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Aristotle commented on that humans had proportionally the largest brains of all animals erectile dysfunction treatment honey cialis with dapoxetine 20/60 mg sale. Consider xatral impotence purchase 20/60 mg cialis with dapoxetine with amex, for example erectile dysfunction medicine reviews cialis with dapoxetine 40/60 mg for sale, that gorillas erectile dysfunction kaiser discount cialis with dapoxetine with amex, although physically larger than humans, only have about one fourth of the brain size. In humans, the average adult brain size is about 1300 cubic centimeters (cm3) and weighs about 1500 grams. If, however, brain size is held constant as it relates to body size, humans compare very well. Thus, if the range of brain size with body size is held constant, the human brain is 21,000 times larger and the neocortex is 142,000 times larger than that of the shrew, a very small, mouselike mammal. This means that if a shrew were the size of a human, its brain would weigh only 46 grams. The body/brain weight formula, however, does not work well with all small animals. Certainly, it is logical to assume that the surface of the body, through which the organism has contact with the environment, is more directly related to brain function than is the total weight in bones and blood. When body surface is taken into consideration, the human comes in first among all vertebrates, with the chimpanzee and the dolphin following second and third (Changeux & Chavaillon, 1995). Large brains are not necessarily more efficient or effective; in fact, absolute brain weight has no significance in itself. It may require a larger brain more time to process information than a smaller one. This does not imply that men, who are, on average, taller and heavier than women, are smarter. After correcting for body size, men and women have brains of approximately equal size. The size of a brain has been an object of debate and controversy for many centuries. Broca, for one, argued that the size of the brains of human races had to account for something (1861). He proposed that "in general, the brain is larger in mature adults than in the elderly, in men than in women, in eminent men than in men of mediocre talent, in superior races than in inferior races. There is a remarkable relationship between the development of intelligence and the volume of the brain" (1861, pp. As evidence, Broca offered findings that 51 unskilled workers had an average brain weight of 1365 grams, compared with the brain weight of 24 skilled workers, which was an average of 1420 grams. Furthermore, it is entirely possible that the unskilled workers were malnourished and, therefore, were smaller in stature than the skilled workers. One has to wonder what Gall himself must have thought of this-his brain measured "only" 1100 grams. The measurement (or mismeasurement) of human intellectual properties according to brain size has been described by the evolutionary biologist Stephen J. Gould in the Mismeasure of Man (1981), in which he presented a fascinating historical account of phrenology and other pseudoscientific explanations of the size of the human brain and its relation to intelligence. What Broca and others did not realize was that body size, as well as many other factors, relates to the complexity of the brain and the nervous systems of humans and other species. In fact, the complexity of the brain depends on many dimensions in addition to brain size, including connectivity, cell density, cell morphology, neurotransmitter complements, and perhaps the most important variable, the rate and duration of neuronal sprouting. Central Postcentral Precentral Superior frontal Middle frontal Parietooccipital Paracentral Central Callosal Cingulate Calcarine Inferior frontal Collateral Superior temporal Middle temporal Lateral fissure Inferior temporal c. In principle, there are many connections within the cortex itself, both horizontal and vertical, as well as to subcortical areas. The frontal and parietal lobes are separated from the temporal lobe by the lateral fissure. The division and naming of the cortex into four lobes is quite arbitrary and is related to the names of the cranial plates that provide protective covering just superior to the lobes. Another way of referring to the topography of the brain is related to the architectural arrangement of neurons in different regions throughout the brain. Brodmann (1909) divided the cortical surface according to these differences and showed that the anatomic organization of the cortex is similar in all mammals.

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Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016 erectile dysfunction protocol food lists purchase cialis with dapoxetine 30mg fast delivery. A prospective randomized controlled study of two fluid regimens in the initial management of septic shock in the emergency department doctor for erectile dysfunction philippines buy generic cialis with dapoxetine 20/60mg online. A multidisciplinary community hospital program for early and rapid resuscitation of shock in nontrauma patients erectile dysfunction kansas city buy generic cialis with dapoxetine line. Out-of-hospital characteristics and care of patients with severe sepsis: a cohort study best erectile dysfunction pills for diabetes order 60 mg cialis with dapoxetine with mastercard. Revision Date September 8, 2017 105 Sickle Cell Pain Crisis Aliases None Patient Care Goals 1. Patient with known sickle cell disease experiencing a pain crisis Exclusion Criteria 1. Obtain vital signs including pulse, respiratory rate, pulse oximetry, and blood pressure 3. Provide evaluation and management of altered mental status per the Altered Mental Status guideline 4. Assess for potentially serious complications other than pain crisis which may include: a. Reassess vital signs and response to therapeutic interventions throughout transport 2. Transport in a position of comfort unless clinical condition requires otherwise Patient Safety Considerations None recommended Notes/Educational Pearls Key Considerations 1. These patients may have a higher tolerance to narcotic pain medications if they are taking them on a regular basis 4. Patients with sickle cell trait can have acute pain crises in extreme conditions. Patients suffering cardiac arrest due to severe hypothermia [see Hypothermia/Cold Exposure guideline] 2. Patients in arrest due to traumatic etiology [see General Trauma Management guideline] Patient Management Assessment 1. The patient in cardiac arrest requires a prompt balance of treatment and assessment 2. In cases of cardiac arrest, assessments should be focused and limited to obtaining enough information to reveal the patient is pulseless 3. Once pulselessness is discovered, treatment should be initiated immediately and any further history must be obtained by bystanders while treatment is ongoing Treatment and Interventions the most important therapies for patients suffering from cardiac arrest are prompt cardiac defibrillation and minimally interrupted effective chest compressions 1. High flow oxygen is applied via a non-rebreather mask with an oropharyngeal airway 2. Pediatric Consideration: For neonates, 3:1 is the recommended compression to ventilation ratio. Either a supraglottic airway or an endotracheal tube may be placed without interruption of compressions 2. Pediatric Consideration: for children, 1 breath every 3-5 seconds is recommended (12-20 breaths/minute) c. There is insufficient evidence to recommend for or against the routine administration during cardiac arrest Consider reversible causes of cardiac arrest which include the following: a. Performing manual chest compressions in a moving vehicle may pose a provider safety concern 111 2. In addition, manual chest compressions during patient movement are less effective in regards to hands on time, depth, recoil and rate 3. Ideally, patients should be resuscitated as close to the scene as operationally possible 4.

