Sunday 25 September 2016

APLS TRACHY

Many children with an established tracheostomy will improve when the blocked tube is removed, allowing them to breathe through the stoma prior to replacing the blocked tube with a new one. However, there are risks in removing the tube from a newly created tracheostomy as, until the stoma track is established, attempted replacement of a tracheostomy tube may be difficult and a blind-ending false track could be created.
Parents who routinely care for their child's tracheostomy at home may be more familiar with tube suction and tube changing for their child than hospital staff in medical areas where this is rarely performed.

If you are unable to pass the suction catheter through the tracheostomy tube, then the tube must be changed immediately with the same size tube. If this fails to relieve the obstruction, or you cannot insert it:
  • Try a half size smaller tube.
  • If it is not possible to insert this, thread a lubricated suction catheter through the size smaller tracheostomy tube. Insert the suction catheter into the stoma and then attempt to guide the new tracheostomy tube along the catheter and into the stoma.
  • If this is unsuccessful then remove the tracheostomy tube.

APLS ETT To estimate endotracheal tube size for emergency intubation use the following formula:

To estimate endotracheal tube size for emergency intubation use the following formula:

NO FAILURE ONLY FEEDBACK = NFOF

Image result for DELAYED RETURN ENVIRONMENT

EVO THEORY OF DTH -BIOLF ONLY CARES ABT SAR

Suzanne Sadedin
Suzanne SadedinPh.D. in theoretical evolutionary biology from Monash University
Updated Aug 3, 2015 · Featured in Forbes · Upvoted by Ben WaggonerPhD in Integrative Biology, university professor, evolutionary biologist and Adriana Heguymolecular biologist, genomics researcher
Excellent question. And before I explain the real answer, which is rather mind-bending, here are some previous arguments and why they are wrong.

Myth 1: We die to make room for younger generations. 
Genes are selfish, and each individual body is a vehicle for a collection of genes. These genes are selected to favor the survival of copies of themselves. Since parents and offspring use the same resources, the death of a parent creates room ecologically for just one offspring. Each gene in the parent has a 50% chance of appearing in this offspring. But it has a 100% chance of appearing in the parent, because it's already there. It's never, then, in the evolutionary interests of a parent to die so an offspring can replace it.

Myth 2: We die because our cells/DNA get damaged with age.
This like saying bad drivers die because of blood loss. It's a proximate mechanism of death, not the evolutionary cause of mortality.

Our somatic cells (the cells that are part of our body) do indeed suffer occasional mutations as they divide. These mutations can kill or damage cells, which is annoying but not generally a big problem as we can make more. However, the worst mutations do something much more dangerous: they help cells to survive and proliferate. That's how you get cancer. Because this risk accumulates over time, cells are normally allowed only a limited number of divisions before they undergo cellular senescence, that is, they die. But the genes that cause cellular senescence can also stop working. So that's one of the ways in which we get old: our somatic cell lineages get older, damaged and mutated, and some become cancerous.

However, the cell/DNA damage idea assumes that this isn't something evolution can counteract. And that's clearly false. Lifespan and cancer rates differ between species, and not in the ways you would expect if they were determined by cell/DNA damage. For instance, once you take into account body size and phylogeny, DNA repair doesn't correlate with lifespan. Lifespan does, however, correlate with ecology: mammal species who typically lead risky lives die younger (even if you protect them from those risks). At one extreme, in the harsh Australian bush we find the male agile antechinus, who dies of stress at the end of a single breeding season. At the other extreme, the naked mole rat can live for three decades in its peaceful underground colonies.

This gets even more puzzling when you start to look at genomics. We have a whole suite of genes devoted to keeping our genome pristine. My favorite is a clever gene called P53 that acts as a "gatekeeper" for cell division. If the cell has too many mutations, P53 will halt division and activate repair mechanisms. If that doesn't fix things, it will make the cell commit suicide. Mutations that break P53 are involved in about half of all human cancers. Now, here's the rub: there's a whole family of genes related to P53 in other mammals, and some work better than others. Naked mole rats, as it happens, have two particularly awesome versions that completely protect them against cancer.

We also know that it's perfectly feasible for genetic modification to immortalize cell lineages, and that going through a haploid stage is not essential for maintaining cell viability. How do we know this? From the strange case of the 11,000 year old dog. The dog as an individual is long dead, but her cells survive today as an infectious cancer on other dogs' genitalia. There's also a quaking aspen in Utah whose roots are at least 80,000 years old.

