By J. Trano. Mount Union College.
There is no standard type Individuals with autism can also have hyperacute or form of autism generic 162.5 mg avalide mastercard. They may be very sensitive to bright lights generic avalide 162.5mg on line, loud This variability is reflected in some of the terms or names noises, or rough textures. Asperger syndrome is a term used to (head-banging, hand-flapping, rocking) sometimes seen describe individuals with autism with language skills. The dif- iors can include throwing temper tantrums for no known ferent terms for autism are partly due to the different reason and developing fixations or obsessive interests. These children had some unique discredited as scientific information about neurological abilities and did not seem to be emotionally disturbed or differences and biologic causes for autism have emerged. He invented the category Early Infantile Autism (sometimes called Kanners syndrome) Genetic profile to describe these children. In a strange coincidence, Hans Asperger made the same discoveries in the same year. He No single specific gene for autism has been discov- also described children with a unique behavioral profile ered. Although the exact cause of autism is unknown, it and used the term Autism to describe them. His original is thought that autism is due to a combination of genetic study was in German and was not translated into English and environmental causes. Because the children that he identi- factors is often referred to as multifactorial inheritance. Multifactorial conditions tend to run in sity, all individuals with autism have deficits in three key families, but the pattern of inheritance is not as pre- areas—social interaction, communication, and reason- dictable as with single gene disorders. In addition to these neurologic problems, individuals recurrence is also less than the risk for single gene disor- with autism often exhibit bizarre repetitive movements ders and is usually derived from empiric or long-term such as hand flapping or head-banging. There are a number of scientific studies that suggest Asperger syndrome—A term used to describe autism is partially due to genetic causes. By examining the rates of concordance (the term used by the American Psychiatric Association number of twin pairs that both have autism) it is possible for individuals who meet some but not all of the to determine if there is a genetic component to autism. Studies that looked at the incidence of twins with autism determined that identical twins are more likely to be con- Savant skills—Unusual talents, usually in art, math cordant (both affected) with autism than fraternal twins.
The atrioventricular bundle avalide 162.5mg mastercard, also known as the bundle These ANS influences allow the heart to meet changing of His generic avalide 162.5 mg with visa, is located at the top of the interventricular septum. Consequently, Smaller Purkinje (pur-KIN-je) fibers, also called conduction the circulatory needs of the body at rest can be met with a myofibers, then travel in a branching network throughout lower heart rate. Variations in Heart Rates The Conduction Pathway The order in which im- pulses travel through the heart is as follows: ◗ Bradycardia (brad-e-KAR-de-ah) is a relatively slow heart rate of less than 60 beats/ minute. A relatively ◗ Sinus arrhythmia (ah-RITH-me-ah) is a regular varia- slower rate of conduction through the AV node allows tion in heart rate caused by changes in the rate and time for the atria to contract and complete the filling depth of breathing. The excitation wave travels rapidly through the bundle of ◗ Premature beat, also called extrasystole, is a beat that His and then throughout the ventricular walls by means of comes before the expected normal beat. As a safety measure, a region of Heart Sounds the conduction system other than the sinoatrial node can generate a heartbeat if the sinoatrial node fails, but it does The normal heart sounds are usually described by the syl- so at a slower rate. Few the beginning of ventricular relaxation and is caused people escape having some damage to the heart and blood largely by sudden closure of the semilunar valves. An abnormal sound caused by any lining of the chambers, but the term most commonly structural change in the heart or the vessels connected refers to inflammation of the endocardium on the with the heart is called an organic murmur. To differentiate these from ◗ Pericarditis (per-ih-kar-DI-tis) refers to inflammation abnormal sounds, they are more properly called func- of the serous membrane on the heart surface as well as tional murmurs. These inflammatory diseases are often caused by in- Checkpoint 14-9 What system exerts the main influence on the fection, but may also be secondary to other types of res- rate and strength of heart contractions? THE HEART AND HEART DISEASE ✦ 295 Arch of aorta Superior vena cava Ductus arteriosus Foramen ovale Left atrium Pulmonary trunk Right atrium Inferior vena cava A B C D E 14 Figure 14-13 Congenital heart defects. The ductus arteriosus (ar-te-re-O-sus) in the fetus is a ◗ Rheumatic (ru-MAT-ik) heart disease originates with small blood vessel that connects the pulmonary artery an attack of rheumatic fever in childhood or in youth. Persis- ◗ Heart failure is caused by deterioration of the heart tis- tence of the vessel after birth is described as patent sues and is frequently the result of long-standing disor- (open) ductus arteriosus (see Fig. The most common single congenital heart defect is a hole in the septum between the two ventricles, a dis- Congenital Heart Disease order known as ventricular septal defect (see Fig. A small defect remaining from the foramen ovale or are not used until a child is born, the fetus has some adap- a small patent ductus may cause no difficulty and is often tations that allow blood to bypass the lungs. In addition, This opening allows some blood to flow directly from the ventricular septal defect creates high blood pressure in right atrium into the left atrium, thus bypassing the the lungs, which damages lung tissue.
After obstruction has been ruled out cheap 162.5mg avalide with visa, failure to respond to these measures with in- creased urine flow most likely indicates an intrinsic renal cause of azotemia cheap avalide 162.5 mg with mastercard. As a general approach, daily intake and output should be closely re- viewed, and daily weights are very useful. Many clinicians remove potassium from the IV fluids immediately in cases of renal failure to prevent accumulation of deadly potassium levels. Optimize hemodynamic status to maximize cardiac output and, hence, renal perfusion. Once you are sure that fluid status is optimal and urine output is still suboptimal, use low-dose dopamine (2–5 mg/kg/min) to dilate the renal vessels. If the patient is fluid-overloaded, use furosemide in increasing doses to diurese fluid. Check the Foley catheter for patency, replacing it immediately if there is any question. Decompression of the upper urinary tracts may require stents or percutaneous drainage. Stress Ulceration The development of stress ulceration in the ICU patient is a serious complication. The pathophysiology is related to diminished blood flow to the viscera in stress situations, leading to alterations in the mucosal barrier to the effects of gastric acid. Prophylaxis • Routine cardiovascular support of perfusion • Routine use of H2 blockers (Pepcid, etc) • Antacid administration (eg, Maalox 30 mL per NG tube q2h). In patients with renal failure, use aluminum hydroxide, avoid magnesium-containing antacids • Enteral feedings, when tolerated, remain a good method to neutralize gastric acid. A clearly visible lesion (bleeding vessel) warrants operative intervention, but diffuse gastritis is best treated initially with aggressive antacid and H2 blocker therapy.