Transfer application for University of Illinois at Urbana Champaign Essay Example for Free

Transfer application for University of Illinois at Urbana Champaign EssayMy high train years demonstrate a strong history of community involvement and social work that gave me a chance to fortify my communication skills, translate leading potential into real actions and let me help other people in meaningful and effective ways. The combination of various activities and burden of multiple responsibilities also prove a challenge to my academic achievements. Thus, I must admit that being involved in volunteering work a few hours a week, working as President of the Snowboarding club and church leader and Vice-President in my Korean church, I spent less time and effort on studies than other students. With this said, the broad signifier of activities did develop my personality and increase my potential to add to diversity on Urbana Champaign campus. Working as President of the Snowboarding club, I learned a apportion about this sport and organization of different sports events. T hroughout my community involvement, such as work in the asylum and in the institution for physically invalid people, I gained knowledge about life that is very different from our usual patterns. As baby-sitter in the orphanage, I got to know many disadvantaged kids whose position was different from mine. Learning to help these people, I realized that humans are very diverse and at the same time united by prevalent feelings of love, hate, trust, hope and sympathy.Besides, being of Korean origin, I can bring to the campus an understanding and appreciation of our rich culture and customs. During my life in the US, I have maintained my ethnic culture through involvement in the initiative in my Korean church that was aimed at helping new people fit into the US environment. I hope to bring this experience in helping new people to University of Illinois, making my experience at transition work for other people. world(prenominal) studies have long captured my interest and hold it to th is point. A foreign national, I am most interested in international trade and development, and specifically the interconnection between these two phenomena. My experience in changing the national environment proved a trigger causing my interest in the field and motivate me to pursue it as a profession.Coming from Korea, I became interested in national political and stinting system and their reflection in peoples contemporary experience. Korea had a rather painful history, being to this point divided into two parts. The striking difference in life standards between North and southwestward Korea intrigued me because not so long ago we were one nation.As I grew up, I realized the importance of a choice of a political and economic system the nation makes. Reading a lot about different economic theories and practices, I developed an interest in how to help poor nations develop better. I come from a relatively prosperous background and feel obliged to help countries with a very low inc ome level to overcome majestic poverty and provide their people with basic benefits.Developing international trade, I consider, can be the answer to many of their problems. Working for one month in 2006 in Essen Tech Co The Department of Trade, I gained further insights into the nature of international trade. There I mingled with professionals in the field who shared with me their expert knowledge and opinions formed on the basis of relevant information, which was very interesting for a novice.At this point, I have some theoretical and practical background in the chosen field. Now I need more substantial knowledge to let me use my potential to the fullest. With deep interest in the field, I believe I can make my involvement into an important contribution.

Attack on Pearl Harbour Essay Example for Free

ack-ack gun on Pearl Harbour EssayAttack on Pearl Harbour * On the morning of December 7, 1941, the Nipponese launched a surprise air attack on the U. S. Naval Base at Pearl Harbor in Hawaii. After just two hours of bombing, more than 2,400 Americans were dead, 21 ships had either been sunk or damaged, and more than 188 U. S. aircraft destroyed * U. S. abandoned its insurance of isolationism and declared war on Japan the following day officially bringing the United States into World War II. The Japanese were tired of negotiations with the United States* They treasured to continue their expansion within Asia but the United States had placed an extremely restrictive embargo on Japan in the hopes of curbing Japans aggression * alternatively than giving in to U. S. demands, the Japanese decided to launch a surprise attack against the United States in an attempt to destroy the United States naval ply even before an official announcement of war was given * The morning of Decembe r 7, 1941, the Japanese attack on Pearl Harbor began. At 600 a. m. the Japanese aircraft carriers began launching their planes amid rough sea * The American Navy was completely unaware that an attack was imminent * Attacking the U. S. aircraft on Oahu was an essential component of the Japanese attack plan * The Japanese were believed that in destroying a large portion of the U. S. airplanes, then they could proceed unhindered in the skies above Pearl Harbor. Plus, a counter-attack against the Japanese attack force would be much more unlikely * By 945 a. m. , just less than two hours after the attack had begun, the Japanese planes left Pearl Harbor and headed back to their aircraft carriers.The attack on Pearl Harbor was over * The death toll among Americans was quite high. A total of 2,335 servicemen were killed and 1,143 were wounded. lxviii civilians were also killed and 35 were wounded * At 1230 p. m. on the day following the attack on Pearl Harbor, President Franklin D. Rooseve lt gave an address to relation in which he declared that December 7, 1941 was a date that will live in infamy. * At the end of the speech, Roosevelt asked Congress to declare war on Japan, officially bringing the United States into World War II

