DOCSLIB.ORG

Principles of ALS Care / Nicholle Brock ; Contributing Author, Brian J

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

AAOS Principles of Author: Nicholle Brock Fire Fighter/Paramedic MedicsPrep Atlanta, Georgia Contributing Author: Brian J. Williams, BS, NREMT-P, CCEMT-P EMS Chief Pembina Ambulance Pembina, North Dakota Medical Editor: Benjamin Gulli, MD Northwest Orthopedic Surgeons Minneapolis, Minnesota 65811_FM00_Printer.indd i 11/24/09 10:01:21 AM World Headquarters Editorial Credits Jones and Bartlett Publishers Chief Education Offi cer: Mark W. Wieting 40 Tall Pine Drive Director, Department of Publications: Marilyn L. Fox, PhD Sudbury, MA 01776 Managing Editor: Barbara A. Scotese 978-443-5000 Associate Senior Editor: Gayle Murray [email protected] AAOS Board of Directors, 2009-2010 www.jbpub.com Joseph D. Zuckerman, MD Jones and Bartlett Publishers Canada President 6339 Ormindale Way John J. Callaghan, MD Mississauga, Ontario L5V 1J2 First Vice President Canada Daniel J. Berry, MD Jones and Bartlett Publishers International Second Vice President Barb House, Barb Mews Frederick M. Azar, MD London W6 7PA Treasurer United Kingdom Thomas C. Barber, MD Jones and Bartlett’s books and products are available through most Richard J. Barry, MD bookstores and online booksellers. To contact Jones and Bartlett Leesa M. Galatz, MD Publishers directly, call 800-832-0034, fax 978-443-8000, or visit our M. Bradford Henley, MD, MBA website, www.jbpub.com. Michael L. Parks, MD E. Anthony Rankin, MD Substantial discounts on bulk quantities of Jones and Bartlett’s William J. Robb, III, MD publications are available to corporations, professional associations, Michael F. Schafer, MD and other qualifi ed organizations. For details and specifi c discount David D. Teuscher, MD information, contact the special sales department at Jones and Paul Tornetta III, MD Bartlett via the above contact information or send an email to G. Zachary Wilhoit, MS, MBA [email protected]. Karen L. Hackett, FACHE, CAE ( Ex-Offi cio ) Production Credits Chief Executive Offi cer: Clayton Jones Associate Production Editor: Sarah Bayle Chief Operating Offi cer: Don W. Jones, Jr. Director of Marketing: Alisha Weisman President, Higher Education and Professional Director, Public Safety Group Sales—Matthew Maniscalco Publishing: Robert W. Holland, Jr. Cover Design: Kristin E. Parker V.P., Design and Production: Anne Spencer Interior Design: Anne Spencer V.P., Manufacturing and Inventory Control: Therese Connell Senior Photo Researcher and Publisher: Kimberly Brophy Photographer: Christine Myaskovsky Acquisitions Editor—EMS: Christine Emerton Composition: diacritech Managing Editor: Carol B. Guerrero Printing and Binding: Courier Companies Associate Editor: Karen Greene Cover Printing: Courier Companies Production Manager: Jenny L. Corriveau Copyright © 2011 by Jones and Bartlett Publishers, LLC All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. The procedures and protocols in this book are based on the most current recommendations of responsible medical sources. The American Academy of Orthopaedic Surgeons and the publisher, however, make no guarantee as to, and assume no responsibility for, the correctness, suffi ciency, or completeness of such information or recommendations. Other or additional safety measures may be required under particular circumstances. Additional illustration and photographic credits appear on page 370, which constitutes a continuation of the copyright page. Library of Congress Cataloging-in-Publication Data Brock, Nicholle. Principles of ALS care / Nicholle Brock ; contributing author, Brian J. Williams. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-7637-6581-1 (pbk.) ISBN-10: 0-7637-6581-3 (pbk.) 1. Emergency medicine. I. Williams, Brian J. (Brian Jeremy), 1976- II. American Academy of Orthopaedic Surgeons. III. Title. [DNLM: 1. Emergencies. 2. Emergency Treatment—methods. 3. Wounds and Injuries—physiopathology. 4. Wounds and Injuries—therapy. WB 105 V773p 2010] RC86.7.V56 2010 616.02'5—dc22 2009014469 6048 Printed in the United States of America 13 12 11 10 09 10 9 8 7 6 5 4 3 2 1 65811_FM00_Printer.indd ii 11/24/09 10:01:22 AM Contents SECTION 1 Preparatory . 1 Chapter 1 The Cellular Environment . .2 Chapter 2 Assessment and Documentation . 12 Chapter 3 Pharmacology . 20 SECTION 2 Trauma . 42 Chapter 4 Trauma . 43 Chapter 5 Bleeding and Shock . 71 Chapter 6 Burns . 86 SECTION 3 Medical Emergencies . 97 Chapter 7 Airway Management and Respiratory Emergencies. 98 Chapter 8 Cardiovascular Emergencies . .124 Chapter 9 Neurologic Emergencies . 181 Chapter 10 Endocrine Emergencies . .199 Chapter 11 Medical Emergencies . .214 Chapter 12 Gastrointestinal Emergencies . 