Mark Corson

By E. Myxir. Bethany College, Scotts Valley, CA.

Seizure Disorders Epilepsy is a clinical syndrome characterised by the presence of recurrent seizures generic 12.5mg hyzaar overnight delivery. Seizures are result of excessive electric impulses discharge of cerebral neurones buy hyzaar 50 mg on line. Classification Partial • Simple partial seizures; can be motor cheap hyzaar 50mg with mastercard, sensory and sensory−motor (consciousness not impaired) • Complex partial seizures; starting with an aura (later impairment of consciousness) and often accompanied by automatic behaviour • Partial seizures becoming progressive (Jacksonian seizures) or generalised. Generalised seizures • Initially generalised; − absence seizures − tonic seizures 63 − myoclonic seizures − tonic−clonic seizures − clonic seizures − atonic seizures. Clinical Features Meticulous history from patient and reliable witness is critical in diagnosing a seizure disorder. Ask about the prodromal phase, aura and the type, duration, frequency and the age of onset of seizures. Management − Acute • During an epileptic attack: − patient should be placed on the left lateral position with head turned to the same side; − tight fitting dresses around the neck should be removed − dentures should be removed − no attempt should be made to insert any instrument into the mouth to avoid tongue bitting as this may have already happened − patient should not be surrounded by too many eager observers − seizures should be allowed to complete its course without physically attempting to hold down the patient. Complex partial seizures will require lifelong drugs Management − Pharmacologic • Start therapy with one drug, usually phenobarbitone. Increase at regular intervals until seizures are controlled or side effects appear. If side effects appear and fits are still not controlled, introduce other drugs and taper off the first drug. Refer If • Seizures not controlled with maximum drug dose • Raised intracranial pressure is suspected. Clinical Features Patient is not able to talk, the tonic phase is not clear and the patient appears in continuous clonic phase, the short tonic phases being difficult to see. If still no response put 80 mg in 500 mls of N/saline, adjust rate to control seizures. Refer If • No response to drip or respiratory depression appears after the doses required to control the seizures. It is a form of generalised tonic−clonic seizure seen characteristically in childhood and meeting the following diagnostic criteria: Occurrence in infancy or early childhood, usually between ages 6 months and 5 years. Management • Acute: − antipyretic measures including tepid sponging and antipyretic medication (avoid use of salicylates: underlying fever may be influenza or varicella) − anticonvulsant drug therapy unnecessary. Abscess, Periapical Usually a swelling found in relation to or around a carious tooth caused by the spread of infection following the death of the pulp. Painful swelling which is either localised or sometimes spreads to other adjacent tissues. Usually it is found on the apical region of the tooth and could be with or without sinus. Clinical Features 68 Characterized by swelling and excessive bleeding of gum, there is severe pain and foul smell. Management • Warm saline mouth−washes or any other available mouth washes • Give metronidazole 7. Clinical Features 69 Starts as a unilateral swelling of soft tissues around lower mandible usually arising from the lower second or third molars. The infection spreads to other tissues crossing the midline and becomes bilateral swelling. The tongue is elevated and falls back thereby obstructing the air−way and thereby causing difficulty in breathing. Gingivitis Acute or chronic inflammation of the gums caused by infection from the accumulation of bacteria plaque around the necks of the teeth. Neoplasms, Salivary Gland & Hereditary/Developmental Disorders The above conditions should be recognised. These could present in various ways such as swelling, ulceration or hardening or lump in the oral cavity and related structures including the jaws. In this group there are other pre−cancerous lesions and cysts which will need to be identified early. Special attention should be given to fibrous dysplasia, ameloblastoma, leucoplakia, mottled and hypoplastic teeth, amelogenesis imperfecta and impacted teeth. Clinical Features These are varied, but any swelling of unknown aetiology or change in normal epithelial colouration should be viewed with suspicion. Clinical Features Severe pain associated with offending tooth, sometimes abscess is present. Periodontitis Acute or chronic inflammation of gums and periodontium (tooth attachment). Management • In acute phase, where there is severe tenderness, give a combination of antibiotic and metronidazole • Give warm saline mouth−washes and analgesics or other mouth washes. Clinical Features Throbbing continuous or intermittent toothache which is worse at night. Temporomandibular Joint Disorders These are varied, of special concern is dislocation. Management Re−assure the patient that it is a temporary thing and that there is no irreversible damage. Reduction of dislocated mandible If the mandibular midline deviates to one side, the dislocation is unilateral. The operator places his thumbs on the external oblique line of the mandible (lateral to the third molars) with fingers placed under the chin. A rotatory motion is performed by the thumbs pressing downwards and forwards, and the fingers pressing upwards until the mandible is reseated. Trauma Oral and maxillofacial trauma may result in the following: • Fractures of the teeth and alveolar bone • Fractures of the maxilla, mandible orbit and nose • Contusions, lacerations and cuts of soft tissues in general, the trauma varies in severity and may be associated with a variety of complications • Severe haemorrhage • Airway obstruction • Trauma to the eye • Injury to intracranial structures • Injuries to the cervical spine • Contamination and/or infection of tissues • Varying degrees of deformity and interference with the function(s) of the injured structure/organ. Investigations • X−ray: Management • Maintain patent airway • Control bleeding without damaging tissue, by suturing or gauze packs • Give injectable penicillin then orally when able to swallow • Give tetanus toxoid • Give analgesics e. Re−implant under local anaesthesia and give gauze pack for biting on while a dental surgeon is contacted for fixation • All suspected fractures to a dental surgeon/maxillofacial surgeon.

