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  1. Why Downloading a file showing error

    I am really clueless, because almost all of others than you two have downloaded. There are 1600 plus downloads till now.
  2. Lots of Docs are asking the question, why I cannot download the file. I have signed up and while click download it shows an error. Please remember you have to signup first here https://www.thedoc.org/register Then you have to join the PLAB club to download files under this club. If you see the JOIN CLUB button in the downloading page like the screen shot below, you first have to join the club by clicking it.
  3. Asha SharanThrashed by a patient's attendants at her private nursing home, Sharan's Clinic, on Binodpur Road in Katihar I reached my nursing home around 10am on June 20 like usual. As soon as I reached the clinic, my 24-hour staff told me that the previous night (June 19) he had an altercation with the attendants of a patient, Puja, when my employees asked them not to move around on the clinic premises at night. Private hospitals usually don't allow attendants inside the premises at night. As far as my clinic is concerned, many patients come with women attendants who stay with the patients. So, we have to restrict entry of attendants at night for safety reasons. My employees told me Puja's brother had brought food around 11.30pm and when my staff objected to his entering the hospital so late, his brother started an argument. I got busy with my work after hearing what my staff had to say. I went on my rounds of the clinic. When I reached Puja's bed, I told her sister-in-law about her husband's misbehaviour with my staff, reminding her of our institution's strict rules. I did not say a word to the patient (Puja) but her sister-in-law got angry. She said private hospitals usually didn't have such rules and she went on to say kaun cheez ka paisa nahi diya hai (We haven't paid for which service?). I was angry after listening to this and told her that her family had deposited only a little amount of the total hospital fee so far. I also told her that if she isn't liking our services, she is free to take the patient somewhere else. I then started checking patients in the outpatient department. Soon, I could hear people shouting outside. My employees informed me that Puja's attendants were screaming. I told my staff to let one attendant enter but to my surprise a group of six people entered my chamber. Screaming, they asked me how I had dared to ask Puja's sister-in-law to take the patient to some other facility. They were continuously hurling abuses at me. I explained why I had said so but the attendants kept shouting. I told them I would call the police. When I said this, one of the attendants hit me on my head with the weighing machine that was in my chamber. I was again hit on the head with a chair. I fell unconscious. My lips were bleeding and a tooth had almost fallen off. The mob left the chamber soon after they saw I was bleeding from my mouth. I am still having antibiotics for the haematoma (clotting of blood) in my head and also taking a dentist's help. I am shaken but I am happy that I followed doctor's ethics even after the incident. I discharged the patient after five days. I had to remove Puja's stitches after her C-section. Even today, if Puja or any of her family members come to my clinic with any problem, being a doctor, I will give them the best treatment available at my end. But I would take legal action against them for lynching my dignity. Source: https://www.telegraphindia.com/1170701/jsp/bihar/story_159495.jsp
  4. The reality is doctors often feel short of words while noting down history. Its not easy task to convert everything what patients say into doctors notes. This is what happen when you're too busy in the OPD Patient has left her white blood cells at another hospital. Patient has chest pain if she lies on her left side for over a year. On the second day the knee was better and on the third day it disappeared. The patient has been depressed since she began seeing me in 1993. Discharge status: Alive, but without my permission. Patient had waffles for breakfast and anorexia for lunch. While in ER, Eva was examined, x-rated and sent home. Skin: somewhat pale, but present. Patient has two teenage children, but no other abnormalities. The patient was in his usual state of good health until his airplane ran out of fuel and crashed. Mrs. Evans slipped on the ice and apparently her legs went in separate directions in early December. Patient was seen in consultation by Dr. Jones, who felt we should sit on the abdomen and I agree. The patient refused autopsy. The patient has no previous history of suicides. She is numb from her toes down. She stated that she had been constipated for most of her life until she got a divorce. Both breasts are equal and reactive to light and accommodation. Examination of genitalia has revealed that he is circus-sized. Patient was found in bed with her power mower. She has no rigors or shaking chills, but her husband states she was hot in bed last night.