230 Chapter 13 Toxicology: Poisoning and Substance Abuse . .241 Chapter 14 Hematology and the Immune System . 252 Chapter 15 Environmental Emergencies . 267 Chapter 16 Obstetric and Gynecologic Emergencies . 282 SECTION 4 Special Populations . 301 Chapter 17 Pediatric Emergencies . 302 Chapter 18 Geriatric Considerations. 323 References . 335 Glossary . 336 Index . .351 Photo Credits . 370 iii 65811_FM00_Printer.indd iii 11/24/09 10:01:22 AM Acknowledgments Jones and Bartlett Publishers would like to thank the following individuals for their review of the manuscript: Rick Barton, BS, CCEMT-P, NREMT-P David Brian Jones, MSN, ACNP, BC, EMT-P Gundersen Lutheran Medical Center Macungie, Pennsylvania La Crosse, Wisconsin Daniel Kane, MEd, BSN, RN, CEN, CCRN, Brandon R. Beck, AS, NREMT-P CFRN, EMT-P Gadsden State Community College Massachusetts General Hospital—Institute Gadsden, Alabama of Health Professions Billerica, Massachusetts J. R. Behan, MICT, CCEMT-P Supervisor Judy Larsen, RN, EMT-P Finney County Emergency Medical Service City of Brookfi eld Paramedic Training Garden City, Kansas Center Brookfi eld, Wisconsin Mark Bird, RN, BSN, CCRN, EMT-P Manatee Technical Institute Thomas T. Levins, BSN, RN, CCRN, CFRN St. Petersburg, Florida University of Pennsylvania Health System PennSTAR Flight Bradley Dean, BBA, NREMT-P Blue Bell, Pennsylvania Davidson County Emergency Services Lexington, North Carolina Jim Mobley, RN, BSN, CEN, CFRN, NREMT-P, FP-C Wake Forest University Baptist Medical Program Director, Regional One Air Center—Trauma Department Medical Service Winston-Salem, North Carolina Spartanburg, South Carolina Randolph Community College Asheboro, North Carolina Tina Nuckols, BSN, RN, CEN, CCEMT-P Alamance Community College Aiken, South Carolina Graham, North Carolina Jeffrey Rockett, AA, AS, EMT-P Robert M. Hawkes, MS, PA-C, NREMT-P Nature Coast EMS Southern Maine Community College Inverness, Florida South Portland, Maine Joshua Tanner, FF/NREMT-P Jeremy H. Huffman, AAS, EMT-P EMS Coordinator Southwestern Community College ALERT Academy Asheville, North Carolina Big Sandy, Texas iv 65811_FM00_Printer.indd iv 11/24/09 10:01:23 AM Timothy Whitaker, NREMT-P, FP-C, CMTE Brian J. Williams, BS, NREMT-P, CCEMT-P Allen Medical Center EMS Chief Stark State College Pembina Ambulance Oberlin, Ohio Pembina, North Dakota The author would like to thank the following individuals for sharing their wisdom and experience and helping to make this book a success: James Augustine, MD James Potts, MD Washington, District of Columbia Meharry Medical College Nashville, Tennessee Regina V. Clark, EdD Kennesaw State University Brandy Slade, RN Atlanta, Georgia Savannah, Georgia Gwinnett Ladsen, MD Meharry Medical College Nashville, Tennessee Acknowledgments v 65811_FM00_Printer.indd v 11/24/09 10:01:24 AM 65811_FM00_Printer.indd vi 11/24/09 10:01:24 AM Preparatory 65811_CH01_Printer.indd 1 11/20/09 10:59:27 PM SECTION 1 Preparatory The Cellular Environment It is important to remember when treating your patients that at the cellular level you are trying to aid the body in maintaining homeostasis (stability, equilibrium) or return it to a homeostatic state. An understanding of basic cellular structure and function—as well as of the cellular environment and how alterations in that environment can lead to disease—is critical in restoring homeostasis. The Cell Cells are the basic structural and functional units of the human body. There are many different types of cells, such as muscle cells, nerve cells, and blood cells. This basic unit of life consists of protoplasm , a fl uid made up of many compounds, such as water, proteins, lipids, ions, and amino acids. The protoplasm of a cell is composed of three vital parts: • A nucleus • Cytoplasm • The cell surface membrane The parts of the cell are illustrated in Figure 1-1 and discussed in the next sections. Components of the Cell Nucleus The nucleus controls all normal cell activities, such as growth and metabolism. It contains the following: • Chromatin: Genetic material and chromosomes, which make up proteins • Nucleoli: Spherical structures that play a part in the building of ribonucleic acid (RNA) Cytoplasm The protoplasm that surrounds the nucleus is called the cytoplasm . It plays a part in cell division and forms the larger part of the human cell. It fi lls the cell, giving it shape, and contains organelles . Organelles are specialized structures that perform specifi c functions. In addition to the nucleus, the cell’s organelles include: • Centrioles – Paired cylindrical structures located near the nucleus – Job description: Play an important role in cell division • Endoplasmic reticulum (ER) – Two forms: Rough ER and smooth ER.
Recommended publications
  • Customs Tariff - Schedule

