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18.03.2014 admin
Find showtimes, watch trailers, browse photos, track your Watchlist and rate your favorite movies and TV shows on your phone or tablet! The Carnaval in Rio de Janeiro is a world famous festival held before Lent every year and considered the biggest carnival in the world with two million people per day on the streets. The Guidelines continue to recommend running through the H’s and T’s in order to arrive at a specific diagnosis and guide treatment in PEA arrest. This new way of thinking about PEA combines initial ECG morphology with the clinical scenario to guide the clinician to the most likely causes, and offer further diagnostic certainty using point of care ultrasound (POCUS). Our experts caution that this approach should be used only when a highly skilled ultrasonographer is present and in a way that does not interrupt high quality chest compressions. While we know that intra-arrest antiarrhythmic medications may improve rates of ROSC in ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) arrests, there has never been a trial to show improvements in long term survival with any antiarryhthmic medication. When it comes to giving antiarrhythmic medication post-ROSC, there is only one RCT of lidocaine post arrest which showed a decrease in the incidence of recurrent VF. The Guidelines state that “there is inadequate evidence to support the routine use of lidocaine after cardiac arrest. We will need to wait for the results of the ROC-ALPS trial to give us a more clear idea of whether or not we should be using antiarrhythmics intra-arrest or post-arrest. In the ED the decision to terminate resuscitation is multi-factorial and there is no absolute time cut off. For patients who receive multiple doses of epinephrine during cardiac arrest resuscitation, if ROSC is achieved, then the patient’s BP tends to be high in the first few minutes.
As an adjunct or replacement of manual pulse checks: rather than depending on manual pulse checks (which have been shown to be inaccurate) to determine ROSC, an arterial line placed early after cardiac arrest can instantly determine whether ROSC is present or not and hence minimize the chest compression pause time.
The literature clearly shows that patients with an initial rhythm of Vfib or showing ongoing signs of STEMI on ECG should be considered for emergency PCI.
For all other patients (those without VFib or STEMI), it is unclear which patients should be transferred for PCI. One of our experts suggests that any patient in whom a cardiac cause is suspected and no other cause is apparent should be considered for emergency PCI.
Again, similar to the decision to terminate resuscitation, multiple factors should be taken into consideration in deciding whether or not to activate the cath lab.
An elevated Troponin: A ROC paper that is currently under peer review as of November 2015 shows a clear association between a higher serum troponin level and a PCI amenable lesion as well as improved outcomes. The Guidelines stipulate that Targeted Temperature Management (TTM) should be initiated for ALL post arrest patients who achieve a ROSC, and it’s up to your intensivist what the target temperature should be between 32 and 36 degrees. It is important to understand that the control arm in the TTM trial still actively cooled patients, just not to the same degree as the 32 degree arm. A pre-hospital RCT in 2013 compared immediate 2L boluses of cooled saline vs in-hospital cooling and showed an increased rate of re-arrest and acute heart failure in the pre-hospital group that received immediate large boluses of cooled NS. About Us Emergency Medicine Cases (EM Cases) is a free online medical education podcast & medical blog dedicated to providing online emergency medicine education & CME for physicians, residents, students, nurses & paramedics.
Her work has been syndicated across a number of media outlets, including The New York Times, and MSNBC.Kristen Nicole published her first book, The Twitter Survival Guide, and is currently completing her second book on predictive analytics.
Carnival happens in many cities in Brazil during the same dates and have difference aspects, the musica, the traditions, but the Carnival in Rio is one of the most visited events in Brazil all year long. Our company does not condone drug use, prostitution or any other illegal activity nor does it engage in business or take any client to any adult themed establishment. Good post-arrest care involves maintaining blood pressure and cerebral perfusion, adequate sedation, cooling and preventing hyperthermia, considering antiarrhythmic medications, optimization of tissue oxygen delivery while avoiding hyperoxia, getting patients to PCI who need it, and looking for and treating the underlying cause.
The first key step is to distinguish between narrow complex and wide complex PEA, with POCUS being used to help differentiate the causes of narrow complex PEA in particular. Ideally, a designated team member provides the specific POCUS role independent of the other team members.
Having an arterial line in place will detect this loss of circulation sooner than standard BP monitors or manual pulse checks.


