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Phys]) n unda wave (move in waves or undulations) v undear wave (move to and fro) vt agitar wave (someone) v facer signos per le mano wave [Hairdressing] n undulation wave n unda wave vi undular wave-band n banda de undas wave-length n longitude de unda wavelike (sounding like waves) adj undisone waver v balanciar herbals on demand shipping order slip inn 1pack visa, vacillar herbs cooking slip inn 1pack low price, hesitar waver v hesitar, balanciar, vacillar waver v vacillar, hesitar, balanciar waverer n homine irresolute waves, move in, be moved by v fluctuar wavy, undulating adj undulate wavy, undulating adj undulate (pp of undular) wavy, undulous, rolling adj undulose wavy adj undose wavy adj undulate, undulose wavy adj undulose, undulate wax candle, cierge (large) Eccl] n cereo wax factory n cereria wax, apply wax to v cerar wax (as in to wax a floor) v incerar wax (grow) vi crescer wax (treat with wax) vt incerar cerar 442 wax adj ceree wax n cera waxchandler n cerero waxen, waxy adj ceree waxer (one who applies wax to a floor) n cerator waxing (as in the waxing of a floor) (act of) n inceramento waxing (growing) n crescimento waxing (treatment with wax) n inceramento waxing adj crescente waxwork n figura de cera waxworks n museo de figuras de cera waxy, waxen adj ceree waxy adj cerose way in (on the -) v. Naut]) n jugo yokel n persona inculte, rustico yolk (of an egg) n vitello yolk (yolk-like, yolk-colored) adj vitellin yolk-colored (yolk, yolk-like) adj vitellin yolk-like (yolk-colored, yolk) adj vitellin yonder adj ille yonder adv ibi York n York York n York A] you all (Amer (familiar plural) pron vos you all (Amer (familiar plural) pron vos (omne) you (familiar and formal plural) pron vos you (familiar singular as object) pron the you (familiar singular as subject) pron tu you (formal singular) pron vos you (indefinite after preposition) pron uno you (indefinite as reflexive object) pron se you (indefinite as subject) pron on, uno you (thee, used as object of verb) pron the you [in familiar or informal use] pron pers tu you [in polite or formal use] pron pers the you [in polite or formal use] pron pers vos youg-man n juvene youg-man n juvene homine young animal n pullo young man, youth, lad, boy n garson young (of animal) n pullo young (young persons) n juvenes young adj juvene younger, junior adj junior younger adj plus juvene younger-brother n fratre cadette younger-sister n soror cadette 453 youngster n juvene youngster n juvene persona young-woman n juvene young-woman n juvene femina your (familiar singular) pron tu your (formal) pron vostre your (indefinite) pron le sue your [1. Serbo-Croatian language) n yugoslavo Yugoslav adj yugoslave Yugoslavia [Geog] n Yugoslavia, Republica Federal de Yugoslavia Yukon [Geog] n Yukon yule (- tide) n natal, noel z (letter -) n littera z (zeta;zed) Zachariah n Zacharia Zaire [Geog] n Zaire Zambia [Geog] n Zambia zany adj de buffon Zanzibar [Geog] n Zanzibar Zarathustra n Zarathustra Zea-, Zee- (sea) occurring in geographical compounds] n zea-, zeezeal n zelo zealot (zealous person) n zelote, zelator zealot [Jewish Antiq] n zelote, zelator zealotism (zealotry) n zelotismo zealotry (zealotism) n zelotismo zealous adj zelose zebra crossing (pedestrian X-ing) n passage pro pedones zebra [Zool] n zebra zebu [Zool] n zebu zed (zee, the letter z) n zeta zee (the letter z, zed) n zeta Zeeland (province in the Netherlands) n Zelanda zenith (zenithal) adj zenital zenith n zenit zenithal (zenith) adj zenital Zephyrus [Cr. Hist] n sionita zip (energy) n energia zip (fastening) n serratura fulmine zipcode n codice postal zipper n serratura fulmine zippy adj energic, rapide zip-up n serrar (le serratura fulmine) zircon [Mineral] n zircon zirconic [Chem] adj zirconic zirconium [Chem] n zirconium zither player n citherista zither n cithera zodiac n zodiaco zodiacal adj zodiacal zoic [Zool] adj zoic zonal adj zonal zone n zona zone v zonar zoo n zoo, jardin zoologic zoographic adj zoographic zoography n zoographia zooid n zooide zoolater (animal worshiper) n zoolatra zoolatry (animal worship) n zoolatria zoolith (zoolite) n zoolitho zoological adj zoologic zoologist n zoologo, zoologista zoology n zoologia zoom in n focalisar con zoom zoom out n distantiar con zoom zoom v montar rapidemente zoom-lens n objectivo zoom zoon [Zool] n zoon (pl. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the Publisher. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Please consult full prescribing information before issuing prescription for any product mentioned in this publication. Published by Reed Elsevier India Private Limited Registered Office: 305, Rohit House, 3 Tolstoy Marg, New Delhi-110001 Corporate Office: 14th Floor, Building No. Keeping in view of the popularity of the book, the first Indian edition (10th edition) was published in 1989. Since then, the book has been updated from time to time in the light of the advances made in this speciality. Our commitment to the students to improve and update the quality of the book, and provide them with the advanced knowledge prompted us to bring out the 16th edition. In this edition, not only we have added the latest knowledge on the subject, but also inserted more illustrations, flowcharts and tables to make the reading easier and understandable. Considering the high associated morbidity and mortality of gynaecological malignancies, we have approached the topic of genital tract cancers more exhaustively in this edition. Emphasis has also been laid on the gynaecological problems amongst adolescents and menopausal women. We owe our special thanks to the entire staff of Elsevier for their wholehearted support and encouragement. We will fail in our duty if we did not make a special reference to Shabina Nasim with whom we interact on a daily basis and also Renu Rawat. We appreciate their professional attitude and their knowledge towards the project, their efficiency and enormous patience to bring out the best for this project. There are many others who have worked behind the scene, we acknowledge our thanks to them. Last, but not the least, we thank our readers and the student community for their unstinted support over the last 25 years. The ninth edition, edited by Dr John Howkins and Dr Gordon Bourne, was brought out in 1971, and its popularity in India has remained undiminished. It is therefore timely and opportune that this standard textbook should be revised by Indian teachers of gynaecology to meet the requirements of our undergraduate students. We consider ourselves fortunate for having been assigned this challenging task by the publishers. In revising the book we have endeavoured to update the contents to include new methods of investigations and treatment. In particular, recent advances in the physiology of menstruation and its hormonal control, carcinoma of the cervix and related preventive measures, endometriosis, and the management of tuberculosis of the genital tract have been incorporated. We have also tried to make the text more concise by deleting information that we felt was unnecessary for the Indian undergraduate student, without substantially changing the original style.