Preventing Blood Stream Infections Health And Social Care Essay

Preventing Blood Stream Infections Health And Social Cargon Essay subject field Patient Safety Goals (NPSG) were introduced in 2002 in order to help address some of the issues that were responsible for causing a majority of the situations that were responsible for creating patient sentry go issues. These goals were implemented in order to put focus on what were deemed to be the most preventable of these issues. One of these goals is the legal community of central line-associated blood stream infections (Lyles, Fanikos, Jewell, 2009). literary productions ReviewCentral venous catheters (CVC) argon indispensable in the care of critically ill patients. However, their custom is not without risk. Catheter-associated bloodstream infections (CA-BSI) are common healthcare-associated infections in intensive care unit (ICU) patients and have been estimated to occur in 3%-7% of all patients with CVC (Warren, et al., 2006). It is well documented that intravascular catheter related complicati ons are associated with extending hospital length of stay, increase direct costs and increasing ICU mortality. Clinicians insert approximately 7 million central venous access devices (CVAD) annually in the United States, and of these, 1 in 20 is associated with a CA-BSI, despite the use of the best available aseptic techniques during catheter insertion and alimony. Overall, an estimated 250,000 CVAD-related CA-BSI occur annually, with an attributed mortality of 12.5% to 25% per occurrence. The national cost of treating CA-BSI equals $25,000 per infection, respectively, or $296 million to $2.3 billion in total. While the human activity of CA-BSI has remained relatively steady, vascular access device use has drastically increased, especially in nonhospital settings (Rosenthal, 2006).A coarse amount of research is directed toward reducing these complications in an effort to improve patient outcomes. A review of the literature provides an overview of current recommendations concernin g intravascular catheter care and research regarding the use of education programs to promote recommended practice.The Centers for Disease Control and Prevention (CDC) published the Guidelines for the Prevention of Intravascular Catheter-Related Infections in 2002, which is the benchmark for all intravascular catheter care recommendations. The guidelines for CVC suggest the replacement of dressings all(prenominal) 7 days or when soiled or loosened, intravenous tubing changes every 72 hours, and the replacement of tubing used to administer blood products and lipid emulsions within 24 hours of infusion initiation (East Jacoby, 2005). According to the CDC, approximately 53% of adult patients in intensive care units have a central venous catheter on any given day (Rupp, et al., 2005).Skin cleansing of the insertion site is regarded as one of the most important measures for preventing catheter-related infection. Historically, povidone-iodine is an germicidal that has been used during the insertion and maintenance of the intravascular devices. It works by penetrating the cell wall of the microorganism. More recently, chlorhexidine has been studied and found to be more effective as a shinny antiseptic to prevent catheter-related infection. It works in less time, retains its antibacterial effect against flora longer, is not inactivated by the presence of blood or human protein, and causes minimal skin irritation. Chlorhexidine works by disrupting the microbial cell wall. It is active against many gram-positive and to a slightly lesser degree gram-negative bacterium (Astle Jensen, 2005).A multistep mathematical process is recommended to prevent CA-BSI that acknowledges educating stave, using maximal barrier precautions (e.g. a sterile gown and gloves, mask, cap, and large sterile drape), performing infection surveillance, and replacing occlusive dressing every 7 days or when needed (Buttes, Lattus, Stout, Thomas, 2006). Other strongly recommended practices inc lude proper hand hygiene, use of chlorhexidine gluconate for insertion site preparation, and avoidanceof routine catheter changes. Catheters impregnated with disinfectant agents are recommended when infection rates are high or when catheters will remain in place for a considerable time (Krein, et al., 2007). Education of module on the proper care of CVC is paramount in reducing the amount of CA-BSI. This is perhaps one of the most cost-effective methods of reducing CA-BSI (Ramritu, Halton, Cook, Whitby, Graves, 2007).ImplementationA staff education program was initiated for the treat personnel that primarily deal with CVC. This education program was aimed at training the ICU and step-down units nursing staff proper care and maintenance of the CVC. Education focused on proper care of the CVC, including when dressing changes should be performed e.g. every 7 days or when the dressing is soiled. Nurses were overly trained in how to appropriately assist with CVC placement and the do cumentation tool that infection control utilizes to evaluate adherence to insertion