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Inhalants Medical anesthetics Lacquer and varnish thinners Propane Toluene Butane Acetone Fuel Propellants Laughing gas, whippets, glue, lighter fluid, nail polish remover, gasoline, kerosene, aerosol sprays Alter mood. Produce effects similar to drunkenness, such as slurred speech, lack of inhibitions and impaired motor coordination. Produce euphoria or erratic mood swings, rapid heartbeat, profuse sweating, agitation and sensory distortions. Chronic use can cause sterility, disruption of normal growth, liver cancer, personality changes and aggressive behavior. Laxatives and emetics Ipecac syrup, Senna Relieve constipation or induce vomiting. Chronic use can cause nosebleeds and changes in the lining of the nose, making it difficult to breathe without sprays. Responding to Emergencies 323 Substance Abuse and Misuse Interestingly, the most common stimulants in America are legal. Leading the list is caffeine, present in coffee, tea, high-energy drinks, many kinds of sodas, chocolate, diet pills and pills used to combat fatigue. Other stimulants used for medical purposes are asthma medications or decongestants that can be taken by mouth or inhaled. Hallucinogens Hallucinogens, also known as psychedelics, are substances that cause changes in mood, sensation, thought, emotion and self-awareness. Hallucinogens often have physical effects similar to stimulants but are classified differently because of the other effects they produce. The person may be irrational and feel threatened by any attempt others make to help. Depressants Depressants are substances that affect the central nervous system by slowing down physical and mental activity. They relieve anxiety, promote sleep, depress respiration, relieve pain, relax muscles, and impair coordination and judgment. Like other substances, the larger the dose or the stronger the substance, the greater its effects. Their street names include "downers," "barbs," "goofballs," "yellow jackets," "reds" or "ludes. These drugs are particularly dangerous because they are often used in combination or with other depressants (including alcohol), which can have deadly effects, and because they are the "date rape drugs" of choice. Frequent drinkers may become dependent on the effects of alcohol and increasingly tolerant of those effects. Alcohol poisoning occurs when a large amount of alcohol is consumed in a short period of time and can result in unresponsiveness and, if untreated, death. Drinking alcohol in large or frequent amounts can have many unhealthy consequences. Alcohol can irritate the digestive system and even cause the esophagus to rupture, or it can injure the stomach lining. Chronic drinking can also affect the brain and cause memory loss, apathy and a lack of coordination. In addition, many psychological, family, social and work problems are related to chronic drinking. Opioid Narcotics While they have a depressant effect, opioid narcotics (which are often derived from opium) are used mainly to relieve pain. Opioid narcotics are so powerful and highly addictive that all are illegal without a prescription, and some are not prescribed at all. Oxycodone, also known by the trade names Oxycontin or Percocet, is a powerful semi-synthetic opioid narcotic that has recently gained popularity as a street drug. Opioid narcotic abuse has become a major health concern in the United States and throughout the world.

It is about the size of a closed fist and is found in the thoracic cavity, between the two lungs, behind the sternum and slightly to the left of the midline. The heart is divided into four chambers: right and left upper chambers called atria, and right and left lower chambers called ventricles (Figure 4-14). The right atrium receives oxygen-depleted blood from the veins of the body and, through valves, delivers it to the right ventricle, which in turn pumps the blood to the lungs for oxygenation. The left atrium receives this oxygen-rich blood from the lungs and delivers it to the left ventricle, to be Figure 4-13. Responding to Emergencies 53 the Human Body pumped to the body through the arteries. There are arteries throughout the body, including the blood vessels that supply the heart itself, which are the coronary arteries. There are four main components of blood: red blood cells, white blood cells, platelets and plasma. The red blood cells carry oxygen to the cells of the body and take carbon dioxide away. Platelets are a solid component of blood used by the body to form blood clots when there is bleeding. Plasma is the straw-colored or clear liquid component of blood that carries the blood cells and nutrients to the tissues, as well as waste products away to the organs involved in excretion. There are different types of blood vessels- arteries, veins and capillaries-that serve different purposes. The exception is the arteries that carry blood to the lungs for oxygenation, the pulmonary arteries. As arteries travel farther from the heart, they branch into increasingly smaller vessels called arterioles. These narrow vessels carry blood from the arteries into capillaries (Figure 4-15). The one exception is the Capillaries pulmonary veins, which carry oxygenated blood away from the lungs. As blood flows through the body, it moves through inferior vena cavae are the large veins that arteries, arterioles, capillaries, venules and veins. Like arteries, veins also branch into smaller vessels the farther away they are from the heart. Unlike arterial blood, which is moved through the arteries by pressure from the pumping of the heart, veins have valves that prevent blood from flowing backward and help move it through the blood vessels. Capillaries are the tiny blood vessels that connect the systems of arteries and veins. Capillary walls allow for the exchange of gases, nutrients and waste products between the two systems. In the lungs, there is exchange of carbon dioxide and oxygen in the pulmonary capillaries. Throughout the body, there is exchange of gases and nutrients and waste at the cellular level. Physiology of the Circulatory System As the heart pumps blood from the left ventricle to the body, this causes a wave of pressure we refer to as the pulse. These "pulse points" occur where the arteries are close to the surface of the skin (e. Oxygen and nutrients are delivered to cells throughout the body, and carbon dioxide and other wastes are taken away, all through the delivery of blood. Responding to Emergencies 54 the Human Body the primary gases exchanged in perfusion are oxygen and carbon dioxide. Most of the oxygen is transported to the cells attached to the hemoglobin, but a tiny amount is also dissolved in the liquid component of the blood, the plasma. The major waste product in the blood, carbon dioxide, is transported mostly in the blood as bicarbonate and transported by the hemoglobin molecule. The Nervous System the nervous system is the most complex and delicate of all the body systems. The center of the nervous system, the brain, is the master organ of the body and regulates all body functions. The primary functions of the brain are the sensory functions, motor functions and the integrated functions of consciousness, memory, emotions and language. Anatomy of the Nervous System the nervous system can be divided into two main anatomical systems: the central nervous system and the peripheral nervous system (Figure 4-16).

