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EpiPens (b) are only indicated for those patients who suffer severe allergic reactions and are not given on an outpatient basis in patients with asthma purchase ventolin 100mcg with visa. Naloxone is a μ-opioid receptor competitive antagonist and its rapid blockade of those receptors reverses the depressive effects of opioids buy ventolin 100 mcg without prescription. Oxygen (a) and respiratory treatments (c and d) can aid in bringing saturations up, but will not treat the underlying cause. This type of mechanism of acquiring pneumonia is com- monly seen in those with swallowing difficulties or a relaxed cardiac sphincter because of alcohol. Given these factors, this patient is in a high- risk category for aspiration pneumonia. The small degree of angulation of the right mainstem bronchus makes the right lung at higher risk. Most particles easily travel down this route, ending up in the right middle or lower lobe of the lung. Antibiotic coverage should be broad, covering for both gram- positive and gram-negative organisms including anaerobes, which are commonly present in the mouth. They are also at risk for fungal pneumonias (e); however, treatment should not be initiated unless there is high clinical suspicion. Within 24 to 48 hours, the clinical course may abruptly deteriorate to septic shock, respiratory failure, and mediastinitis. As there is Shortness of Breath Answers 75 no evidence for human-to-human transmission, disease in humans occurs when spores are inhaled. Though S pneumoniae and H influenzae (a and d) can cause respiratory failure, it is unlikely to occur in a healthy 32-year-old man. It is similar to B anthracis in that sheep, cattle, and goats are the primary reservoirs. However, deterio- ration because of Q fever is not as rapid as that seen in anthrax. Other causes of exudative effusions include the following: infec- tion, connective tissue diseases, neoplasm, pulmonary emboli, uremia, pancre- atitis, esophageal rupture, postsurgical, trauma, and drug-induced. They (1) limit oxygen deterioration, (2) decrease mortality and respiratory failure, and (3) accelerate recovery. It is important to initiate steroid therapy prior to starting antibiotics to avoid wors- ening hypoxia that is secondary to the inflammatory reaction caused by dying organisms. Gram stain is unlikely to be useful in 76 Emergency Medicine acutely identifying the organism in community-acquired pneumonia and silver stain is required to see pneumocystis. Nebulizer treatment (d) is ancillary and may provide relief of symptoms in a wheezing patient with pneumonia, but is not appropriate for initial management of this patient. These include dust, various perfumes, underlying upper- respiratory infections, cigarette smoke, menstrual flow, and various medica- tions including aspirin. The medical intervention in this patient should include a β2-agonist nebulized solution, corticosteroids, and oxygen admin- istration. The most useful measure to track the patient’s progress with each treatment is a peak expiratory flow, and should be a part of the initial assessment and monitoring. More com- monly, peak flow meters are used which measure the peak expiratory flow rate in liters per second starting with fully inflated lungs. Both of these mea- surements require full patient cooperation whose values should be the aver- age of three consecutive forced expirations. A chest radiograph (b) is useful if the patient does not improve after standard asthma treatments and there is suspicion of a different etiology for the patient’s dyspnea. The peptide then acts as a natural diuretic and vasodilatory agent in lowering stress on the heart. A rectal temperature (d) is not a necessary next step, but may be utilized at a later time when evaluating infection as another trigger. The note from the facility states that the patient is complaining of abdominal pain, having already vomited once. Which of the findings on plain abdominal film is strongly suggestive of mesenteric infarction? They were at a restaurant a day before for dinner and both ate the seafood special, which consisted of raw shellfish. Which of the following is responsible for the majority of acute episodes of diarrhea? A 79-year-old man was being commemorated at an awards dinner for his 50 years of service at the local bank. The patient states that he usually drinks a six-pack of beer daily, but increased his drinking to two six-packs daily over the last week because of pressures at work. He notes decreased appetite over the last 3 days and states he has not had anything to eat in 2 days.