    Customs Tariff - Schedule

    CUSTOMS TARIFF - SCHEDULE 99 - i Chapter 99 SPECIAL CLASSIFICATION PROVISIONS - COMMERCIAL Notes. 1. The provisions of this Chapter are not subject to the rule of specificity in General Interpretative Rule 3 (a). 2. Goods which may be classified under the provisions of Chapter 99, if also eligible for classification under the provisions of Chapter 98, shall be classified in Chapter 98. 3. Goods may be classified under a tariff item in this Chapter and be entitled to the Most-Favoured-Nation Tariff or a preferential tariff rate of customs duty under this Chapter that applies to those goods according to the tariff treatment applicable to their country of origin only after classification under a tariff item in Chapters 1 to 97 has been determined and the conditions of any Chapter 99 provision and any applicable regulations or orders in relation thereto have been met. 4. The words and expressions used in this Chapter have the same meaning as in Chapters 1 to 97. Issued January 1, 2020 99 - 1 CUSTOMS TARIFF - SCHEDULE Tariff Unit of MFN Applicable SS Description of Goods Item Meas. Tariff Preferential Tariffs 9901.00.00 Articles and materials for use in the manufacture or repair of the Free CCCT, LDCT, GPT, UST, following to be employed in commercial fishing or the commercial MT, MUST, CIAT, CT, harvesting of marine plants: CRT, IT, NT, SLT, PT, COLT, JT, PAT, HNT, Artificial bait; KRT, CEUT, UAT, CPTPT: Free Carapace measures; Cordage, fishing lines (including marlines), rope and twine, of a circumference not exceeding 38 mm; Devices for keeping nets open; Fish hooks; Fishing nets and netting; Jiggers; Line floats; Lobster traps; Lures; Marker buoys of any material excluding wood; Net floats; Scallop drag nets; Spat collectors and collector holders; Swivels.
  • Modulation of Dialysate Levels of Dopamine, Noradrenaline