Alcohol, even though taken in small amounts have a health promoting effect, when taken in more amounts it will have short term and long term un healthy impacts. Central and peripheral nerves systems, as well as cardiovascular systems are also its targets. When dealing with environmental diseases injuries caused by physical forces have to be thought about. These could be caused by mechanical forces, extreme high or low temperatures, atmospheric pressure changes or electromagnetic energy. Which one of the following is the most common cause of mortality among cigarette smokers a. This generates ammonia as a by-product, which is toxic to the cells [2] and can affect protein glycosylation [3,4] and cell viability, lowering protein production and changing glycosylation patterns. Lower ammonia concentrations can be advantageous in attaining high cell yields, particularly for cells that are sensitive to ammonia toxicity [5]. L-glutamine spontaneously decomposes into ammonia and pyrrolidone carboxylic acid at a rate dependent on pH and temperature [1]. The slight increase of the lag phase is attributed to the time needed to release the peptidase and digest the dipeptide. Yang M, Butler M (2002) Effects of ammonia and glucosamine on the heterogeneity of erythropoietin glycoforms. Yang M, Butler M (2000) Effects of ammonia on the glycosylation of human recombinant erythropoietin in culture. Christie A, Butler M (1994) Growth and metabolism of a murine hybridoma in cultures containing glutamine-based dipeptides. It is not intended for human or animal diagnostic, therapeutic, or other clinical uses, unless otherwise stated. All trademarks are the property of Thermo Fisher Scientific and its subsidiaries unless otherwise specified. Adult Taenia saginata Mature proglottids Scolex the tapeworms: Taenia saginata (beef tapeworm) Taenia solium (pork tapeworm) -> Cysticercosis Echinococcus granulosus (dog tapeworm) -> Hydatid Disease Immature proglottids Gravid proglottids cm scale Taenia saginata scolex Suckers Taenia saginata the beef tapeworm 1 10/14/2009 Taenia Adult Embryonated, infectious taeniid eggs Hexacanth larva Hooklets Egg shell Cannot distinguish species of Taenia tapeworms based on morphology of eggs Pathogenesis: None Gravid Proglottid of Taenia saginata Uterine branches Uterus the central uterus of T. Prevent cows from coming into contact with human feces - maintain good sanitary it practices. Identify species based on proglottid morphology Drug of Choice: Praziquantel Taenia solium the Pork Tapeworm O C N N O Mode of Action: Interferes with invertebrate Ca 2+ ion channels 3 10/14/2009 Adult Taenia solium Embryonated, infectious taeniid eggs Hexacanth larva Hooklets Scolex Egg shell Cannot determine the species of Taenia based on egg morphology Taenia solium scolex Hooks Suckers Photo: E. Grave Gravid proglottid Taenia solium Whole cysticercus of Taenia solium Uterine branches number less than 10 per side 4 10/14/2009 Drug of Choice: Praziquantel Pathogenesis: None O C N N O Mode of Action: Interferes with invertebrate Ca 2+ ion channels Prevention and Control: 1. Cysticercus "Alien" Radiogram of lower leg with numerous calcified cystercerci of T. Neurological deficits, dependent upon location the Dog tapeworm Hydatid Disease in Humans Diagnosis: Must differentiate between cysticercosis and other possible lesions (benign cysts, solid tumors, etc. Praziquantel or albendazole plus steroids if multiple symptomatic cysticerci are inoperable (still being studied) Traditional farming practices help to maintain the cycle in animals and humans. Navaho, Arizona Abattoir, Ecuador 9 10/14/2009 Adult of Echinococcus granulosus Hydatid Cyst diagram Mature proglottid Gravid proglottid Scolex with suckers and hooks Radiogram of upper body showing elevation in right lobe of liver due to large hydatid cyst Hydatid cyst of Liver Distribution of Hydatid cysts Liver - 63% Lungs - 25% Muscles - 5% Bone marrow - 3% (usually fatal) Kidney - 2% Spleen - 1% Brain - 1% (usually fatal) Visualize: Hydatid cyst, daughter cysts, hydatid fluid 10 10/14/2009 Hydatid cyst of Parietal Lobe Petri dish filled with daughter cysts of Echinococcus granulosus Pathogenesis and Clinical disease: 1. Hydatid cyst per se is not a problem as a single cyst in liver, while it is immunologically silent. Microscopic examination of fluid from hydatid cyst after surgical removal see removal, "hydatid sand" B. Sixteen global committees, divided by subspecialty and guided by individual subspecialty chairs, updated the existing guidelines and references, reinforcing essential cognitive and technical ophthalmic skills.