  5. Surviving USMLE Step 2CK

    USMLE Step 2CK experience by Ashok Chaudhary, Test Date April 11,2017) Hello , I may be new to many of you.I am a government officer working under Ministry Of Health,Government of Nepal.I got my Step 2CK score report a few days back.I am sorry for the delay in writing this.I am writing this with a hope of making you all believe that “If I can do good,you can do it even better” and vice versa.I have named this file “surviving step 2CK” because during the course of its preparation,I think,my life was like that of in a survival mode,roughly speaking. If you have read my step 1 experience,I want to assure you that this is gonna be shorter than that.Partly because the study materials for step 2CK are less diverse than that of step 1 and partly because I don’t want to hypnotise anymore. I started my preparation for CK with the book named ”step-up to medicine”.Many people I talked to and many experiences I had read suggested MTB2 for medicine and MTB3 for other subjects like pediatrics,surgery,OB&Gyn.I bought those books as well.Actually I began with MTB2 for medicine and instantly realized that it was not my type of book.I didn’t have that bullet proof jacket to bear all those bullet styled points of MTB2.I think I was able to read only initial few pages of that book and was soon searching for its alternative.”step up” was a nice alternative I think.Its written in more of explanatory way and reading it was a smoother process.Took almost 1 month to finish it.Plz don’t get scared with the time I took for it.I was working at government hospital and it was so for the most of my preparation.So some days I could study well and some days weren’t that good.Combining job with study wasn’t very easy,I think. After stepup,I subscribed to uworld for 6 months.There were 4 or 5 days remaining in the subscription when I took the exam.If ,for step 1,First aid and uworld were the holy sources;for step 2,uworld is both.Many of you in the beginning phase of your preparation may find it difficult to accept this fact and I also didn’t realize that initially.Is it true?Are you kidding me?Only uworld and no books?Yes it is true.I am not kidding and books have very minor role.I think I didn’t remember a thing from step up but the greatest help was it made my transition to the uworld easier and smoother.Understand uworld very well.Dont just read it for the sake of reading.The tables/charts in uworld are like the pages of first aid for Step1.I mean each and every word there is for the purpose.Simply cramming up only wont help you.You need to understand those and then if needed mug them.But yes,there are few topics which you have to just mug it up.There is not much point in wasting your time understanding the developmental milestones of a child and screening/vaccination guidelines age and evaluation of pap smear of the female of age 23 and 26.But yes there is some logic behind it. Whatever you don’t understand from uworld,consult uptodate for that.Both the google and Wikipedia for the step 2 is uptodate.I think most of the things given in uworld are derivatives of the things that are already available in uptodate.You cant go through all of uptodate.It is very very detailed.So consult Uptodate for topics which are difficult to comprehend from uworld and you can also consult it for topics which are not given in uworld.Would you believe it if I said many sentences given in uworld seem to be exact copies of uptodate? And yes prepare the notes from uworld from the beginning.I had made brief notes of volatile things and things that were added from uptodate.it was brief because I did revision from uworld online on my laptop itself.Some people find reading from the notes/notebooks easier,so if you have time you can make detailed notes as well.I took photos of all the uworld tables/algorithms/charts and I used to go thru them whenever I got time like while going to my gym and while travelling.It helped me consolidate the things given there.I cant overemphasize the importance of those tables/charts.Very important and they are many. I also did CMS forms(all offline) for most of medicine,OBG,Psychiatry and few of surgery.If you have time go through all of them.If you don’t have time,go through psychiatry and OBG at least.I also did some topics from uw-3 like portions of cardiology,psychiatry and biostat.For biostat,also do Biostat review from step 1 and those portions from first aid for step 1.Actually,first aid for step 1 helps a lot for step 2.Many topics are related and while doing 1st round of uworld,I got many many qsns right because of knowledge of step 1.So I think,having read for step 1 before step 2 helps very significantly.I don’t know how much is the impact of taking step 2ck first has on step 1 exam,but I am very sure that taking step 1 before step 2 has big impact on step 2.There were many topics which I studied from “first aid for step 1 “ for my ck exam.I read mtb3 rapidly for peds,obg and surgery.I think I completed those within 1 week.I don’t know how useful it was but I did it because everybody else was doing it. I had read uworld total of 2 times from laptop and my short uworld notes once. During thelast month before my exam,I took nbme 4,6,7(all offline).4 and 6 were good,7 was demoralizing .If you are drooling for your friend’s girlfriend and you want your friend to break up with her,ask him to take nbme 7.Dont get demoralized with nbme 7 my friends.It is very ..hmm…what should I say…idiotic or you can call it stupid.Yes it is hard but it more weird than it is hard.Exam