    Modulation of Dialysate Levels of Dopamine, Noradrenaline

    Modulation of Dialysate Levels of Dopamine, Noradrenaline, and Serotonin (5-HT) in the Frontal Cortex of Freely-Moving Rats by (-)-Pindolol Alone and in Association with 5-HT Reuptake Inhibitors: Comparative Roles b of -Adrenergic, 5-HT1A, and 5-HT1B Receptors Alain Gobert, Ph.D. and Mark J. Millan, Ph.D. (-)-Pindolol, which possesses significant affinity for 5-HT1A, involved. (-)-Pindolol potentiated the increase in FCX levels b 5-HT1B, and 1/2-adrenergic receptors (AR)s, dose- of 5-HT elicited by the 5-HT reuptake inhibitors, fluoxetine dependently increased extracellular levels of dopamine and duloxetine, and also enhanced their ability to elevate (DA) and noradrenaline (NAD) versus 5-HT, in dialysates FCX levels of DA—though not of NAD. In contrast to of the frontal cortex (FCX), but not accumbens and (-)-pindolol, betaxolol and ICI118,551 did not affect the striatum, of freely-moving rats. In distinction, the actions of fluoxetine, whereas both WAY100,635 and b preferential 1-AR antagonist, betaxolol, and the SB224,289 potentiated the increase in levels of 5-HT—but b preferential 2-AR antagonist, ICI118,551, did not increase not DA or NAD levels—elicited by fluoxetine. In basal levels of DA, NAD, or 5-HT. Further, they both dose- conclusion, (-)-pindolol modulates, both alone and together dependently and markedly blunted the influence of with 5-HT reuptake inhibitors, dopaminergic, adrenergic, (-)-pindolol upon DA and NAD levels. The selective 5-HT1A and serotonergic transmission in the FCX via a complex b receptor antagonist, WAY100,635, slightly attenuated the pattern of actions at 1/2-ARs, 5-HT1A, and 5-HT1B (-)-pindolol-induced increase in DA and NAD levels, while receptors.
  • Approaches to the Prevention of Perioperative Myocardial Ischemia

    Approaches to the Prevention of Perioperative Myocardial Ischemia

    253 m CLINICAL CONCEPTS AND COMMENTARY Richard B. Weiskopf, M.D., Editor Anesthesiology 2000; 92:253–9 © 2000 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Approaches to the Prevention of Perioperative Myocardial Ischemia Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/92/1/253/398628/0000542-200001000-00038.pdf by guest on 25 September 2021 David C. Warltier, M.D., Ph.D.,* Paul S. Pagel, M.D., Ph.D.,† Judy R. Kersten, M.D.† PREVENTION of perioperative myocardial ischemia is on the horizon promise to reduce the risk of myocardial essential to avoid the mechanical, metabolic, and elec- ischemia or infarction. Although some of these new trophysiologic changes associated with acute imbal- drugs act by altering the myocardial oxygen supply/ ances in the relationship between myocardial oxygen demand relationship, others directly protect myocar- supply and demand. Myocardial ischemia of sufficient dium from ischemic injury. This brief review outlines severity or prolonged duration may result in reversible established methods used for the prevention of myocar- (e.g., myocardial stunning) or irreversible (e.g., infarc- dial ischemia and also discusses potential future thera- tion) damage, malignant ventricular arrhythmias, or car- peutic strategies that may attenuate the reversible and diogenic shock. These potentially disastrous conse- irreversible sequelae of ischemia. At present, the major- quences are associated with high morbidity and ity of data has been obtained in patients with severe mortality in patients with coronary artery disease. Elec- coronary artery disease undergoing coronary artery by- pass graft surgery. The applicability of results obtained in tive surgical procedures may be delayed until unstable this patient population must be extrapolated with care coronary artery disease is treated by angioplasty or sur- to patients with less severe coronary disease or those gical revascularization.
  • Ventricular Rhythms Originate Below the Branching Portion of The

    Ventricular Rhythms Originate Below the Branching Portion of The

    Northwest Community Healthcare Paramedic Program VENTRICULAR DYSRHYTHMIAS Pacemakers Connie J. Mattera, M.S., R.N., EMT-P Reading assignments: Bledsoe Vol 3; pp. 96-109 SOPs: VT with pulse; Ventricular fibrillation/PVT; Asystole/PEA Drugs: Amiodarone, magnesium, epinephrine 1mg/10mL Procedure manual: Defibrillation; Mechanical Circulatory Support (MCS) using a Ventricular Assist Device KNOWLEDGE OBJECTIVES: Upon completion of the reading assignments, class and homework questions, reviewing the SOPs, and working with their small group, each participant will independently do the following with at least an 80% degree of accuracy and no critical errors: 1. Identify the intrinsic rates, morphology, conduction pathways, and common ECG features of ventricular beats/rhythms. 2. Identify on a 6-second strip the following: a) Idioventricular rhythm b) Accelerated idioventricular rhythm c) Ventricular tachycardia: monomorphic & polymorphic d) Ventricular escape beats e) Premature Ventricular Contractions (PVCs) f) Ventricular fibrillation g) Asystole h) Paced rhythms i) Intraventricular conduction defects (Bundle branch blocks) 3. Systematically evaluate each complex/rhythm for the following: a) Rate (atrial and ventricular) b) Rhythm: Regular/irregular - R-R Interval, P-P Interval c) Presence/absence/morphology of P waves d) Presence/absence/morphology of QRS complexes d) P-QRS relationships f) QRS duration 4. Correlate the cardiac rhythm with patient assessment findings to determine the emergency treatment for each rhythm according to NWC EMSS SOPs. 5. Discuss the action, prehospital indications, side effects, dose and contraindications of the following during VT a) Amiodarone b) Magnesium 6. Describe the indications, equipment needed, critical steps, and patient monitoring parameters for cardioversion and defibrillation. 7. Identify the management of a patient with an implanted defibrillator and/or pacemaker.
  • G Protein‐Coupled Receptors