For example generic ventolin 100 mcg with mastercard, when they’re both caught in an unexpected traffic jam buy ventolin 100 mcg low cost, they view the event through their own life-lenses and thus experience different thoughts and feelings. Susan’s entitled life-lens leads her to feel rage and have thoughts like, “No one in this town knows how to drive. After all, changing the way you feel starts with identifying your problematic life-lenses. If you aren’t aware of your own life-lenses, you’re powerless to do anything about them. The questionnaire in Worksheet 7-1 is designed to clarify which life-lenses may be causing you trouble. After you identify them, we tell you a little more about how they work, where they come from, and most importantly, what you can do about them. Before you start mark- ing the life-lenses in the worksheet that apply to you, consider the following tips: Answer as honestly as possible. Sometimes, people respond how they think they “should” answer rather than responding with honest self-appraisals. Take your time to reflect on various events and situations that have happened to you that are relevant to each lens. For example, in answering questions about abandonment-fearful versus intimacy-avoidant, ponder the relationships you’ve had and how you feel and react to those close to you. Chapter 7: Correcting Your Life-Lenses: A New Vision 101 Base your answer on how you feel and react in situations that relate to each lens. For example, if you frequently feel inadequate but know in your head that you’re actu- ally not inadequate, answer on the basis of how you feel when your adequacy comes into question, such as when you’re asked to make a speech. For example, if you’re a perfectionist, you may also quite often feel inadequate when you make a mistake. Or if you normally feel unworthy and undeserving, you may find yourself feeling quite angry and entitled on occasions when your needs unexpect- edly go unmet. People often flip between opposite lenses, so don’t worry if you seem a little inconsistent. If you see parts of the description that apply and others that don’t, underline the parts that fit and rate your- self on those parts in terms of how often they apply to you. I’d just as soon lost without someone in my life, and I worry stay away from any emotional involvement; I don’t about losing those I care about. I don’t there’s a right way and a wrong way to do things, like taking on things I’ve never done before if and I want to do things the right way. I worry about whether I’ve done the conscience stand in my way if I want something wrong thing. I never let It’s hard for me to set limits with people, so I anyone see how I feel. Any life-lens that you rate as 3 or above probably gives you trouble now and then. If you dis- cover that you have many life-lenses that you rate as 3 or above, don’t worry. Take a few minutes now to reflect on the results of your Problematic Life-Lenses Questionnaire. In Worksheet 7-2, jot down thoughts about how these life-lenses may be causing you to have troubling emotions. Don’t worry if you’re not quite sure of the connec- tions; we give you more ways of seeing the lenses’ influence on your life in the next few sections of this chapter. Worksheet 7-2 My Reflections How life-lenses work You may wonder just how much trouble life-lenses create and why we say they’re the root cause of most emotional turmoil. The exercise in this section is likely to convince you of just how much life-lenses affect your vision and your emotional life. After you identify your life-lenses, it’s a good idea to consider more examples of how the lenses lead to problematic thoughts and feelings. Notice how the life-lenses are a broad theme and the thoughts are specific to a given event. See how life-lenses influence how the fathers inter- pret this identical event and respond to their daughters. Chapter 7: Correcting Your Life-Lenses: A New Vision 103 Jim has a guilty and blameworthy life-lens. He feels like he’s done something wrong, even when it’s not his fault (see Worksheet 7-3). Worksheet 7-3 Jim’s Influence of Life-Lenses Event: My daughter is 30 minutes late getting home.

