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By K. Kent. Southern Utah University.

Palpation of an arterial pulse in the neck each of the following could be observed or is best accomplished at 1 order 400mg hoodia otc. List four surface features of the cranium palpated: (a) the distal tendinous (a) the carotid triangle purchase 400mg hoodia mastercard. Identify the four regions of the face and and small saphenous veins; (d) the (d) the submandibular triangle. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 342 Unit 4 Support and Movement Critical-Thinking Questions 2. A Saturday afternoon athlete crashed to the intensive care physician when possible complication of using the while mountain biking without a helmet. He sustained deep cuts across the front of neck is required for the rapid 3. It is often necessary in the critical care his knee, across the back of his elbow, administration of fluids and medications. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 Nervous Tissue and the Central Nervous System 11 Organization and Functions of the Nervous System 344 Developmental Exposition: The Brain 346 Neurons and Neuroglia 348 Transmission of Impulses 357 General Features of the Brain 358 Cerebrum 363 Diencephalon 372 Mesencephalon 373 Metencephalon 374 Myelencephalon 376 Meninges 378 Ventricles and Cerebrospinal Fluid 381 Spinal Cord 384 Developmental Exposition: The Spinal Cord 390 CLINICAL CONSIDERATIONS 391 Clinical Case Study Answer 396 Chapter Summary 397 Review Activities 398 Clinical Case Study A 56-year-old woman visited her family doctor for evaluation of a headache that had persisted for nearly a month. Upon questioning the patient, the doctor learned that her left arm, as she put it, “was a bit unwieldy, hard to control, and weak. He also found weakness, al- though less significant, of the left lower extremity. Sensation in the limbs seemed to be normal, although mild rigidity and hyperactive reflexes were present. Expressing concern, the doctor told the patient that she needed a CT scan of her head, and explained that there could be a problem within the brain, possibly a tumor or other lesion. After explaining the patient’s case, the doctor remarked parenthetically that he believed he knew where the problem was located. Why did the doctor suggest to the patient that there might be a problem within her brain when the symptoms were weakness of the extremities, and then just on one side of her body? Explain the muscle weakness in terms of neuronal path- ways from the brain to the periphery. FIGURE: Improvements in radiographic imaging have greatly enhanced the Hints: Remember the controlling and integrating function of the brain.

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However discount hoodia 400 mg mastercard, drug abusers discount hoodia 400mg on line, especially illicit needle users, are more prone to true illness than the general population. Illicit drug users frequently exhibit tachyphylaxis to narcotic analgesics. Do Not Lose Your Patient in X-Ray One last thing to remember: it is easy to forget patients sent out of the ED for studies. CONCLUSION Malpractice litigation and the fear of being sued are unfortunate aspects of practicing medicine in American culture. Never forget the importance of good documentation in the medical record. It is often said that physicians have already lost just by being sued, even if they ultimately win the case. It is an agonizing experience to be called a bad doctor when you know that you did not commit mal- practice. And if you think that you really did do something suboptimal, then you have to deal with your own guilt. I would strongly suggest availing yourself of professional counsel- ing if depression, guilt, or anger are significant. Many local and state medical associations have support groups for doctors involved in malpractice litigation. It is important to realize that no matter what happens in the legal case in question, it is an aberration. Physicians treat thousands of patients in their careers, and far more than 99% of patients are helped by their physicians’ care. Chapter 9 / Emergency Medicine 113 In the end, the best defense against being sued is to practice good medicine. If you are a good doctor, communicate well with your patients, and pay attention to documentation, you will have gone a long way toward not only preventing lawsuits but also truly helping the people who come to you for care. Malpractice litigation fear and risk management beliefs among teaching hospital physicians. Relation between negligent adverse events and the outcomes of medical malpractice litigation.

