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Flashcard 1451904601356

Tags
#charisma #myth
Question
How do you give the perfect handshake?
Answer
1. First things first: make sure your right hand is free.
2. Avoid holding a drink in your right hand, especially if it’s a cold drink, as the condensation will make your hand feel cold and clammy.
3. Rise if you’re seated. And keep your hands out of your pockets: visible hands make you look more open and honest.
4. Make sure to use plenty of eye contact, and smile warmly but briefly: too much smiling could make you appear overeager.
5. Keep your head straight, without tilting it in any way, and face the person fully.
6. Keep your hand perfectly perpendicular, neither dominant (palm down) nor submissive (palm up). If you’re in doubt, angle your thumb straight to the ceiling.
7. Open wide the space between your thumb and index finger to make sure you get optimal thumb-web contact.
8. Ensure contact between the palms of your hands by keeping your palm flat—not cupped— and by draping your hand across your partner’s diagonally.
9. Try to wrap your fingers around your partner’s hand, scaling them one by one, as if you were giving a hug with your hand. You will almost have your index finger on their pulse —almost, but not quite.
10. Once full contact is made, lock your thumb down and squeeze firmly, about as much as your partner does. Shake from the elbow (not the wrist), linger for a moment if you want to convey particular warmth, and step back


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1. First things first: make sure your right hand is free. Shift anything it may be holding to your left hand well in advance. You don’t want to have to fumble at the last moment. 2. Avoid holding a drink in your right hand, especially if it’s a cold drink, as the condensation will make your hand feel cold and clammy. 3. Before shaking someone’s hand, whether you are a man or a woman, rise if you’re seated. And keep your hands out of your pockets: visible hands make you look more open and honest. 4. Make sure to use plenty of eye contact, and smile warmly but briefly: too much smiling could make you appear overeager. 5. Keep your head straight, without tilting it in any way, and face the person fully. 6. Keep your hand perfectly perpendicular, neither dominant (palm down) nor submissive (palm up). If you’re in doubt, angle your thumb straight to the ceiling. 7. Open wide the space between your thumb and index finger to make sure you get optimal thumb-web contact. 8. Ensure contact between the palms of your hands by keeping your palm flat—not cupped— and by draping your hand across your partner’s diagonally. 9. Try to wrap your fingers around your partner’s hand, scaling them one by one, as if you were giving a hug with your hand. You will almost have your index finger on their pulse —almost, but not quite. 10. Once full contact is made, lock your thumb down and squeeze firmly, about as much as your partner does. Shake from the elbow (not the wrist), linger for a moment if you want to convey particular warmth, and step back

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Fearon et al. [41] found that when participants reported pain reproduction at the greater trochanter on the FABER test, in the absence of difficulty manipulating shoes and socks (which will be difficult if limited in FABER), this formed a strong basis for diagnosis of greater trochanteric pain syndrome, together with pain on palpation of the greater trochanter.

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What a man wishes, he also believes. Similarly, what we believe is what we choose to see. This is commonly referred to as the confirmation bias.

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Mental Models: The Best Way to Make Intelligent Decisions
nt to get, we come up with better solutions. Inversion works not just in mathematics but in nearly every area of life. As the saying goes, “Just tell me where I’m going to die so I can never go there.” 2. Falsification / Confirmation Bias <span>What a man wishes, he also believes. Similarly, what we believe is what we choose to see. This is commonly referred to as the confirmation bias. It is a deeply ingrained mental habit, both energy-conserving and comfortable, to look for confirmations of long-held wisdom rather than violations. Yet the scientific process – includi




The modern scientific enterprise operates under the principle of falsification: A method is termed scientific if it can be stated in such a way that a certain defined result would cause it to be proved false. Pseudo-knowledge and pseudo-science operate and propagate by being unfalsifiable – as with astrology, we are unable to prove them either correct or incorrect because the conditions under which they would be shown false are never stated.

