Cpc Icd-9-Cm Coding Essay

Cpc Icd-9-Cm Coding Essay
1. A 54–year–old patient is seen by the physician in the outpatient clinic setting for CLL that is
currently in remission. The patient's WBC counts, particularly lymphocytes remain within normal
limits 2. Susan Oster, 45, is admitted to the hospital with a temperature of 38.5º C, heart rate 102
beats/min, respiration 20/min with septicemia and SIRS. WBC 12,500. Documentation states
respiratory and acute hepatic failure are due to septicemia. 3. OPERATIVE REPORT
PATIENT: Mara Bell Lee
PHYSICIAN: Randy Greenfield,
MD PREOPERATIVE DIAGNOSIS: Pleural effusion with unknown cause.
POSTOPERATIVE DIAGNOSIS: Pleural effusion with unknown cause.
PROCEDURES PERFORMED:
Diagnostic thoracentesis.
Four–quadrant pleural biopsy,
Pleural ... Show more content on Helpwriting.net ...
Downey, MD PROCEDURE PERFORMED: Central venous access placement. INDICATION:
Massive gastrointestinal bleed.
The procedure was done emergently because of the patient's critical condition. His right IJ area was
prepped in the usual fashion. It was very difficult to visualize his right IJ vein, even though his
habitus should have allowed us to do so, but the patient was, I believe, severely intravascularly
volume depleted, and his vein was collapsing. I have attempted to access the right internal jugular
vein multiple times, both under real–time ultrasound guidance and even later on blindly. I was able
to get blood return and hit the vein; however, I was not able to advance the guidewire. I was able to
advance it one time and put the catheter in, and it was nonfunctioning. I had to take the catheter out
and tried multiple other times on the right IJ vein without success. That procedure was terminated.
Pressure was applied. There was no cervical hematoma whatsoever. The patient was uncomfortable
because of the length of the procedure but did well otherwise. Hemodynamically, he was
unchanged, and his oxygen saturations remained stable.I prepped the IJ vein area in the usual
fashion. One percent lidocaine was used for local anesthesia. Again, the left IJ vein was collapsing.
With deep inspiration, the vein could be well visualized on the real–time and ultrasound guidance,
after which I could get access to the left IJ vein. A wire was advanced without difficulty while the
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Suprascapular Nerve Block Report
To the Editor,
We would like to share our experience and thoughts about the Ultrasound guided combined
posterior cord and selective suprascapular block for shoulder surgery.
Out of our experience shoulder surgeries, no matter if arthroscopic or open, can cause severe
postoperative pain and discomfort. Several analgesic techniques, such as intra–articular injection of
local anaesthetics, parenteral opioids, brachial plexus block, and selective suprascapular and axillary
nerve block are used with different success and side effect profile.
The interscalene brachial plexus block remains the mainstay for analgesia
In shoulder surgery. The interscalene block technique is more effective in controlling postoperative
pain, causing lower pain scores and requiring less rescue morphine .
However, it may eventually be associated with complications ... Show more content on
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The Ultrasound guided approach was suprascapular, looking for the suprascapular nodge, Ligament
and the artery below it. We injected 10cc of Ropivacaine 0.5% in the targeted area.
After the blockade of the posterior cord and suprascapular nerve the patient received a General
Anaesthetic. The total dose of Fentanyl used for the intervention was 75mcg.
Post operative the patient woke up with no pain. Troughout the surveillance time in Post Anaesthetc
Care unit and Daycare Unit the patient did not require any additional opioids or other pain
medication.
At discharge the patient mentioned a Pain score of VAS 2 feeling like a muscle ache after a workout.
This soreness is possibly due to some strain on the pectoralis major and minor muscles during the
surgery.
Patient was discharged 3 ½ hours after the block was performed.
At the phone interview post Op day one patient reported a satisfactory pain relive for 13h without
oral opioids and some sensation impairment for 20h. The patient had some pain issues as the block
wore off, leading to some discomfort but manageable with oral

Evaluation, Diagnosis, And Therapeutic Interventions
1. The article has discussed only four elements out of five in the given case. The four elements such
as clinical examination, evaluation, diagnosis, and therapeutic interventions are well explained in
this study but there is not enough information on prognosis. Croft et al (2015) stated that through
information on patient prognosis we could coordinate data from biological, social, and clinical
database for more powerful and productive care in this advanced medicinal world. The prognosis
indicates possible future outcomes in patients with given conditions or health problems. 2.
Examination: The examination of the given case study includes the patient 's all basic information
such as age, occupation, work hours, physical demand, and ... Show more content on
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A diagnosis is well–explained and interventions are also timely scheduled, but there is not enough
information on expected outcomes from each intervention. Intervention: A well– designed
therapeutic treatment plan was implemented following thorough examination, evaluation, and
diagnosis. Initially, the patient was given grade IV manual mobilization in the affected
thoracolumbar (T10 to L2 vertebrae) region to reduce the pain and minimize spinal restriction
(Doubleday et al., 2003). Also, the PT added psoas muscle stretching in prone position and pelvis
was stabilized with the mobilization belt. In later visits, the PT added the trunk, abdominal and
lower–extremity muscle strengthening exercises in different positions, and balance exercises in
single and double–limb standing. 3. Visceral pain originates from the internal body organs such as
respiratory, digestive, urogenital, and endocrine systems, the spleen, the heart, and the great blood
vessels (Goodman & Snyder, 2013). Visceral pain is not localized, and it usually produces referred
pain. Initially, the signs of visceral disease can be observed as "sensory, motor, and/or trophic
changes in skin, subcutaneous tissues, and muscles, and the symptoms can be itching, dysesthesia,
skin temperature changes, or dry skin" (Goodman & Snyder, 2013, p.113). Signs and symptoms of
visceral problems are associated with Autonomic Nervous System responses such as the change in
pulse rate,

Group 1 Bee Sting Final Fall 2014 Essay
BIOL 2010, Anatomy and Physiology I
FINAL EXAM
Group 1
Tammy Bohanan, Hannah Thompson, and Hannah Grigsby
Bee Sting,
Fall 2014
The Case: It's a warm Fourth of July and you are walking across the park to your favorite picnic
spot. You are allergic to and highly phobic about bee stings. While walking, you hear a buzzing
sound to your right. You turn your head and see a large bee hovering over your right shoulder. You
reach with your left hand to swat the bee, but just as you make contact, it stings you anyway. You
notice that you are sweating and your skin turns red. You realize that your Epi–pen was left in the
car, so you panic and begin sprinting back to the car to get it.'
The Assignment: Name and describe all of the ... Show more content on Helpwriting.net ...
CO2 is released as a waste product. The 2–carbon acetyl group binds to coenzyme A. At this point,
the process starts to move into the mitochondria and the Krebs Cycle is initiated. There is a net gain
of 2 ATP and 2 molecules of NADH produced.
During Krebs Cycle, the acetyl CoA breaks down further into two molecules of carbon dioxide
during each turn of the cycle. In the process, the molecules FAD and NAD are reduced to FADH2
and NADH. 2 ATP is generated during the Krebs Cycle.
The reduced FADH2 and NADH enter the Electron Transport System where they are re– oxidized to
FAD and NAD. These electrons release energy which forms 32 ATP molecules.
During aerobic respiration, there is a total net gain of 36 ATP.
2. (6 pts) Turn your head to the right. (Create a table* that describes which muscles move which
bones across which joints under the control of which nerves)
Action
Muscle
Origin
Insertion
Nerve

Turn head right:
Rotation to the shoulder of opposite side
Sternocleidomastoid
Manubrium of Sternum and Clavicle
Mastoid Process of temporal bone and the occipital bone
Accessory Nerve
Flexion and slight rotation of the head
Scalenes
(scalenus anterior, scalenus medius, and scalenus posterior)
Transverse processes of clavicle vertebrae
First two ribs
Cervical nerves (C3–C6)
3. (10 points) Trace the image of the bee to perception. (Include all focusing, transduction,
transmission and perception processes and structures)
The ear receives