If a plant produces a large volume of sludge cheap 50mg hyzaar mastercard, the sludge could be dewatered cheap hyzaar 12.5 mg free shipping, thickened cheap 50 mg hyzaar visa, or conditioned to decrease the volume of sludge. Turbidity of source water, dosage, and type of coagulant used are the most important factors which determine the amount of sludge produced in a treatment of water. A common way for a synthetic organic chemical such as dioxin to be introduced to a surface water supply is from an industrial discharge, agricultural drainage, or a spill. There are four sporozoites in each Cryptosporidium oocyst, and they are generally banana-shaped. Equalization storage is the volume of water needed to supply the system for periods when demand exceeds supply. Generally, a water storage tank’s interior coating (paint) protects the interior about 3-5 years. Health concerns regarding sulfate in drinking water have been raised because of reports that diarrhea may be associated with the ingestion of water containing high levels of sulfate. Of particular concern are groups within the general population that may be at greater risk from the laxative effects of sulfate when they experience an abrupt change from drinking water with low sulfate concentrations to drinking water with high sulfate concentrations. Formally, "sulfide" is the dianion, S2-, which exists in strongly alkaline aqueous solutions formed from H2S or alkali metal salts such as Li2S, Na2S, and K2S. Thus, the exact sulfur species obtained upon dissolving sulfide salts depends on the pH of the final solution. Such inorganic sulfides typically have very low solubility in water and many are related to minerals. In fact, the bonding in transition metal sulfides is highly covalent, which gives rise to their semiconductor properties, which in turn is related to the practical applications of many sulfide materials. They also reduce the interfacial tension between oil and water by adsorbing at the liquid-liquid interface. When micelles form in water, their tails form a core that can encapsulate an oil droplet, and their (ionic/polar) heads form an outer shell that maintains favorable contact with water. When surfactants assemble in oil, the aggregate is referred to as a reverse micelle. In a reverse micelle, the heads are in the core and the tails maintain favorable contact with oil. Surfactants are also often classified into four primary groups; anionic, cationic, non-ionic, and zwitterionic (dual charge). They also reduce the interfacial tension between oil and water by adsorbing at the liquid- liquid interface. When micelles form in water, their tails form a core that can encapsulate an oil droplet, and their (ionic/polar) heads form an outer shell that maintains favorable contact with water. When surfactants assemble in oil, the aggregate is referred to as a reverse micelle. In a reverse micelle, the heads are in the core and the tails maintain favorable contact with oil. Surfactants are also often classified into four primary groups; anionic, cationic, non-ionic, and zwitterionic (dual charge). Anaerobic water undesirable for drinking water purposes because of color and odor problems are more likely to occur under these conditions. Taste and odor problems in the water may happen if sludge and other debris are allowed to accumulate in a water treatment plant. Trichloroethylene is a colorless liquid which is used as a solvent for cleaning metal parts. Drinking or breathing high levels of trichloroethylene may cause nervous system effects, liver and lung damage, abnormal heartbeat, coma, and possibly death. When determining the total dissolved solids, a sample should be filtered before being poured into an evaporating dish and dried. Demineralization may be necessary in a treatment process if the water has a very high value Total Dissolved Solids. Ion exchange is an effective treatment process used to remove iron and manganese in a water supply. When determining the total dissolved solids, a sample should be filtered before being poured into an evaporating dish and dried. Demineralization may be necessary in a treatment process if the water has a very high value Total Dissolved Solids. Can be used to accomplish accurate and reliable remote monitoring and control over a long distribution system. A method of testing by adding a reagent of known strength to a water sample until a specific color change indicates the completion of the reaction. Generally, the higher the total alkalinity, the greater the resistance to pH change. If total coliform is present, the sample will also be tested for either fecal coliform or E. The weight per unit volume of all volatile and non-volatile solids dissolved in a water or wastewater after a sample has been filtered to remove colloidal and suspended solids. These systems do not have to test or treat their water for contaminants which pose long-term health risks because fewer than 25 people drink the water over a long period. It must meet or surpass all drinking water standards to be considered safe to drink. The most common class of disinfection by-products created when chemical disinfectants react with organic matter in water during the disinfection process. The most common class of disinfection by-products created when chemical disinfectants react with organic matter in water during the disinfection process. These tubes are approximately 1 inch deep and 36 inches long, split-hexagonal shape and installed at an angle of 60 degrees or less. These tubes provide for a very large surface area upon which particles may settle as the water flows upward.