guidelines. Posters were also placed in the nurses break and conference areas that had educational material related to proper care of CVC. Documentation was also placed in the physicians lounges that encouraged utilization of maximal barrier precautions during CVC insertion.The facility that was observed currently utilizes a few different means of measurement with regards to CA-BSI. First, a checklist is utilized during CVC insertion that evaluates adherence to insertion guidelines by the staff. This checklist is sent to infection control and entered into a database which is correlated with patient data regarding CA-BSI. Second, in patients that are identify as having a CA-BSI, after catheter removal, laboratory microbiological studies of the catheter, blood, and insertion site swabs are performed to identify causality of the infection.Implementation Compared to Literature SuggestionsPractices that r educe the risk of CA-BSI include the adjacent (1) use of maximal barrier precautions during CVC insertion (i.e., a surgical mask, sterile gown, sterile gloves, and large sterile drapes), (2) placement of the catheter in the subclavian vein sort of than the internal jugular or femoral vein, (3) changing catheters only when necessary, and (4) changing dressings on CVC exit sites when they become nonocclusive, soiled, or bloody. These practices have been incorporated into national guidelines. Currently, the healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) recommends that hospitals implement comprehensive educational programs that teach proper CVC insertion and maintenance techniques (Warren, et al., 2006). These practices are mostly in line with what is implemented at the observed facility. One difference, which is not in line with these recommendations, is that the observed facility has a high number of inter nal jugular insertions rather than utilizing the subclavian vein. When asked about this, many of the physicians stated that access was easier to identify utilizing ultrasound during insertion and they preferred this method over subclavian insertion.Recommended ChangesFirst, implementation of an education program for providers that is focused on infection control, especially the recommendation of utilizing the subclavian vein insertion for CVC placement as a freshman choice in patients that have no contraindications to this placement. Second, procuring the second-generation antiseptic catheter, coated with chlorhexidine and silver sulfadiazine on the internal and external surfaces, to more effectively prevent microbial colonisation in patients that are identified as being at risk. Decreased bacterial colonization, a critical step in the pathogenesis of catheter-associated infection, may correlate with prevention of catheter-related bacteremia (Rupp, et al., 2005). Third, education and training needs to be expanded to any nurses that may be responsible for caring for a patient with a CVC. These areas include non-critical care areas such as pediatric and medical floors. Larger numbers of patients with CVC are now found in non-ICUs than in ICUs and that CA-BSI rates in those settings are higher. Catheter types and insertion sites vary greatly among settings. For example, jugular and femoral insertion sites are common in ICUs subclavian and peripheral sites are more common elsewhere. So strategies for reducing CA-BSI must be tailored to the setting (Hadaway, 2006).

The Hotel And Tourism Tourism Law Tourism Essay

The Hotel And Tourism Tourism Law Tourism EssayIn problems with the Environmental Issues or Laws, with the cooperation of our tourism they develop aw beness, concern and knowledge of the purlieu and its antithetical importance and other things. Those are different laws that pee-pee rule in Philippine tourism, including or even the different political sympathies office is involved too. It provide also provide current situation that have in the tourism, travel and making hospitality which may be analyzed, interpreted and doing what can do on laws that have. The Environment laws protect our natural resources by controlling businesses that have the possible cause to them. Due to the matter of these laws, the Environmental Protection was formed whose main tariff that must have d i is to control and decrease pollution in finding out some materials that could cause harm, to see that companies that may cause environmental injury, they sets right of practice to lessen environmental effe ct and to carried punishments for those who did not follow environmental rules.Therefore, for any industry or in the hotel and tourism, it is helpful to be salubrious known with the matter that given by our environmental laws, and responsible for law that government given, and the kinds of different way and some business through which those environmental laws are need to implement. Tourism or the Hotel Management can have different effects on a given area such as frugalal, social, environmental etc.The most importanteconomiceffect that tourism has is that it provides moreemploymentfor the people in that area and hence in a way increases their stockof living. In fact certain economies primarily run on tourism.As a result it also helps the region as a whole to develop and as a result the governing bodies can utilize the funds to promote thedestinationand make it more attractive for tourists.Tourism is now one of the worlds largest industries and one of its fastest that is develop i n our country. For many countries tourism is seen as a main used for wide development, as it alert to the new different economic performance or activities