Bionic Reconstruction Lab Report
Bionic reconstruction is an innovative method integrating nerve and muscle transplants with
prosthetic arms that work with electrical signals. Researchers from University of Vienna alongside
the engineers at the University Medical Center Goettingen explored this technique with three
Austrian men suffering from brachial plexus. Patients with this condition experience avulsions –
pulling and tearing of nerve networks – in the neck or back area resulting in a perpetually
functionless hand. This revolutionary technique of advanced prosthetic treatments allows paralyzed
individuals to eventually regain the ability to use their own arms for daily activities. The experiment
included nine months of vigorous cognitive training for the patients, hybrid ... Show more content
on Helpwriting.net ...
The Action Research Arm Test (ARAT) measures the ability to perform tasks such as lifting cans,
unbuttoning shirts etc. The Southampton Hand Assessment Procedure (SHAP) evaluates the
efficiency and success of prosthetic limbs. The Disabilities of Arm, Shoulder and Hand (DASH)
questionnaire calculates the difficulty for the patients to complete assigned tasks. The results of
these tests showed the pain increased from 5·3 (SD 4·73) to 30·7 (14–0) on the ARAT, improved
from 9·3 (SD 1·5) to 65·3 (SD 19·4) on the SHAP and from 46·5 (SD 18·7) to 11·7 (SD 8·42) on the
DASH survey These outcomes demonstrate the success of the first bionic reconstruction using
prosthetic hands by representing the ease for the patients using the bionic arms to complete daily
activities. In conclusion, brachial plexus injuries often lead to permanent paralysis of hands, so the
use of bionic reconstruction offers a method to regain the ability of performing daily activities. The
success of this case opens many doors for further advancements in electromyopgraphic signals and
prosthetic hands. The advanced technology can be used for military purposes or anyone with
paralysis prohibiting or reducing their motility. This technology allows for patients to regain control
of their lost limbs more effectively than with current prosthetic

The Flexor Tgitorum Equilibrium
The flexor digitorum which is on the anterior forearm arises from the medial epicondyle of the
humerus by the common tendon. The flexor digitorum lies between the superficial and deep groups.
In the anterior fingers, which inserts on the sides of the middle phalanges, splits at the level of the
proximal phalanges, permitting the deeper tendons of the FDP to pass on through to the bases of the
distal phalanges. It is from the intermuscular septa between it and the adjacent muscles, and from
the antebrachial fascia. It divides into four tendons, which pass, together with that of the extensor
indicis proprius, through a separate compartment of the dorsal carpal ligament, within a mucous
sheath. Flexor digitorum flexes digits at MCP and PIP joints,

Case Study: S/O EMT Perez
S/O EMT Perez was requested by Gate One to assist with an Ambulance escort to CT–403 on the
early morning of 8/7/2015. When arriving at gate at Gate One S/O EMT Perez realized that the
ambulance crew was already enroot To CT–403. S/O EMT Perez managed to catch up with the Four
Butler Private Ambulance Crew Members at the door of CT–403 (due to his stature Mr. Haskey
required the Bariatric unit). The resident returning, a Mr. Robert Haskey was reportedly discharged
from Holy Cross that night. S/O EMT Perez unsecured the door to let the Butler Associates into the
apartment to place the resident in his bed. While Butler was in the process of unloading Mr. Haskey
S/O EMT Perez announced his presence and proceeded into the room where Mrs. Mary Haskey ...
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Haskey was very upset by this, she was under the impression that Mr. Haskey was going to Arbor
Ridge for rehabilitation. Mr. Haskey retorted by saying "Arbor ridge was full so they are putting me
here". Mr. Haskey was very adamant of this and insisted in being put in his own bed. Mrs. Haskey
was very distressed by this and stated "I can't take care of you, I'm not a nurse and I don't know how
to help you and if you fall I cannot possibly lift you up". While on the way out S/O EMT Perez was
very unsure about the situation at hand and stated to Mrs. Haskey that he would immediately report
this to his supervisor. After S/O EMT Perez cleared he talked to his supervisor S/S EMT Salamy
about the situation and eventually found out after following up with the Arbor Ridge Nursing staff
that Mr. Haskey had a room ready for him and that the staff were waiting for his arrival. After
receiving this news S/O EMT Perez, S/O EMT Ayesu and S/S Salamy reported back up to CT–403
and S/S Salamy explained the situation to Mrs. Haskey and apologized for the mis–communication
error that had happened at some point during the return process. S/O EMT Ayesu and S/S EMT
Salamy escorted Mr. Haskey to his room at Oak Grove 3205 and with the help of S/O EMT Perez
and the nursing staff placed MR. Haskey in his

Bupivacaine Research Paper
Levobupivacaine is the S(−)–enantiomer of racemic bupivacaine; it has less cardiotoxicity compared
with bupivacaine,1, 2 and its pharmacology and duration of anesthesia are similar to those of
bupivacaine.2
Numerous studies have been conducted on the use of local anesthetic agents with adjuvants such as
clonidine (a partial α2–adrenoreceptor agonist) and tramadol3, 4 for a brachial plexus block to
improve the quality and duration of anesthesia, and these studies have shown that the adjuvants may
prolong anesthesia and analgesia. Moreover, dexmedetomidine is a α2–receptor agonist that has
more selectivity than clonidine and has analgesic and sedative properties.5, 6 Although several
studies have described the effects of dexmedetomidine on neuroaxial and peripheral nerve blocks,7,
8, 9 to date, there is only 1 study available, performed by Esmaoglu et al,10 on the effect of adding
dexmedetomidine to levobupivacaine for an axillary brachial plexus block. In view of the idea that
decreasing the dose of dexmedetomidine may help to reduce side effects such as bradycardia and
hypotension, we wanted to evaluate the effect of dexmedetomidine at a lower dose than that used in
their study and the results. We think that more studies on this issue are needed. ... Show more
content on Helpwriting.net ...
The primary outcome of our study was the duration of sensory block, and the secondary outcome
was postoperative analgesia. We hypothesized that adding dexmedetomidine will prolong the
duration of anesthesia and analgesia with a shorter onset

Blood Pressure Procedure
Getting your blood pressure taken is the first thing that nurses do when giving a check up to their
patients. When getting blood pressure checked the nurses put the arm ring, which goes around the
arm of the patient, is very uncomfortable and bulky. I have thought of a way that uses newer
technology. The supplies I will be using would be the blood pressure monitor and a piece of the heat
monitor. The piece of the heart monitor I would be using is the clamp that goes on the patient's
finger. The reason I am going to use this is because it is, seems to be, the more efficient way to make
the blood pressure monitor less uncomfortable and bulky as I had stated earlier. Sense I'm not using
the clamp for the heart monitor to check the heart I need to enhance the clamper. The way I would
enhance the clamper would be to make the sensor a little more sensitive to the blood flow going
through the arteries. Instead of the blood pressure monitor going around the patients arm it would
clamp on top the finger. In order to get the proper measurement, ... Show more content on
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Like I stated in the paragraph before this one, one would also try to take medicines to try and get the
blood pressure back on a stable level. The list of medicines that might work are above. Some foods
that can help get high blood pressure back to normal are: peas, baked potatoes, celery, green beans,
papaya fruit, oatmeal, guava, yogurt, tomatoes, kiwis, blueberries, spinach, avocados, cantaloupe,
prunes, carrots, dandelion, salmon, skim milk, watermelon, raisins, spices, beans, dark chocolate,
beets, bananas, nuts, and oranges. The tree worst things that can rise blood pressure are: fast food,
alcohol, and