The same applies to permanent organ damage. Some organs heal and regenerate, some don't. Some species can regenerate organs that others can't. A salamander can grow a whole new leg. There's even a jellyfish that can reverse its development when it's damaged. All in all, natural selection is clearly capable of creating creatures who can fix cellular and DNA damage and repair damaged organs.

So: evolution can fix these problems for us, and it doesn't. What the heck, evolution, aren't we friends?

Well, no, actually, evolution is not our friend. If anything, it's our genes' friend. And there's a very good reason our genes don't actually care about us.

Mutations are a problem evolution can fix. But death isn't. Accidents happen. Diseases happen. Sabre-toothed cats happen (well, not any more, but you get the point). No matter how hard our genes try to help us survive, sometimes they're going to fail. These failures are often, as far as your genes are concerned, random. And that means our genes can't afford to get too invested in the survival of any individual. In the long term, the only way a gene can survive is to spread -- to copy itself through a population.

So from a gene's-eye view, every investment in your survival is a potential trade-off with the creation and survival of your potential descendants. And, rather obviously, the more likely you are to die randomly, the less it makes sense for your genes to invest in the survival side of the equation.

Every day of your life, the Universe in effect rolls a pair of many-sided dice. Snake eyes, you're dead. Every day the probability that the Universe has at some point in the past killed you increases. And at some time after your birth, on average, you're dead.

Look at this from your genes' perspective. Your genes don't know about you specifically, their behavior is selected based on statistics. They don't want to invest in somebody who is, on average, dead. Younger people are, on average, more likely to be alive. So if your genes have to choose between investing in (on average) the survival and/or reproduction of young you versus old you, they'll pick young you.

And quite often they do have to choose. Early in development, for instance, you really need genes that allow lots of cellular proliferation. Your body can't grow without it. But too much cellular proliferation when you're fully-grown is a big problem. So it's a delicate balance, and what's good for you when you're a kid can be bad for you when you're grown up. There are other genes that manage these risks by switching genes on and off throughout your life, but that makes the network even more complex and failure-prone. You end up with an intricate genomic dance going on throughout your whole life. So it's hardly surprising that some genes end up helping you now and harming you later.

One example may be Huntington's Disease, a horrible dominant genetic disorder that slowly destroys your brain and kills you. The disease usually starts to affect people in middle age. However, young people with the Huntington's gene have more children on average. It's thought that the Huntington's gene strengthens the immune system by increasing activity of P53, making them healthier and more fertile. Other possible examples include atherosclerosis, sarcopenia, prostate hypertrophy, osteoporosis, carcinoma and Alzheimer's disease.

As life goes on, your genes effectively stop caring what happens to you. After a certain point, it's so unlikely that you're still alive that your genes can safely assume you'll already be dead. So your genomic programming can contain all sorts of wacky stuff that only kicks in after this point, just because there's no noticeable selection against it.

The really fascinating part (by which I mean the really depressing part) is how this effect reinforces itself. The more likely it is that you're dead, the less your genes care about you. The less your genes care about you, the more likely it is that you're dead. And this has been going on throughout our evolutionary history, so we've accumulated all sorts of weird malfunctions that kick in late in our lives. The human genome is riddled with them, and most of the genes involved are also part of normal development and reproduction. These malfunctions cluster around a certain age: the age when evolution stops caring about us because, statistically speaking, we're already dead.

So mortality is an evolutionary prophecy that fulfills itself in a multitude of ways. And that's why there's no single key to eternal life. Poor old Gilgamesh.

SPOCK You know more than you think you do."

You know more than you think you do."

CONFIRMATION BIAS

confirmation bias

AVAILABILITY BIAS

availability heuristic

MILLIGAN Money couldn't buy friends, but you got a better class of enemy.

Money couldn't buy friends, but you got a better class of enemy.

10000 YRS THE LONG NOW


EATING MEAT IS LIKE SMOKING


The illiterate of 21st century will not be those who cannot read and write ,but those who cannot learn, unlearn and relearn - Alvin Toffler


The illiterate of 21st century will  not  be those who cannot  read and write ,but those who cannot learn, unlearn and relearn -  Alvin Toffler

Mindful dishwashing can decrease stress and calm the mind, a new study finds.