that have in the government. Tourism may have a positive economic effect on the balance of payments, on employment, on gross income and harvest-festivalion, but it may also have negative effects, particularly on the environment. Unexpected things in developing tourism can result in such a worse of the environment that tourist growth can be demanded. Being the major source of tourist product of the government, therefore it should be protected in order to have something development of tourism and doing good for the country in following years.In additional of business activities worldwide and as a result of more high knowedge , there has been increasing learn to everyone and concern with the injury to human health and environmental damage that cause by the different business activities .These problems is need for business and indust ry to be controls at all levels, and for the main that could be hardly sustain development to be launch in transnational and national environmental laws to make sure that foreign investment and other business activities lead to development that is sustainable in environment . In this way, the Hotel and Tourism Management play an important role in development . If the government takes the recommended actions for development and promotion it will establish market targets that state the number and types of tourists that the country will be able to attract. To make sure that national and local tourism development agreements stress a policy of sustainable tourism development.Incentives that given by the government can encourage many corporations involved in the tourism business to do more their activities to have more recently having a large countries. Thinking of environmental problems it will assist the manager in helping such individual obligation for and liability to environmenta l damage, in integrating environmental affairs with operations, and in developing policies and professionals to manage environmental issues. Tour operators have a great deal of influence on the destinations, activities and overall experience of tourists. Therefore its hard that they have understand the idea of ecotourism and the conservation requirements of protected areas that have rules to follow. They need to be fully aware that the ecotourism product they are trying to promote is easily broken and must be carefully preserved. The tourism industry is also an important partner since it is a alert source of information round need trends, promotion and marketing. It would bring attention to the present and future environmental issues facing the health of our planet and the people it supports. And our responsibility to protect the health and well-being of that ecosystem come on to beginning of a day on the number of aware that surrounds in the world.Philippine laws rule the rights and obligations of which support in the hospitality and tourism industry. It provides for their rights, liabilities and even benefits as order by law. It affects the orbiculateization of the tourism industry, also in opportunity to begun addition or widely into the international market or in target grow internationally. Realize the level of technology and technological capabilities within the host country in order to pass judgment the advantages or disadvantages the hotel may face. Human activities are sources of environmental impacts. Since a sustainable environment must be achieved, individuals should make efforts towards developing and defend the environment in learning of good methods, techniques, and policies.Human activities are sources of environmental impacts. Since a sustainable environment must be achieved, every person should make efforts towards developing and protecting the environment by learning or doing of good methods, techniques, and policies. Support different developing countries efforts to implement different things that could have in development the practices and protect the global environment. To make sure that the goal is in full support of environmental laws.Overall, consideration of the environment and stick to environmental laws and regulations have become important in the day-to-day behavior of business or in the Hotel and Tourism Management all in the Philippines or throughout the world. Working together by the businesses, workers, environmentalists, and government officials is to find economically into our environment. In helping of our government rules as well our tourism department, we can do better for the everyones life. Inspite of rising the demands of needs of everyone, of everyone come to army full support to the strong campaign for the different environmental laws or regulations, with the biggest role of our tourism in advocating and promote or not violating any rules to anyone who is responsible, we should have all t he confident to win this one.. With the skills or knowledge of all in the tourism management and see how that connects and from there start volunteering for programs and tell people about it. But before that first learn how blessed we are and how rich our natural resources are, you would be inspired and motivated to take better care of it. From there, you start with yourself not only our government who pay attention on it.Sourceshttp//www.egerton.ac.ke/index.php/bsc-ecoahos.htmlhttp//bio427.blogspot.com/2010/10/environmental-laws-of-philippines.html-.http//wiki.answers.com/Q/What_are_the_Philippine_tourism_lawsixzz2718t1XVm

Investigation of Thyroid Emergencies

