Starring: Neuza Amaral, Malu Brandao, Sandra Brea, Simone Carvalho, Sandra Castro, Claudio Cunha, Rogerio Froes, Luiz Gustavo, Carlos Imperial, Ana Maria Kreisler, Mauricio Lessa, Miriam Nascimento, Petty Pesce, Fernando Reskiĭownload Link(s): Amada - 301.5 MB Amada - 301.5 MB Amada - 301.5 MB _ Softcore Erotic Movies (Vintage | Retro | Classic) Vintage Full Movies Collection (19xx - 1995) Old Magazines Collection (Retro | Vintage | Classic) Vintage Short Loops Collection (Tabu, Magma, SWV etc.) Starring: Helena Ramos, Carlos Casan, Petty Pesce, Denis Derkian, Liana Duval, Cavagnole Neto, Aldo Bueno, Paulo Leite, Zelia Toledoĭownload Link(s): Mulher - 400.0 MB Mulher - 300.3 MB It all culminates in a pill popping party in which even more people get naked and have sex.ĭownload Link(s): College - 291.1 MB College - 291.1 MB College - 291.1 MB (“C’mon girl, it’s the changing of the guard!”) Then the two nymphos double team a young pledge to “initiate” him into the fraternity. Another gal gets off on watching her best friend ball a smooth talking frat boy then swapping places with her. One chick offers up her body to her grey haired professor in order to get a passing mark. Starring: Forman Shane, Marsha Jordan, Gee Gentell, Linda Stiles, Ron Negri, Dianna Rosano, Randy Lee, Samantha Scott, Julia Blackburn, Ray Cyr, Michelle Rodan, Moose Howard, Sandy Solee, Tim Diamondĭescription: A bunch of sorority sisters from “LSD University” go out “looking for kicks” and get it on in a variety of ways.
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Mucositis, a painful inflammation and ulceration of the mucous membranes lining the digestive tract, can involve both the oral tract and the gastrointestinal tract. For compounded preparations such as mouthwashes, there are various formulations that pharmacists can use based on the experience and needs of the individual physician and patient, respectively. Treatment is mainly supportive, involving both nonpharmacologic and pharmacologic methods. Symptoms, which may include altered taste perception, sores, and varying degrees of pain, usually appear 4 to 5 days after treatment initiation. It seems to be particularly associated with fluorouracil, doxorubicin, and methotrexate. 2011 36(7)(Oncology suppl):12-15.ĪBSTRACT: Oral mucositis is a widespread and potentially serious consequence of high-dose chemotherapy and radiotherapy. Silver Nitrate Stick Helps Manage Aphthous Ulcers. Īm Fam Physician. 2000 Jul 1 62(1):149-154. Silver nitrate cautery in aphthous stomatitis: a randomized controlled trial. The treatment is simple and cost-effective in patients with infrequent recurrences.” Br J Dermatol 2005īr J Dermatol. 2005 Sep 153(3):521-5. The effect is rapid and lasts for the duration of the lesion. We did not observe any side-effects in our study. Lesions can be numbed with topical lidocaine prior to chemical cautery, and patients should rinse with water for several minutes after the procedure.Ī RCT published in the British Journal of Dermatology found that “One application of silver nitrate can decrease the severity of pain in aphthous ulceration without significantly shortening or prolonging healing time. Although silver nitrate cautery may cause more tissue necrosis and longer healing time if it is left in place too long, I have not found this to be a problem.” You should warn them that the procedure may sting for a moment but, considering that they are already in pain, they don’t really notice much difference. Have patients swish out the silver nitrate and send them home. When the ulcer turns white, remove the stick. The procedure is simple: wet the tip of the stick and gently touch it to the ulcer. Obviously, one needs to be sure there is no other apparent etiology but, because the most common cause is not related to underlying disease, the silver nitrate stick works wonders, and patients walk out of the office pain free. In children and in women who may be pregnant, tetracycline should be avoided because of its tendency to discolor teeth.Īn AAFP letter to the editor in 2001 explained how to use silver nitrate sticks to treat aphthous ulcers. Triamcinolone 0.1% in Orabase (Kenalog in Orabase)Īpply to dried ulcer 2 to 4 times daily until healedĢ00 mg, one to two times daily for 3 to 8 weeks Warning: contraindicated in pregnancyĪpply to dried ulcer two to four times daily Treatment for oral aphthous ulcers can bed divided into:ġ capsule dissolved in 180 mL of water rinse with this suspension four times daily for 4 to 5 daysĥ mL “swish and spit” four times daily for 4 to 5 daysġ tablet dissolved in 180 mL of water rinse with this suspension twice daily for 4 to 5 days Common Treatments for Aphthous Ulcers, AAFP Antibiotic therapy in this case would prevent bacterial superimposition. I’ve also seen similar treatment used for significant oral ulcers caused by Herpes (HSV1 and HSV2). Tetracycline and minocycline are the best. Topical and systemic antibiotic treatments are empiric and are used because of a belief that some as-yet-undiscovered infectious agent is causing the aphthous ulcer. I’ve also worked with another attending who just gave a z-pack as the antibiotic. *Some people use magic mouthwash preparation. The patient will open it up and put in small amount of water and swish and swallow. Until such guidelines are established, physicians should take this treatment into consideration when standard ACLS measures have failed to successfully terminate refractory ventricular fibrillation.