Mindful dishwashing can decrease stress and calm the mind, a new study finds.

Human history has been shaped by three major revolutions: the Cognitive Revolution (70,000 years ago), the Agricultural Revolution (10,000 years ago), and the Scientific Revolution (500 years ago).

Human history has been shaped by three major revolutions: the Cognitive Revolution (70,000 years ago), the Agricultural Revolution (10,000 years ago), and the Scientific Revolution (500 years ago).

CAS REVOLN

All of life is practice in one form or another

All of life is practice in one form or another

KOL DR PRACTICE we tend to forget the many who fail, remember the few who succeed

we tend to forget the many who fail, remember the few who succeed

INET COGNITIVE OFFLOADING

The more times people look up facts online, the less they prefer to rely on their own memories for even the simplest questions.
Psychologists have called this ‘cognitive offloading’.

CAMUS You will never be happy if you continue to search for what happiness consists of. You will never live if you are looking for the meaning of life.”

You will never be happy if you continue to search for what happiness consists of. You will never live if you are looking for the meaning of life.”

Wanting positive experience is a negative experience; accepting negative experience is a positive experience

Wanting positive experience is a negative experience; accepting negative experience is a positive experience

Calm down, amigo

Calm down, amigo

APLS Intubation should take no longer than approximately 30 seconds, or, as a very rough guide, for how long the operator can hold their breath easily

Intubation should take no longer than approximately 30 seconds, or, as a very rough guide, for how long the operator can hold their breath easily

Children born in the later preterm period have been shown to exhibit lower school readiness, spatial abilities, verbal reasoning, educational achievement, and poorer school performance in the early school years than their peers born after 37 weeks

Children born in the later preterm period have been shown to exhibit lower school readiness, spatial abilities, verbal reasoning, educational achievement, and poorer school performance in the early school years than their peers born after 37 weeks

DASARATH HAD 4 KIDS-SNSKRT -DASARATHASYA CHOUBACHHA


VINI VICI VIDI ELOOM DEKLOOM JITLOOM


APLS If evidence of massive haemothorax: •insert chest drain •commence blood volume replacement, simultaneously if possible

 If evidence of massive haemothorax:
  • insert chest drain
  • commence blood volume replacement, simultaneously if possible

APLS If evidence of tension pneumothorax: •perform immediate needle decompression •follow with chest drain

If evidence of tension pneumothorax:
  • perform immediate needle decompression
  • follow with chest drain

SELF INTEREST IS THE ONLY GOOD?


CENTRAL POLYSYNDACTYLY

APLS If chest injury: •consider tension pneumothorax and haemothorax, flail segment and open pneumothorax TOFH

T-TENSION PNTHX
O-OPEN PNTHX
F-FLAIL CHEST
H-HMTHX

APLS If dealing with a trauma case: •control of major haemorrhage occurs simultaneously •consider cervical spine

If dealing with a trauma case:
  • control of major haemorrhage occurs simultaneously
  • consider cervical spine

The art of being happy lies in the power of extracting happiness from common things. ~ Henry Ward Beecher

The art of being happy lies in the power  of extracting happiness from common things. ~ Henry Ward Beecher 

QKSTN -NILTRY KIHADI COMPLEX


POLITICS IS SUCH LESS LUMPIER.....CLICKING PETITIONS


-APLS-LLFAO-LOOK LISTEN FEEL FOR AIRWAY OBS


APLS Resuscitation efforts are unlikely to be successful and cessation can be considered if there is no return of spontaneous circulation at any time with up to 20 minutes of cumulative life support and in the absence of recurring or refractory VF/pVT

Resuscitation efforts are unlikely to be successful and cessation can be considered if there is no return of spontaneous circulation at any time with up to 20 minutes of cumulative life support and in the absence of recurring or refractory VF/pVT
EXCEPT POISONING AND HYPOTHERMIA

APLS Saturations should then be maintained between 94% and 98%

Saturations should then be maintained between 94% and 98%

MNDFL-BEYOND OWN CONTROL ACCEPTANCE -BOCA


MINDFLNESS

Image result for 4 FOUNDATIONS OF MINDFULNESS

CREATE A THOUGHT- ANGER ANGER ANGER ANGER ANGER, DROWSY DROWSY DROWSY ......