Sciatic Nerve Lab Report
In FSNB group sciatic nerve is blocked first. The operator stand on the side that is to be blocked,
facing the patient with the ultrasound machine across the other side of the patient.The patient was
put in the supine position, the hip was abducted, externally rotated, and the knee flexed then
exposure of the calf and foot. With the patient in the proper position for blocking sciatic nerve by
anterior approach, the doppler curved probe (SonoScape®, SSI–6000, China) was placed 10 cm
distal to the inguinal crease so as to identify the sciatic nerve. After standard skin preparation,
subcutaneous anesthesia was done at the puncture site with lidocaine 1% 1 ml. A 22–gauge, 150–
mm insulated b–bevel needle (Stimuplex; B–Braun, Boulogne–Billancourt, France) connected to the
nerve stimulator was inserted and directed posteriorly and laterally with a 10°–15° angle relative to
the vertical plane. At a depth of 5 cm, the nerve stimulator was set to deliver a current of 5.0 mA.
Within a depth of 10–15 cm, the sciatic nerve was identified via stimulation and muscular responses
of one of its two components: plantar flexion or inversion of the foot for the tibial nerve (TN) and
dorsiflexion or eversion of the foot for the common peroneal nerve (CPN).If no muscular response
was obtained at a depth of 15 cm or if the needle ... Show more content on Helpwriting.net ...
At that time, the stimulator was switched off. After a negative aspiration test, 20 ml of bupivacaine
0.25% and 10 ml of 1% lidocaine was injected, the nerve needle tip preferably inferiorly to the
nerve so that the local anesthetics elevated the nerve and separated it from the artery rather than
pushed it

Answer Key Essay
International Classification of Diseases Tenth Revision Procedure Coding System (ICD–10–PCS)
An Applied Approach 2013 Update for use with 2012 Edition Revisions and Exercise Answer Key
Lynn M. Kuehn, MS, RHIA, CCS–P, FAHIMA Therese M. Jorwic, MPH, RHIA, CCS, CCS–P,
FAHIMA ICD–10–PCS Flashcards The first step in mastering ICD–10–PCS is to become familiar
with the terminology, structure and format of this new code set. In addition to the Flash Card
software program found on the CD–ROM in the back of the text, AHIMA also offers a deck of ICD–
10–PCS flashcards. These high quality flashcards will help you to learn all of the definitions. The
full–color flashcards define the 31 Medical and Surgical Root Operations and the ... Show more
The last sentence now reads "Example: In the Lower Joints body system, the device value 3 in the
root operation Insertion specifies Infusion Device and the device value 3 in the root operation
Replacement specifies Ceramic Synthetic Substitute." Coding Guideline B3.1b on page 35 updated.
The Guideline now reads: "Components of a procedure specified in the root operation definition and
explanation are not coded separately. Procedural steps necessary to reach the operative site and close
the operative site, including anastomosis of a tubular body part, are also not coded separately." Also
in this Guideline there is a sentence added to the Example that reads: "In a resection of sigmoid
colon with anastomosis of descending colon to rectum, the anastomosis is not coded separately."
New Coding Guideline B4.8 to be added on page 46 On page 56 in Operative Report #2 in the
Description of Operative Technique in the 9th line, change the sentence to read: "A portion of the
skin of the plantar aspect of the foot

Advantages And Disadvantages Of Bupivacaine
LOCAL ANAESTHETICS BUPIVACAINE Figure 10 Bupivacaine is an amide linked local
anaesthetic .Bupivacaine has a relatively slow onset of action (approximately 30 min) but a
prolonged duration of action. These features are related to its physicochemical characteristics
particularly its pKa value and extensive protein binding. Its main advantage compared to lidocaine
and prilocaine is its prolonged duration of action, and it is commonly used to produce infiltration
and conduction anaesthesia. In addition, it is the standard drug that is used to produce extradural
lumbar and thoracic blockade and to produce spinal subarachnoid anaesthesia. The main
disadvantage of bupivacaine is its ability to cause significant cardiotoxicity, ... Show more content
The management of local anaesthetic toxicity can be challenging, and in the case of cardiac toxicity,
prolonged resuscitation efforts may be necessary. Therefore, understanding the circumstances that
can lead to systemic toxicity of local anaesthetics and being prepared for treatment is essential to
optimize the patient outcome. Systemic toxicity is typically manifested as central nervous system
(CNS) toxicity (tinnitus, disorientation, and ultimately, seizures) or cardiovascular toxicity
(hypotension, dysrhythmias, and cardiac arrest). The dose capable of causing CNS symptoms is
typically lower than the dose and concentration that result in cardiovascular toxicity. This is because
the CNS is more susceptible to local anaesthetic toxicity than the cardiovascular system. However,
bupivacaine toxicity may not adhere to this sequence, and cardiac toxicity may precede the
neurologic symptoms. Although less common, cardiovascular toxicity is more serious and more
difficult to treat than CNS

Peripheral Nerve Complications
The incidence of hoarseness was 11% after PACU discharge and lasted a mean of 2 days. The
etiology of these symptoms was not formally established. It is possible that symptoms were due to
prolonged block of the phrenic and recurrent laryngeal nerves. (Liu et al, 2010). Borgeat et al 2001,
in a prospective study of ISB using a nerve stimulator concluded that one patient with Marfan
disease (0.2%) suffered pneumothorax. 0.2%of cases had episode of central nervous system toxicity
in the form of incoherent speech. Aspiration of blood was encountered in 0.5%of patients but no
hematoma was subsequently observed. Nerve injury after brachial plexus anesthesia varied from 0
to more than 5%. (Borgeat et al, 2001). Peripheral nerve complications are generally directly
attributed to the performance of the block itself, but this concept was challenged by Selander et al
1979, who indicated that other factors may be responsible as well. (Selander et al, 1979). In 1974
Ward reported an incidence of 3% of symptomatic pneumothorax after ISB by paraesthesia blind
technique. The pneumothorax was almost certainly produced by the prior attempt to carry out a
supraclavicular block, as it is difficult to imagine the apex of the lung reaching as high as C6, the
level of an ... Show more content on Helpwriting.net ...
Horner's syndrome, of which the patient is usually unaware, occurs in up to 75% of interscalene
blocks. Case reports of more significant complications have included cardiac arrest (Edde &
Deutsch, 1977), spinal anaesthesia (Ross & Scarborough, 1973), epidural anaesthesia (Scammell,
1979) and permanent nerve damage (Barutell et al., 1980). In the first and last of these reports
needle lengths of 6 cm and 8 cm respectively were

Single Injection Technique Essay
Landmark techniques of axillary brachial plexus block: Perivascular "Single–Injection" Technique
The patient lies supine, the arm was abducted about 90° and the elbow is flexed about 90° and
externally rotated. The axillary artery, which is usually palpated readily, acts as a landmark. The
coracobrachialis muscle runs cranial to the axillary artery. The palpating fingers find the gap
between the axillary artery and coracobrachialis somewhat distal to the axillary crease (Fig. 22). The
injection site is located where the lateral edge of pectoralis major crosses the axillary artery. The
needle used for the block is 22G, 5–6 cm long short bevel for optimal identification of the
neurovascular sheath. Following sterilization, intracutaneous local ... Show more content on
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However, undetected venous puncture may occur if the venous lumen collapses during aspiration.
Intra–arterial injection causes sudden hand paleness and paresthesia, which may stay few minutes.
Seizures, loss of consciousness, and cardiac arrest are the results of intravascular infusion of a large
LA dosage. Frequent needle aspiration during a slow injection is a must. Afterward arterial puncture,
haematoma might happen. A firm steady pressure must be applied over the puncture point for 5–10
min if the artery has been punctured. Symptoms of LA overdose show after 5–10 min of injection in
contrast to the accidental intravascular injection, in which symptomatic appear during or
immediately after the unintentional injection. The ordinary clinical picture is: dizziness,
lightheadness, circum–oral paraesthesie, tunnel vision, brady– alternately tachycardia, anxiousness
which in the end progress to loss of consciousness and seizures. Immediately oxygen should be
supplied, a sedative/hypnotic administered, and airway supported if necessary. (Koscielniak–
Nielsen,