Emergency physicians should know where to locate these protocols and how to utilize them herbals postums perses 16 slip inn 1pack line. When there are other children at home mobu herbals extracting balm order slip inn 1pack online, the safety of these children must also be considered. The physician should carefully document the findings of mistreatment or self-neglect and the reasons for declaring the patient incapable of acting in his or her own best interest. When a patient agrees to intervention, a variety of options can be exercised depending on the type Unique Issues in Emergency Medicine 613 Child abuse, elder abuse, intimate partner violence (a) (b) Figure 41. Note the subperiosteal new bone along the lateral aspect of the femur and medial margins of the tibia. Subtle rims of subperiosteal new bone are present along the diaphyses of both bones. If the situation involves physical abuse, severe neglect, or abandonment, and no immediate solution can be arranged, hospital admission is warranted. Admission provides the opportunity for necessary medical treatment and additional time to activate the appropriate social support resources. In non-life-threatening situations, a solution can be tailored to fit individual circumstances. Even though the caregiver may be the source of abuse, she/he is also likely to provide the greatest amount of support for the victim. Options for support should be provided to the family in an attempt to diffuse the stress and anxiety that preceded the abuse. Brief supportive counseling by physicians may result in a dramatic catharsis for a victim who until then has been suffering in silence. It is very important for the physician to let a victim know that the abuse and violence is not her or his fault. A few kind, supportive words from an authority figure such as a physician goes a long way in alleviating some of the guilt and shame a victim feels once her abuse has been revealed. Several comforting phrases to use after any type of abuse is uncovered are listed below: 1. The majority of 614 Unique Issues in Emergency Medicine Documentation Most states provide specific reporting forms for child abuse, child sexual abuse, sexual assault, and elder abuse. Documentation of family violence in the medical chart may be the only written evidence of abuse, and may play a crucial role in aiding the patient. Appropriate documentation by the physician can be crucial in subsequent legal proceedings against the perpetrator or in child custody cases. Many district attorney offices file charges against perpetrators of family violence based solely on carefully documented medical, protective service, and police records, and do not require that the victim press charges or testify in court against the perpetrator. Record what the patient and/or caretaker tells you using exact words in quotations. Spontaneous utterances such as "He said he was going to beat me until he killed me" can be used in court and for danger assessment. Record any inconsistencies that lead you to suspect abuse despite caretaker or patient denial. Record the name and relationship of alleged perpetrator and time, date, and place of assault using the exact address if possible. Document the services provided during the visit, either in the physician note or the social worker/victim advocate note. As with appropriate written documentation, photographs can make a difference in subsequent legal proceedings. Clinicians have several options for photographing injuries; the best method depends on what is available in each setting. Other types of photography (35-mm film, digital, slide film, or video) can be used as long as a secure chain of evidence can be established. Every step of the process, from picture taking to film developing and return, should be accounted for and signed over on a written form. Most institutions that utilize colposcopy for sexual assault examinations have a formal protocol for dealing with photographic evidence. It often involves handing over the film or digitally-recorded images to law enforcement at the end of the examination. Although not mandated by all states, consent for photography is required by most institutions in competent patients.

Evidence to date suggests that non-progressive impedance-adjusted lowenergy biphasic countershock (150 J three times) is safe herbs uses order slip inn 1pack fast delivery, acceptable herbals on demand slip inn 1pack discount, and clinically effective. False readings have also been reported in patients who ingested carbonated liquids prior to intubation. A chest X-ray can help determine the location of the tip of the endotracheal tube in relation to the carina. The therapeutic goal is to convert these nonperfusing rhythms into perfusing ones. Antiarrhythmic agents such as amiodarone, lidocaine and procainamide raise the fibrillation threshold. Administration of these agents should always be followed by repeated countershocks. Asystole and bradycardia Bradycardia leading to asystole uniformly has a poor prognosis. In addition, it is an additional route of entry for some resuscitation medications, such as atropine, epinephrine, and lidocaine. Refer to Chapter 2 for a detailed discussion of the preparation and performance of definitive airway management. Atropine and epinephrine are two medications that have demonstrated benefit in this setting. Though early transcutaneous pacing should be considered for bradycardia, routine transcutaneous pacing for asystole has not been shown to improve survival. A recent large randomized study from Europe comparing epinephrine with vasopressin for patients in asystole demonstrated that vasopressin was superior to epinephrine, suggesting that vasopressin followed by epinephrine may be more effective than epinephrine alone in the treatment of refractory cardiac arrest. The most common causes include severe hypovolemia (usually related to significant blood loss), hypoxia, acidosis, pericardial tamponade, tension pneumothorax, large pulmonary embolus, myocardial infarction, hypothermia, or drug overdose. If the situation warrants, pericardiocentesis or needle thoracostomy should be performed. Tachycardias Tachycardias may be common in patients prior to hemodynamic collapse. There are numerous reasons for patients to have tachycardia, not all of which cause hemodynamic compromise. The key issue in patients with tachycardia is whether or not the patient tolerates their heart rate. In other words, is the patient stable and able to support a reasonable blood pressure that provides perfusion to the brain at that heart rate. The diagnosis and management of bradyarrhythmias and tachyarrhythmias is discussed in greater detail in Chapter 4. This information is likely to be obtained while the patient is being resuscitated or stabilized. Another member of the health care team may search for it if the physician cannot leave the bedside. Communicate the critical nature of the situation while providing reassurance that care is being provided and that the patient is not suffering. If appropriate, it is also important to reassure the family that they did not cause or contribute to the situation. Cardiopulmonary and cerebral resuscitation History Obtaining historical information about a patient in cardiac arrest can be difficult. Information must be gathered from pre-hospital providers, family, previous medical records, medication lists, or primary care physicians. An attempt to learn the following information should be made: What were the events surrounding the arrest Ask whether the patient was having any concerning Physical examination Following the secondary survey, the physical examination should focus on vital systems and additional clues that might point to the cause of the arrest.