qsns were not in any way like that.Instead exam was closer to uwsa2 for me. I did uwsa1 online around 8 days prior and got 288.Yes…I also didn’t believe it thatswhy I had to shell out another 35$ to take uwsa2.It was 273 or 4.Exam was close to uwsa2 . Friends,practice time management very well.The resources for step 2 ck may be less than step 1,but the exam was harder,that is what I felt.Time was very tight.On a good block,I finished 3 minutes earlier and within that I had to review 8 or 9 qsns which I had marked.It was not a good feeling.I remember making some very silly errors and I think time pressure contributed significantly to it.Believe me,in every block you will get 7 or 8 or 9 very confusing qsns and that’s what that makes them difficult.The topics of the qsns are not new,even the options are not new(most of them).What makes them difficult is the very twisted way of asking qsns and the confusion between two options.If you think that you have understood the qsn and you are confused among two options in that qsn,just pick one option,mark it and move to another qsn,review it at last.Dont lose much time on it.In the exam,it may be very tempting that reading the qsn once again may help you clear your confusion among two options.Do so only if you have not understood the qsn properly or the options properly.If you think you have understood the qsns and options but you are still confused,pick one and move on. Many times during preparation,I used to feel so blank.I used to think I don’t know anything and some days were frustrating and depressing.Avoid those things/fb posts/persons who make you feel yourself inadequate,no matter whoever they are. Friends,the preparation time was not easy and I think it wont be very easy for many of you.It is very difficult to focus on your studies when many of your friends are busy talking about messi and ronaldo,when they are busy measuring how much cranberry juice to add to the whiskey,when they are busy making plans for a trekking, when there are so many responsibilities towards your family.But I believe,”if you want to have what other don’t have,you need to do what others cant do.” All the best
  6. The sister of Eman Abd El Aty, an Egyptian woman thought to have been the world's heaviest, has accused doctors of lying about her weight loss after surgery in India. She underwent surgery in Mumbai's Saifee hospital, and last week doctors said she had lost 250kg (550lbs). But her sister said this was untrue, adding that her sister was in delicate health as she may have had a stroke. The hospital has angrily rejected the allegations. The row began on Monday when Ms Abd El Aty's sister, Shaimaa Selim, released a short video on social media, alleging that her sister was still unable to speak or move, and had not lost as much weight as the hospital was claiming. On Tuesday, she told the BBC that the hospital was lying about her weight loss. "He [Dr Muffazal Lakdawala, who led the operation] didn't weigh her before and after. If he has any proof of her weight loss, show us the video of her weight before and after." Describing her sister's health as delicate, she said: "Oxygen is not normal in her body. She has to wear an oxygen mask almost all the time. There is a tube from her nose to her stomach because she can't eat or drink well from her mouth. But a spokeswoman for the hospital told the BBC that Ms Abd El Aty was weighed again on Monday and she now weighed 172kg. Dr Lakdawala also strongly denied the allegations in a tweet. Image copyright TWITTER Eman Abd El Aty suffered a stroke at the age of 11 and her weight meant she was unable to leave her home for 25 years. She was flown in a special aircraft in January to Mumbai's Saifee hospital where she underwent bariatric surgery in March by a team of doctors, led by Dr Lakdawala. The hospital says she can now fit into a wheelchair and sit up for longer periods of time. It released new pictures of Ms Abd El Aty following weight reduction surgery. Reports say Ms Selim is unhappy because the hospital authorities believe that Ms Abd El Aty's treatment is almost over and that she can be sent home to Alexandria soon. "There are cases like this in other parts of the world. In America and in other countries, there are heavyweight people. They have been in the hospital for one or two years to lose weight and become normal. "But just after a month or two here, the doctors say that I can take my sister back. I asked them how, as she is still very big and if anything happens to her in Egypt, how can I go to a hospital there? "It would be impossible and nobody would help me in Egypt. I said, 'Please please keep her for a long time to help her lose weight'," her sister said. Bariatric surgery, also known as weight loss surgery, is used as a last resort to treat people who are dangerously obese (having a body mass index of 40 or above, or 35 with other obesity-related health conditions).
  7. Anaphylaxis Quiz

    Anaphylaxis
  8. Epinephrine Auto Injector

    Epinephrine Auto Injector helps self injecting Epinephrine in an Anaphylaxis Patient at the required doses. It is used as a shot intramuscular injection. These are used as intermediate measures while definitive treatment must be followed by a trained physician in an emergency setup. This means Epinephrine auto injector is not complete treatment for a patient with anaphylaxis. What is Epinephrine Auto Injector: Just like any other auto injector (Morphine Auto Injector, Insulin Auto injector), Epinephrine auto Injector is also a dose calibrated injector.