Gibbs Model Of Reflective Report
The topic I'm choosing to discuss for this clinical skills assignment is the manual
sphygmomanometer or also known as the manual blood pressure. All nursing students are required
to have the ability to carry out the clinical or practical skill safely (Nursing and Midwifery Council
2008). The reflective model I will be using for this reflection on this skill is the Gibbs' Model of
Reflection (1988) which consists of five elements. They are the descriptions, feelings, evaluation,
analysis, conclusion and an action plan. The reason why I chose this skill of all other clinical skills
is because this blood pressure taking skills is a procedure that is almost every day are carry out. I
could see that there are different tips on how to perform the blood pressure taking skills during
observing ... Show more content on Helpwriting.net ...
Washing my hands before performing the skills encourages good practice (WHO 2002). Evidence
has shown that the cross infection between patients has decrease with the introduction of the
campaign on washing your hands (NSPA 2008) Gaining consent from the patient before performing
the skills is part of the nursing and midwifery code (2008). I must gain permission from a patient
before performing any clinical procedure and the patient have their rights to reject or disapprove the
treatment or care given by me. I as a nurse must respect any decision made by the patient. The aim
of gaining permission or consent is to help the patient to understand the procedure that is being
carried out. I have to make sure that the patient does not have any restrictive clothing on the arms
and the arm must be placed on a flat surface. An evidence shows that when blood pressure taken
with the arm hanging or suspending, the blood pressure can be 10–12 mmHg higher compare to
when taken in flat surface (Mallett & Dougherty

The Importance Of Observation On Human Development
1. Observation: A 53–year male who has spent frequent amount of time working in a warehouse
which requires a lot of lifting of heavy objects and seems to have strained his lower back and is
having weakness in his right leg. In addition, the patient has a weak patellar reflex in his right leg
and a normal patellar reflex in his left leg. However, his calcaneal reflex response for both legs was
normal.
2. Question: Does this man have a herniated disk in the lumbar region of his spine and if so which
lumbar is herniated and how is affecting the functioning of his legs and what we can to fix that.
3. Hypothesis: Based on his age, the strenuous lifting that he does in his job, I suspect that he has
herniated Nucleus Pulposus from either L2 to L4. The compression of the dorsal divisions of the
ventral rami of his lumbar spine is causing his femoral nerve to not properly work on his right leg.
4. Prediction: I predict that he has a herniated lumbar disk on L3 or L4 caused by improper lifting
and due to his increased age, which has made his bones more brittle. Consequently, I predict he will
experience some weakness in his right leg, when he is standing or trying to lift something.
Consequently, he will experience pain since the dorsal horn compressed along with the ventral
horned being compressed.
5. Test: The tests we perform is an MRI of his lumbar spine, and I also want to test his skin
sensations via a prick test on his leg to see if the dorsal root ganglia of his L3 or L4 is damaged,
since right now it just appears that his ventral root of his L3 or L4 is damaged since he has a muscle
weakness suggesting that the right ventral horn is being compressed by the right lumber vertebrae
body.
6. Conclusion: Yes, he has a herniated disk on L3 which was confirmed by the MRI showed that he
had a herniated nucleus pulposus of the L3 disc and he had some mild sensation loss in his right leg.
A herniated disk is a disk that has slipped or ruptured. Herniated discs are more common as one gets
older since the bones become more brittle overtime prone to rupture under stress such as heavy
lifting. Consequently, our patient is 53 is and due to his age, he did rupture his L3 disc due to
improper lifting. The muscles

The Three Trunks Of The Plexus
Rick Winstead
Steve Hammons
PTA 150
2/13/15
Brachial Plexus At first glance, the brachial plexus may be a bit intimidating. The nerves arising
from it and the muscles of the trunk and upper extremity of which it innervates may seem
overwhelming, but as one begins the process of adding all of the components together in an orderly
fashion, it begins to be seen in a much more easily understood manner. The first step in this process
is to gain a grasp on the basic main structure of the plexus, and then gradually build on that
foundation. The basic organization is split into five areas. These are the roots, trunks, divisions,
cords, and terminal branches. The five roots originate from spinal nerves C5, C6, C7, C8, and T1. It
is important to remember that these five areas contain both motor and sensory components. Next are
the three trunks of the plexus. The roots of C5 and C6 combine to form the upper trunk, C7
continues on its own to form the middle trunk, and the lower trunk is formed by C8 and T1. Each
trunk then divides into an anterior and posterior division. The divisions then combine to form cords.
The anterior divisions of the upper and middle trunk combine to form the lateral cord, the anterior
division of the lower trunk forms the medial cord, and all three posterior divisions combine to make
the posterior cord. Finally, the cords give way to the terminal branches of the brachial plexus. The
lateral cord splits and becomes the musculocutaneous nerve, and a

Martin-Gruber Anastomosis
ur in the forearm region. It is composed in crosses of axons which may produce changes in the
innervations of the upper limb muscles, mainly motor part of intrinsic muscles in the hand
(MANNERFELT, 1966; KIMURA, MURPHY and VARDA, 1976). Anastomosis in which the
branch anastomotic originates proximally in the median nerve and unites distally in the ulnar nerve
is known as Median–
Ulnar anastomosis type or Martin–Gruber anastomosis.
Martin, a Swedish anatomist, in 1763 was the first one to consider the possibility of connection
between the fascicles of the median and ulnar nerves in the forearm (MARTIN,
1763). In the following century, in 1870, Gruber dissected
250 forearms and found 38 connections (GRUBER, 1870)
(15.2%), thenceforth, anastomosis ... Show more content on Helpwriting.net ...
It can arise between the branches destined to the deep flexor muscle of the fingers, or directly in the
median to the ulnar nerve, or between the anterior interosseous and ulnar nerves or in combinations
between these types of anastomoses
(NAKASHIMA, 1993).
However, another type of anastomosis can happen in the forearm. When the anastomotic branch
originates proximally in ulnar nerve and unites distally to median nerve is simply called anastomosis
of Median–Ulnar type, or Martin–Gruber reverse anastomosis or Marinacci anastomosis. Marinacci
in
1964 made a case report of a patient who traumatized the medium nerve in forearm, but still had
preservation of the median nerve innervations in the hand muscles, although had denervation of the
flexor muscles in forearm (MARINACCI,
1964). The Marinacci anastomosis is infrequently notified.
In some studies this type of anastomosis had not been found, being considered for many authors as
anatomical anomaly.
The occurrence of the Martin–Gruber or Marinacci anastomoses can be understand by the fact that
the median and ulnar nerves were developed from a similar embryonic region (ALMEIDA, VITTI
and GARBINO,
1999). In addition, there are studies with high incidence

The Trapezius Muscle Essay
The trapezius muscle:
– Origin: it has an extensive origin from the base of the skull to the upper lumbar vertebrae.
– Insertion: it inserts on the lateral aspect of the clavicle, acromion, and scapular spine.
– Nerve supply: It is innervated by the spinal accessory nerve.
– Action: It functions mainly as a scapular retractor and elevator of the lateral angle of the
scapula[19].
The rhomboids muscles:
The rhomboids, consisting of the major and minor muscles.
– Origin: the major and minor muscles originate from the spinous processes of C7 and T1 and T2 to
T5, respectively.
– Insertion: They insert on the medial aspect of the scapula.
– Nerve supply: The dorsal scapular nerve innervates the rhomboids.
– Action: and retract and elevate the scapula. [19]
The levator scapulae muscle:
– Origin: originates on the transverse processes of the cervical spine.
– Insertion: inserts on the superior angle of the scapula.
– Nerve supply: Innervation is from the third and fourth cervical spinal nerves.
– Action: The levator scapule elevates the superior angle, resulting in upward and medial rotation of
the scapular body[19].
The serratus anterior muscle:
– Origin: it takes origin from the bodies of the first nine ribs and the anterolateral aspect of the
thorax
– Insertion: it inserts through three portions from the superior to the inferior angle of the scapula.
– Nerve supply: Innervation is by the long thoracic nerve, and nerve injuries here often manifest as a
winged scapula.
–