    G Protein‐Coupled Receptors

    S.P.H. Alexander et al. The Concise Guide to PHARMACOLOGY 2019/20: G protein-coupled receptors. British Journal of Pharmacology (2019) 176, S21–S141 THE CONCISE GUIDE TO PHARMACOLOGY 2019/20: G protein-coupled receptors Stephen PH Alexander1 , Arthur Christopoulos2 , Anthony P Davenport3 , Eamonn Kelly4, Alistair Mathie5 , John A Peters6 , Emma L Veale5 ,JaneFArmstrong7 , Elena Faccenda7 ,SimonDHarding7 ,AdamJPawson7 , Joanna L Sharman7 , Christopher Southan7 , Jamie A Davies7 and CGTP Collaborators 1School of Life Sciences, University of Nottingham Medical School, Nottingham, NG7 2UH, UK 2Monash Institute of Pharmaceutical Sciences and Department of Pharmacology, Monash University, Parkville, Victoria 3052, Australia 3Clinical Pharmacology Unit, University of Cambridge, Cambridge, CB2 0QQ, UK 4School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD, UK 5Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Anson Building, Central Avenue, Chatham Maritime, Chatham, Kent, ME4 4TB, UK 6Neuroscience Division, Medical Education Institute, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK 7Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK Abstract The Concise Guide to PHARMACOLOGY 2019/20 is the fourth in this series of biennial publications. The Concise Guide provides concise overviews of the key properties of nearly 1800 human drug targets with an emphasis on selective pharmacology (where available), plus links to the open access knowledgebase source of drug targets and their ligands (www.guidetopharmacology.org), which provides more detailed views of target and ligand properties. Although the Concise Guide represents approximately 400 pages, the material presented is substantially reduced compared to information and links presented on the website.
  • A Simplified and Structured Teaching Tool for the Evaluation and Management of Pulseless Electrical Activity

    A Simplified and Structured Teaching Tool for the Evaluation and Management of Pulseless Electrical Activity

    R e v i e w Med Princ Pract 2014;23:1–6 Received: February 27, 2013 DOI: 10.1159/000354195 Accepted: July 2, 2013 Published online: August 13, 2013 A Simplified and Structured Teaching Tool for the Evaluation and Management of Pulseless Electrical Activity a b a, c L a s z l o L i t t m a n n Devin J. Bustin Michael W. Haley a b c D e p a r t m e n t s o f Internal Medicine and Emergency Medicine, and Pulmonary and Critical Care Consultants, Carolinas Medical Center, Charlotte, N.C., USA K e y W o r d s Introduction Pulseless electrical activity · Cardiopulmonary resuscitation · Electrocardiogram · Echocardiogram Patients with pulseless electrical activity (PEA) ac- count for up to 30% of cardiac arrest victims [1, 2] . The survival rate of patients with PEA is much worse than that A b s t r a c t of cardiac arrest patients with shockable rhythms [1, 3] . Cardiac arrest victims who present with pulseless electrical Studies suggest that cause-specific treatment of PEA is activity (PEA) usually have a grave prognosis. Several condi- more effective than general treatments offered by ad- tions, however, have cause-specific treatments which, if ap- vanced cardiac life support (ACLS) guidelines such as plied immediately, can lead to quick and sustained recovery. cardiac massage, epinephrine and vasopressin [4] . High- Current teaching focuses on recollection of numerous con- er-dose epinephrine has actually been shown to be associ- ditions that start with the letters H or T as potential causes of ated with worse outcomes [5] .
  • Alpha-2 Adrenergic Agonists to Prevent Perioperative Cardiovascular Complications: a Meta-Analysis