A simplified and structured teaching tool for the evaluation and management of pulseless electrical activity. Resuscitation Outcomes Consortium-Amiodarone, Lidocaine or Placebo Study (ROC-ALPS): Rationale and methodology behind an out-of-hospital cardiac arrest antiarrhythmic drug trial.
Termination-of-resuscitation rule for emergency department physicians treating out-of-hospital cardiac arrest patients: an observational cohort study.
Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries.
Effect of prehospital induction of mild hypothermia on 3-month neurological status and 1-year survival among adults with cardiac arrest: long-term follow-up of a randomized, clinical trial. We are Canada's most listened to emergency medicine podcast with thousands of listeners and well over one million podcast downloads since 2010. The wasteland needs you and there’s no harm in looking up a few hints on running Sanctuary or the Castle.Working hard to get your settlements up to 100 Happiness?
Hence, our experts recommend that if lidocaine is given intra-arrest and ROSC is achieved, then it is reasonable to continue a lidocaine infusion post-ROSC. It is therefore recommended by many critical care experts to start vasopressors early in the post-arrest phase and target a MAP of 65 in order to maintain adequate cerebral perfusion pressure. Morrison recommends to wait a few minutes after ROSC to let the heart settle and then start cooled IV saline in small boluses. A statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa).
He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine, the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute and is on the advisory board of The Teaching Institute. Our Advisory Board includes prominent leaders in the faculty of the University of Toronto Divisions of Emergency Medicine.
Nick and all related titles, logos and charactersare trademarks of Viacom International Inc.×No results found, showing results for Sorry, no results found!
Looking to fashion an army that will wear whatever you want them to?You’re going to need all the Fallout 4 Settlement tips and tricks to make that happen.
After listening to part 1, my friend Scott Weingart of EMCrit asked me if he could chime in to give us his take on the controversies discussed in this series; and of course, I obliged.
If a central line has not been placed yet soon after ROSC, it is safe to start vasopressors in a peripheral IV until central access has been obtained. Helman in a round-table, case-based discussion on key practice changing clinical emergency medicine topics, which are then carefully edited to maximize your learning. Our Guest Experts, Canada's brightest minds in emergency medicine, are carefully chosen for each episode topic. A TGW Travel Expert will be happy to answer all of your questions and plan that bucket-list trip you have been dreaming of. Thankfully Non-Fiction Gaming has just the details you need to build a sustainable town.Unlocking the Benevolent Leader AchievementBenevolent Leader is a tough achievement to get in Fallout 4. So in this episode we discuss the controversies in post-arrest care with some of the most important researchers in ACLS and co-authors of The Guidelines as well as one of the most influential critical care educators in the world. Morrison offer us their opinion on the new simplified approach to diagnosing the underlying cause of PEA arrests. Give us a call at 1-877-456-9453 or 786-522-3667 (Office Hours: Monday – Friday, 9am – 6pm Eastern Standard).
If happiness falls too low, you can lose control of a settlement.Some structures such as defence posts and shops require you to assign settlers manually. The button to equip them is listed on the bottom of the screen in the trade menu and varies by platform. So if you have 20 settlers and want them to be really happy, have at least 40 food.Each settler can usually work 6 food worth.
Settlers will always drink from a local water source, then draw water that is needed from a supply line.


Mattresses make them happier than sleeping bags, and beds with frames make them happier than mattresses. These shops will also generate passive income over time and are a great way not to go broke in the Commonwealth.
Initial investment can be a bit steep, but it soon pays off.You have to have two points in the Local Leader perk from the Charisma tree (requires 6 CHA and level 14) to be able to build shops. Profit deposited into your workbench will be based on the number of settlers you have.DefenceYour settlement has chance of being attacked. A base with less defence than the total of its combined resources is likely to be attacked. A base with a 2X Defence to Resources ratio is almost never attacked.Make your defences high up and hard to access. Build or use natural choke points and defend them heavily.Defend the inside of your base, too. Enemies can and will spawn inside your walls.Put your generators well behind your defences. They are primary targets keep them safe.Supply LinesSupply Lines connect the workshops of settlements. Provisioners can not be killed, thought they may be mortal on Survival difficulty.Like all settler they can be equipped including guns, grenades, and Combat Armour.
The key will be displayed in the list at the bottom of the screen and varies by platform.Power GeneratorsMedium Generators are the lowest net junk cost per power produced.
Use large generators if you are at your build limit and need space.Lights do not consume power but must be near a Power Coupler to work. If your base is full, you can move a settler to another settlement, and that settlement can grow again.A Bell or a Siren will alert settlers to danger. Your settlers will use it on their own when they see danger.Brahman might, one day, for a few seconds, hang out at a Brahman Feeding Trough. Do not believe their lies.Once your settlers are nice and well fed, assign excess settlers to the Scavenger Stations.
Once your base is set up feel free to decorate liberally.Caravans can be added to your settlements by completing a quest chain in Bunker Hill. First clear the National Guard Armoury for Deb, then talk to Kessler to get the quest Kill Zeller.
This will cause the traders from Bunker Hill to stop at your settlements.Anything Missing?Do you know how I can tell if someone is a Synth? They don’t leave a comment below when they have other Fallout 4 Settlement tips to add. Medium generator take place of 6 small generators, and makes only 5 energy, while small generators placed on the same space, make 12 energy. Big generator take place of 8 small generators, and have hight of 2 floors, so its basically 16 small generators, and makes only 10 energy, while small generators placed on the same space, make 16*3=48 energy. If you have WW DLC – just scrap all your generators and build one reactor for 100 energy (two, if you real energy waster, noone can waste more than 200 energy in this game).So i pass the sinth test, or i have to destroy all humans in this location? If you turn it off without replacing it with a pylon your power grid will be broken at that point, only being powered on the end where the generator is located. Settlement was getting busy so I turned off the beacon for a bit… resources on the generator end continued to work.




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