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That is hoodia 400 mg with mastercard, the relationship between ology with a particular emphasis on clinical correlations hoodia 400mg visa. This information is absolutely essential to understanding the po- or pathway. This includes, but is not limited to, 1) the location sition of a lesion and correlating this fact with the deficits seen in the of the cells of origin for a given tract/pathway, 2) its entire neurologically compromised patient. For example, is the deficit on course throughout the neuraxis and cerebrum, 3) the location of the same side as the lesion (ipsilateral), on the opposite side (con- the decussation of these fibers, if applicable, 4) the neurotrans- tralateral), or on both sides (bilateral)? The concept of laterality mitters associated with the neurons comprising the tract/pathway, is usually expressed as “right,” “left,” or “bilateral” in reference 5) a brief review of its blood supply, and 6) a summary of a num- to the side of the deficit(s) when written on the patient’s chart. The structure of an atlas does not allow a detailed structure and function, to provide a range of clinical examples definition of each clinical term on the printed page. However, for each tract/pathway, and to help the user develop a knowl- the full definition of each clinical term or phrase is available on edge base that can be easily integrated into the clinical setting. Embryologically, SVE cell groups ap- spinal cord and brainstem of the adult (right). In the neural tube, the pear between those associated with GSE and GVE components. As de- alar plate and its associated GSA and GVA components are posterior velopment progresses, however, SVE cell groups migrate (open ar- (dorsal) to the sulcus limitans (SL) while the basal plate and its related row) to anterolateral areas of the tegmentum. Cell groups associated GVE and GSE components are anterior (ventral) to the SL. In the adult with the GSA functional component are displaced from their postero- spinal cord, this general posterior/anterior relationship is maintained, lateral position in the developing brainstem by the newly acquired cell although the neural canal (as central canal) is reduced and/or absent. Conse- Two major changes occur in the transition from spinal cord to brain- quently, structures associated with the GSA component are located stem in the adult. First, as the central canal of the cervical cord enlarges (open arrow) in more anterolateral and lateral areas of the brainstem. Consequently, in the brainstem is represented by an oblique line drawn through the brain- adult, the sulcus limitans is present in the brainstem with motor com- stem beginning at the SL. The medial (from midline) to lateral posi- ponents (adult derivatives of the basal plate) medial to it, and sensory tions of the various functional components, as shown on the far right components (adult derivatives of the alar plate) are located laterally. Abbreviations GSA General somatic afferent SSA Special somatic afferent GSE General somatic efferent SVA Special visceral afferent GVA General visceral afferent SVE Special visceral efferent GVE General visceral efferent SL Sulcus limitans Cranial nerves Components of Cranial and Spinal Nerves 175 G G S S G S G S V V V V S S E E E A A A A Midbrain 2 1. Substantia gelatinosa, nucleus proprious 19 22 and associated GSA receptive areas Thoracic 25.

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By K. Kent. Southern Utah University.

Palpation of an arterial pulse in the neck each of the following could be observed or is best accomplished at 1 order 400mg hoodia otc. List four surface features of the cranium palpated: (a) the distal tendinous (a) the carotid triangle purchase 400mg hoodia mastercard. Identify the four regions of the face and and small saphenous veins; (d) the (d) the submandibular triangle. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 342 Unit 4 Support and Movement Critical-Thinking Questions 2. A Saturday afternoon athlete crashed to the intensive care physician when possible complication of using the while mountain biking without a helmet. He sustained deep cuts across the front of neck is required for the rapid 3. It is often necessary in the critical care his knee, across the back of his elbow, administration of fluids and medications. Nervous Tissue and the © The McGraw−Hill Anatomy, Sixth Edition Coordination Central Nervous System Companies, 2001 Nervous Tissue and the Central Nervous System 11 Organization and Functions of the Nervous System 344 Developmental Exposition: The Brain 346 Neurons and Neuroglia 348 Transmission of Impulses 357 General Features of the Brain 358 Cerebrum 363 Diencephalon 372 Mesencephalon 373 Metencephalon 374 Myelencephalon 376 Meninges 378 Ventricles and Cerebrospinal Fluid 381 Spinal Cord 384 Developmental Exposition: The Spinal Cord 390 CLINICAL CONSIDERATIONS 391 Clinical Case Study Answer 396 Chapter Summary 397 Review Activities 398 Clinical Case Study A 56-year-old woman visited her family doctor for evaluation of a headache that had persisted for nearly a month. Upon questioning the patient, the doctor learned that her left arm, as she put it, “was a bit unwieldy, hard to control, and weak. He also found weakness, al- though less significant, of the left lower extremity. Sensation in the limbs seemed to be normal, although mild rigidity and hyperactive reflexes were present. Expressing concern, the doctor told the patient that she needed a CT scan of her head, and explained that there could be a problem within the brain, possibly a tumor or other lesion. After explaining the patient’s case, the doctor remarked parenthetically that he believed he knew where the problem was located. Why did the doctor suggest to the patient that there might be a problem within her brain when the symptoms were weakness of the extremities, and then just on one side of her body? Explain the muscle weakness in terms of neuronal path- ways from the brain to the periphery. FIGURE: Improvements in radiographic imaging have greatly enhanced the Hints: Remember the controlling and integrating function of the brain.