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Unexplained trauma to erectile dysfunction bathroom discount 40/60mg cialis with dapoxetine fast delivery genitourinary systems or frequent infections to what is an erectile dysfunction pump order cialis with dapoxetine 20/60mg otc this system f treatment erectile dysfunction faqs cheap cialis with dapoxetine 40/60 mg amex. Start with a primary survey and identify any potentially life-threatening issues 2 erectile dysfunction drugs and high blood pressure best 30 mg cialis with dapoxetine. Document thorough secondary survey to identify clues of for potential abuse/maltreatment: a. Inability to communicate due to developmental age, language and/or cultural barrier b. Unexplained trauma to genitourinary systems or frequent infections to this system g. Assess physical issues and avoid extensive investigation of the specifics of abuse or maltreatment, but document any statements made spontaneously by patient. Report concerns about potential abuse/maltreatment to law enforcement immediately, in accordance with state law, about: a. For patients transported, report concerns to hospital and/or law enforcement personnel per mandatory reporting laws Patient Safety Considerations 1. If no medical emergency exists, the next priority is safe patient disposition/removal from the potentially abusive situation 2. All states have specific mandatory reporting laws that dictate which specific crimes such as suspected abuse or maltreatment must be reported and to whom they must be reported. It is important to be familiar with the specific laws in your state including specifically who must make disclosures, what the thresholds are for disclosures, and to whom the disclosures must be made 2. Clues to abuse or maltreatment can vary depending on the age group of the patient and on the nature of the abuse. Document findings by describing what you see and not ascribing possible causes. Accessed August 13, 2017 Revision Date September 8, 2017 52 Agitated or Violent Patient/Behavioral Emergency Aliases Acute psychosis, patient restraint Patient Care Goals 1. Provision of emergency medical care to the agitated, violent, or uncooperative patient 2. Patients exhibiting agitated or violent behavior due to medical conditions including, but not limited to: a. Note medications/substances on scene that may contribute to the agitation, or may be relevant to the treatment of a contributing medical condition 2. Attempt verbal reassurance and calm patient prior to use of pharmacologic and/or physical management devices b. Continued verbal reassurance and calming of patient following use of chemical/physical management devices 53 3. The numbering of medications below is not intended to indicate a hierarchy/preference of administration b. Stretcher straps should be applied as the standard procedure for all patients during transport ii. Supplemental straps or sheets may be necessary to prevent flexion/extension of torso, hips, legs by being placed around the lower lumbar region, below the buttocks, and over the thighs, knees, and legs 55 c. Secure all four extremities to maximize safety for patient, staff, and others iii. Multiple knots should not be used to secure a device Patient Safety Considerations the management of violent patients requires a constant reevaluation of the risk/benefit balance for the patient and bystanders in order to provide the safest care for all involved. Do not attempt to enter or control a scene where physical violence or weapons are present 3. Uncontrolled or poorly controlled patient agitation and physical violence can place the patient at risk for sudden cardiopulmonary arrest due to the following etiologies: a. Excited delirium/exhaustive mania: A postmortem diagnosis of exclusion for sudden death thought to result from metabolic acidosis (most likely from lactate) stemming from physical agitation or physical control measures and potentially exacerbated by stimulant drugs. Positional asphyxia: Sudden death from restriction of chest wall movement and/or obstruction of the airway secondary to restricted head or neck positioning resulting in hypercarbia and/or hypoxia 6. Apply a cardiac monitor as soon as possible, particularly when pharmacologic management medications have been administered 7. All patients who have received pharmacologic management medications must be monitored closely for the development of hypoventilation and oversedation a.

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References:

  • http://www.healthpolicyplus.com/ns/pubs/7146-7259_LegalEnvrnmentAssessmentMadagascarJune.pdf
  • https://www.apa.org/ed/precollege/topss/lessons/memory.pdf
  • https://www.cshlpress.com/pdf/sample/2013/Antibodies2/AB2Intro7Part1.pdf
  • https://www.alfa.com/media/BioGLB.pdf