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This is a common arrhythmia occurring before cardiac arrest and often in the post-resuscitation period discount thorazine 100 mg on line. In atrial fibrillation the ventricular response is irregular, unlike the regular ventricular pattern seen with other rhythms that arise above the AV junction. At faster ventricular rates it may be difficult to determine whether the rhythm is regular because the variation in the R-R interval, which is a feature of atrial fibrillation, becomes less pronounced. Atrial fibrillation may Pulseless (heart rate Narrow complex Atrial usually >250 beats/ tachycardia fibrillation then seem to be regular and the distinction can only be made minute) if an adequate rhythm strip is examined carefully for variability Synchronised DC shock* If not already done, give oxygen Follow AF algorithm in the underlying rate. Guidance to treat atrial fibrillation is 100J : 200J : 360J and establish intravenous (i. Vagal manoeuvres (caution if possible digitalis toxicity, acute ischaemia, or presence of carotoid bruit for carotoid Regular narrow complex tachycardia sinus massage) Vagotonic manoeuvres, such as the Valsava manoeuvre or Adenosine 6 mg by rapid bolus injection; if unsuccessful, carotid sinus massage, should always be considered as first line follow, if necessary, with up to 3 doses each of 12 mg every 1-2 minutes*** treatment. Caution is required, however, as profound vagal Caution with adenosine in known Wolff-Parkinson-White syndrome tone may cause a sudden bradycardia and trigger ventricular Seek expert fibrillation, particularly in the presence of acute ischaemia or help digitalis toxicity. If this is unsuccessful up to three further doses of 12 incrementally to 12 mg/minute) over 10 minutes, then 300 mg over 1 hour OR and repeat shock mg may be given, allowing one to two minutes between - Verapamil 5-10 mg i. If adenosine fails to convert the rhythm, then expert - Amiodarone: 300 mg i. In the presence of one or more of these adverse signs Doses throughout are based on an adult of average body weight treatment should consist of synchronised DC cardioversion A starting dose of 6 mg adenosine is currently outside the UK licence for this agent. If this is unsuccessful a further ** Note 2: Not to be used in patients receiving blockers. Patients on dipyridamile, carbamazepine, or with denervated hearts have a markedly exaggerated effect, which may intravenous injection and subsequent infusion of amiodarone. If circumstances permit, up to one hour should be allowed for the drug to exert its anti-arrhythmic effect before further Algorithm for narrow complex tachycardia (presumed supraventricular attempts at cardioversion are made.
Acupuncture treatment: Side effects and complications reported by Swedish physiotherapists order thorazine 100 mg visa. Population based survey of complementary and alternative medicine usage, patient satisfaction, and physician involvement. Complementary and alternative medi- cine and psychologic factors: Toward an individual differences model of complementary and alternative medicine use and outcomes. Paper Presented at the Qualitative Research Conference, Studying Human Lived Experience: Symbolic Interaction and Ethnographic Research ’96, McMaster University, Hamilton, Ontario. Paper Presented at the 14th World Congress of Sociology, International Sociological Association, Montréal, Québec. Approaches to complementary therapies: Diverse perspectives among people with HIV/AIDS. Paper Presented at the Qualitative Analysis Conference 1991, Carlton University, Ottawa, Ontario. Chinese medicine: Its history, philosophy, and practice, and why it may one day dominate the medicine of the West. An international survey of the use and attitudes regarding alternative medicine by patients with inflammatory bowel disease. A randomized controlled study of reviewer bias against an unconventional therapy. Client choices among osteopaths and ordinary physicians in a Michigan community. Professions and the public interest: Medical power, altruism and alternative medicine, London: Routledge. A diagnosis for our times: Alternative health’s submerge- d networks and the transformation of identity. Contextualizing alternative medicine: The exotic, the marginal and the perfectly mundane. Basics of qualitative research: Grounded theory procedures and techniques. Utilization of alternative therapies in attention-deficit hyperactivity disorder.
Following current conventions quality thorazine 50mg, the BMA distinguishes three types of domestic violence: physical, sexual and psychological. The latter category includes criticism, verbal abuse and ‘being forced to do menial/trivial tasks’ as well as humiliation and degradation, extreme jealousy/possessiveness and ‘being made to think they are going mad’. Using this definition the final estimate of prevalence is that ‘one in four women will experience domestic violence at some time in their lives’. The ‘one in four’ statistic is repeated in all the recent reports and it echoes around any lecture theatre or conference hall in which domestic violence is discussed. It is worth examining one of the key sources of this figure, which is referenced in all current handbooks and guidelines—a major survey of domestic violence in North London, conducted under the aegis of Middlesex University and Islington Council (Mooney 1993). The study adopted a definition of domestic violence, similar to that of the BMA, as conduct including ‘mental cruelty, threats, sexual abuse, physical violence and any 122 THE PERSONAL IS THE MEDICAL other form of controlling behaviour’ (Mooney 1993:8). The team of researchers conducting the interviews were ‘all chosen for their understanding of and commitment to the problem of domestic violence’ and given ‘intensive training’ (Mooney 1993:10). The first stage of the study took the form of an interview and the completion of a questionnaire, conducted with the researcher and the subject alone together. This aimed to clarify the subject’s perception of what constituted domestic violence. The next stage involved the subject completing a more extensive questionnaire in private; in the final stage women who had experienced violence had a further ‘in depth’ interview. The key encounter here is the first stage interview between a researcher chosen for her ‘commitment to the problem of domestic violence’ and the subject, who has generously given up her time and is keen to be helpful to a project she knows to be concerned about the issue of domestic violence. The fact that they are alone protects the subject from external influences (an understandable precaution if the interview is in the subject’s home), but it inevitably also maximises the influence of the researcher. The result is clearly more of a tutorial than an investigation: it is not surprising that, as they talk over different ‘vignettes of conflict situations’ the subject’s definition of domestic violence tends to expand to correspond with that of the investigator. It is also not surprising that this approach yields results which suggest levels of domestic violence vastly greater than those recorded in conventional crime surveys, which include questions about domestic violence in wider questionnaires (and report rates of between 2 and 4 per cent). While Mooney seeks to explain this difference by the greater accuracy of her findings, the real explanation lies in her methodology. Mooney notes with approval the subjects’ ‘acceptance of a broad definition of domestic violence’.
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