Common Birth Injury Research Paper
Exploring Common Causes of Birth Injuries After nine months of pregnancy, countless hours of
labor, parents expect to be handed a healthy, screaming newborn. Sadly, more than 25,000 American
children are born each year with a birth injury of some type. It can be a frightening and confusing
time if a baby is born with an injury. Parents may struggle with understanding what caused their
child's injury, so read on to learn about common birth injuries and their causes. What Exactly Is A
Birth Injury? A birth injury is defined as a trauma, such as broken bones, abrasions or other injuries
that a baby suffers during labor and delivery. Not to be confused with a genetic condition, birth
injuries are created by outside forces such as forceps, being ... Show more content on
Helpwriting.net ...
The most common fracture is to the clavicle while the doctor is attempting to adjust the baby into
the correct position to ease their birth. Shoulder and arm fractures may also occur if the newborn is
treated roughly by the staff during delivery. Caput Succedaneum – Another injury caused by a
difficult birth, Caput Succedaneum is what happens when too much pressure is put on the baby
during the birthing process. Parents may observe what appears to be bruising and swelling on their
child's head. This is not a life threatening problem and should heal on it's own. Brachial plexus
injury – Brachial plexus injury is a nerve condition that affects the shoulders, arms and hand. It is
caused by a complicated labor and delivery. If the child has turned into the breech position, the labor
becomes harder and the chances of nerves being damaged increases. Perinatal Asphyxia – This
injury happens when a baby does not get enough air during delivery. It can be caused by the mother
being sedated and the baby is born too early, fractures, or the equipment used by the doctor to
remove a child who is stuck in the birth canal or is in the breech

Essay about Lab Report: Blood Pressure
Variables Affecting Human Arterial Pressure and Pulse Rate
BIOL–204
Introduction:
The woozy feeling when standing up too quickly. After going for a run, feeling as if one more beat
and the heart would project itself out of the chest. Or quite the opposite and being in a very relaxed
state. These are all changes one experiences at some time or another. What causes the different
feelings and how each variable affects pulse rate and blood pressure has many wondering. Because
of this curiosity, an experiment was performed to get some answers. The purpose of the experiment
is to see how different variables affect pulse rate and blood pressure. Before starting the experiment,
self educating ... Show more content on Helpwriting.net ...
It is hypothesized that while doing this, the subject arterial pressure and pulse rate will increase.
This is to be thought because while the subject is spelling the words the mind will be under a lot of
stress therefore causing acts of anxiety or nervousness to arise, making the heart beat faster than
normal.
Procedure:
"For procedures, refer to Lab 6, Activity 2, in the Anatomy and Physiology Lab Manual."
Results: (See Below)
Exercise
Baseline
Immediate
1 Minute
2 Minutes
3 Minutes
Well Conditioned Subject
BP:188/70 mmHg
HR: 61 BPM
BP: 162/62 mmHg
HR: 76 BPM
BP: 138/70 mmHg
HR: 74 BPM

BP:132/68
mmHg
HR:72 BPM
BP: 130/64 mmHg HR:70 BPM
Poorly Conditioned Subject
BP: 122/44 mmHg HR: 60 BPM
BP: 134/65 mmHg
HR: 76 BPM
BP: 128/50 mmHg HR: 64
Discussion/Conclusion: To start off the experiment, a baseline was needed in order to be able to
compare the different variables through out the experiment. The subject was instructed to sit and
relax quietly while the blood pressure cuff and pulse plethysmograph were placed properly. After the
blood pressure was taken and analyzed, it was found that the subject's blood pressure was 122/64
mm Hg and a pulse rate of 60 bpm. Now that the baseline was obtained, continuing with the
changing variables could take place. Starting with the variable of postural changes, the subject first
reclined for three minutes. After the two minutes, the

The 2000 Meter Row Case Study
The 2000–Meter Row: A Case in Homeostasis
Adapted from the National Center for Case Study Teaching in Science* by Nathan Strong
At the start 1. Recall that Jim's heart and respiratory rate are increased, he was sweating and that his
mouth was dry before the raise began. Explain what is happening to his autonomic nervous system
(including which division is the most active) and specify exactly how those ANS responses are
creating the symptoms noted. What changes do you think are occurring in the digestive and urinary
systems at this time? (8 points)
In his autonomic nervous system, the sympathetic division was the most active before and during
the race because it is what prepares your body for extra somatic activity. It activated ... Show more
Now, pick one of those muscles and trace their control from the appropriate brain structure all the
way to the NMJ. Be sure to include all intermediate structures, synapses, plexuses and nerves.
(8 points)
Movement of the deltoid begins in the cerebrum of the brain, but more specifically: in the frontal
lobe, the premotor cortex is relaying instructions to the primary motor cortex. The primary motor
cortex contains the upper motor neurons whose axons will travel down the pyramids of the medulla
oblongata and synapse on lower motor neurons in the anterior gray horns of spinal cord segments
C5–C6. From there, the ventral rami of spinal nerves C5–C6 form the superior trunk of the brachial
plexus, which splits into two divisions. We will follow the posterior division that supplies to
extensor muscles. This posterior division then runs into the posterior cord from which the axillary
nerve is derived. The axillary nerve's motor end innervates the deltoid through its neuromuscular
junction.
4. Rowing full speed is putting maximum demands on Jim's muscles. What metabolic process is
providing most of the energy for Jim's muscles at this point and why do Jim's muscles feel like they
are burning? (5 points)
As Jim's muscles are at maximum demand, his mitochondria are unable to produce the needed ATP
through aerobic respiration because oxygen is unable to diffuse fast enough into his muscle fibers.
At this time anaerobic

Male Ap + Tg Sprague Dawley
Methods Materials Male AP+ Tg Sprague–Dawley (SD) rats weighing 350–450 g will be used in
this study. There will be a total of 40 rats which will be divided into four groups with ten in each
group. Adult DRG from C1 to L1 will be dissected from rats ≥ 8 weeks of age using standard
techniques. Operative Techniques DRG isolation, plating, and axon elongation: Adult DRG from C1
to L1 will be dissected from SD rats ≥ 8 weeks of age using standard techniques.14,32,33 Dissected
DRGs are treated in 0.25% collagenase–P (Boehringer Mannheim) in Neurobasal media
(Invitrogen) for 1.5 hours followed by a treatment in 0.25% trypsin in cell dissociation buffer for an
additional 1.5 hours. After trypsin inhibition, the pellet will be resuspended in complete medium and
mechanically separated using a fire polished pasture pipet until the DRGs are completely
dissociated. The DRG cells will be plated along the elongation interface and maintained in complete
growth medium consisting of Neurobasal Media supplemented with B27 (Invitrogen), 1% FBS
(Hyclone) and 1mM L–Glutamine (Invitrogen), 2.5g/L glucose, and 10μg/mL 2.5S nerve growth
factor (Becton Dickinson). After cells attach, DRG cultures will be immediately treated with mitotic
inhibitor cocktails consisting of 5 μM cytosine arabinoside, 20 μM 5–fluoro–2'–deoxyuridine and 20
μM uridine. Five days after plating, the axon fascicles spanning the two overlapping membranes
will be elongated. Stretch–induced axon elongation is controlled by

Brachial Plexus Injury Research Paper
Throughout the sports world today, injuries a very common. An injury is "as any significant
condition limiting function that caused an athlete to seek medical care by a trainer or physician,
caused a practice or match to be discontinued, and resulted in lost time from athletic participation
for 1 or more days" (Pasque). It is not uncommon to hear of a player pulling a muscle, tearing their
ACL, getting a concussion, etc. Certain sports have a higher probability of getting certain injuries
than others. For example, in football, wrestling and hockey, "injury to the brachial plexus, or
brachial plexopathy, is one of the most common upper extremity injuries" (Kuzman). Football and
wrestling are two high impact sports that have high risk for both ... Show more content on
Helpwriting.net ...
There is a reason these are more common in contact sports other than non–contact sports. Some of
"the most common injury mechanisms were tackling, running, being tackled, twisting, turning,
jumping and landing" (Wong). Each of these movements are exactly what football players and
wrestlers have to do. Football players are all the time getting hit from behind or even hit from the
side knocking them unconscious. Most of the time the "lower extremities are often injured during
tackling as players cannot respond quickly enough to avoid such rapid and unpredictable
movements (Wong). Also the age range and gender does not play a factor. It would be more
common in males in a way just because football and wrestling are a more male dominant sport.
Rules for the sports are changing to try and prevent/decrease the amount of injuries in both sports.
Studies have shown since the rules have changed the injuries have gone down but are still