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Mental Models: The Best Way to Make Intelligent Decisions
rather than violations. Yet the scientific process – including hypothesis generation, blind testing when needed, and objective statistical rigor – is designed to root out precisely the opposite, which is why it works so well when followed. <span>The modern scientific enterprise operates under the principle of falsification: A method is termed scientific if it can be stated in such a way that a certain defined result would cause it to be proved false. Pseudo-knowledge and pseudo-science operate and propagate by being unfalsifiable – as with astrology, we are unable to prove them either correct or incorrect because the conditions under which they would be shown false are never stated. 3. Circle of Competence An idea introduced by Warren Buffett and Charles Munger in relation to investing: each individual tends to have an area or areas in which they really, truly




Flashcard 1689040588044

Question
What a man wishes, he also believes. Similarly, what we believe is what we choose to see. This is commonly referred to as the [...].
Answer
confirmation bias


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What a man wishes, he also believes. Similarly, what we believe is what we choose to see. This is commonly referred to as the confirmation bias.

Original toplevel document

Mental Models: The Best Way to Make Intelligent Decisions
nt to get, we come up with better solutions. Inversion works not just in mathematics but in nearly every area of life. As the saying goes, “Just tell me where I’m going to die so I can never go there.” 2. Falsification / Confirmation Bias <span>What a man wishes, he also believes. Similarly, what we believe is what we choose to see. This is commonly referred to as the confirmation bias. It is a deeply ingrained mental habit, both energy-conserving and comfortable, to look for confirmations of long-held wisdom rather than violations. Yet the scientific process – includi







#bias #confirmation #mental #models
The desire to be right and the desire to have been right are two desires, and the sooner we separate them the better off we are. The desire to be right is the thirst for truth. On all counts, both practical and theoretical, there is nothing but good to be said for it. The desire to have been right, on the other hand, is the pride that goeth before a fall. It stands in the way of our seeing we were wrong, and thus blocks the progress of our knowledge.

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Confirmation Bias: Why You Should Seek Out Disconfirming Evidence
eems to immediately support our views. When we feel as if others ‘cannot see sense’, a grasp of how confirmation bias works can enable us to understand why. Willard V Quine and J.S. Ullian described this bias in The Web of Belief as such: <span>The desire to be right and the desire to have been right are two desires, and the sooner we separate them the better off we are. The desire to be right is the thirst for truth. On all counts, both practical and theoretical, there is nothing but good to be said for it. The desire to have been right, on the other hand, is the pride that goeth before a fall. It stands in the way of our seeing we were wrong, and thus blocks the progress of our knowledge. Experimentation beginning in the 1960s revealed our tendency to confirm existing beliefs, rather than questioning them or seeking new ones. Other research has revealed our single-mind




The modern scientific enterprise operates under the principle of falsification: A method is termed scientific if it can be stated in such a way that a certain defined result would cause it to be proved false

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The modern scientific enterprise operates under the principle of falsification: A method is termed scientific if it can be stated in such a way that a certain defined result would cause it to be proved false. Pseudo-knowledge and pseudo-science operate and propagate by being unfalsifiable – as with astrology, we are unable to prove them either correct or incorrect because the conditions und

Original toplevel document

Mental Models: The Best Way to Make Intelligent Decisions
rather than violations. Yet the scientific process – including hypothesis generation, blind testing when needed, and objective statistical rigor – is designed to root out precisely the opposite, which is why it works so well when followed. <span>The modern scientific enterprise operates under the principle of falsification: A method is termed scientific if it can be stated in such a way that a certain defined result would cause it to be proved false. Pseudo-knowledge and pseudo-science operate and propagate by being unfalsifiable – as with astrology, we are unable to prove them either correct or incorrect because the conditions under which they would be shown false are never stated. 3. Circle of Competence An idea introduced by Warren Buffett and Charles Munger in relation to investing: each individual tends to have an area or areas in which they really, truly




Flashcard 1689049238796

Question
The modern scientific enterprise operates under the principle of [...]: A method is termed scientific if it can be stated in such a way that a certain defined result would cause it to be proved false
Answer
falsification


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The modern scientific enterprise operates under the principle of falsification: A method is termed scientific if it can be stated in such a way that a certain defined result would cause it to be proved false

Original toplevel document

Mental Models: The Best Way to Make Intelligent Decisions
rather than violations. Yet the scientific process – including hypothesis generation, blind testing when needed, and objective statistical rigor – is designed to root out precisely the opposite, which is why it works so well when followed. <span>The modern scientific enterprise operates under the principle of falsification: A method is termed scientific if it can be stated in such a way that a certain defined result would cause it to be proved false. Pseudo-knowledge and pseudo-science operate and propagate by being unfalsifiable – as with astrology, we are unable to prove them either correct or incorrect because the conditions under which they would be shown false are never stated. 3. Circle of Competence An idea introduced by Warren Buffett and Charles Munger in relation to investing: each individual tends to have an area or areas in which they really, truly







R 62 Pharmacokinetics is a term used to describe the study of the changes in the concentration of a drug during the processes of absorption, distribution, metabolism or biotransformation, and elimination from the body.