Compare Salk vacSabin vaccine a bag saccades /s keIdz/ plural noun controlled rapid movements of the eyes made when a person is changing the direction in which they are focusing herbals scappoose oregon purchase 1pack slip inn visa. Compare Sabin salivary calculus salivary gland salivate salivation Salk vaccine ferring to saliva herbals and supplements purchase slip inn 1pack online, see words beginning with ptyal, ptyalo- or sial-, sialo-. Saliva acts to keep the mouth and throat moist, allowing food to be swallowed easily. It also contains the enzyme ptyalin, which begins the digestive process of converting starch into sugar while food is still in the mouth. Because of this association with food, the salivary glands produce saliva automatically when food is seen, smelt or even simply talked about. Most diets contain more salt than each person actually needs, and although it has not been proved to be harmful, it is generally wise to cut down on salt consumption. Also called saprophyte saprophytic sarcsarcoid sarcoidosis the longest vein in the body, runs from the foot up the inside of the leg and joins the femoral vein. The short (posterior) saphenous vein runs up the back of the lower leg and joins the popliteal vein. It is thought that increasing the amount of unsaturated and polyunsaturated fats, mainly vegetable fats and oils, and fish oil, and reducing saturated fats in the food intake helps reduce the level of cholesterol in the blood, and so lessens the risk of atherosclerosis. Also called thoracic outlet synscale scalenus scalenus syndrome drome scale off / skeIl f/ verb to fall off in scales scaler / skeIl/ noun a surgical instrument for scaling teeth scales /skeIlz/ noun a machine for weighing the nurses weighed the baby on the scales. It is caused by a haemolytic streptococcus and can sometimes have serious complications if the kidneys are infected. Schilling test / IlI test/ noun a test to see Schilling test school nurse scissor legs if someone can absorb Vitamin B12 through the intestines, to determine cases of pernicious anaemia [After Robert Frederick Schilling (b. Also called sclerotic, sclerotic sclera scleral lens / sklIrl lenz/ noun a large contact lens which covers most of the front of the eye scleritis /skl raItIs/ noun inflammation of the sclera sclero- /sklIr/ prefix 1. The conjunctiva, or inner skin of the eyelids, connects with the sclera and covers the front of the eyeball. Its precise cause is not known, but it is thought that the shortage of daylight may provoke a reaction between various hormones and neurotransmitters in the brain. Also called scurf scurvy form on the skin seborrhoeic rash / sebri Ik r / noun creted by a sebaceous gland, which makes the skin smooth. It also protects the skin against bacteria and the body against rapid evaporation of water. Treatment consists of vitamin C tablets and a change of diet to include more fruit and vegetables. Also called secondary health care secondary cartilaginous joint / sekndri k t l d Ins d Int/ noun a joint where the surfaces of the two bones are connected by a piece of cartilage so that they cannot move. Also called tertiary bronchi segmentation / se mn teIn/ noun the movement of separate segments of the wall of the intestine to mix digestive juice with the food before it is passed along by the action of peristalsis segmented / se mntId/ adjective formed of segments segregation / se rI eIn/ noun 1. Also called hospital trust self-harm / self h m/ noun a deliberate act by which someone injures part of their body as the result of a personal trauma. Also called pituself-retaining catheter self-wounding sella turcica harm nomas or seminomata. A high rate of sensitivity means a low rate of people being incorrectly classed as negative. Compare specificity sensorineural deafness / sensri njrl defns/, sensorineural hearing loss / sensri njrl hIrI ls/ noun deafness caused by a disorder in the auditory nerves or sensitising agent sensitive sensitivity sensorineural deafness sensory deprivation / sensri deprI veIn/ noun a condition in which a person becomes confused because they lack sensations sensory nerve / sensri n v/ noun a nerve which registers a sensation such as heat, taste or smell and carries impulses to the brain and spinal cord.