Investigation of Thyroid EmergenciesUnit 1 Thyroid EmergenciesAuthorsDr. Khalid KhatibDr. Subhal Dixit1.0 ObjectivesAfter reading this unit, you pull up stakes be able toEnumerate thyroid gland diseases which will work the diligent in the intensive help unitDescribe the clinical features, investigation and preaching of throid stormDescribe the clinical features, investigation and treatment of hypothyroid coma andDescribe the clinical features, investigation and treatment of obstructive symptoms delinquent to goiter.1.1 IntroductionThyroid emergencies comprise a miniscule fraction of forbearings with thyroid dysfunction, who land up hospitalized in the intensive c ar unit (ICU) as a consequence of their ab ordinary thyroid physiology or anatomy. As these considerations are infrequently encountered in the ICU, a proper understanding of the hormonal pathophysiology and varied clinical features will lead to appropriate and timely institution of hormonal and supportive treatment , ultimately rendition survival benefit to the patient. The following conditions constitute thyroid emergencies i) thyroid storm, ii) hypothyroid coma, and iii) massive goiter causing compression of the airline businesss and large line of work vessels.1.2 Thyroid StormIt is in like manner known as thyroid crisis or thyrotoxic crisis and is an extreme physiological condition due to thyroid hormone excess. A very severe, life ominous and decompensated form of thyrotoxicosis, it is rare (seen in 1-2% of patients admitted for thyrotoxicosis) but mortality rates approach 10-20%. Thyroid storm may be seen even in patients who capture not been diagnosed with hyperthyroidism. The male to female ratio is 13.Causes i) Graves disease, i) Toxic multinodular goiter, iii) Solitary nodular goitre iv) Subacute thyroiditis v) Postpartum thyroiditis, vi) Thyrotoxicosis pointitia, vii) Metastatic thyroid malignancy.Whatever the etiology of hyperthyroidism, its conversion to thyroid storm requ ires the addition of precipitating factors.Precipitating factors i) Infection, ii) Trauma, iii) Surgery- of the thyroid gland or non-thyroidal, iv) exactlelike myocardial infarct or Acute coronary syndrome, v) Pregnancy, labor, complicated delivery vi) Burns vii) Medical illnesses- congestive heart failure, diabetic ketoacidosis, cerebrovascular accident, pulmonary thromboembolism, sepsis, viii) Stress- emotional ix) Abrupt interruption of thyroid drug therapy, x) Administration of iodine compounds or radioiodine (I131 or I123 ), xi) Others- chem some otherapy for leukemia, radiation therapy to neck malignancies, aspirin over demigod, organophosphate poisoning, exercise, status epilepticus and drugs (tyrosine kinase inhibitors, lithium, biological agents like interleukin 2 and interferon).Clinical features i) Central Nervous System- apathy, agitation, delirium, confusion, paranoia, and coma. ii) cardiovascular System- congestive heart failure, tachyarrhythmia (atrial fibrillation , supraventricular tachycardia, ventricular tachycardia and ventricular fibrillation,) sinus tachycardia, dilated cardiomyopathy, high cardiac output state, and pulmonary hypertension. iii) Gastrointestinal tract- vomiting, diarrhoea, jaundice, diffuse abdominal pain occasionally present tenseing as acute abdomen. iv) Respiratory system- dyspnea, tachypnea and acute respiratory failure. v) Thermoregulation- fever, hyperthermia and diaphoresis. vi) Nutrition- weight loss. vii) Renal- proteinuria, acute renal failure.viii) Electrolyte disturbances- hypercalcemia, ketoacidosis, lactic acidosis. viii) Hematology- leucocytosis, hypercoagulable state leading to thromboembolism.Some elderly patients may have very few signs of hyperthyroidism and present with stupor, apathy, coma, and congestive heart failure (apathetic thyroid storm).Diagnosis i) It usually needs to be based on clinical judgment and treatment started even before testing ground results are available. A semiquantative scal e developed by Burch and Wartofsky can be used to definitively identify patients with thyroid storm. ii) Thyroid function tests(TFT) TFTs reveal increase in free T3 and free T4 while TSH will be very low (even undetectable). iii) Other laboratory investigations Serum bilirubin, transaminases, blood glucose levels may be increased while potassium and total cholesterol may be decreased. directmentPrinciples of treatment i) Treat the hyperthyroid state. ii) clog the military forces of circulating T3 and T4. iii) Treat the multiorgan dysfunction. iv) Treat the precipitating scram.i) Treat the hyperthyroid state1) Prevent new thyroid hormone synthesis (Thionamides) 2) Prevent new thyroid hormone release (Thionamides) 3) Prevent conversion of circulating T4 to T3 ( steroids, lithium, high dose iodine and iodinated contrast medium)Thionamides Propylthiouracil, Carbimazole, Methimazole are used in the treatment of hyperthyroid state.Propylthiouracil (PTU) a) superman Loading dose- 500-1 000 mg followed by a maintenance dose of 250 mg every 4-6 hours. b) It additionally prevents peripheral conversion of T4 to T3. c) It is given either viva voce (if patient is conscious and able to swallow) or through the nasogastric tube or rectally. d) Onset of action is rapid. e) PTU has potential for hepatotoxicity. f) Hence it is preferred now only in pregnancy, where other thionamides cannot be used.Methimazole or Carbimazole a) Dose 20-30 mg every 4-6 hours may even go up to 60-80 mg every 4-6 hours. b) They are preferred over PTU unless the patient is pregnant. c) They can be given orally, through the nasogastric tube, rectally, or even endovenously.Steroids a) Hydrocortisone is used in the dose of 100 mg intravenously or intramuscularly every 6 hours and continued