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Essentially, it is the study of what the body does to a drug once the agent has been introduced into the system.

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This transfer of drug to various sites depends on several intrinsic proper- ties of the agent, such as molecular size, degree of ionization, lipid solubility, and protein binding.

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molecules with molecular weights greater than 100 to 200 do not cross the cell membranes.

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Pas- sive transport does not require energy and involves transfer of a drug from an area of high concentration to an area of lower concentra- tion. Active transport mechanisms are generally faster and require energy.

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It may involve exchange of one molecule for another called antiport or transport of two molecules together in the same direction referred to as symport

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The charged (ionized) form is water soluble, and the uncharged (nonionized) form is lipophilic.

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nonionized molecules are lipid soluble, they can diffuse across cell membranes such as the blood-brain, gastric, and placental barriers to reach the effect site.

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The higher the degree of ionization, the less access the drug has across tissues such as the gastrointestinal tract, the blood-brain and placental barriers, and liver hepatocytes

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This is important in that ionized drugs are not absorbed well when taken orally and may not be metabolized by the liver to a significant extent. Instead, they commonly are excreted via the renal system

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the degree of ionization of an agent at a particular site is determined by the dissociation constant (pK a ) of the agent and its pH gradient across the membrane

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The pK a is the negative log of the equilibrium constant for the dissociation of the acid or base.

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Acids are usually defined as proton donors, whereas bases are made up of molecules that can accept a proton.

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When the pH is equal to the pK a , the two species exist in equal amounts; for example, because phenobarbital has a pK a of 7.4 and blood has a pH of 7.4, in the bloodstream the drug is pres- ent in equal proportions of charged and uncharged forms

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If a drug is a weak acid and if the pH of the fluid environment is below the pK a , most of the drug’s protons are associated with the drug molecule, and the predominant species is uncharged and therefore lipid soluble

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if the pH is below the pK a for a drug that is a weak base, an abundance of protons exists, and most of the drug tends to ion- ize as the proton is donated by the drug molecule, which results in a species that is highly charged and therefore lipid insoluble

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The degree of ionization for a specific agent can vary across a membrane that separates fluids with different pH values.

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As the drug enters the stomach, a very acidic environment with a pH of 1.9, morphine accepts protons and becomes ionized, and ion trapping occurs

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CHAPTER 6    Pharmacokinetics 63 t From these equations an estimate of the degree of drug absorp- tion can be developed. 4,5 Acids are usually defined as proton donors, whereas bases are made up of molecules that can accept a proton. When the pH is equal to the pK a , the two species exist in equal amounts; for example, because phenobarbital has a pK a of 7.4 and blood has a pH of 7.4, in the bloodstream the drug is pres- ent in equal proportions of charged and uncharged forms. It is of importance to note that relatively modest changes in the pH of the environment, when it is close to the pK a , are more significant in changing the ratio of charged to uncharged forms than the same change in pH at some value far removed from the pK a . For example, phenobarbital, with a pK a of 7.4, is for the most part nondissociated and therefore is nonionized at a pH of 1.4. This results from the fact that the pH is well below the pK a , and when phenobarbital is in a relatively strongly acidic envi- ronment with an abundance of protons, it does not give up its protons readily. If a drug is a weak acid and if the pH of the fluid environment is below the pK a , most of the drug’s protons are associated with the drug molecule, and the predominant species is uncharged and therefore lipid soluble (Figure 6-2). Conversely, if the pH is below the pK a for a drug that is a weak base, an abundance of protons exists, and most of the drug tends to ion- ize as the proton is donated by the drug molecule, which results in a species that is highly charged and therefore lipid insoluble 4 (Figure 6-3). The effects of pK a and pH on ionization are sum- marized in Box 6-1. 6 Ion Trapping Ion trapping has several anesthesia-related applications. Influ- ences on oral absorption of drugs, maternal-fetal transfer, and central nervous system toxicity of local anesthetics are commonly cited. The degree of ionization for a specific agent can vary across a membrane that separates fluids with different pH values. For example, morphine sulfate, a base with a pK a of 7.9 when pres- ent in the blood (pH 7.4), exists in appreciable amounts in both ionized and nonionized forms. The uncharged drug fraction moves freely across tissue membranes, and the charged fraction does not. As the drug enters the stomach, a very acidic environment with a pH of 1.9, morphine accepts protons and becomes ionized, and ion trapping occurs 4 (Figure 6-4 illustrates this phenomenon using diazepam as an example). The drug, however, will be absorbed later, as stomach contents move farther down the gastrointestinal tract to the more basic and favorable environment of the small intestine. A similar scenario occurs when agents are transferred between a mother and a fetus, where the placenta is the membrane separat- ing fluids with varying pH values—that of the fetus is more acidic than that of the mother. Again, the lipid-soluble fraction of basic agents such as lidocaine (pK a 7.9) crosses to the placenta easily. However, once there, because of the lower pH of the fetus, the drug becomes more ionized and cannot easily cross the lipid bilayer of placenta, resulting in accumulation of drug in the fetus. Finally, ion trapping may occur in a local anesthetic overdose situation in which high concentrations of a basic local anesthetic agent have entered the central nervous system and caused toxicity. If the patient experiences respiratory arrest and hypoxia, the resulting EXTRACELLULAR MEMBRANE INTRACELLULAR Carrier Diffusion through aqueous channel Diffusion through lipid FIGURE 6-1 Routes by which solutes can traverse cell membranes. (From Rang HP, et al. Rang and Dale’s Pharmacology. 7th ed. Edin- burgh: Churchill Livingstone; 2012:100.) FIGURE 6-2

