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  1. Nov 08, 2021 · (3) Section 1.1(2)(e) does not apply to a word, expression or statement on a container which has a capacity of 20 millilitres or less, or on the label of such a container if: a) an appropriate authority approves the use of smaller letters; and

    • 01 Feb 2021
    • 01 Feb 2021
    • Abstract
    • Case Presentations
    • Critical Appraisal of The Literature
    • Epidemiology, Etiology, and Pathophysiology
    • Differential Diagnosis
    • Prehospital Care
    • Emergency Department Evaluation
    • Diagnostic Studies
    • Treatment
    • Prevention

    Mammalian bites are fairly common presentations in the emergency department (ED). In fact, half of all Americans will be bitten by an animal or another human during their lifetime.1,2Not surprisingly, domestic cats and dogs are responsible for most bites. That said, emergency clinicians must be prepared to address bites from all types of animals, including exotic and wild species. Bite injuries can cause morbidity from pain, cosmetic disfigurement, poor functional outcome, and infectious complications. The emotional impact to patients and their families must also be managed. Closure techniques and the treatment of clinically apparent infections are relatively straightforward. The major controversies surrounding mammalian bites involve their initial management. Should patients with bite wounds be given antibiotics prophylactically at presentation? Should bite wounds be closed primarily, or does this procedure increase the risk of infection? Although the examples of mammalian bites gi...

    The emergency department is in chaos, and your chart rack is full. You pick up the next chart and are relieved to see the chief complaint: "Scratches on hand and leg." However, your relief turns to dismay when you see a 15-year-old boy in the room with his very concerned mother and you hear the following history: The patient was carrying the family cat into the house when the pet became frightened by an unleashed dog. The cat bit the patient on the left hand before running into the bushes. The dog ran after the cat, with the patient in hot pursuit. As the patient retrieved his cat, the dog bit him on the right calf. The patient quickly sought out the dog's owner, a local homeless man. When approached by the patient, the man rudely denied responsibility for the dog's actions. Still a novice at conflict resolution skills, the patient argued with the dog's owner, eventually punching him in the face and sustaining a wound to his third MCP joint. The cat is healthy and has received all o...

    Ovid MEDLINE®, CINAHL®, and PubMed databases were searched for all articles on mammalian bites published between 1995 and 2008. Search terms included mammalian bites, animal bites, bite wounds, cat bites, bites, pediatric wounds, and bites and stings. A search of the Cochrane Database of Systematic Reviews produced a single review of 8 studies on mammalian bites that was updated in 2001.3In addition, the clinical report and policy statement databases of the American College of Emergency Physicians and the American Academy of Pediatrics were reviewed, and one relevant report was found. A search of the Agency for Healthcare Research and Quality's online National Guideline Clearinghouse™ also yielded one relevant report. These articles served as the basis for further literature searches, which were performed manually. In all, approximately 500 articles were reviewed, and 122 are included here. Literature on the management of pediatric mammalian bites largely consists of case reports, r...

    The true incidence of mammalian bites is unknown because many victims do not seek treatment for minor injuries and mandatory reporting is not in effect in all states. However, it is estimated that each year nearly 2 million bites result in medical treatment in the United States, with nearly half of these presenting in the ED.4 In all, the evaluation and treatment of bite wounds account for about 1% of all visits to EDs.2This number is expected to rise as animals and humans increasingly share space. In most cases, animal bites are attributed to house pets.2 In one study on animal aggression, 89% of attacks were caused by dogs, 8% by cats, and 3% by other species.5 The study indicated that most injuries were single bites and that children younger than 15 years were 1.4 times more likely than other age groups to be attacked. Reports from the U.S. Department of Health and Human Services also indicate that male children are at greater risk of being bitten than female children.6 In additi...

    The chief concerns in the differential diagnosis of bite wounds are those related to wound severity or potential exposure to infectious disease. Cases of human bites also bring the possibility of child abuse to the clinical situation. (See Table 4.)

    Prehospital care providers must be aware that dog bites have the rare but serious potential to threaten life or limb and that patients may require triage to a trauma center. Although no data exist to support one method of prehospital care over another, it has been suggested that if ED care is likely to be delayed for more than 1 hour, wounds should be cleaned at the scene and covered with sterile dressings. Hands and feet should be immobilized if injured.6


    A thorough patient history should be obtained, including the following information about the bite wound: 1. Animal characteristics: The species of animal that bit the patient may give clues about the expected injury pattern. The immunization status of the animal should be determined. Unprovoked attacks or attacks by animals that cannot be located or captured may necessitate rabies immunoprophylaxis. Unfortunately, the term provoked attack is not clearly defined. Dogs naturally will exhibit te...