DITRACTED DISTRACTED DISTRACTED......

HINDRANCE TO MEDITATION -OBSTRUCTS CLARITY OF MIND

Image result for 5 HINDRANCES

APLS CAPNOGRAPHY Adrenaline will decrease and bicarbonate increase the measured CO2. Levels of less than 2 kPa (15 mmHg) should prompt attention to chest compression adequacy.

Adrenaline will decrease and bicarbonate increase the measured CO2. Levels of less than 2 kPa (15 mmHg) should prompt attention to chest compression adequacy.

WAR PEACE CRIME AND PUNISHMENT


SANKHARA

Image result for SATIPATTHANA SUTTA

MNDFL -NEUTRAL FEELING-CALM CALM CALM


MNDFL TUMMY RISE-FALL, MECHANICAL REPETITIVE ARDUOUS NATURAL


REALITY IS JUST EXPERIENCE

Image result for SATIPATTHANA SUTTA

SATTIPATTHAAN SUTTA

Image result for SATIPATTHANA SUTTA

SATTIPATHAN SUTTA

Image result for SATIPATTHANA SUTTA

LF REALITY

CRAZY

MURDOCH "Between saying and doing, many a pair of shoes is worn out."

PETER"It's better to have loved and lost than to have to do forty pounds of laundry a week."

"It's better to have loved and lost than to have to do forty pounds of laundry a week."

Saturday 24 September 2016

CHAPLIN Life is a tragedy when seen in close-up, but a comedy in long-shot."

Life is a tragedy when seen in close-up, but a comedy in long-shot."

Every one is my teacher, every event a gift, we are all peers; One

Every one is my teacher, every event a gift, we are all peers; One

MID AGE TIME FLIES

Our brain encodes new experiences, but not familiar ones, into memory, and our retrospective judgment of time is based on how many new memories we create over a certain period. In other words, the more new memories we build on a weekend getaway, the longer that trip will seem in hindsight.

KEEP BMI UNDER 28 -GP


high-fat and high-sugar diet causes problems with memory inhibition in the hippocampus.

high-fat and high-sugar diet causes problems with memory inhibition in the hippocampus.

APLS Amiodarone is the treatment of choice in shock-resistant VF and pVT.

Amiodarone is the treatment of choice in shock-resistant VF and pVT. 

hypothermia

Unlike cooling, rewarming should be gradual and take place over 8-24 hours. If the patient is stable, simply reset the Arctic Sun at 37C with a rewarming rate of0.1C/hr. If the patient develops hemodynamic instability, dysrhythmia, or severe bleeding while being cooled, start rewarming to 37C immediately at a rate of 0.3C/hr

Hypothermia slows coagulation.



Hypothermia slows coagulation.

EVIDENCE

Image result for TYPES OF EVIDENCE

WRIGHT "Curiosity killed the cat, but for a while I was a suspect."

"Curiosity killed the cat, but for a while I was a suspect."

ADMED Low ALT levels are associated with increased long-term mortality among middle-aged patients with stable coronary heart disease

Low ALT levels are associated with increased long-term mortality among middle-aged patients with stable coronary heart disease

PED RASH VESBUL

vesiculobullous dagram highlight

PED RASH MACPAP

maculopapular diagram highlight

RASH ERYTH PEDS

erythematous diagram highlight

RESH PETECH PED

petechiael rashes highlight

MCD he rash is initially erythematous, maculopapular and appears first on the wrist and ankles, then becomes palpable petechiae, mimicking Rocky Mountain spotted fever. The rash quickly spreads to the rest of the body coalescing into palpable purpura.

he rash is initially erythematous, maculopapular and appears first on the wrist and ankles, then becomes palpable petechiae, mimicking Rocky Mountain spotted fever. The rash quickly spreads to the rest of the body coalescing into palpable purpura. 