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However discount hoodia 400 mg mastercard, drug abusers discount hoodia 400mg on line, especially illicit needle users, are more prone to true illness than the general population. Illicit drug users frequently exhibit tachyphylaxis to narcotic analgesics. Do Not Lose Your Patient in X-Ray One last thing to remember: it is easy to forget patients sent out of the ED for studies. CONCLUSION Malpractice litigation and the fear of being sued are unfortunate aspects of practicing medicine in American culture. Never forget the importance of good documentation in the medical record. It is often said that physicians have already lost just by being sued, even if they ultimately win the case. It is an agonizing experience to be called a bad doctor when you know that you did not commit mal- practice. And if you think that you really did do something suboptimal, then you have to deal with your own guilt. I would strongly suggest availing yourself of professional counsel- ing if depression, guilt, or anger are significant. Many local and state medical associations have support groups for doctors involved in malpractice litigation. It is important to realize that no matter what happens in the legal case in question, it is an aberration. Physicians treat thousands of patients in their careers, and far more than 99% of patients are helped by their physicians’ care. Chapter 9 / Emergency Medicine 113 In the end, the best defense against being sued is to practice good medicine. If you are a good doctor, communicate well with your patients, and pay attention to documentation, you will have gone a long way toward not only preventing lawsuits but also truly helping the people who come to you for care. Malpractice litigation fear and risk management beliefs among teaching hospital physicians. Relation between negligent adverse events and the outcomes of medical malpractice litigation.

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That is hoodia 400 mg with mastercard, the relationship between ology with a particular emphasis on clinical correlations hoodia 400mg visa. This information is absolutely essential to understanding the po- or pathway. This includes, but is not limited to, 1) the location sition of a lesion and correlating this fact with the deficits seen in the of the cells of origin for a given tract/pathway, 2) its entire neurologically compromised patient. For example, is the deficit on course throughout the neuraxis and cerebrum, 3) the location of the same side as the lesion (ipsilateral), on the opposite side (con- the decussation of these fibers, if applicable, 4) the neurotrans- tralateral), or on both sides (bilateral)? The concept of laterality mitters associated with the neurons comprising the tract/pathway, is usually expressed as “right,” “left,” or “bilateral” in reference 5) a brief review of its blood supply, and 6) a summary of a num- to the side of the deficit(s) when written on the patient’s chart. The structure of an atlas does not allow a detailed structure and function, to provide a range of clinical examples definition of each clinical term on the printed page. However, for each tract/pathway, and to help the user develop a knowl- the full definition of each clinical term or phrase is available on edge base that can be easily integrated into the clinical setting. Embryologically, SVE cell groups ap- spinal cord and brainstem of the adult (right). In the neural tube, the pear between those associated with GSE and GVE components. As de- alar plate and its associated GSA and GVA components are posterior velopment progresses, however, SVE cell groups migrate (open ar- (dorsal) to the sulcus limitans (SL) while the basal plate and its related row) to anterolateral areas of the tegmentum. Cell groups associated GVE and GSE components are anterior (ventral) to the SL. In the adult with the GSA functional component are displaced from their postero- spinal cord, this general posterior/anterior relationship is maintained, lateral position in the developing brainstem by the newly acquired cell although the neural canal (as central canal) is reduced and/or absent. Conse- Two major changes occur in the transition from spinal cord to brain- quently, structures associated with the GSA component are located stem in the adult. First, as the central canal of the cervical cord enlarges (open arrow) in more anterolateral and lateral areas of the brainstem. Consequently, in the brainstem is represented by an oblique line drawn through the brain- adult, the sulcus limitans is present in the brainstem with motor com- stem beginning at the SL. The medial (from midline) to lateral posi- ponents (adult derivatives of the basal plate) medial to it, and sensory tions of the various functional components, as shown on the far right components (adult derivatives of the alar plate) are located laterally. Abbreviations GSA General somatic afferent SSA Special somatic afferent GSE General somatic efferent SVA Special visceral afferent GVA General visceral afferent SVE Special visceral efferent GVE General visceral efferent SL Sulcus limitans Cranial nerves Components of Cranial and Spinal Nerves 175 G G S S G S G S V V V V S S E E E A A A A Midbrain 2 1. Substantia gelatinosa, nucleus proprious 19 22 and associated GSA receptive areas Thoracic 25.

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