    Physical Examination

    Bites vary in severity from minor to limb or life threatening. The emergency clinician should perform a complete trauma evaluation on a child who is bitten if the situation calls for it. All children who are victims of an animal attack should be evaluated from head to toe to identify signs of both penetrating and blunt trauma. Wounds should be assessed for location, depth of penetration, amount of devitalized tissue, and the presence of any foreign material. Assessments of neurovascular funct...

    The physical examination is the most important aspect of the initial evaluation of bite wounds. Few diagnostic studies will affect initial treatment. Unless clinically indicated for excessive blood loss, a complete blood cell count is rarely useful. Even in the presence of infection, the white blood cell count is rarely elevated.55 Some controversy exists regarding the necessity of obtaining routine wound cultures on fresh, noninfected bite wounds because the results do not reliably predict which wounds will become infected.56 However, cultures in grossly infected wounds may guide therapy. Both aerobic and anaerobic cultures should be obtained, and the microbiologist should be informed of the animal responsible for the wound so that a diagnosis of Pasteurella infection can be considered if needed. Some pathogens are slow growing, so cultures should be held for 7 to 10 days. Erythrocyte sedimentation rate and C-reactive protein level are elevated in the majority of clinically evident...

    As mentioned previously, most bites are not life threatening. However, these injuries can be a source of stress for the emergency clinician, particularly when they occur in children. Some controversy surrounds the management of simple bites as well as life-threatening wounds. Treatment of bites should include consideration of analgesia, local wound management, infection prevention, and management of complications (as described in the Complicationssection). Analgesia is often achieved locally during acute treatment, but patients may require systemic medications depending on the severity of the injury. Younger children in particular may require procedural sedation for the management of wounds. As with other traumatic injuries, immobilization and elevation of the bite wound promote analgesia. Local wound management consists of wound exploration, thorough irrigation, debridement of necrotic tissue, and closure (if appropriate; see discussion that follows). Infection prevention in bite w...

    Animal bite prevention is important in the pediatric group. Certain predictable behaviors observed in both humans and animals typically result in injury. Bites can result when a child tries to remove a pet from a fight with another animal. Although avoidance of this rescue attempt is most prudent, if a child insists on intervening in an animal fight, he or she should grab the pet's hind legs and pull it away rather than trying to pry the animals apart at the head and mouth.2 Interacting with an animal during feeding times can also be potentially dangerous, as the animal's natural instinct is to protect its meal. Education on how to interact with dogs may be helpful in preventing dog bites. An Australian study indicates that after only 30 minutes of instruction, children were much less likely than members of a control group to exhibit potentially dangerous behavior around a dog.42The study involved 7- to 8-year-old children who were taught how to approach dogs, how to recognize angry...

  2. Nov 17, 2021 · (A) GCase western blot of day 90 3x-1 DA neurons treated with FTI + DILT for 2 weeks. Coomassie is shown as a loading control. Quantification of combined data from 3x-1, 2 is shown to the right. (B) EM analysis of day 90 SNCA-3X DA neurons (shown, 3x-2) treated with DMSO vehicle or FTI + DILT for 2 weeks. Example ER segments are highlighted in red.

  3. Nov 16, 2021 · We compared responses in acute phase samples (day 2) to convalescent phase samples (day 7). Following incubation, plates were washed and developed with a 0.55 mg/mL solution of 2,2ʹ 0-azinobis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS; Sigma) with 0.03% H 2 O 2 (Sigma), and optical density at 405 nm was determined with a Vmax microplate ...

  4. Nov 17, 2021 · (C) PLA was done in day 70 DA neurons (shown, 3x-2) to assess CANX (top) and GRP94 (bottom) associations with α-syn. The isogenic control for 3x-2 was used to assess background signal. Right: PLA signal in day 70 and 90 neurons was quantified as in (A) using n = 3–4 biological replicates per 3x line. Scale bar, 25 μm.

  5. Nov 24, 2021 · Aspirin, when large doses (8 to 12 pills a day) are taken. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. Certain antibiotics, especially aminoglycosides (such as gentamicin, streptomycin, and neomycin).

  6. Dec 02, 2021 · How much does it cost to put a dog to sleep at PetSmart? It is natural to develop affection and longing feelings towards a pet. However, its life may have to be ended to avoid unnecessary suffering and when it is unlikely that its health will improve. PetSmart contracts with Banfield Pet Hospitals, a national veterinary practice.

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