Reflection On Clinical Skills Activities Essay
Introduction The last week of classes for NURS1005 were a series of clinical skills activities. These
activities refreshed the student's minds on what they will be doing on placement and how to do it.
We got assessed on three clinical skills; taking and recording vital signs, blood glucose levels and
doing a urine analysis. I've chosen to reflect on taking vital signs and how I performed them.
Reflection is a very important part of learning from experiences which is essential in nursing.
Nursing practises continue to change and it is easier to go with and to add to that change if you are
reflecting on your practise. This essentially makes nursing practises better for the patients. I have
reflected on the process of how I took the vital signs during my clinical skills activities. I was very
nervous but believe I performed them well due to how I was taught, what I have read and seen and
the vital signs signified how my peer was acting which was healthy and within a normal range. Even
though I felt I did them well, there were improvements that could and have happened since. Most of
the improvements are minor in comparison to the strengths I have but it is important to recognise
improvements when needed so you are giving the best and accurate care. I was aware of these
improvements needed and tried to strengthen them during my clinical placement which helped me
learn different ways of doing processes and also the rationale behind the processes. Value of
personal reflection in

A Research Lab On Nervous Tissue
Discussion
Literature review In the year of 2007, our Neurosurgery Research Laboratory experimented a
nervous tissue interface consisted of stretch–grown nervous tissue which enabled us to detect and
record real–time efferent signals conducted down the nerve and stimulate afferent sensory
signaling.32 This bi–directional signaling system was composed of a stretch–grown nervous tissue
construct coupled to an electronic interface at one end (Fig. 4). To engineer this unique living and
functional nervous tissue in vitro, we utilized bundles of axons spanning two populations of
neuronal somata (Fig. 5).34 This technique allowed us to produce nerve tracts consisting of up to
106 axons grown at rates of at least 10 mm/day and reaching a remarkable 10 cm in length while
maintaining normal structure as well as function (Figs 5 and 6).37 Most importantly, these
manipulated neuron populations still retained the remarkable ability to generate axon potentials that
could propagate across the stretch–grown axons.31 These neuron constructs were then determined to
be capable of surviving long term as well as maintain their geometry after transplantation in both the
spinal cord18 and peripheral nerve lesions in animal models.13
Using the same techniques, we continued to explore a clinically relevant source of neurons that
could be engineered into transplantable nervous tissue constructs–human DRG neurons.15 Two
primary sources were sought out: (1) DRG neurons harvested from patients

Intussusception Case Study
Intussusception Intussusception is one of the surgical emergencies that occurs in childhood.
"Intussusception occurs when one segment of bowel telescopes into another adjacent segment,
causing obstruction" (Nelson & Hostetler, 2002). This form of obstruction can occur at any point in
the gastrointestinal tract, the most common location is at the ileocolic. The blockage cause the blood
supply interruption to the colon that cause ischemia to bowel. Intussusception also cause heavy
bleeding and perforation which heightens the risk for infection, shock, and dehydration. It is most
commonly presents in children under 2 years old. Male are more susceptible to have intussusception
than females, in fact the ratio is 4 to 1. "From 2000 through 2009, the 26 states included in the
analysis reported a total of 10 836 intussusception ... Show more content on Helpwriting.net ...
"Initial screening abdominal radiographs are indicated to evaluate patients for signs of obstruction,
perforation, masses, or findings suggestive of intussusception" (Nelson & Hostetler, 2002). But
radiologic x–ray are sometimes nonspecific, so ultrasonography is the imaging modality most
commonly used to diagnose intussusception. This study is noninvasive and very quick and it can
also use to identify alternative causes of symptoms other than intussusception. One study performed
by Usang, Inah, Inyang, and Ekabua (2013), showed that the ultrasound was highly accurate in the
diagnosis of intussusception with an experienced tech and its sensitivity was around 87%. One of
the major advantage of using ultrasound is the reduced risk of radiation exposure from Computer
tomography or x–rays. Contrast enemas have been traditionally used in Intussusception for both
diagnostic and therapeutic treatment, one adverse result is the risk of

Erb 's Palsy : A Form Of Brachial Plexus Palsy
Erb's Palsy
Amanda Metrikin
5/11/16
Pediatrics
Erb's palsy is a form of brachial plexus palsy. Brachial plexus palsy occurs when nerves in the
brachial plexus get damaged and signals cannot travel in their normal pattern from the brain to the
arm muscles. This causes paralysis (palsy) or weakness in the arm (brachial) region, as well as
atrophy of the deltoid, biceps, and brachialis muscles. About two out of every 1,000 babies have this
condition and it often occurs during birth when the infant's neck is stretched during a difficult
delivery. Common risk factors of Erb's palsy include use of forceps or a vacuum during delivery,
large infant size, small maternal size or excessive maternal weight gain, a large infant, breech birth,
or prolonged labor. Recovery of movement and feeling in the arm can reoccur with daily physical
and occupational therapy, as well as an active role by the parents to help maintain maximum
function (Erb's Palsy Ortho Info).
The brachial plexus is made up of five large nerves, which come out of the spinal cord between the
vertebrae and give movement and feeling to the arm. After coming out of the neck, the nerves come
together and then divide amongst the muscles and tissues of the arm. The area of the brachial plexus
runs from the neck and passes under the collarbone and is the major area of the nerves of the armpit.
When the upper nerves are affected, this is known as Erb's palsy. The infant may not be able

Golfer with Brachial Neuritis Misdiagnosed Essay
During Dr. Wallace's clinic, one of the golf girls came into the Athletic Training Room complaining
of right shoulder pain. Dr.Wallace first began the evaluation by asking if she remembered how she
hurt her shoulder. The golfer said she had been at home during winter break and was wearing socks
in the house. She said she was running and fell and when she was falling, she attempted to catch
herself by using a nearby wall. Dr. Wallace then checked her strength by asking her to abduct her
shoulders as far as she could. He then added resistance and noticed weakness in her right shoulder.
He tested the ligaments and told her they were all intact. He also asked her if she had been
experiencing any numbness, tingling, etc. since she fell and she ... Show more content on
Helpwriting.net ...
She still had some loss in her sensory neurons, but they showed some slight improvement from the
initial evaluation. A follow–up MRI also showed a "...decrease in the brachial plexus thickening and
hyperintensity." (Gazioglu) The patient in this case study experienced rare symptoms. Patients who
are usually diagnosed with brachial neuritis have severe pain in the shoulder and some even have
localized pain. Only a small number of patients have pain that subsides to the fingers of the affected
side. This case study supports the signs and symptoms along with the treatment that our team doctor
prescribed. When I asked him about the situation, he said that he asked her if she had the flu recently
because sometimes the brachial plexus can give off flu like symptoms such as a fever, fatigue,
cough, and runny nose. He said this condition is called brachial neuritis. He said the majority of the
time it affects one side of the shoulder and that's why he asked the golfer is she had any of the
symptoms or the flu during the break. He said that the muscles become weak and in some cases,
paralyzed. For treatment, Dr. Wallace said he prescribes pain relievers so it won't bother the patient
as much. He said in severe cases, the patient will undergo surgery and then see a physical therapist
to help regain strength in the shoulder. When I asked if he thought the golfer had had brachial
neuritis he said most likely no since