till the condition of the patient improves completely. b) If Dexamethasone is used, the dose is 2 mg intravenously every 6 hours. c) Doses of both the drugs need to be tapered appropriately before they are stop.Li thium a) Dose 1200 mg per day in 3-4 divided doses. b) Lithium is used if thionamides are contraindicated and patient is allergic to iodine. c) Serum lithium levels are monitored to prevent toxicity.High dose Iodine a) Lugols iodine or potassium iodide solution is used. b) Dose 0.3 ml or 10 drops of Lugols iodine diluted to 50 ml every 8 hours, orally or through the nasogastric tube. c) Its action is due to the Wolff-Chaikoff effect leading to the suppression of thyroid hormone release and peripheral conversion of T4 to T3. d) It should be administered at least one hour after administration of thionamide drugs. e) atomic number 11 iodide may be used intravenously (dose- 500-1000 mg), but it is not easily available as a sterile solution.Iodinated contrast solution 0.5-1 gm every 12 hours.Cholestyramine at a dose of 4gm, 2-4 times a day orally, reduces enterohepatic circulation of thyroid hormones. In refractory cases, plasma exchange, peritoneal dialysis or hemofiltration may be use d to reduce the circulating thyroid hormones.ii) Prevent the effects of circulating T3 and T4Beta blockers 1) They block the hyperadrenergic effects of the excessive thyroid hormones. 2) They can be used if there are no contraindications to their use (history of asthma, COPD or congestive heart failure). 3) They must be used with continous cardiac monitoring. 4) Propranolol is used most commonly at the dose of 60-80 mg, three times a day, orally or through the nasogastric tube. It may as well as be used intravenously at the dose of 10 mg at the rate of 0.5-1 mg per minute till heart rate is less than 100 per minute and then continued orally as above. 5) If propranol is contraindicated, cardioselective betablockers (metoprolol, atenolol), calcium channel blockers or digoxin may be used. 6) Esmolol, an ultra short acting beta blocker, is preferred by some, as an intravenous infusion of 50-100 mcg/kg/min with a loading dose of 250-500 mcg/kg.iii) Treat the multiorgan dysfunction1) Ma nage the patient in intensive care unit. 2) Take care of ABC (airway, breathing, and circulation). 3) Respiratory support with oxygen therapy or mechanical ventilation (noninvasive or invasive) as necessary. 4) Resuscitation and hemodynamic support- Intravenous infusions to correct fluid and electrolyte disturbances. 5) Antipyretics- cooling mattresses and cold sponging are used along with paracetamol to reduce the raised temperature. Salicylates are avoided as they reduce thyroid hormone binding to thyroglobulin and may in fact worsen thyroid storm. 6) Treat hypertension. 7) Treat delirium and agitation by sedation with haloperidol and benzodiazepines. 8) Provide nutritional support with adequate dextrose infusions and vitamin (especially thiamine) supplementation. 9) Treat the tachyarrythmias with antiarrythmic drugs if patient is hemo- dynamically stable or by electrical cardioversion if unstable. Treat congestive heart failure with diuretics and ACE inhibitors.iv) Treat the pr ecipitating cause1) attend and treat the focus of infection. 2) Use broad spectrum antibiotics on empiric basis as appropriate. 3) Send urine and blood cultures. 4) Treat trauma, diabetic ketoacidosis, myocardial infarction and other precipitating factors as per usual principles.Once thyroid storm has been treated the hyperthyroid state should be treated definitively with antithyroid drugs, radioiodine or thyroidectomy.1.3 Hypothyroid comaIt is also known as myxedema coma or myxedematous coma and is due to very severe, untreated hypothyroidism manifesting with reduced temperature and altered mental status. It is an want to be treated in an ICU and has high mortality, but fortunately it is rare. Typically the patient is an elderly female with history of hypothyroidism with or without adequate treatment, who may have stopped treatment, or may have suffered an intercurrent stressful situation (infection). Occasionally coma may be the first presentation of hypothyroidism. Rarely hypo thyroid coma may be seen in young females, some of whom may be pregnant.Precipitating factors i) Burns, ii) Trauma, iii) Surgery, iv) Severe infection- pulmonary or urinary tract infection, sepsis, v) Low ambient temperature, vi) Cardiac diseases- myocardial infarction, congestive heart failure, vii) Cerebrovascular accident viii) Labour, ix) Anesthesia x) Drugs- neuroleptics, sedatives (benzodiazepines), xi) Intake of large amounts of liquids, xii) Seizures, xiii) Gastrointestinal bleeding.Some of the common causes of hypothyroidism are i) Chronic autoimmune thyroiditis, ii) Thyroidectomy (total or partial), iii) sculpt disease treated with radioiodine, iv) Secondary hypothyroidism- hypopituitarism, v) Drugs- amiodarone, lithium.Clinical features i) Hypothermia- is usually severe with temperature approximately 26.70C (800F). Rarely, temperature may even reach 210C. In some cases, temperature may be normal in the heading of infection. ii) Altered mental status- may present as disor ientation, depression, paranoia, hallucination, cerebellar signs, amnesia, disturbed memory, abnormal EEG findings, seizures, status epilepticus, stupor, obtundation or coma. iii) Cardiovascular system- abnormalities present as bradycardia, prolonged QT interval, varying degrees of AV block, ventricular arrhythmias (torsades de pointes), pericardial effusion, reduced cardiac output or shock. iv) Respiratory system- disturbances