  9. Anaphylaxis Kit

    Anaphylaxis Kit should be a standard component of any Emergency Medical Services. A patient in anaphylaxis deteriorates very fast and anaphylaxis kit is handy to save life. So, what are the anaphylaxis kit contents? How can it be prepared? An ideal Anaphylaxis Kit should contain the following: A portable bag with space for injections, syringes and vials An instruction booklet or Anaphylaxis Management Plan 02x Epinephrine Auto Injector 02× Hydrocortisone sodium succinate 100mg 01 × 1ml Chlorphenamine Injection 10mg in 1ml 01 x IV Cannula 18g Green 02 x Needle 23G x 1¼ 02 × 1ml syringe 01 x Guedel Airway Size 0, 1, 2, 3 and 4 one each 01 x Resuscitation Face Shield 01x Normal Saline 500 ml Anaphylactic Kit is not for routine use and only be used by trained medical practitioner or under supervision. Epinehrine auto injector can be used by a patient when prescribed by a doctor as self injector.
  10. Anaphylaxis Management Plan

    Anaphylaxis management Plan helps health professionals quickly assess and treat a patient on anaphylaxis. In a true anaphylactoid reaction one seldom gets time to do investigations to establish a diagnosis. Patient sinks fast and early treatment saves life. Anaphylaxis management plan has the following components: Assesment: A quick assessment to know the status of the patient includes vitals pulse, BP, Respiratory Rate, SPO2 Life Suport: Get IV aceess, Start O2, Give ventilatory support Diagnosis: Diagnosis should be clinical and based on history. Ask following questions to patient or his Next of Kin : “Have you been exposure to a known allergy/trigger?" “When did symptoms start, and what are you current medications?" “Has this happened before?” “Are you asthmatic?” Treatment: IM ADRENALINE (1:1000) 0.5 ml (500mcg); repeat at 5 minute intervals if no improvement. This route is not recommended after cardiac arrest Or, IV (1:10,000) 0.5 ml (50mcg) if severely ill, peri-arrest or pulseless; ie the dose is different NEB SALBUTAMOL 5mg (if wheezy) IV HYDROCORTISONE 200mg IV CHLORPHENIRAMINE 10mg Procedures High flow oxygen: >10 l/min IVI + IV fluid challenge: 500 – 1000 mL. Repeat if necessary Lie patient flat, elevate legs Monitor cardiac and respiratory function
  11. Fake Ultrasound Picture Maker? It's a surprise to see, how many people are after these fake reports everyday. Most of them look for fake pregnancy reports. Others go for malingering various medical conditions. Though the purpose of faking a pregnancy is not very clear, often it seems to be revenge, excuses and for maternity benefits. The advantage of this is, they can fake an abortion also later. From my personal experience, I have faced people visiting me and asking for fake ultrasound pictures. They just want the name, date typed and fake an ailment. There may be people, lab out there providing such fake reports for a price. But the probable legal implications they are risking is huge. It is unethical to provide such reports and should be discouraged as a whole. That is where recording and checking your ultrasound settings may be useful, if you don't want somebody selling your reports. In modern USG machines you can set a pass lock to prevent this. Out of curiosity, I looked for such things and what I found was really entertaining. I landed on a website http://www.fakeababy.com who provides everything to fake a pregnancy starting from a initial Urine beta HCG to 3D fake Ultrasound reports. They even sell wearable breast implants to mimic pregnancy stages and a pregnant silicon belly too. My goodness. Everything is delivered online. Means, it is a popular business, may be the purpose of using these are not limited just to mimicry. There I found another answer. Couple, who are going on surrogacy and trying to hide that from others, this is a way. I had seen one or two reports generated online from them and these shall look real to non professionals. Of course, an ultrasound tech or Radiologist can identify them as fake. I thought though, these can be used as good prank!
