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The ventral rami 173 Human Anatomy and Physiology supply the anterior and lateral wall of the back and the lower limbs effective 100mcg advair diskus asthma symptoms in 2 month old. Branches of the Spinal Nerves Each spinal nerve continues only a very short distance away from the spinal cord and then branches into small posterior divisions and rather large anterior divisions discount advair diskus 500 mcg with mastercard asthma treatment list. The larger anterior branches interlace to form networks called plexuses, which then distribute branches to the body parts. The cervical plexuses supplies motor impulses to the muscles of the neck and receive sensory impulses from the neck and the back of the head. The largest of these branches is the sciatic nerve, which leaves the dorsal part of the pelvis, passes beneath the gluteus maximus muscle, and extends down the back of the thigh. At its beginning it is nearly 1 inch thick, but it soon branches to the thigh muscles; near the knee it forms two subdivisions that supply the leg and the foot. These afferent impulses from the viscera are translated into reflex responses without reaching the higher center of the brain; the sensory neurons from the organs are grouped with those that come from the skin and voluntary muscles. In contrast, the efferent neurons, which supply the glands and the involuntary muscles, are arranged very differently from those that supply the voluntary muscles. In these g~ each message is transferred at a synapse from the first neuron to a second one and from there to the muscle or gland cell. This differs from the voluntary (somatic nervous system, in which each motor 176 Human Anatomy and Physiology nerve fiber extends all the way from the spinal cord to the skeletal muscle with no intervening synapse. The sympathetic pathways begin in the spinal cord with cell bodies in the thoracic and lumbar regions, the thoracolumbar area. The sympathetic fibers arise from the spinal cord at the level of the first thoracic nerve down to the level of the second lumbar spinal nerve. From this part of the cord, nerve fibers extend to ganglia where they synapse with a second set of neurons, the fibers of which extend to the glands and involuntary muscle tissues. Many of the sympathetic ganglia form the sympathetic chains, two cord like strands of ganglia that extend along either side of the spinal column from the lower neck to the upper abdominal region. The nerves that supply the organs of the abdominal and pelvic cavities synapse in three single ganglia farther from the spinal cord. The second neurons of the sympathetic nervous system act on the effectors by releasing the neurotransmitter epinephrine (adrenaline). The parasympathetic pathways begin in the craniosacral areas, with fibers arising from cell bodies of the midbrain, medulla, and lower (sacral) part of the spinal cord. From these centers the first set of fibers extends to autonomic ganglia that are usually located near or within the walls of the effector organs. These neurons release the neuro transmitter acetylcholine, leading to the description of this system as cholinergic (activated by acetylcholine). These actions are all carried on automatically; whenever any changes occur that call for a regulatory adjustment, the adjustment is made without conscious awareness. The sympathetic part of the autonomic nervous system tends to act as an accelerator for those organs needed to meet a stressful situation. If you think of what happens to a person who is frightened or angry, you can easily remember the effects of impulses from the sympathetic nervous system: 1. This produces hormones, including epinephrine, that prepare the body to meet emergency situations in many ways. Increase in blood pressure due partly to the more effective heartbeat and partly to constriction of small arteries in the skin and the internal organs 5. Dilation of blood vessels to skeletal muscles, bringing more blood to these tissues 179 Human Anatomy and Physiology 6. The sympathetic system also acts as a brake on those systems not directly involved in the response to stress, such as the urinary and digestive systems. If you try to eat while you are angry, you may note that your saliva is thick and so small in amount that you can swallow only with difficulty. Under these circumstances, when food does reach the stomach, it seems to stay there longer than usual.