present as hypoventilation and hypercarbia or respiratory failure requiring mechanical ventilation. v) Renal and electrolyte disturbances- manifests as hyponatremia, edema, retention of urine or rarely renal failure. vi) Gastrointestinal- manifestations are constipation, paralytic ileus, ascites, gastroparesis, and gastrointestinal bleeding. vii) Hematological- problems are coagulopathy due to vonWillebrand syndrome and reduction of coagulation factors, DIC (disseminated intravascular coagulation), granulocytopenia and microcytic or macrocytic anemia. viii) G eneral- manifestations of hypothyroidism like macroglossia, ptosis, generalized skin swelling or cool dry skin, periorbital edema, obesity and depressed deep heftiness reflexes.Diagnosis i) It should be suspected clinically. ii) TSH is raised in most cases. It may rarely be normal in pituitary causes of hypothyroidism. Severe systemic illness and drugs (inotropes, steroids) used to treat the associated systemic illness will cause blunting of the TSH elevation. iii) T3 and T4 levels are low. iv) Hyponatremia, hypoglycemia, hypoxia, respiratory acidosis, hypercapnia, hypercholesterolemia and elevated LDH and serum creatinine kinase levels may be present.TreatmentPrinciples of treatment i) Thyroid hormone supplementation. ii) Steroids. iii) Correction of fluid and electrolyte disturbances. iv) Treatment of precipitating cause.i) Thyroid hormone supplementation a) Supplementation with L-thyroxine with or without addition of liothyronine. b) Therapy is sort of intravenous. c) There is no consensus on the best therapeutic regime. d) Dose of L-thyroxine- High dose (300-400mcg on day 1 and then 50-100 mcg/day on subsequent days) is preferred by some. Though tolerated by young patients, it may cause sudden cardiac death in the elderly. Hence a press down dose is preferred (100mcg on day 1 and then 50-100mcg on subsequent days). e) Liothyronine- at a dose of 10-25 mcg (bolus), intravenously and then 10 mcg intravenously every 4 hours for the first 24 hours and every 6 hours over the next 48 hours and then oral therapy with L-thyroxine (50-100 mcg daily), as feasible. Initial therapy with liothyronine may be preferred, as it has better bioavailability and peripheral conversion of T4 to T3 is impaired in hypothyroid coma. Care should be taken during liothyronine therapy as excess T3 may increase mortality. f) Combined T4+T3 approach to avoid above complications, a combined approach with L-thyroxine and liothyronine is advised as shown in control panel no. 1.Table No. 1 Combined L-thyroxine and liothyronine therapyii) Steroids a) Hydrocortisone at a dose of 50-100 mg intravenously every 6 hours, is preferred. b) It is required to treat the associated adrenal insufficiency.iii) Correction of associated fluid, electrolyte and other disturbances a) Maintain airway and provide mechanical ventilation if necessary. b) Hyponatremia- is a frequent occurrence and needs correction by restricting water intake or by intravenous infusion of isotonic saline (if serum sodium is less than 120). If hyponatremia is more severe, infusion of 3% NS is used very carefully. Occasionally, Conivaptan may be used in patients with euvolemic or hypervolemic hyponatremia. c) Hypothermia- is treated with passive and gradual heating with blankets and air warmers.iv) Treatment of precipitating cause a) Appropriate antibiotics (broad- spectrum) are started for bacterial infections. b) Diuretics are used to treat volume overload and pulmonary edema. c) Intravenous glucose is used in the presence of hypoglycemia d) Inotropes are used if shock is present while digoxin is used with care for congestive heart failure.1.4 Airway and vascular obstruction due to goitre crude enlargement of the thyroid gland, especially substernal and intrathoracic extension, causes compression of the airway and the great vessels at the thoracic inlet. Sometimes massive hemorrhage inside a thyroid nodule, malignant thyroid disease, metastasis to thyroid gland and Reiters thyroiditis may cause compressive symptoms.Symptoms and signs i) Dyspnea- usually chronic with acute or subacute exacerbations, ii) Stridor, dysphonia, iii) Dysphagia, choking, iv) Fullness and pressure in neck, v) prize vena cava syndrome- causing facial edema, cyanosis and venous engorgement of face and arms, vi) Esophageal varices, vii) Phrenic or laryngeal nerve paralysis, viii) Horners syndrome, ix) Chylothorax, and x) Sleep apnea.Treatment a) Continous positive airway pressure (CPAP) application or intubation and mechanical ventilation for maintaining patency of the airways and to treat respiratory distress. b) In a few cases where intubation is not possible, emergency tracheostomy may be required. c) Surgery to relieve the obstruction in the form of thyroidectomy and associated sternotomy, if required. d) Radioiodine and percutaneous laser ablation may be preferred in some patients.1.5 Let us sum it upThyroid storm occurs in hyperthyroid patients in the presence of precipitating circumstances leading to a hyperadrenergic condition which is fatal unless treated with care. It is treated with thionamides, beta blockers and correction of abnormal organ function.Hypothyroid coma usually presents in the winter months, in elderly females, in the presence of a precipitating cause. The patient has profound hypothermia and altered mental status or coma. It is treated with supplementation of thyroid hormones and treatment of the associated multiorgan dysfunction.Obstruction of the airway and bloo d vessels in the neck by an enlarged thyroid gland is very rare.