    Alpha-2 Adrenergic Agonists to Prevent Perioperative Cardiovascular Complications: a Meta-Analysis

    SPECIAL ARTICLE Alpha-2 Adrenergic Agonists to Prevent Perioperative Cardiovascular Complications: A Meta-analysis Duminda N. Wijeysundera, MD, Jennifer S. Naik, MD, W. Scott Beattie, MD, PhD ␣ ϭ ϭ PURPOSE: To investigate the effects of 2-adrenergic agonists 0.99; P 0.05) and ischemia (RR 0.76; 95% CI: 0.63 to 0.91; on perioperative mortality and cardiovascular complications in P ϭ 0.003) significantly. They also reduced mortality (RR ϭ adults undergoing surgery. 0.47; 95% CI: 0.25 to 0.90; P ϭ 0.02) and myocardial infarction METHODS: MEDLINE (1966 to May 2002), EMBASE (1980 (RR ϭ 0.66; 95% CI: 0.46 to 0.94; P ϭ 0.02) during vascular to May 2002), the Cochrane Clinical Trials Register, the Science ␣ surgery. During cardiac surgery, 2-adrenergic agonists re- Citation Index, and bibliographies of included articles were duced ischemia (RR ϭ 0.71; 95% CI: 0.54 to 0.92; P ϭ 0.01) and searched without language restriction. Randomized trials com- were associated with trends toward lower mortality (RR ϭ 0.49; paring preoperative, intraoperative, or postoperative (first 48 95% CI: 0.12 to 1.98; P ϭ 0.3) and a reduced risk of myocardial hours) administration of clonidine, dexmedetomidine, or infarction (RR ϭ 0.83; 95% CI: 0.35 to 1.96; P ϭ 0.7). mivazerol with controls were included. Studies had to report CONCLUSION: Alpha-2 adrenergic agonists reduce mortality any of the following outcomes: mortality, myocardial infarc- and myocardial infarction following vascular surgery. During tion, ischemia, or supraventricular tachyarrhythmia.
  • Marrakesh Agreement Establishing the World Trade Organization

    Marrakesh Agreement Establishing the World Trade Organization

    No. 31874 Multilateral Marrakesh Agreement establishing the World Trade Organ ization (with final act, annexes and protocol). Concluded at Marrakesh on 15 April 1994 Authentic texts: English, French and Spanish. Registered by the Director-General of the World Trade Organization, acting on behalf of the Parties, on 1 June 1995. Multilat ral Accord de Marrakech instituant l©Organisation mondiale du commerce (avec acte final, annexes et protocole). Conclu Marrakech le 15 avril 1994 Textes authentiques : anglais, français et espagnol. Enregistré par le Directeur général de l'Organisation mondiale du com merce, agissant au nom des Parties, le 1er juin 1995. Vol. 1867, 1-31874 4_________United Nations — Treaty Series • Nations Unies — Recueil des Traités 1995 Table of contents Table des matières Indice [Volume 1867] FINAL ACT EMBODYING THE RESULTS OF THE URUGUAY ROUND OF MULTILATERAL TRADE NEGOTIATIONS ACTE FINAL REPRENANT LES RESULTATS DES NEGOCIATIONS COMMERCIALES MULTILATERALES DU CYCLE D©URUGUAY ACTA FINAL EN QUE SE INCORPOR N LOS RESULTADOS DE LA RONDA URUGUAY DE NEGOCIACIONES COMERCIALES MULTILATERALES SIGNATURES - SIGNATURES - FIRMAS MINISTERIAL DECISIONS, DECLARATIONS AND UNDERSTANDING DECISIONS, DECLARATIONS ET MEMORANDUM D©ACCORD MINISTERIELS DECISIONES, DECLARACIONES Y ENTEND MIENTO MINISTERIALES MARRAKESH AGREEMENT ESTABLISHING THE WORLD TRADE ORGANIZATION ACCORD DE MARRAKECH INSTITUANT L©ORGANISATION MONDIALE DU COMMERCE ACUERDO DE MARRAKECH POR EL QUE SE ESTABLECE LA ORGANIZACI N MUND1AL DEL COMERCIO ANNEX 1 ANNEXE 1 ANEXO 1 ANNEX
  • Cap11 Adrenolitico