RASH PEDS PEMV

four broad categories based on visual and tactile characteristics:[2]
  • Petechial/Purpuric
  • Erythematous
  • Maculopapular
  • Vesiculobullous
PEMV

RASH PEDS

Historical and physical “red flags” in a patient with an unknown rash include:[1]
  • Fever
  • Toxic appearance
  • Hypotension
  • Mucosal lesions
  • Severe pain
  • Very old or young age
  • Immunosuppressed
  • New medication

APLS -SOL RP if at any time there are signs of life, such as regular respiratory effort, coughing, eye opening or a sudden increase in end tidal CO2, stop CPR and check the monitor:

if at any time there are signs of life, such as regular respiratory effort, coughing, eye opening or a sudden increase in end tidal CO2, RCEC-stop CPR and check the monitor:
  • If still VF/pVT, continue with the sequence as above
  • If asystole, change to the asystole/PEA sequence
  • If organised electrical activity is seen, check for signs of life and a pulse; if there is ROSC, continue post resuscitation care. If there is no pulse (or a pulse below 60 beats/min with no signs of circulation) and no other signs of life continue the asystole/PEA sequence

APLS Whenever venous access is not attainable within 1 minute, intraosseous access should be used as it is rapid and effective

Whenever venous access is not attainable within 1 minute, intraosseous access should be used as it is rapid and effective

APLS Many AEDs can detect VF/pVT in children of all ages and differentiate ‘shockable’ from ‘non-shockable’ rhythms with a high degree of sensitivity and specificity.

Many AEDs can detect VF/pVT in children of all ages and differentiate ‘shockable’ from ‘non-shockable’ rhythms with a high degree of sensitivity and specificity.

APLS Recommended sizes are 4.5 cm for children UNDER 10 kg and 8–12 cm for children OVER10 kg. One pad is placed over the apex in the mid-axillary line, whilst the other is put immediately below the clavicle just to the right of the sternum.

Recommended sizes are 4.5 cm for children <10 kg and 8–12 cm for children >10 kg. One pad is placed over the apex in the mid-axillary line, whilst the other is put immediately below the clavicle just to the right of the sternum. 

APLS With immediate identification of VF/pVT, asynchronous electrical defibrillation of 4 joules per kilogram (J/kg) should be carried out immediately and the protocol continued as below.

With immediate identification of VF/pVT, asynchronous electrical defibrillation of 4 joules per kilogram (J/kg) should be carried out immediately and the protocol continued as below.

PROBLEM 2: Dark energy The universe is flying apart faster and faster

PROBLEM 2: Dark energy

The universe is flying apart faster and faster

APLS Recognised causes of VF/pVT in children include underlying cardiac disease, usually congenital, hypothermia and some drug overdoses. A sudden witnessed collapse is also suggestive of a VF/pVT episode.

Recognised causes of VF/pVT in children include underlying cardiac disease, usually congenital, hypothermia and some drug overdoses. A sudden witnessed collapse is also suggestive of a VF/pVT episode.

PROBLEM 1: Dark matter Galaxies rotate too quickly for their visible matter

PROBLEM 1: Dark matter

Galaxies rotate too quickly for their visible matter

PEDS RASH A rash associated with fever or hypotension should make you worry about potentially deadly diagnoses

 A rash associated with fever or hypotension should make you worry about potentially deadly diagnoses

There’s only a one in 135 chance that there’s a single pair of exact doppelgangers

There’s only a one in 135 chance that there’s a single pair of exact doppelgangers

CRT PED

Perhaps the true value in measuring CRT is that it provides a cognitive stop point in the management of a sick child – five seconds to get ourbreathing under control – before going forward. There is data to suggest that pressing for longer leads to a longer CRT (by up to 1.4 seconds) but these results were inconsistent.

emergency medicine has taken from surgery and pediatrics, critical care and obstetrics, endocrinology and psychiatry, and we have created something unique. And in doing so, we altered the world’s expectations of what medicine should be.

 emergency medicine has taken from surgery and pediatrics, critical care and obstetrics, endocrinology and psychiatry, and we have created something unique.  And in doing so, we altered the world’s expectations of what medicine should be.

“Emergency Medicine is the most interesting 15 minutes of every other specialty.”

“Emergency Medicine is the most interesting 15 minutes of every other specialty.”

ion at www.meditation.org.au Saturday, 16 July 2016 - What we are today comes from our thoughts of yesterday, and our present thoughts build our life of tomorrow: Our life is th e creation of our mind. – Buddha

ion at www.meditation.org.au
 What we are today comes from our thoughts of yesterday, and our present thoughts build our life of tomorrow: Our life is th e creation of our mind. – Buddha

BYOMKESH SN TV KOHEN KOBI KALIDAS


WADDELLS TRIAD -RTA

Waddell Triad's Triad

VEGAN X REDUCED CA

Only the vegan group got a significant drop in IGF-1. These findings demonstrate that, unlike in rodents, long-term severe caloric restriction in humans does not reduce the level of this cancer-promoting hormone. It’s not how many calories we eat, but the protein intake that may be the key determinant of circulating IGF-1 levels in humans; and so, reduced protein intake may become an important component of anti-cancer and anti-aging dietary interventions.