This can be accomplished with beta-blockers herbals guide order slip inn 1pack without prescription, calcium channel blockers rumi herbals slip inn 1pack on line, or digoxin. However, if atrial fibrillation with pre-excitation is suspected, these agents are contraindicated. Due to the disorganized atrial contraction associated with this dysrhythmia, atrial fibrillation predisposes individuals to thrombus formation in the left atrial appendage. Accordingly, atrial fibrillation carries an increased risk of thromboembolic stroke. Anticoagulation with adjusted dose warfarin can reduce the risk of thromboembolism. Principles of Emergency Medicine 77 Atrial flutter is commonly associated with underlying heart disease, such as ischemic heart disease or dilated cardiomyopathy. It is considered to have the same pathologic spectrum as atrial fibrillation, and patients with atrial flutter often have concomitant atrial fibrillation. Less commonly it is associated with myocarditis, blunt chest trauma, or pulmonary embolism. The treatment of atrial flutter in stable patients is rate control with a beta-blocker or calcium channel blocker. Ibutilide, amiodarone, or procainamide can also be used to convert atrial flutter to sinus rhythm. Ibutilide should be used with caution in patients with structural heart disease or hypomagnesemia, as there is a higher risk of torsades de pointes in these patients. Atrial flutter carries with it a lower risk of thromboembolism than atrial fibrillation, but anticoagulation should be considered in patients with coexistent atrial fibrillation, patients greater than 70 years of age, patients with prior thromboembolism, or patients with structurally abnormal hearts. Atrial flutter is curable through radiofrequency catheter ablation, so these patients should be referred to a cardiologist for further evaluation. It is commonly associated with chronic lung disease and can be a manifestation of theophylline toxicity. Treatment should be directed primarily at the underlying chronic lung disease, although judicious use of calcium channel blockers may provide symptomatic relief through rate control. Electrical cardioversion is not effective given the numerous sites of atrial ectopy present. While no set of criteria will absolutely differentiate the two, several criteria have been developed to assist clinicians. The P wave temporarily "captures" the ventricle, but the underlying wide-complex rhythm eventually takes over. Serum electrolytes should be drawn in all patients, and hypokalemia and hypomagnesemia should be corrected if present. It is a wide-complex tachycardia with an undulating amplitude that varies Stable ventricular tachycardia monomorphic or polymorphic Treatment of torsades de pointes is aimed at interrupting the ventricular rhythm and restoring sinus rhythm. Electrolyte abnormalities such as hypokalemia, hypocalcemia, and hypomagnesemia should be aggressively corrected. Atrial fibrillation with pre-excitation this is a special case of atrial fibrillation where conduction occurs antegrade down a pre-existing bypass tract (Figure 4. Patients who manifest this rhythm should be referred to a cardiologist for radiofrequency catheter ablation of the bypass tract to prevent recurrences. It is commonly seen following acute myocardial infarction, and is known as a "reperfusion dysrhythmia. In some instances, the ventricular pacemaker may be the only functioning pacemaker in the heart, and suppressing it with antidysrhythmics such as lidocaine can lead to asystole.

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References:

• https://www.mayoclinicproceedings.org/cms/10.1016/j.mayocp.2013.07.013/attachment/15071587-6e78-460c-8d03-31c1e99bb15e/mmc2.pdf
• https://www.michigan.gov/documents/CIS_WSH_part451_54075_7.pdf
• https://www.novo-pi.com/ozempic.pdf
• https://aac.asm.org/content/aac/35/12/2457.full.pdf