    Cap11 Adrenolitico

    SECCION II: CAPITULO 11 DROGAS SIMPATICOLITICAS O ADRENOLITICAS Malgor - Valsecia Como anteriormente se mencionara, el siste- Son un grupo de drogas que actúan en la ter- ma Simpático o Adrenérgico cumple num ero- minación adrenérgica, a nivel axoplasmático o sas e importantísimas funciones biológicas sobre receptores presinápticos alfa2, salvo indispensables para la modulación y regula- estos últimos agentes, los adrenolíticos presi- ción de organismos y sistemas que son vitales nápticos tienen ac tualmente un uso clínico para el mantenimiento de una vida normal. terapéutico limitado. CLASIFICACIÓN DE DROGAS SIMPATICO- Las drogas simpaticolíticas o adrenolíticas LÍTICAS son un grupo numeroso de fármacos que in- terfieren con las funciones del sistema simpá- I.SIMPATICOLITICOS PRESINAPTICOS. tico, las mismas actúan básicamente de dos maneras diferentes: a.Axoplasmáticos: I- Inhiben la liberación de las catecolaminas en *Reserpina (Serpasol) la terminación adrenérgica, actuando a nivel Deserpidina presináptico y Rescinamina Guanetidina (Ismelin) II- Bloquean los receptores adrenérgicos en Batanidina las células efectoras a nivel postsináptico. Debrisoquina (Declinax,Sintiapress) Bretilio Las primeras son drogas simpaticolíticas que IMAO:Pargilina (Eutonil;Tranilcipromina (Parna- inhiben la síntesis de catecolaminas. Interfie- te) ren con los proceso de depósito y liberación de las mismas. Algunas actúan a nivel central reduciendo la activi dad simpática cerebral. b.Agonistas alfa 2:(Adrenoliticas de accion Este grupo de fármacos son los llam ados central) Simpaticolíticos presinápticos. Los simpati- colíticos postsinápticos son los bloqueantes Clonidina (Catapresan) de los receptores alfa y beta adrenérgicos. *Alfa-metil-dopa (Aldomet) Guanabenz (Rexitene) Todos estos agentes adrenolíticos son drogas Guanfacina (Estulic,Hipertensal) de gran utilidad terapéutica, capaces de gene- rar una solución farmacológica a numerosos padecimientos clínicos, principalmente en el II.SIMPATICOLITICOS POSTSINAPTICOS área cardiovascular.
  • Wirkung Von Sekretin Auf Neurotransmitter Im Hippokampus Der Ratte

    Wirkung Von Sekretin Auf Neurotransmitter Im Hippokampus Der Ratte

    Aus der Abteilung für Psychiatrie und Psychotherapie im Kindes- und Jugendalter, Universitätsklinik für Psychiatrie und Psychosomatik der Albert-Ludwigs-Universität Freiburg Direktor: Prof. Dr. E. Schulz WIRKUNG VON SEKRETIN AUF NEUROTRANSMITTER IM HIPPOKAMPUS DER RATTE Inaugural-Dissertation zur Erlangung des Medizinischen Doktorgrades der Medizinischen Fakultät der Albert-Ludwigs-Universität Freiburg im Breisgau Vorgelegt 2003 VON ANDRÉ KUNTZ Geboren in Thionville (F) Dekan: Prof. Dr. med. Christoph Peters Erster Gutachter: PD Dr. rer. nat. H.-W. Clement Zweiter Gutachter: Prof. Dr. Dr. med. D. van Calker Jahr der Promotion: 2006 MEINEN ELTERN GEWIDMET I INHALTSVERZEICHNIS ___________________________________________________________________________ INHALTSVERZEICHNIS INHALTSVERZEICHNIS I ABKÜRZUNGSVERZEICHNIS IV ABBILDUNGSVERZEICHNIS VI TABELLENVERZEICHNIS VII GLEICHUNGSVERZEICHNIS VII 1 EINLEITUNG 1 1.1 SEKRETIN 4 1.1.1 GESCHICHTE 4 1.1.2 STRUKTUR 5 1.1.3 SYNTHESE 6 1.1.4 FUNKTIONSWEISE VON SEKRETIN 6 1.1.5 KLINISCHE ANWENDUNG VON SEKRETIN 7 1.1.6 SEKRETINREZEPTOREN 8 1.1.7 SEKRETIN BEI VERSCHIEDENEN SPEZIES 9 1.1.8 ZNS 10 1.1.9 FUNKTION IM GASTROINTESTINALTRAKT 12 1.1.10 SEKRETIN/ VIP/ PACAP-SUPERFAMILIE 13 1.1.11 HYPOKRETINE/OREXINE 14 1.1.12 AUTISMUS 15 1.1.12.1 Geschichte des Autismus 15 1.1.12.2 Häufigkeit 16 1.1.12.3 Krankheitsbild 16 1.1.12.4 Ursachen und Komorbidität 17 1.1.12.5 Therapie 17 1.2 NEUROTRANSMITTER UND AUTISMUS 20 1.2.1 GLUTAMAT 21 1.2.2 GABA 24 1.2.3 KATECHOLAMINE 25 1.2.3.1 Noradrenalin und Adrenalin 26 1.2.3.2
  • New Concepts in Pharmacological Efficacy at 7TM Receptors: IUPHAR