He suggested that this pay-off is related to their beliefs about the seriousness and treatability of an illness buy ventolin 100mcg. For example discount ventolin 100 mcg, a child presenting with abdominal pain may result in an original hypothesis of appendicitis as this is both a serious and treatable condition, and the benefits of arriving at the correct diagnosis for this condition far outweigh the costs involved (such as time-wasting) if this hypothesis is refuted. Marteau and Baum (1984) have argued that health professionals vary in their perceptions of the serious- ness of diabetes and that these beliefs will influence their recommendations for treatment. Brewin (1984) carried out a study looking at the relationship between medical students’ perceptions of the controllability of a patient’s life events and the hypothetical prescription of antidepressants. The results showed that the students reported variability in their beliefs about the controllability of life events; if the patient was seen not to be in control (i. This suggests that not only do health professionals report inconsistency and variability in their beliefs, this variability may be translated into variability in their behaviour. The original hypothesis will also be related to the health professional’s existing knowledge of the patient. Such factors may include the patient’s medical history, knowledge about their psychological state, an under- standing of their psychosocial environment and a belief about why the patient uses the medical services. Stereotypes are sometimes seen as problematic and as confounding the decision-making process. However, most meet- ings between health professionals and patients are time-limited and consequently stereotypes play a central role in developing and testing a hypothesis and reaching a management decision. Stereotypes reflect the process of ‘cognitive economy’ and may be developed according to a multitude of factors such as how the patient looks/talks/ walks or whether they remind the health professional of previous patients. Without stereotypes, consultations between health professionals and patients would be extremely time-consuming. Other factors which may influence the development of the original hypothesis include: 1 The health professional’s mood. The health professional’s mood may influence the choice of hypotheses and the subsequent process of testing this hypothesis. Positive affect was induced by informing subjects in this group that they had performed in the top 3 per cent of all graduate students nationwide in an anagram task. All subjects were then given a set of hypothetical patients and asked to decide which one was most likely to have lung cancer. The results showed that those subjects in the positive affect group spent less time to reach the correct decision and showed greater interest in the case histories by going beyond the assigned task. The authors therefore concluded that mood influenced the subjects’ decision-making processes. Factors such as age, sex, weight, geographical location, previous experience and the health professional’s own behaviour may also effect the decision-making process. For example, smoking doctors have been shown to spend more time counselling about smoking than their non- smoking counterparts (Stokes and Rigotti 1988). Further, thinner practice nurses have been shown to have different beliefs about obesity and offer different advice to obese patients than overweight practice nurses (Hoppe and Ogden 1997). In summary, variability in health professionals’ behaviour can be understood in terms of the factors involved in the decision-making process. In particular, many factors pre-dating the development of the original hypothesis such as the health professional’s own beliefs may contribute to this variability. Communicating beliefs to patients If health professionals hold their own health-related beliefs, these may be communicated to the patients. They assessed the effect of offering surgery either if it would ‘increase the probability of survival’ or would ‘decrease the probability of death’. The results showed that patients are more likely to choose surgery if they believed it increased the probability of survival rather than if it decreased the probability of death. The phrasing of such a question would very much reflect the individual beliefs of the doctor, which in turn influenced the choices of the patients. The results showed that how risk was presented influenced both the participants’ ratings of how preventable the illness was and their beliefs about causes. In a similar vein, Misselbrook and Armstrong (2000) asked patients whether they would accept treatment to prevent stroke and presented the effectiveness of this treatment in four different ways. Therefore, although the actual risk of the treatment was the same in all four conditions, the ways of presenting this risk varied and this resulted in a variation in patient uptake. Harris and Smith (2004) carried out a similar study but compared absolute risk (high vs low risk) with comparative risk (above average vs below average). However, doctors not only have beliefs about risk but also about illness which could be communicated to patients. Patients were asked to read a vignette in which a person was told either that they had a problem using a medical diagnostic term (tonsillitis/gastroenteritis) or using a lay term (sore throat/stomach upset). The results showed that although doctors are often being told to use lay language when speaking to patients, patients actually preferred the medical labels as it made the symptoms seem more legitimate and gave the patient more confidence in the doctor.