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If all the cells are counted in such a strip purchase advair diskus 100mcg online asthma symptoms for babies, the differential totals will approximate closely to the true differential count cheap advair diskus 100mcg without prescription asthma 9 months pregnant. The Exaggerated Battlement Method In this method, one begins at one edge of the film and counts all cells, advancing inward to one-third the width of the film, then on a line parallel to the edge, then out to the edge, then along the edge for an equal distance before turning inward again. For example: • Erythrocytes: size, shape, degree of hemoglobinization; presence of inclusion bodies, presence of nucleated red cells (if so, the total leucocyte count must be corrected. The fact that a patient may have 60% polymorphs is of little use itself; he may have 60% of a total leucocyte count of 8. Band (stab) cells are generally counted as neutrophils but it may be useful to record them separately. An increase may point to an inflammatory process even in the absence of an absolute 122 Hematology leucocytosis. The Cook-Arneth Count Arneth attempted to classify the polymorphonuclear neutrophils into groups according to the number of lobes in the nucleus and also according to the shape of the nucleus. The procedure was too cumbersome for routine used and was modified by Cooke, who classified the neutrophils into five classes according to the number of lobes in the nucleus. Some workers suggest that the strand must be less than one- quarter of the width of the widest part of the lobe. The count is performed by examining 100 neutrophils and placing them in their correct class: • Class I: No lobes (An early cell in which the nucleus has not started to lobulate). That means if the figures were to be plotted on graph paper, the peak of the graph would move to the left hand side of the normal curve. Neutrophils • Neutrophilia / Neutrophilic leucocytosis This is an increase in the number of circulating neutrophils above normal and the conditions associated with this include: overwhelming infections, metabolic disorders (uremia, diabetic acidosis), drugs and chemicals (lead, mercury, potassium chlorate), physical and emotional stress, hematological disorders (e. They are primarily seen in infectious mononucleosis which is an acute, self-limiting infectious disease of the reticuloendothelial tissues, especially the lymphatic tissues. What other elements of the blood film should be evaluated while doing the differential leucocyte count? The most immature reticulocytes are those with the largest amount of precipitable material and in the least immature only a few dots or strands are seen. The number of 130 Hematology reticulocytes in the peripheral blood is a fairly accurate reflection of erythropoietic activity assuming that the reticulocytes are released normally from the bone marrow and that they remain in the circulation for the normal period of time. Complete loss of basophilic material probably occurs as a rule in the blood stream after the cells have left the bone marrow. The ripening process is thought to take 2-3 days of which about 24 hours are spent in the circulation. Although reticulocytes are larger than mature red cells and show diffuse basophilic staining (polychromasia) in Romanowsky stained films, only supravital staining techniques enable their number to be determined with sufficient accuracy. Better and more reliable results are obtained with new methylene blue than brilliant cresyl blue as the former stains the reticulo-filamentous material in the reticulocytes more deeply and more uniformly than does the latter. The exact volume of blood to be added to the dye solution for optimal staining depends upon the red cell count. A larger proportion of anemic blood and a smaller proportion polycythemic blood should be added than normal blood. After incubation, resuspend the cells by gentle mixing and make films on glass slides in the usual way. In a successful preparation, the reticulofilamentous material should be stained deep 132 Hematology blue and the non-reticulated cells stained diffuse shades of pale greenish blue. Counting An area of the film should be chosen for the count where the cells are undistorted and where the staining is good. To count the cells, the oil immersion objective and if possible eye pieces provided with an adjustable diaphragm are used. If such eyepieces are not available, a paper or cardboard diaphragm in the center of which has been cut a small square with sides about 4mm in length can be inserted into an eyepiece and used as a substitute. The counting procedure should be appropriate to the number of reticulocytes as estimated on the stained blood film. Very large numbers of cells have to be surveyed if a reasonably accurate count is to be obtained when the reticulocyte number is small.

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Types of Trauma: Trauma can be classified according to the: I- Cause: Homicidal injuries Road traffic accident and falls Industrial accidents cheap advair diskus 100 mcg online asthma definition 2014, burn discount 100 mcg advair diskus mastercard asthma symptoms stomach pain, etc. I- The primary survey and resuscitation This part of management comprises a quick evaluation of the patient to detect immediately life threatening situations and institution of measures to correct them. In a trauma victim, it may be compromised by the back fallen tongue, broken tooth, vomitus, blood etc. If the air way is compromised, use suctioning, jaw trust, positioning, oropharyngeal tube or endotracheal tube to open it, taking care of the cervical spine. It may be compromised by pneumothorax, hemothorax or multiple rib fractures causing flail chest. Look for external hemorrhage and arrest it by pressure, bandaging or tourniquet if the other methods fail. Tachycardia, hypotension, pallor may mean bleeding into the body cavities or from an obvious external wound. E- Expose (undress) the patient fully for examination not to miss serious injuries. It includes the following aspects: A- Take History: The informant may be the injured patient, relatives, police or ambulance personnel. The history should include: • Time of injury, • Mechanism of injury, • Amount of bleeding, • Loss of consciousness, • Any intervention performed or drugs given should be asked for. C- Make necessary investigations such as hematocrite, cross-match, urinalysis, X-ray, ultrasound, etc. However, never send a patient with unstable vital signs for investigation or referral before resuscitation. These include poor condition and design of roads, traffic mix (sharing of road by vehicles of different speeds and pedestrians), poor condition of the vehicles and poor traffic rule enforcement. The incidence of this serious problem can be reduced by improving the public awareness and the quality of training given to the drivers and strict enforcement of traffic rules. Moreover, improving the design and quality of the roads and regular checkup of vehicle fitness would help alleviate the problem. In many developing countries like Ethiopia, the magnitude of the problem is big due to high distribution of firearms among civilians who have little or no knowledge on safe handling and usage. It is made worse by the presence of large number of land mines, which are remnants of repeated wars and conflicts in these poor nations. Generally, missile injuries may be caused by bullets from pistols, rifles, machine guns or fragments from exploded grenades and mines. The degree of injury sustained depends on the amount of energy transferred from the missile to the patient as formulated below. The extensive tissue injury with the high degree of contamination creates a perfect medium for life threatening infection to occur. Missile injuries are classified into: I- Low- velocity missile injuries • Comprise missiles fired from hand guns (<400m/s) • Injury is limited to the path of the bullet. All patients with missile injuries should receive broad spectrum antibiotics and tetanus prophylaxis. It is mostly seen in developing countries where there is overcrowding, poor housing designs and wide spread usage of open fire for cooking. Types of burns, according to the mechanism, include: • Flame burn • Scalding • Chemical burn • Electrical burn, etc. The severity of a burn injury is a function of the burn depth (degree) and the extent or percentage of the body surface that is burned. Determining the percentage of burn surface is important to calculate the amount of fluid requirement while determination of burn depth is important for burn wound management. Classification of Burn according to depth (degree) 1- First degree burn: It involves the epidermis only and manifests with erythema. The extent or percentage of burn is determined by the “rule of nine” in which the body surface is divided into eleven parts each constituting 9% of the total (fig. In children, the size of the hand may be used to estimate the burn surface, which is approximately 1%. Endotracheal intubation or tracheotomy may be needed in patients with burns involving the air way.

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