Present Data Collected Before and After a Standard Period...
Pulse rate before the exercise.
1st attempt 2nd attempt 3rd attempt
69 77 80
After the exercise:
115 110 108
The pulse rate increases each time due to the acknowledgment of the pulse and I therefore was able
to get more accurate results.
Breathing rate before the exercise:
28 24 19
After the exercise:
45 39 31
Before the exercise the breathing decreased when I was counting how many breaths I can take in a
minute. However whilst breathing, my breathing rate was not normal but it was essential for me to
keep the results reliable.
Temperature before the exercise:
1st attempt 2nd attempt 3rd ... Show more content on Helpwriting.net ...
After the exercise, we then took the measurements of our pulse, breathing rate and temperature too
to see the change. Once we had completed this the first time, we then did it 2 other times, so in total
3 time so that the data was reliable and trustworthy. (Stretch, B., & Whitehouse, M. (2007).
Also as none of us had any allergies, we therefore had no need to take any medication whilst the

exercise was taking place. Before the exercise had taken place me and my partner were both calm
and relaxed, however one the exercise had been undertaken we then started to breathe very heavily
and also consumed a full water bottle due to dehydration.
The pulse can be taken on two pressure points. One on the neck this is called carotid artery however
it is sometimes quiet hard to find, so people measure from the wrist, the Radial artery, with two
fingers as the thumb as a pulse but is uneven and can affect accuracy. The average heart rate for 15–
20 year olds is 122–163 bmp. Exercise causes the blood to pump faster, making our intake for
oxygen more and temperature rise, which creates sweat.
The results of my pulse rate, breathing rate and temperature before and after the exercise are down
below.
Pulse rate before the exercise.
After the exercise:
36.9 36.9 36.9
The temperature was relatively constant before and after the exercise.
Bar charts for the results
Key=
Series 1=

5 Types of Physical Therapy
Physical Therapy There are different types of therapies, but the 5 types of therapies that I have
chosen are as follows: Sport therapy Impotency: New Therapy Chest physical therapy Burner
syndrome Osteoarthritis of the Knee Sport therapy: Today in sports athletes bear many mental and
physical obstructions from there competitive environment. Negative belief and psychological
pressure from spirited moments; create many interruptions for athletes who do not focus mental
pictures in their minds. A bright picture is one that allows individuals to see stress and negative
belief as a challenge, rather than an intimidation. Psychologists assist athletes in coping with many
obstructions that might occur, so that when they get in a pressured predicament, they can react
rapidly to the situation. Psychological pressure has a main effect on athletes' performance and
individual aptitude, rather than the physical state. Psychologist tries to set high principles for
athletes to uphold poise and discipline. Athletes must make forgoes, in which they have to follow
steps in order to complete these tasks: first, relax, and let your mind put back all the negative
feelings with positive ones. Secondly, gain knowledge from mistakes and make adjustments. To
achieve last physical performance it is essential for one's mind and body work in tandem. The mind
is a message center that permits the body to achieve whatsoever it wants. Coaches and psychologists
believe your mind concludes, how fast,

Hospital Birth Defects
Birth Defects Associated With Out–Of–Hospital Births
At a point in history, Homebirths and Midwives were prevalent when delivering. However; the use
of these two methods plateaued as many people were concerned with the health of the infants and
the mothers. The ultimate goal of delivery is the safety and protection of both the mother and the
child. For a time, and still to this day, women turned to hospitals to ensure that safety. However, as a
new wave of feminism has empowered mothers to take control of the natural birthing process, more
and more women are reverting back to the home birth method. Though homebirth goes smoothly for
most mothers, there is always the potential for complications that many mothers are not prepared to
handle. ... Show more content on Helpwriting.net ...
However, the best choice should be the one that achieves the ultimate goal of the safe delivery. The
statistics hold the records and can be paramount for a mother who wants to make the decision. The
figures indicate that birth at home is risky when compared to birth in the hospital mostly where there
are a delivery complications, and emergency services are needed. According to the Federal birth
registers, out of a thousand babies born at home, 3.9 would likely to have birth defects mostly
associated with delivery emergency and complications. On the other hand, the same statistics claim
that for the hospital–based deliveries, only 1.8 of one thousand babies faced birth–related defects
(Mathews, Curtin & through Friday, 2015). The statists also point out that there is a high risk of
deficiency when the baby is born at home than when born in the hospital environment. The defects
as result of childbirth–related complication are high in midwives attended birth than those delivery
process carried out in hospital when there is an emergency. Statisticians document 7 defects per one
thousand deliveries that have associated birth complications with deliveries attended by midwives.
According to the statistics done in the years 2016 by the Center for Disease Control and Prevention,
the home delivery has gained favors than hospital delivery in the recent time. This implies that as
more birth

Rivulets: A Fictional Narrative
Amy stopped to pull her water bottle from her pack, downing the rest of it. She stuffed the bottle
back in, next to her full back–up bottle. "I'm happy there don't seem to be other hikers, but damn is
it hot," said Catherine, hoisting herself up to sit on a path–side boulder, "Let's rest again." "Again?"
Amy asked, "It's not even hot, Cath." She walked up to where Catherine sat, putting her hands on
the other woman's open knees and standing between them. "Yes, again. I'm tired," Catherine whined,
trying to feign a pout but smiling, "and I'm not nearly as in shape as you." Amy laughed, "Fine, I
have to pee anyways." Catherine leaned forward, kissing Amy's forehead. "Watch out for poison
ivy!" she called out as Amy stepped off the path ... Show more content on Helpwriting.net ...
The adrenaline in her system made her forget about her calf, the blood streaming from the wound in
rivulets. It also made her forget about the trail, which she ran away from for ten minutes before she
realized her mistake. Going back the way she came wasn't an option. Hands on knees, she bent,
trying to catch her breath and gain her bearings. Before she turned to head in the direction she hoped
the path was, she noticed the wet feel of her foot, and looked down. The formerly white sock
peeking up over the top of her boot was red, and the pain hit her suddenly, now that she was so
boldly confronted with it. Catherine bit back the groan climbing up her throat, and turned her leg to
look at the bite itself. Two dripping, thick crescents encircled her calf, outlined by dark bruising.
Drying streams of blood made their way down her leg and into her boot, staining the sock. The
exposed flesh where the coyote's teeth had torn into was red around the edges, but a dark pink with
the visible bunches of muscle. She dry–heaved at the sight of it, and tears began to run down her
face. After a few deep breaths, she gritted her teeth and began to run again, though slower

A Historical Perspective And Classification Of Obpp
Introduction
A historical perspective and classification of OBPP was first described by the Scottish obstetrician
William Smellie in an article for midwives in 1764 [1] He documented the observation of resolution
of bilateral upper extremity paralysis in a child with face presentation at birth. Danyau performed an
autopsy of a newborn with brachial plexus palsy in 1851, providing the first anatomic description of
this lesion.[2] but classic description of shoulder paralysis, internal rotation contracture and waiter's
tip deformity was given by Erb in 1874 as cited by Gilbert A et al. [3,4]. Duchenne and Balliere and
Erb described cases of upper trunk nerve injury, attributing the findings to traction on the upper
trunk, now called Erb's palsy (or Duchenne–Erb's palsy).[5] In 1885, the French neurologist Augusta
Klumpke [6] described the clinical picture of OBPP affecting the lower plexus trunk at C8–Th1,
leading to paralysis of the muscles of the hand and ipsilateral pupillary dilatation, called Horners
sign. Therefore, OBPP affecting the lower trunk is often referred to as Klumpkes palsy. OBPP
diagnosed at birth is defined into three groups in accordance with the International Classification of
Diseases :
P 14.0 Erbs palsy caused by injury at delivery
P 14.1 Klumpkes palsy caused by injury at delivery
P 14.3 Other injury of the brachial plexus at delivery
P 14.0 and P 14.1 are the most common diagnoses. P 14.3 is rarely used and seems to be applied in
cases with