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#morganmikhail
Intravenous injections completely bypass the process of absorption

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Increasing cadence by 10 % has also been shown to result in increased activity of GMed during the late swing phase but not during the stance phase [71].

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ntric abductor loads, such as hopping and bounding. Modifications of running technique might also be required. Reductions in peak hip adduction in running can be successfully altered with visual biofeedback [69] and increases in cadence [70]. <span>Increasing cadence by 10 % has also been shown to result in increased activity of GMed during the late swing phase but not during the stance phase [71]. <span><body><html>

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#knee #pain #patelofemoral #pfp
Conclusion: The evidence consistently demonstrated that both hip strengthening and neuromuscular exercise has a beneficial effect on pain and function in people with PFP. Strengthening exercise pre- dominantly addressed abductor and external rotator muscle groups

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Flashcard 1689169300748

Tags
#1 #ccmc #jrs
Question
Minimal changes
Flexion of the trunk and the kidney rest may significantly affect venous return, CO
Answer
Minimal changes


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Flashcard 1689170611468

Tags
#1 #ccmc #jrs
Question

Flexion of the trunk and the kidney rest may significantly affect venous return, CO
Answer
Minimal changes


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Potential clinical changes are conceptualized by the follow- ing phenomena. Some drugs are bound extensively to proteins in the plasma because of their innate affinity for circulating and tissue proteins.

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#1 #junior
Paired cartilages � arytenoids, corniculate and cuneiform

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#1 #junior
EPIGLOTTIS Functionally separates larynx from trachea

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#1 #airway #ccmc #jrs

Epiglottis

Like a lid that prevents solids and liquids from entering the trachea while swallowing

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#1 #airway #ccmc #jrs
THYROID CARTILAGE
Largest cartilage of the larynx

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#1 #airway #ccmc #jrs
CRICOID CARTILAGE
Ring shaped cartilage connected to the thyroid cartilage by the cricothyroid ligament at the level of the 6th vertebrae

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#1 #airway #ccmc #jrs
ARYTENOID CARTILAGES
Attached to the cricoid cartilage by the cricoarytenoid muscles Attached to vocal cords and span across larynx to part of the thyroid cartilage

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#1 #airway #ccmc #jrs
CORNICULATE CARTILAGES “Horn -like” rest on top of each arytenoid cartilage During swallowing, epiglottis meets with corniculates to seal off airway

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#1 #airway #ccmc #jrs
MUSCLES Abductors – open cords for inspiration � Posterior Cricoarytenoids are the sole abductors � “Pull Cords Apart”

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#1 #airway #ccmc #jrs
Adductors – close cords for phonation, Partial closure for exhalation � Lateral Cricoarytenoids are the primary adductors � “Leave Cords Alone”