  12. You read over your notes. Then you read them over again. Then you read them over a third time. Then you take the test and are surprised at just how much you missed. Despite reading everything three times! A lot of study time is wasted because of one problem: you fail to learn things the first time around. Repeatedly going over the same information like putting a band-aid over a sieve. It may reduce the water that slips through, but it doesn’t solve the fundamental problem: that you have too many holes. The key to reducing the amount of time you study is simple: learn things the first time you see them, instead of after dozens of repetitions. This is all easier said than done. I’m sure if your mind was without holes you could easily capture any information that slipped into it. The real question is how can you do this? I don’t believe it is just a matter of being a genius or chance, but based on how you study. Step One: Find the Holes If you want to repair a leaky brain, you need to figure out where the holes are. Identify what type of information you have trouble remembering. Recognize when you’ve just gone over information you don’t quite understand. Here’s a few questions to ask yourself after every chunk of ideas to find your holes: What from this section am I most likely to forget? What concepts are completely new to me? (Rather than ones that feel familiar) Which ideas am I having the most difficulty grasping? When you identify weak points, you can invest more time in fixing those instead of wasting time with a blanket studying technique of all information. Step Two: Repair Weak Points Once you’ve identified potential weak-points, you should immediately seek to fix them. Drop everything your doing and seek out a fix for the problem. Programmers understand that a bug left in the system can create several hundred times the cost to fix it later. As a learner, you need to understand that the same principle of fixing problems quickly also applies. There are hundreds of books written on various strategies to fix weak points, which is a bit outside the scope of this quick article. But here are a few starting points: Memorizing? If you need to store arbitrary information, try using the link method. This is where you visualize an exaggerated image that combines the two things you want to associate. You can memorize formula’s this way by linking vivid pictures to the different symbols. A formula such as F = C/A, could become a scale with hundreds of (F)eathers on side and a giant (C)aterpillar sitting over millions of (A)nts. Conceptualizing? If you need to understand information try drawing a picture or diagram to combine the ideas. Retaining? If you need to retain a complicated mass of information try using metaphors and vivid examples to connect the abstract information into something you can easily relate to. Repairing weak points in your understanding isn’t that difficult – if you first know where they are. Simply focusing on a piece of information can help you understand it. But if you don’t know which parts you’re missing, it is easy to skim over everything and not realize what you’ve missed. Step Three: Check Your Understanding Do you “get” it. Does the information make sense to you at a deeper level, or does it seem arbitrary, meaningless or difficult to derive? Most school tests and virtually all real-life tests are designed to answer a single question: do you understand what you’re studying? If you aren’t sure, that’s when you need to start working deeper. Keep asking yourself “why” until you reach a point where the subject makes sense. Here are some tips for improving your understanding: Look for sensory descriptions.Your brain isn’t a computer. It’s designed to retain emotional, vivid and sensory information better than abstract or dry details. Link a sensation, picture or story to the abstract details. When learning how to do determinants (a form of math using matrices) I imagined my hands moving through the diagonals, one adding and one taking away. Get the background. A lot of information that seems meaningless makes more sense when given a context. If your stuck on trying to wrap your head around a particular point, do some research into it’s origins. This may take more time up-front, but can save hours as future concepts are built upon it. Step Four: Test Yourself Whenever you’re experimenting with new learning methods, you need to measure the results. Check to see whether your new system is actually helping you remember more. Once you get familiar with a system, you can more accurately judge the extent of your knowledge. But until then, test regularly so you can tweak the system to fix errors. The best tests are objective ones. If you’re in school, look for past exams, tests or textbook questions to check your understanding. If you’re teaching yourself, come up with short exercises that can prove to you conclusively you know what you’re doing. The most important piece of advice I can give is this: treat study time as being sacred. Go in with the expectation that you will either learn everything through the first go, or you will identify areas that need further clarification. Focus and become aware of any potential holes so you can learn things once.