Ĭardioversion defibrillation dual sequential refractory ventricular fibrillation.Ĭopyright © 2016 Elsevier Inc. Previously used in the electrophysiology suite, this technique has recently been used in the emergency department and prehospital setting for out-of-hospital cardiac. The patient is converted to a normal sinus rhythm and there are no. The double sequential defibrillation is successful. Further investigation on cardiac resuscitation should be conducted to standardize the dual sequential defibrillation delivery procedure. Dual sequential external defibrillation (DSED) is the process of near simultaneous discharge of two defibrillators with differing pad placement to terminate refractory arrhythmias. Dual Sequential Defibrillation in Shock Refractory VF Resuscitation. Figure 2: Placement of AED pads during double sequential defibrillation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case shows that dual sequential defibrillation may be a successful method for terminating refractory ventricular fibrillation. When attempting defibrillation, the BIPHASIC trial showed that increasing the amount of energy corresponds to a better chance of defibrillation. The patient had immediate return of spontaneous circulation, underwent cardiac catheterization, and was discharged home 1 week later. Dual-sequential defibrillation is a novel intervention for refractory ventricular fibrillation that has a small but growing body of evidence. After four unsuccessful defibrillation attempts, a second defibrillator was placed on the patient, and the two were activated almost simultaneously. VF ventricular fibrillation ROSC return of spontaneous circulation DSED double sequential external defibrillation. While in the emergency department, the patient developed ventricular fibrillation, and ACLS was initiated. The patient's initial work-up, including an electrocardiogram and cardiac troponin, did not show evidence of acute ischemia, and she was admitted to the observation unit for further evaluation. This pilot study sought to determine the feasibility and safety of a full scale RCT comparing these. Vector change defibrillation switching pads from the anterior-lateral to anterior-posterior position. In this case, two defibrillators were used to deliver a greater than normal energy waveform over an extended time interval to return a patient to a normal sinus rhythm.Ī 56-year-old woman presented to the emergency department with complaints of chest pain, nausea, and vomiting. Double sequential external defibrillation 2 rapid sequential shocks given via 2 defibrillators with pads attached in 2 different planes. When treatments defined by the ACLS guidelines are unsuccessful in terminating a lethal dysrhythmia, the use of alternative strategies may prove useful. Current guidelines for the treatment of adult patients in cardiac arrest are supplied by the American Heart Association through basic life support and advanced cardiovascular life support (ACLS) provider courses. They offer a wide range of benefits from increasing the market value of your property to giving you another liveable space. Log structures within the confines of your property are remarkable investments. 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With the release of OpenCore Legacy Patcher 1.0.0, we're proud to announce macOS Sonoma support! And with it, 83 unsupported Mac models will be able to run Apple's latest OS! For those upgrading prior to OpenCore Legacy Patcher 1.0.0, see below: These updates are not critical, however may help resolve issues with macOS. 1.0.1 is a bug fix release for some Broadcom WiFi cards and graphics issues in macOS Sonoma. You can even suspend web and application activity tracking for My Activity, but that could impact the features like autocomplete suggestions. You can change your settings for ultimate privacy, depending on how much of your online activity you allow Google to track. If you are one of those privacy-conscious hawks, you can adjust your settings in the Privacy Checkup. However, the feature also offers you an option to delete items as well - everything in a particular date range or by specific topics. 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