APLS PEA ALGO IF SOL CHECK RHYTHM IF PERFUSABLE RHYTHM CHECK PULSE SOL RP


APLS 100-120 RATE CC, VENTILATION RATE 10-12, RATIO 15 TO 2


Friday 23 September 2016

Chronic illness is stored up trauma

Chronic illness is stored up trauma


APLS CARD ARREST ALGOPED

SAFE STIM SHOUT

AOM LLF 5RB

SOL-P

CPR 15/2

ASSESS RHYTHM


VF/VT     VS      PEA AS

BUDDHISM IS AN EDUCN SYSTEM

////////////////////ME ABRHMC RELIGNS ARE FAITHS

///////////////////level of carbon dioxide in the atmosphere has been rising.   It has been monitored since 1956 at the Mauna Loa Observatory (MLO) in Hawaii.   Mauna Loa was originally chosen as a carbon dioxide monitoring site because it is located far from any continent and offers a good average value for the air over the central Pacific.


////////////////////NO GREED HATRED DELUSION IS NIRVANA


///////////////////MIDDLE WAY = GENEROSITY COMPASSION WISDOM


///////////////////KARMA IS ACTION OF BODY SPEECH MIND


//////////////////GOOD KARMA VS BAD KARMA eg GREED HATRED DELUSION VS GENEROSITY COMPASSION WISDOM BY BODY SPEECHMIND


/////////////EINSTEIN MOST RECOGNISABLE SCIENTIST IN WORLD WHEN ASKED WHO ARE YOU?  I AM A STUDENT OF PHYSICS


//////////////MONKS ARE HAPPY TO BE MONKS


///////////////



Ah! Vanitas Vanitatum! Which of us is happy in this world?
Which of us has his desire? Or having it, is satisfied?
—William Makepeace Thackeray, Vanity Fair


///////////According to the Second Noble Truth, desire, or craving (tanha in Pali, trishna in Sanskrit, translated as “thirst”) is the source of dukkha, dissatisfaction. 

//////////A Chinese proverb describes the cycle: Man takes a drink; drink takes a drink; drink takes the man.)

///////////poet Marianne Moore as ultimate truth: “satisfaction is a lowly / thing, how pure a thing is joy.” Satisfaction was the opiate of the masses, I declared, and joy the nectar of the gods. I wanted nectar. 

///////// Buddha, “one who is awake.”


/////////////ONLY THE HAPPY MIND CAN UNDERSTAND SUFFERING

///////////JUNG  craving for alcohol as “a low level of the spiritual search of our being for wholeness, expressed in medieval language: the union with God.

//////////Diamond Sutra:
All composite things are like
     a dream, a fantasy, a bubble
     and a shadow
Like a dewdrop and a flash of
     lightning—
They are thus to be regarded.

///////////Buddhism teaches us that desire, for all the agony and ecstasy, is no match for the truth.

/////////////VAN GOGH 
///////////////////B MONK MEAL -EAT FROM BOWL WHATEVER IS THERE -NO CRAVING

//////////////////I WANT IT I M NOT GETTING IT-TANHA-CAUSE COMING FROM WITHIN-DEALING WITH IT - B MONK TRAINING


//////////////////DTHING another “rainbow” in the process of dissolving from this world


//////////////////////////


Tuesday 20 September 2016

Beware of Advice From Successful Outliers

Beware of Advice From Successful Outliers

Many hearing-impaired people are immune to seasickness,

Many hearing-impaired people are immune to seasickness, 

Optimism is the one quality more associated with success and happiness than any other. – Brian Tracy

Optimism is the one quality more associated with success and happiness than any other. – Brian Tracy

You learn more from failure than from success. Don’t let it stop you. Failure builds character. – Unknown

You learn more from failure than from success. Don’t let it stop you. Failure builds character. – Unknown

The only person you are destined to become is the person you decide to be. – Ralph Waldo Emerson