  13. Table of Contents What is Anaphylaxis Definition of Anaphylaxis Pathophysiology of Anaphylaxis Mechanism of Action of Anaphylaxis Types of Anaphylaxis Causes of Anaphylaxis Risk Factors For Anaphylaxis Signs and Symptoms of Anaphylaxis Treatment of Anaphylaxis References What is Anaphylaxis Anaphylaxis or Anaphylactic Reaction is the most severe from of acute onset and rapidly progressive allergic reaction, often proves fatal, if not treated timely. Anaphylaxis is a true medical emergency. There is often (but not always) a history of previous sensitivity to an allergen, or recent history of exposure to a new drug (eg vaccination). Definition of Anaphylaxis Anaphylaxis is defined as a severe, life-threatening, generalised or systemic hypersensitivity reaction after systemic exposure to specific antigen involving multiple systems and organs which often characterized by vascular collapse,hypotension, shock and/or distress due to laryngeal edema or intense bronchospasm. Other manifestations may include nausea, vomiting, abdominal cramps, and diarrhea. Anaphylaxis word depicts Ana (without), phylaxis (protection). Though, there is no predisposing age, gender, race or geographic factors, there is a increased incidence after eighteen, reason being probably people after that age group are sensitized already. ⇑ Back to Table of Contents Pathophysiology of Anaphylaxis Anaphylaxis is a a IgE-mediated type I hypersensitivity reaction. Though Anaphylaxis can occur at any age, the mean age was 29.3 years (range, 0.8 to 78.2 years) in a study. In another, there was an age range of 1-79 years, with a mean of 37 years. Though exact anaphylaxis pathophysiology for all incidents are not known, in almost all cases, it is caused by exposure to specific antigen with previous history of hypersensitivity. When allergen binds to IgE-sensitised mast cells and basophils, histamine is released from their intracellular granules. Mast cells are widely distributed but are most concentrated in skin, lungs, and GI mucosa; histamine facilitates inflammation and is the primary mediator of clinical atopy. Histamine causes the following: Local vasodilation (causing erythema) Increased capillary permeability and edema (producing a wheal) Surrounding arteriolar vasodilation mediated by neuronal reflex mechanisms (causing flare) Stimulation of sensory nerves (causing itching) Smooth muscle contraction in the airways (bronchoconstriction) and in the GI tract (increasing GI motility) Increased salivary and bronchial gland secretions When released systemically, histamine is a potent arteriolar dilator and can cause extensive peripheral pooling of blood and hypotension; cerebral vasodilation may be a factor in vascular headache. Local vasodilation (causing erythema) Increased capillary permeability and edema (producing a wheal) Surrounding arteriolar vasodilation mediated by neuronal reflex mechanisms (causing flare) Stimulation of sensory nerves (causing itching) Smooth muscle contraction in the airways (bronchoconstriction) and in the GI tract (increasing GI motility) Increased salivary and bronchial gland secretions When released systemically, histamine is a potent arteriolar dilator and can cause extensive peripheral pooling of blood and hypotension; cerebral vasodilation may be a factor in vascular headache Highlights IgE-mediated type I hypersensitivity reaction Mediators are histamine, leukotriene C4, prostaglandin D2, and tryptase ⇑ Back to Table of Contents Mechanism of Action of Anaphylaxis There is a rapid onset of increased secretion from mucous membranes followed by bronchial smooth muscle tone elevation in a already sensitized person. Vascular smooth muscle tone decreases fast and capillary permeability gets increased post exposure. These effects results from histamine, leukotriene C4, prostaglandin D2, and tryptase, the primary mediators of anaphylaxis. In the classic form, mediator release occurs when the antigen (allergen) binds to antigen-specific immunoglobulin E (IgE) attached to previously sensitized basophils and mast cells. These mediators gets released immediately once the antigen binds the masr cells. Thus, exposure to an inciting substance causes direct release of mediators, a process that is not mediated by IgE. Increased mucous secretion and increased bronchial smooth muscle tone, as well as airway edema, contribute to the respiratory insufficiency ⇑ Back to Table of Contents Types of Anaphylaxis Anaphylaxis types can be classified broadly as Immunological and non-immunological. Immunological. Though immunological is the most common form, non immunological type cases are reported. It appears that non immunological has a lesser severe form of anaphylaxis than the immunological types of anaphylaxis. Immunological further can be subdivided into IgE and non IgE mediated types. True Anaphylaxis: True anaphylaxis follows the chain of pathophysiology of anaphylaxis, and resultant of release of mediators from mast