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SOMNIUM  EQUESTRIAN

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Elias Perez
Elias Perez

Mp4 Shock In Hindi


Most new implantable cardioverter defibrillators (ICDs) can do the same job as a pacemaker, as well as detect dangerous heart rhythms. Once these are detected, the ICD can deliver a shock to restore your heart back to its normal rhythm.




Mp4 Shock in hindi



The most important complication of hemorrhage is circulatory impairment with tissue hypoxemia. Melena, hematemesis, or hematochezia indicates that a potentially lethal situation may be developing. A 15% loss of blood volume is usually readily tolerated and compensated by contraction of large veins and recruitment of fluid from extravascular sites. As the volume depletion becomes greater, constriction of arterioles, shunting of cardiac output from nonvital areas such as skin and bone, tachycardia, decreasing cardiac output, and orthostatic hypotension occur. The patient is likely to be thirsty and feel faint when standing. After 40 to 50% depletion of blood volume, complete loss of the ability to compensate occurs with shock, impaired flow of blood to vital organs, tissue hypoxemia, lactic acidosis, and ultimately, death.


Rapid correction of blood volume is essential. In dogs, irreversible changes occur within 4 hours after a phlebotomy that maintains a reduction of 35 mm Hg mean arterial pressure. Earlier transfusion will save most of the animals. The role of many homeostatic mechanisms and pathogenetic mediators in the response to hypovolemic shock is just beginning to be elucidated. These mediators include catecholamines, renin, complement, kinins, and lysosomal enzymes. The goal of therapy is to protect each link in the delivery of oxygen to cells by restoring and maintaining normal blood volume.


The description of acute hemorrhage should trigger three management steps. First, restore and maintain normal blood volume. A history suggesting an active gastrointestinal hemorrhage should alert the physician to the immediate need for treatment of hypovolemia and shock. Next, the site and cause of the bleeding should be established. This is becoming increasingly important as methods using interventional endoscopy or radiology are developed to stop hemorrhage. Finally, a treatment regimen should be planned, based on diagnosis and the condition of the patient. This regimen might include pharmacologic therapy to reduce gastric acidity, endoscopic coagulation of bleeding ulcers or sclerosis of varices, embolization of bleeding vessels using angiography, or operation. The regimen must also provide for long-term management of the underlying disease.


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