The only person you are destined to become is the person you decide to be. – Ralph Waldo Emerson

It’s not whether you get knocked down, it’s whether you get up. – Vince Lombardi

It’s not whether you get knocked down, it’s whether you get up. – Vince Lombardi

Motivation is what gets you started. Habit is what keeps you going – Jim Rohn

Motivation is what gets you started. Habit is what keeps you going – Jim Rohn

Many of life’s failures are people who did not realise how close they were to success when they gave up. – Thomas Edison

Many of life’s failures are people who did not realise how close they were to success when they gave up. – Thomas Edison

Small daily improvements are the key to staggering long term results – Unknown

 Small daily improvements are the key to staggering long term results – Unknown

Don’t compare yourself with anyone in this world… if you do so, you are insulting yourself – Bill Gates

Don’t compare yourself with anyone in this world… if you do so, you are insulting yourself – Bill Gates

In the end, we only regret the chance we didn’t take – Lewis Carroll

In the end, we only regret the chance we didn’t take – Lewis Carroll

If you can’t fly, then run, if you can’t run, then walk, if you can’t walk, then crawl, but whatever you do, you have to keep moving forward. – Martin Luther King Jr.

If you can’t fly, then run, if you can’t run, then walk, if you can’t walk, then crawl, but whatever you do, you have to keep moving forward. – Martin Luther King Jr.

Be so good they can’t ignore you. – Steve Martin

 Be so good they can’t ignore you. – Steve Martin

It always seems impossible until it’s done. – Nelson Mandela

It always seems impossible until it’s done. – Nelson Mandela

Whether you think you can or you think you can’t, you’re right. – Henry Ford

Whether you think you can or you think you can’t, you’re right. – Henry Ford

The price of anything is the amount of life you exchange for it. – Henry David Thoreau

 The price of anything is the amount of life you exchange for it. – Henry David Thoreau

Success is walking from failure to failure with no loss of enthusiasm. – Winston Churchill

Success is walking from failure to failure with no loss of enthusiasm. – Winston Churchill

Great minds discuss ideas. Average minds discuss events. Small minds discuss people. – Eleanor Roosevelt

Great minds discuss ideas. Average minds discuss events. Small minds discuss people. – Eleanor Roosevelt

The number one reason people fail in life is because they listen to their friends, family, and neighbors. – Napoleon Hill

 The number one reason people fail in life is because they listen to their friends, family, and neighbors. – Napoleon Hill

Strive not to be a success, but rather to be of value. – Albert Einstein

Strive not to be a success, but rather to be of value. – Albert Einstein

When one door closes, another opens; but we often look so long and so regretfully upon the closed door that we do not see the one which has opened for us. – Alexander Graham Bell

When one door closes, another opens; but we often look so long and so regretfully upon the closed door that we do not see the one which has opened for us. – Alexander Graham Bell

If you don’t build your dream, someone else will hire you to help them build theirs. – Dhirubhai Ambani

 If you don’t build your dream, someone else will hire you to help them build theirs. – Dhirubhai Ambani

It does not matter how slowly you go, so long as you do not stop. – Confucius

It does not matter how slowly you go, so long as you do not stop. – Confucius

First they ignore you. Then they laugh at you. Then they fight you. Then you win. – Mahatma Gandhi

First they ignore you. Then they laugh at you. Then they fight you. Then you win. –  Mahatma Gandhi

You’ll never change your life until you change something you do daily. The secret of your success is found in your daily routine. – John C. Maxwell

You’ll never change your life until you change something you do daily. The secret of your success is found in your daily routine. – John C. Maxwell

You may have to fight a battle more than once to win it. – Margaret Thatcher

You may have to fight a battle more than once to win it. – Margaret Thatcher

You miss 100% of the shots you don’t take. – Wayne Gretzky

You miss 100% of the shots you don’t take. – Wayne Gretzky

Make each day your masterpiece. – John Wooden

Make each day your masterpiece.  – John Wooden

Someone is sitting in the shade today because someone planted a tree a long time ago. —Warren Buffett

Someone is sitting in the shade today because someone planted a tree a long time ago. —Warren Buffett

Develop success from failures. Discouragement and failure are two of the surest stepping-stones to success. – Dale Carnegie

Develop success from failures. Discouragement and failure are two of the surest stepping-stones to success. – Dale Carnegie

