laboratory data to make identifications/Gram-negative bacilli/2 19. Escherichia, Edwardsiella, and Enterobacter include Leminorella, Rahnella, and Tatumella. Blood is present in the stools of patients biological characteristics/Gram-negative bacilli/2 infected with Shigella as a result of invasion and 20. Young children may also fluid and electrolyte loss preceded by bloody stools exhibit bloody stools when infected with 2–3 days before is characteristic of shigellosis but Campylobacter. Cold enrichment of feces (incubation at 4°C) in phosphate-buffered saline prior to subculture onto enteric media enhances the recovery of: A. Which group of tests, along with colonial Answers to Questions 22–26 morphology on primary media, aids most in the rapid identification of the Enterobacteriaceae? Indole, oxidase, MacConkey, and blood agar on MacConkey agar is distinctive, showing flat, plates pink (lactose-positive) colonies with a ring of bile precipitation. Which group of tests best identifies the Morganella urease, and deaminate phenylalanine. Which group of tests best differentiates Enterobacter Citrate 95 0 aerogenes from Edwardsiella tarda? Both species are usually identifications/Gram-negative bacilli/2 motile and arginine dihydrolase positive. Enterobacter sakazakii can best be differentiated from Enterobacter cloacae by which of the following characteristics? Members of the genus Cedecea are best Answers to Questions 27–31 differentiated from Serratia spp. Positive phenylalanine deaminase Cedecea, negative for Serratia) and gelatin hydrolysis D. B Biochemical differentiation is essential because identifications/Gram-negative bacilli/2 Citrobacter isolates may give a false-positive agglutination test with Salmonella grouping 28. Microbiology/Apply knowledge of fundamental biological characteristics/Gram-negative bacilli/2 29. However, catheterized urine sample from a nursing home Morganella can be differentiated from Proteus spp. Te lactose-negative isolate tested positive based upon H2S, indole, ornithine decarboxylase, for indole, urease, ornithine decarboxylase, and and xylose fermentation. Indole Microbiology/Evaluate laboratory data to make identifications/Gram-negative bacilli/2 31. Which of the following organisms, found in normal fecal flora, may be mistaken biochemically for the genus Yersinia? Microbiology/Apply knowledge of fundamental biological characteristics/Gram-negative bacilli/2 7. Why might it be necessary for both pink Answers to Questions 32–35 (lactose-positive) and colorless (lactose-negative) colonies from an initial stool culture on 32.
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