Lord :: Essays Papers

LordEvery wizard, at one time or another, has dreamed of running away to a deserted island to get away from the life of the real world, however in William Goldings Lord of the Flies this perceived dream of a deserted island is brought to reality. When the dream did come true for some English boys things dont actually puzzle start out as glorious as imagined. Human nature went into effect and let dark run wild. The Island paradise they once saw turned into a bally(a) nightmare. A message that ran rampant throughout the novel was that evil is inherited in everyone. By looking at three very primal scenes, one can see how the effects of evil are permanently etched into everyones personality. Understanding those events are vital to understanding the overall theme of the book.The unbroken proctor of inherent evil didnt start off right away when the boys arrived at the island. Evil slowly crept into the open. This valid lay invites me to show you one of the commencement moments where evil attacked. Henry (a little boy on the island) was playing on the beach when several triumphant splashes in the water surrounded him. It was the arm of Roger (a spirit that experience evil more than anyone) who was throwing stones at the littlun. This key point in the book illustrated how Roger began to love the power he could put up over other animated things. He enjoyed this power, but was still living by the rules of the real world. I could see the good slipping away from Roger even though there was a distance around Henry, perhaps six yards in diameter, into which he dare not throw (62). This was one of the many meetings with evil that Roger would join in on. This strong point in the book paints a clear image of how evil wanders in peoples souls.As done with very intricate novels, things are hidden that you have to essay for. These monumental points are found deep into the book. They dont pop out right away. With the help of others, one of the se symbolic moments trampled over our faces. The enjoyment that the boys had from killing a sow made a light bulb click on and we realized that that Golding made this event to appear like a rape.Lord Essays papersLordEveryone, at one time or another, has dreamed of running away to a deserted island to get away from the life of the real world, but in William Goldings Lord of the Flies this perceived dream of a deserted island is brought to reality. When the dream did come true for some English boys things dont actually turn out as glorious as imagined. Human nature went into effect and let evil run wild. The Island paradise they once saw turned into a bloody nightmare. A message that ran rampant throughout the novel was that evil is inherited in everyone. By looking at three very important scenes, one can see how the effects of evil are permanently etched into everyones personality. Understanding those events are vital to understanding the overall theme of the book.The c onstant reminder of inherent evil didnt start off right away when the boys arrived at the island. Evil slowly crept into the open. This valid point invites me to show you one of the first moments where evil attacked. Henry (a little boy on the island) was playing on the beach when several triumphant splashes in the water surrounded him. It was the arm of Roger (a character that experienced evil more than anyone) who was throwing stones at the littlun. This key point in the book illustrated how Roger began to love the power he could have over other living things. He enjoyed this power, but was still living by the rules of the real world. I could see the good slipping away from Roger even though there was a space around Henry, perhaps six yards in diameter, into which he dare not throw (62). This was one of the many meetings with evil that Roger would join in on. This significant point in the book paints a clear image of how evil wanders in peoples souls.As done with very in tricate novels, things are hidden that you have to search for. These monumental points are found deep into the book. They dont pop out right away. With the help of others, one of these symbolic moments trampled over our faces. The enjoyment that the boys had from killing a sow made a light bulb click on and we realized that that Golding made this event to appear like a rape.

Charles Dickens and Mark Twains lessons Essay -- GCSE English Literatur

group DFriday IIFinal essayCharles Dickens and scrawl boths lessonsWriters buns not only entertain their readers by telling an appealing story, but they can also educate the readers and open their minds. Charles Dickens and Mark Twain atomic number 18 both very famous and important writers. Although Dickens is British and Twain American, they had the same purpose with their writing. They both wrote novels that made stories appealing to the common human race as well as to educate state. A comparison of the two novels Hard times by Charles Dickens and The adventures of Huckleberry Finn by Mark Twain can show that although both writers lived in different societies they shared the same point of views about life and utilise their writing to educate their readers and change their societies positively.Both books rib individuals who think that they are superior to others, by doing this the writers want to show their readers that this is a wrong thing to do. In The adventures of Huck leberry Finn the general southern public is satirised, as they are mostly portrayed as ignorant, prejudiced individuals. In their society, whites are seen as the superior race, and blacks are owned as property, and are slaves to common folk. The word Nigger" is employ multiple times in the story, as to stress their ignorance. It is illegal for blacks to get proper education, so in no way could they rise up, and seemingly be forever oppressed. This is shown as Jim, a black slave is constantly called a Nigger, even by Huckleberry, who is the only character in the book that treats Jim as a person. In Hardtimes the arrogance of the upper classes is satirised. The characters Mrs. Sparsit and James Harthouse represent the upper class in the novel. Mrs. Sparsit clings fiercely to her heritage and faded glamour. She is arrogant to those beneath her and despises the efforts of the workers to organize a union. Harthouse is revealed as cynical and directionless. He seduces Louisa, one of the important characters and treats this as a division, without thinking of the consequences of his actions.In both stories the conflict of the wisdom of the heart and the wisdom of the passing play is brought out to show people that they sometimes have to let their heart guide them. In Hardtimes, Gradgrind represents the wisdom of the head. His philosophy is utilitarianism. This philosophy is based on scientific laws that d... ...nce between Charles Dickens and Mark Twain. They both were against unequal treatment between people. In Mark Twains case the inequality between black and white in America and in Charles Dickens case the inequality between the different social classes in England. They both believed that people essentially have good paddy wagon but are distracted from what their good hearts tell them by their heads which are filled by society with wrong philosophies. In Hard clock the wrong philosophy is utilitarianism and in The adventures of Huckleberry Finn it is the philosophy that whites are superior to blacks and that blacks are thus their property. Mark Twain and Charles Dickens were both against abusive societies that made the lives of people a struggle. They both lived in such societies and wanted to change this. They dreamt of an idealistic society where people are equal and listen to their good hearts and used their writing skills and wrote novels like Hard Times and The Adventures of Huckleberry Finn to educate people.ReferencesDickens, Charles. Hard Times. London Penguin books, 1995.Twain, Mark. The adventures of Huckleberry Finn. New York W. W. Norton & Company inc. 1990.