You must expect great things of yourself before you can do them. —Michael Jordan

You must expect great things of yourself before you can do them. —Michael Jordan

Poor people have big TVs. Rich people have a big library. – Jim Rohn

Poor people have big TVs. Rich people have a big library. – Jim Rohn

Patience, persistence, and perspiration make an unbeatable combination for success. – Napoleon Hill

Patience, persistence, and perspiration make an unbeatable combination for success. – Napoleon Hill

Stop chasing the money and start chasing the passion. Tony Hsieh

Stop chasing the money and start chasing the passion. Tony Hsieh

Tough times never last, but tough people do. – Dr. Robert Schuller

Tough times never last, but tough people do. – Dr. Robert Schuller

The best revenge is massive success. – Frank Sinatra

The best revenge is massive success. – Frank Sinatra

Double down on whats working. Cut the rest. – Tai Lopez

Double down on whats working. Cut the rest. – Tai Lopez

We become what we think about most of the time, and that’s the strangest secret. – Earl Nightingale

We become what we think about most of the time, and that’s the strangest secret. – Earl Nightingale

Security Is Mostly A Superstition. Life Is Either A Daring Adventure Or Nothing. – Helen Keller

Security Is Mostly A Superstition. Life Is Either A Daring Adventure Or Nothing. – Helen Keller

The only thing standing between you and your goal is the bullshit story you keep telling yourself as to why you can’t achieve it. – Jordan Belfort

The only thing standing between you and your goal is the bullshit story you keep telling yourself as to why you can’t achieve it. –  Jordan Belfort

Live as if you were to die tomorrow. Learn as if you were to live forever. – Mahatma Gandhi

 Live as if you were to die tomorrow. Learn as if you were to live forever. – Mahatma Gandhi

I find that the harder I work, the more luck I seem to have. – Thomas Jefferson

I find that the harder I work, the more luck I seem to have. – Thomas Jefferson

The successful warrior is the average man, with laser-like focus. – Bruce Lee

The successful warrior is the average man, with laser-like focus. – Bruce Lee

MA BABA GOTO


Don’t worry about failure; you only have to be right once. —Drew Houston

Don’t worry about failure; you only have to be right once. —Drew Houston

Your attitude, not your aptitude, will determine your altitude. – Zig Ziglar

Your attitude, not your aptitude, will determine your altitude. – Zig Ziglar

In man a working level of narcissism is inseparable from selfesteem, from a basic sense of self-worth.

In man a working level of narcissism is inseparable from selfesteem, from a basic sense of self-worth.

DIETARY FATS

HEDBERG I find that ducks' opinion of me is greatly influenced by whether or not I have bread.

I find that ducks' opinion of me is greatly influenced by whether or not I have bread.

ALCHOLICS OR DRUG ADDICTS KEEP UP THE HABIT TO FEEL NORMAL


True happiness is... to enjoy the present, without anxious dependence upon the future.” - Lucius Annaeus Seneca.

True happiness is... to enjoy the present, without anxious dependence upon the future.”
- Lucius Annaeus Seneca.

Monday 19 September 2016

MALROTN PEDS

Malrotation in infancy and childhood

Arthur

SMJ  2016 August 30
BACKGROUND AND AIMS: The cardinal features of bilious vomiting and abdominal distension assist in the diagnosis of malrotation and volvulus, an often fatal condition in the neonate. When these symptoms are absent, however, diagnosis becomes trickier. In the older child, these classic symptoms are less likely to occur, or occur at a later stage, meaning these children suffer from a delay in diagnosis and consequently do poorer. There is a need, therefore, to identify the common presenting features in these older children in order to facilitate earlier diagnosis and improve outcomes.
METHODS: We reviewed the current literature (Appendix 1) and then undertook a retrospective study in our own department to explore the presenting complaint, time to diagnosis, intraoperative findings and outcome of all children over the age of 28 days who underwent a Ladd's procedure for malrotation at Royal Hospital for Sick Children, Glasgow (RHSC) between 1998 and 2014.
RESULTS: It was found that children between the ages of 28 days and 15 years are more likely to display signs and symptoms such as chronic abdominal pain and non-bilious vomiting. Their complication rate was found to be significant.
CONCLUSION: Education surrounding the timely diagnosis of malrotation in the post-neonatal child is crucial.