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#1 #airway #ccmc #jrs
Aryepiglottic muscles closes laryngeal inlet Thyroepiglottic muscles opens laryngeal inlet Transverse arytenoids adducts vocal cords Oblique arytenoids controls sphincters to vestibule Thyroarytenoids relax cord tension Cricoarytenoids increases vocal cord tension

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#1 #airway #ccmc #jrs
LIGAMENTS - VOCAL CORDS smallest area in the adult airway True vocal cords are pale white ligaments False cords are the aryepiglottic folds Two strong bands of elastic tissue attached to the angle of the thyroid cartilage and dorsally to the arytenoid cartilage

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#1 #airway #ccmc #jrs
LIGAMENTOUS MEMBRANES Thyrohyoid membrane connects thyroid cartilage to hyoid bone Cricothyroid membrane connects thyroid cartilage and cricoid membrane Cricothyrotomy is performed through this membrane

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#1 #airway #ccmc #jrs
TRACHEA air conduit to the lower airways
cricoid cartilage to the carina C 6 to T 4-5 17 to 18 horseshoe structures interconnected with fibroelastic tissue for expansion

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#1 #airway #ccmc #jrs
MORE ABOUT THE TRACHEA Trachea is 10 – 12 cm long and 20 mm in diameter From lips to mid- trachea is 20 – 22 cm From lips to carina is 24 – 28 cm The larynx is @ C3 - C6 and the carina is @ T5 A properly placed ETT shows on x-ray with the distal tip at T2 (suprasternal notch)with distal tip above carina

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#1 #airway #ccmc #jrs
TRACHEAL RECEPTORS Irritant receptors circumferential to trachea stimulation causes constriction Stretch receptors posterior wall regulates depth and rate of breathing stimulation causes dilation of airway to increase airflow

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#1 #airway #ccmc #jrs
SENSORY NERVE SUPPLY Trigeminal Nerve (V) nerve supply to the nasopharynx, soft and hard palates and the anterior 2/3 of the tongue opthalmic division anteriorly maxillary division posteriorly (sphenopalatine nerves) mandibular division- lingual nerve - anterior 2/3 of tongue

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#1 #airway #ccmc #jrs
Facial Nerve (VII) nerve supply to the soft and hard palates and the tongue Glossopharyngeal Nerve (IX) nerve supplies the posterior 1/3 of the tongue, the roof of the pharynx, tonsils and soft palate

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#1 #airway #ccmc #jrs
Vagus Nerve (X) Recurrent laryngeal nerve � sensory to larynx below the cords and to the trachea Superior laryngeal nerve � divides into external (motor) and internal (sensory) laryngeal nerves that supplies the larynx above the cords (between epiglottis and cords)

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#1 #airway #ccmc #jrs
Recurrent laryngeal nerve Major motor nerve all of the muscles of the larynx except the cricothyroid muscle External laryngeal nerve motor to cricothyroid muscle

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#1 #airway #ccmc #jrs
LARYNGOSPASM Forceful involuntary spasm of laryngeal muscles d/t sensory stimulation of superior laryngeal nerve Pharyngeal secretions or passing of ETT through the larynx during extubation

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#1 #airway #ccmc #jrs
LARYNGOSPASM
Treatment Gentle positive pressure Lido 1-1.5 mg/kg IV Sux 0.25-1mg/kg

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#1 #airway #ccmc #jrs

LARYNGEAL NERVE DAMAGE

External branch of the Superior Laryngeal nerve weakness and huskiness of voice vocal cords can not be tensed cricothyroid muscle is paralyzed

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#1 #airway #ccmc #jrs
LARYNGEAL NERVE DAMAGE
Recurrent laryngeal nerve - unilateral hoarseness paralyzed cord assumes an intermediate position Recurrent laryngeal nerve- bilateral aphonia both cords in intermediate position cords can flop together during inspiration obstruction emergency!!

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#1 #airway #ccmc #jrs
AIRWAY ASSESSMENT Thyromental distance Distance from chin to thyroid Should be at least 6 cm (three fingerbreadths). If less anticipate difficulty visualizing trachea Mandibular shape Micrognathic, prognathic

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Aortic slenosis is recognized by its characteristic systolic murmur, best heard in the second right intercostal space (over the aortic arch) with transmission into the neck. Aortic regurgitation is recognized by its dias- tolic murmur, best heard along the left sternal border.

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