Intravenous fluid therapy is important in the treatment of all types of shock except for cardiogenic shock. Ringer-lactate, within 48 hours of administering ceftriaxone Contra-indicated in neonatal jaundice Annotate dose and route of administration on referral letter. There are three types of dehydration: hypotonic or hyponatremic (primarily a loss of electrolytes, sodium in particular), hypertonic or hypernatremic (primarily a loss of water), and isotonic or isonatremic (equal loss of water and electrolytes). In humans, the most commonly seen type of dehydration by far is isotonic (isonatraemic) dehydration which effectively equates with Hypovolemic, but the distinction of isotonic from hypotonic or hypertonic dehydration may be important when treating people who become dehydrated. Physiologically, dehydration, despite the name, does not simply mean loss of water, as water and solutes (mainly sodium) are usually lost in roughly equal quantities to how they exist in blood plasma. In hypotonic dehydration, intravascular water shifts to the extra vascular space, exaggerating intravascular volume depletion for a given amount of total body water loss. The former can lead to seizures, while the latter can lead to osmotic cerebral edema upon rapid rehydration. It defines water deficiency only in terms of volume rather than specifically water. Signs and symptoms Symptoms may include headaches similar to what is experienced during a hangover, a sudden episode of visual snow, and dizziness or fainting when standing up due to orthostatic hypotension. Untreated dehydration generally results in delirium, unconsciousness, swelling of the tongue and, in extreme cases, death. In the presence of normal renal function dehydration is associated usually with a urine output of less than 0. Differential diagnosis 12 P a g e In humans, dehydration can be caused by a wide range of diseases and states that impair water homeostasis in the body. These include: o o o o o o o o o o o External or stress-related causes Prolonged physical activity with sweating without consuming adequate water, especially in a hot and/or dry environment Prolonged exposure to dry air, e. Treatment For some dehydration oral fluid is the most effective to replenish fluid deficit. For severe cases of dehydration where fainting, unconsciousness, or other severely inhibiting symptom is present (the patient is incapable of standing or thinking clearly), emergency attention is required. Fluids containing a proper balance of replacement electrolytes are given intravenously with continuing assessment of electrolyte status. Reversal or improvement of symptoms or problems when the glucose is restored to normal Symptoms of hypoglycemia usually 3. The hypoglycemia is dependent on (1) presence or absence of effects, and do not occur until the blood sugar is in the level of 2. Signs and symptoms Hypoglycemic symptoms and manifestations can be divided into those produced by the counter regulatory hormones (epinephrine/adrenaline and glucagon) triggered by the falling glucose, and the neuroglycopenic effects produced by the reduced brain sugar. Adrenergic manifestations Shakiness, anxiety, nervousness Palpitations, tachycardia Sweating, feeling of warmth (although sweat glands have muscarinic receptors, thus "adrenergic manifestations" is not entirely accurate) Pallor, coldness, clamminess Dilated pupils (mydriasis) 14 P a g e Feeling of numbness "pins and needles" (paresthesia) Glucagon manifestations Hunger, borborygmus Nausea, vomiting, abdominal discomfort Headache Neuroglycopenic manifestations Abnormal mentation, impaired judgment Personality change, emotional liability Fatigue, weakness, apathy, lethargy, daydreaming, sleep Confusion, amnesia, dizziness, delirium Stupor, coma, abnormal breathing Generalized or focal seizures Causes the circumstances of hypoglycemia provide most of the clues to diagnosis. Circumstances include the age of the patient, time of day, time since last meal, previous episodes, nutritional status, physical and mental development, drugs or toxins (especially insulin or other diabetes drugs), diseases of other organ systems, family history, and response to treatment. When hypoglycemia occurs repeatedly, a record or "diary" of the spells over several months, noting the circumstances of each spell (time of day, relation to last meal, nature of last meal, response to carbohydrate, and so forth) may be useful in recognizing the nature and cause of the hypoglycemia. Glucose requirements above 10 mg/kg/minute in infants, or 6 mg/kg/minute in children and adults are strong evidence for hyperinsulinism. Finally, the blood glucose response to glucagon given when the glucose is low can also help distinguish among various types of hypoglycemia. Treatment Management of hypoglycemia involves immediately raising the blood sugar to normal, determining the cause, and taking measures to hopefully prevent future episodes. The blood glucose can be raised to normal within minutes by taking 10-20 grams of carbohydrate. This amount of carbohydrate is contained in about 100-120 ml of orange juice or non-diet soda. Starch is quickly digested to glucose (unless the person is taking acarbose), but adding fat or protein retards digestion.