    New Concepts in Pharmacological Efficacy at 7TM Receptors: IUPHAR

    British Journal of DOI:10.1111/j.1476-5381.2012.02223.x www.brjpharmacol.org BJP Pharmacology Dr Terry Kenakin, University of International Union of Basic North Carolina, Pharmacology, Chapel Hill, North Carolina, and Clinical Pharmacology United States, Phone: 919-962-7863, Fax: 919 966 7242 Review or 5640, [email protected] ---------------------------------------------------------------- Keywords receptor theory; agonism; New concepts in efficacy; drug discovery ---------------------------------------------------------------- Received pharmacological efficacy at 8 May 2012 Revised 3 August 2012 7TM receptors: IUPHAR Accepted Review 2 12 September 2012 This is the second in a series of reviews written by committees Terry Kenakin of experts of the Nomenclature Committee of the International Department of Pharmacology, University of North Carolina School of Medicine, Chapel Hill, NC, Union of Basic and Clinical USA Pharmacology (NC-IUPHAR). A listing of all articles in the series and the Nomenclature Reports from IUPHAR published in Pharmacological Reviews can be found at http://www. GuideToPharmacology.org. This website, created in a The present-day concept of drug efficacy has changed completely from its original collaboration between the British Pharmacological Society description as the property of agonists that causes tissue activation. The ability to (BPS) and the International visualize the multiple behaviours of seven transmembrane receptors has shown that Union of Basic and Clinical drugs can have many efficacies and also that the transduction of drug stimulus to Pharmacology (IUPHAR), various cellular stimulus–response cascades can be biased towards some but not all is intended to become a pathways. This latter effect leads to agonist ‘functional selectivity’, which can be “one-stop shop” source of favourable for the improvement of agonist therapeutics.
  • Customs Tariff - Schedule

    Customs Tariff - Schedule

    CUSTOMS TARIFF - SCHEDULE 99 - i Chapter 99 SPECIAL CLASSIFICATION PROVISIONS - COMMERCIAL Notes. 1. The provisions of this Chapter are not subject to the rule of specificity in General Interpretative Rule 3 (a). 2. Goods which may be classified under the provisions of Chapter 99, if also eligible for classification under the provisions of Chapter 98, shall be classified in Chapter 98. 3. Goods may be classified under a tariff item in this Chapter and be entitled to the Most-Favoured-Nation Tariff or a preferential tariff rate of customs duty under this Chapter that applies to those goods according to the tariff treatment applicable to their country of origin only after classification under a tariff item in Chapters 1 to 97 has been determined and the conditions of any Chapter 99 provision and any applicable regulations or orders in relation thereto have been met. 4. The words and expressions used in this Chapter have the same meaning as in Chapters 1 to 97. Issued January 1, 2019 99 - 1 CUSTOMS TARIFF - SCHEDULE Tariff Unit of MFN Applicable SS Description of Goods Item Meas. Tariff Preferential Tariffs 9901.00.00 Articles and materials for use in the manufacture or repair of the Free CCCT, LDCT, GPT, UST, following to be employed in commercial fishing or the commercial MT, MUST, CIAT, CT, harvesting of marine plants: CRT, IT, NT, SLT, PT, COLT, JT, PAT, HNT, Artificial bait; KRT, CEUT, UAT, CPTPT: Free Carapace measures; Cordage, fishing lines (including marlines), rope and twine, of a circumference not exceeding 38 mm; Devices for keeping nets open; Fish hooks; Fishing nets and netting; Jiggers; Line floats; Lobster traps; Lures; Marker buoys of any material excluding wood; Net floats; Scallop drag nets; Spat collectors and collector holders; Swivels.