Arterial Lines
Arterial Lines 3/8/05
1– What is an a–line? 2– What are the parts of an a–line? 3– Does it matter if the flush setup is made
with saline or heparin? 4– What are a–lines used for? 5– What do I have to think about before the a–
line goes in? 6– What is an Allen test? 7– Where can a–lines go besides the radial artery? 8– Who
inserts a–lines? 9– How is it done? 10– What kinds of problems can happen during a–line
placement? 11– How do I use an a–line to monitor blood pressure? 12– How should I set the alarm
limits? 13– How do I draw blood samples from a–lines? 14– What order ... Show more content on
Helpwriting.net ...
4– What are a–lines used for?
Two things mainly: blood pressure monitoring, and for patients who need frequent blood draws. Any
patient on more than a small amount of any vasoactive drip really needs to have an a–line for proper
BP management – if they're sick enough to be put in the unit and need pressors, then they're sick
enough for an a–line. Non–invasive automatic blood pressure cuffs are useful, but if a person is
labile – push for an a–line.
Certain situations absolutely require an a–line for BP monitoring: any use of any dose of nipride, for
example. This is a truly powerful drug – it works very quickly, and your patient can rapidly get into
all sorts of trouble unless you're monitoring BP continuously.
I've heard lately that there's a trend towards using fewer a–lines – it seems silly (and painful) to have
your patient get stuck what seems like twelve times in a shift for labs and ABGs. Remember that it's
always been our unit's policy for nurses to send ABGs after every vent change, or for any clinical
change that the patient makes.
Update – this has changed a little: ABGs probably don't seem to be necessary for vent changes that
are only going to affect oxygenation: changes in FiO2 or PEEP, since the O2 sat will keep you

A Brief Note On The Mechanism Of Injury
Mechanism of injury:
Obstetric brachial plexus palsy is caused by traction to the brachial plexus during labour. In the
majority of cases delivery of the upper shoulder is blocked by the mother's pubic symphysis
(shoulder dystocia). If additional traction is applied to the child's head, the angle between the neck
and the shoulder is forcefully widened, overstretching the ipsilateral brachial plexus. Recently, the
exact origin of OBPP was again a matter of debate. It was suggested that intrauterine maladaptation,
not nerve traction, causes the plexopathy. [43]
However OBPP at birth is one of the causes of permanent neurological disability. The delivery
process is associated with several factors which, together, may result in OBPP in the newborn but it
is difficult to predict OBPP based on antenatally available information. Despite extensive research
one OBPP, there is no generally accepted strategy for prevention. [7]
Fortunately, Permanent damage to the upper roots is uncommon. Usual involvement is of the
suprascapular, axillary and musculocutaneous nerves. Muscles most often paralyzed are
supraspinatus and infraspinatus supplied by the suprascapular nerve, which is fixed between two
points and does not accommodate stretching. In more severely affected patients, deltoid, biceps,
brachialis and subscapularis are also involved. Patients with C5 and C6 palsies usually have residual
weakness of rhomboids and serratus anterior leading to mild winging of scapula, an acceptable

Effects Of Caffeine On The Body Metabolism
Caffeine is one of the most prevalent drugs consumed around the world, and is frequently used by
athletes in efforts to enhance their performance. It is defined by the Medical Dictionary as "A bitter
white alkaloid, C8H10N4O2 that stimulates the central nervous system and body metabolism"
(2010). Some believe that increasing their caffeine intake will then improve their energy and
endurance levels during long–term sporting events such as running, biking, or swimming. Caffeine
is found in an assortment of foods and drinks including but not limited to coffee, tea, cokes and cola
products, chocolate and energy drinks. Caffeine can also be found in some over–the–counter
medications.
In a recent research study produced by the Kinesiology Department of Delaware University, the
following findings were presented: that caffeine is a vasoconstrictor and stimulant; caffeine can
increase blood pressure by contracting the heart and blood vessels in non–habitual users; caffeine
changes the electro–physiological activity of the heart, increasing conductivity, even in limited
doses (University of Delaware). In regards to the gastrointestinal side effects, the UD study wrote
that caffeine stimulates gastric secretion, stating that some individuals are sensitive to caffeine and
suffer ill effects such as acid indigestion, heartburn, abdominal pain, gas or constipation to varying
degrees. In addition, caffeine inhibits vasopressin, and it acts as a powerful diuretic. Liver
metabolism is

Humeral Shaft Fractures
Humeral shaft fractures account for 3 to 5% of all fractures in adults and for 20% of all humeral
fractures. Fractures of the humerus can occur proximally, mid–shaft, or distally. Humeral shaft
fractures occur most commonly in the elderly and are significantly associated with impairment of
independence and quality of life. Majority of the fractures are non–displaced and can be treated
non–operatively, which is still the standard treatment of isolated humeral shaft fractures. Although
non–surgical management of humeral shaft fracture can be associated unsatisfactory results.
Surgical treatment is reserved for specific conditions and offers better outcomes. Humeral shaft
fractures those managed with internal fixation supports relative stabilization ... Show more content
It provides strength and resistance to both torsional and bending forces. The proximal humerus
articulates with the glenoid cavity of the scapula to form the shoulder joint. The muscles and
tendons of the rotator cuff, the acromion, and ligamentous attachments between the coracoid process
of the scapula and the acromion serve to both stabilize the gleno–humeral joint and provide a wide
range of motion of the shoulder joint. The distal humerus articulates with the radius and ulna at the
elbow. The greater tuberosity is located on the superior aspect of the humerus just lateral to the
humeral head and it provides attachment for three of the rotator cuff muscles supraspinatus,
infraspinatus and teres minor. The lesser tuberosity of the humerus is located on the anterior surface
of the humerus and provides attachment for the subscapularis muscle. To classify the fractures, the
lesser tuberosity marks the boundary between the proximal humerus and the mid–shaft. Humeral
shaft is enveloped in the muscles and soft tissue which provide favorable non–operative healing
mechanism in uncomplicated fractures. Muscles originating on the humeral shaft include the
brachialis, brachioradialis, and the medial and lateral heads of the triceps brachii. The deltoid,
pectoralis major, teres major, latissimus dorsi, and coracobrachialis all insert on the humeral shaft.
Different location of the fracture along the humeral shaft will have specific deforming forces acting
on the fracture fragments. Fractures near the midpoint of the shaft can have proximal fragment
pulled laterally by the deltoid, while the distal fragment pulled medially by the triceps and biceps.
Fractures near mid–shaft of the humerus are more likely to shorten than proximal or distal fractures
due to the strong pull of the biceps and triceps muscles. The blood supply to the humeral shaft

Shark Attack Case
Final Case Study ("Shark Attack")
1. During eight year old Jim Morris's shark attack surgeons had to mark five major organ systems
for reattachment surgery. The five major organs include the cardiovascular system, the nervous
system, the skeletal system, the integumentary system, and the muscular system. The cardiovascular
system is mainly responsible for transporting oxygen which essential in the body, fighting diseases
and infections, the transportation of hormones, excreting waste, and transporting nutrients.
Secondly, the nervous system which is made up of the brain, the brain stem, and spinal cord is
significant because it functions as a major receptive community. The nervous system three main
functions is sensory input of information ... Show more content on Helpwriting.net ...
Full usage of the arm for Jim is unlikely because the doctors know that the power of surgery allows
for the nerves to reattach but not fully regain its normal function once the nerve is damaged. In the
future, some typical activities and movements that Jim would probably have problems with is sports
such as football, basketball, and swimming because of the physical needs of a fully functioning arm.
Additional activities could include shot put, gymnastics, pole vaulting, jumping rope and many more
fitness activities. Being that Jim is right handed and his right hand is not a fully functioning hand
and has less strength than his left arm, restricted movement activities involve any motor skills that
would require his right hand to aid him but if his right hand is dominate the best thing for Jim to do
is strengthen his left arm.
6. The reattached nerves would not recover as quickly and completely as the reattached muscles
after Jim's surgery because the body will repair itself by regenerating the muscles. Theses
regenerating nerve muscles will automatically grow down the nerve and restore muscle by
supplying it with nerves through regrowth. If they connect correctly the motor nerve to muscle and
sensory nerve to skin will recover. If they do not connect correctly, they will not completely

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