cells. True anaphylaxis is always appear only in a previously immunized individual. Pseudo Anaphylaxis: The presentation, symptoms and signs of pseudoanaphylaxis is similar to that of true anaphylaxis. But it appears without any history of previous sensitization. Some drugs exert pharmacological effects on the immune systems which result in a response that is independent of its recognition structures. Thus they activate effector and amplification mechanisms that are normally triggered by specific immune processes. That is how Pseudo anaphylaxis results. Pseudo anaphylaxis needs same management and treatment as true anaphylaxis. Depending on course of anaphylaxis it can be classified as under: Uniphasic Anaphylactic reaction: Single episode of anaphylactic reaction and often self limiting. Biphasic Anaphylactic reaction: Second episode of anaphylactic reaction, which may be more severe in intensity. Protracted Anaphylactic reaction: Extended duration lasting for upto 30 hrs and not limiting by medications ⇑ Back to Table of Contents Causes of Anaphylaxis In most cases cause of anaphylaxis cannot be determined. Thats why idiopathic amounts for as large as 37% of the cases. In known cases, food is the primary cause of allergies. Pharmacologic Agents: The most commonly encountered drugs in anaphylaxis is parenteral antibiotics (especially penicillins), IV contrast media, NSAIDs like Aspirin or any other drugs with positive allergic history. Foods: Certain foods (most notably, peanuts), seafood, fish, shellfish, milk and eggs, wheat, oral medications and many other types of exposures also have been implicated. Stinging Insects: Insect stings from bees, hornets, yellow jackets, wasps, fire ants etc. Multiple bites are more vulnerable to anaphylaxis than single. Latex: Latex, though rare causes anaphylaxis rarely Exercise Induced Anaphylaxis: Triggered by exercise and varies from person to person. Often related to eating habits before exercise or weather - hot, cold or humid has also been linked to anaphylaxis in some people. Caution Don't delay diagnosis and treatment in the want of establishing the etiology. In most cases it is Idiopathic. ⇑ Back to Table of Contents Risk Factors For Anaphylaxis Comorbidities: asthma (particularly if poorly controlled), atopy, COPD, psychiatric disorders (due to under recognition), cardiovascular disease, mastocytosis Concurrent medications:, alcohol/antidepressants/sedatives etc impair recognition of symptoms, beta-Blockers and ACE inhibitors worsen them Recent anaphylactic reaction Age: children (under recognised), adolescents (risk-taking behaviour), elderly (increased mortality due to multiple medications) ⇑ Back to Table of Contents Signs and Symptoms of Anaphylaxis Symptoms are acute in onset, variable and may affect: Skin/mucosal tissue: pruritus, generalised hives, flushing, swelling of lips, tongue, uvula/palate, larynx, nose, eyes + other areas (angio-oedema) Respiratory tract: dyspnoea, wheeze, nasal congestion, rhinorrhoea, sneezing, hoarseness, cough GI: nausea, vomiting, abdominal pain, diarrhoea, incontinence Cardiovascular: chest pain, palpitations, syncope, altered mental status, shock, cardiac arrest CNS: sense of impending doom, throbbing headache, dizziness, confusion, tunnel vision, loss of consciousness Other: metallic taste in mouth, dysphagia, dysphonia, uterine contractions Signs of Anaphylaxis: Pale, clammy skin, urticaria Hypotension, tachycardia, bradycardia (a late sign), other dysrhythmia Increased respiratory rate, wheezing/bronchospasm, stridor (laryngeal obstruction), cyanosis Decreased level of consciousness Management of Anaphylaxis References
  14. Handheld ultrasound device is the future of all USG scanners. No wires, no more clutters. These devices are so user friendly, cozy and portable that any radiologist can hardly resist from getting one. We compare the best of them available in today. 1 Clarius Wireless Handheld Ultrasound Device Clarius manufactures one of the most advanced handheld ultrasound device, which wirelessly streams data to most iOS and Android devices. You can see view live view on your iPad or Android screen with the help of a simple app. There is a cloud storage option also, and a digital library is just a touch away. It has passed recently CE Mark approval for the commercial sale of the C3 and L7 Clarius Wireless Ultrasound Scanners for use by medical professionals. C3 Scanner is capable of multipurpose scanning of all parts of the patient’s torso, including the heart. The devices exhibit outstanding resolution with its convex array for abdominal and lung images. L7 is Linear Array Ultrasound Scanner and ideal for guiding procedures. Easy to sterilize and keep clean. One can easily get fine detail from 1 to 7 cms from L7. Both the devices come with full body metal jacket which gives a premium look. These devices have 45 minutes of active battery life and 7 plus hrs standby time. Approx Cost $‎6,900.00 for BW / $‎9,900.00 with Color Doppler Official Page Product Page For Ultimate Portability, User friendliness, Premium Look and feel, Cloud Storage, FDA CE Approved, Included Warranty Against Price 2 Philips Lumify App Based Handheld Ultrasound Device Phillips Lumify handheld ultrasound probes are time tested device and connects to your tab or smartphone with a micro USB port. Its got a simple interface to manipulate and requires just an installation of the Lumify App. Lumify goes where you go, so you can start scanning without searching for equipment in the emergency department. It looks more or less like a standard ultrasound probe with a micro USB on the far end. Lumify doesn't need to be charged. Once connected, It is powered by your Android device. The Lumify app enables users to store scans, images and has the ability to share via email. It also has cloud based storage ability. The app only recognizes Lumify probes, and during first set up device registration is required. Unfortunately Lumify doesn't support iOS. Lumify has three types of probes, S4-1, L12-4 and C5-2. Lumify S4-1 is suitable for Lung, Echo, Abdomen, Ob Gynae and FAST. Lumify L12-4 is meant for soft tissue, superficial, MSK and Vascular in addition to Lungs. Approx Cost Flexible pricing options starting at $199/month, with 12 & 24 month subscriptions Official Page Product Page For Portable Design, Flexible Pricing Against Wired Connectivity, No support for iOS, Only available for distribution in the USA 3 Healcerion SONON 300L Handheld Ultrasound Machine Healcerion’s SONON 300L, 300C and 300MC are both CE and FDA approved product line in mobile ultrasound device compatible with iOS and Android technology. Quite a small to fit in your pocket and light enough to operate with two fingers. With a weight of 369g and 78(W) x 229(L) x 38(H)mm dimension, it's one of the best devices to carry around. Just like Clarius it has Wifi (2.4GHz) connectivity and can be paired with an existing smartphone or tablet to conduct scans. The device has a 2600 mAh Li ion Rechargeable battery, which delivers amazing scan time of 3 hrs. The SONON mobile application supports both iOS and Android device and providers can scan patients and transmit images and recordings securely to any hospital via Wi-Fi, 3G, or LTE networks. SONON 300L is for MSK(Muscular-skeletal), Orthopedics, Vascular, Pediatrics, Sports medicine, Point of care, Ultrasound-guided procedures and color doppler. 300MC is basically designed for Veterinary, Pediatrics, Neonatal, Point of care, while 300C is only suitable for general and Ob Gyne. Approx Cost SONON 300L: 8,000USD, SONON 300C: 6,000USD Official Page Product Page For High Resolution, Color Doppler, Wireless Connectivity, Portable and Sleek Design, Compatible with any Smartphone or Tab, CE and FDA approved Against No Cloud 4 Fujifilms Sonosite iViz Handheld Ultrasound Device Unlike Claurius and Lumify, Fujifilm Sonosite is not compatible to Tab or Smartphones via apps. It comes with a 7 inch display system. The high-resolution touch screen and innovative thumb operated user interface helps the doctor quickly go through various modes and enables quick diagnosis. iViz supports a range of clinical applications, interchangeable transducers, and optimization controls allowing accurate assessment. The display unit can be easily held on left hand enabling the user operate with his thumb, while his right hand scans through the transducer. Integrated Wi-Fi and Bluetooth connectivity allows iViz to connect to Hospital Medical IT Systems, Cloud Solutions or Patient Vital Sensors. There is a remotely diagnosing capability via secure cloud-based telemedicine solutions where patient information can be accessed iViz and send reports to the EMR, Other connectivity like Micro USB, HDMI ports, and audio ports allow iViz fully compatible to any other medical Info systems. Approx Cost Official Page Product Page For Cloud Strage,Connectivity, Flexible Pricing, Telemedicine Functionality Against Comes with a display unit, cannot go really mobile 5 Mobisante MobiUS SP1 System Handheld Ultrasound Mobile Mobisante's MobiUS is an irresistible deal when it comes to appearance and feel. MobiUS SP1 System comes with a 800×480 WVGA touchscreen that easily slips in pockets. Along with the probe it weighs 11.6 oz. only. It has 8GB internal storage and connects to PC or other devices via WiFi or PC sync. There is another option for 3G connectivity. The in built battery allows continuous scan time over 60 min. It supports two types of transducers 3.5 and 5.0 MHz which is for Abdominal, OB/Gyn and guidance procedures. The Second type is 7.5 and 12 MHz and suitable for vascular, guidance procedures, small organs. The product is FDA approved. Approx Cost $7495.00 Official Page Product Page For Wireless Connectivity, Size, FDA approved Against Low resolution display, No Cloud, Non compatible with other Smartphone or Tab,
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