This is the original opinions discount ventolin 100 mcg visa, especially if their environment sup- principle behind politicians’ perennial attempts to por- ports the initial opinion generic 100mcg ventolin fast delivery. This practice has come to include dis- veloped by psychologist William McGuire, focuses on a tinguishing and distancing themselves from “Washing- chronological sequence of steps that are necessary for suc- ton insiders” who are perceived by the majority of the cessful persuasion to take place. They must then sage itself, the method by which the message is present- yield to the argument, and retain it until there is an oppor- ed is at least as important as its content. Attitude: Your Most Priceless Posses- provokes fear; and whether it presents its strongest argu- sion. New York: Cambridge University Press, present an identical message to two different groups, the 1986. The Psychology of Attitude Change and still vary because audience variables such as age, sex, Social Influence. Philadelphia: Temple University Press, and intelligence also affect attitude change. Some have at- tributed it to the superior verbal skills of females which may increase their ability to understand and process ver- Attraction, interpersonal bal arguments. Others argue that it is culturally deter- A favorable attitude toward, or a fondness for, an- mined by the greater pressure women feel to conform to other person. The effect of intelligence on attitude change is in- Both personal characteristics and environment play conclusive. According to another theory, a who come into contact regularly and have no prior nega- person will choose a partner who will enhance his or her tive feelings about each other generally become attracted own self-image or persona. Researchers generally ac- to each other as their degree of mutual familiarity and knowledge a specific set of courting or flirting behaviors, comfort level increases. Initially, first meet also determines how they will feel about each both men and women use varied repertoires of body lan- other. One is more likely to feel friendly toward a person guage to signal interest and/or availability. Women draw attention to themselves and opinions two people share, the greater the probabili- by tossing or playing with their hair, tilting their heads, ty that they will like each other. The first that disagreement on important issues decreases attrac- connection is generally made through eye contact, often tion. One of the most important shared attitudes is that an intent gaze which is then lowered or averted. If the liking and disliking the same people creates an especial- eye contact is positively received, a smile often follows ly strong bond between two individuals. If the attrac- tion progresses, the next step is casual touching in in- Personality type is another determinant of interper- nocuous areas such as the shoulder, wrist, or forearm. In areas involving control, such as dom- The final step in the initial romantic attraction is known inance, competition, and self-confidence, people tend to as mirroring or body synchrony, which is a matching of pair up with their opposites. With bodies aligned and fac- plementary pairing of a dominant person with a submis- ing each other, the couple begins to move in tandem, sive one. People gravitate to others who are like them- leaning toward each other, crossing their legs, or tilting selves in terms of characteristics related to affiliation, their heads. By these actions, the couple mutually trans- including sociability, friendliness, and warmth. Infants begin to mirror adult behavior shortly ance, even among members of the same sex. Each cul- after birth, and the technique is consciously practiced by ture has fairly standard ideas about physical appearance therapists, salespeople, and others whose work depends that serve as powerful determinants in how we perceive on establishing a sense of closeness with others. Kindness, sensitivity, intelligence, modesty, ally, the adoption of each other’s postures may be seen in and sociability are among those characteristics that are virtually any grouping of individuals who feel comfort- often attributed to physically attractive individuals in re- able with and are close to each other. In one study, attractive job applicants (both male and female) were given markedly preferential Further Reading treatment by prospective employers compared with Berscheid, Ellen. New greater role in the attraction of males to females than York: Springer-Verlag, 1988. No matter what the circum- stances are, behavior is often seen as reflecting a per- son’s general traits (such as kindness or aggression) rather than as a response to a specific situation. Attribution theory The type of interpersonal attraction that has particu- An area of cognitive therapy that is concerned with lar interest to most people is attraction to the opposite how people explain the causes of behavior, both sex. To a certain extent, romantic attraction is influenced their own and those of others. A person with an internal locus of control, an edly; and distinctiveness is concerned with whether the “internal,” for example, will believe that her perfor- behavior occurs in other, similar, situations. For exam- mance on a work project is governed by her ability or by ple, if a friend consistently fails to repay a loan, an inter- how hard she works.