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![]() The same amount of substance ingested by a 20 kg patient and a 100 kg patient can have a very different prognosis. How much does the patient weigh? For figuring out doses of both poisons and antidotes. What else? Slurred speech? Jaundice? Slow pulse? Rapid pulse? Sweating? Diarrhea? Drowsiness? Hyperactivity? Don’t forget to check for things like burns around the mouth and unusual odors. What are the signs and symptoms? Practically everything has nausea and vomiting. What was the time-frame? Chronic exposure? Eating paint chips vs. What’s the most it could have been? That’s the number we’re going with. How much was ingested? Count the number of pills left in the bottle, or see how much lye was in the bottle, or your best guesstimate. sometime after 2:00 pm but before 4:00 pm) is the next best thing, and is often the only thing you’ll know if it was a toddler getting into the cardiac meds in Granny’s purse. If you don’t know the exact time, a range (e.g. When did the patient ingest the substance? Two minutes ago, an hour ago, a week ago … what (if anything) we can do about the situation can be time-critical. Know where the MSDS for your workplace are stored. by the front door, in the custodian’s office, in the supervisor’s desk). In a work environment you’ll find information on every substance in the place in the MSDS (Material Safety Data Sheets) that are stored at some known and accessible location (e.g. If it’s possible, and it’s safe to do so, take the original packaging with you. You should be aware that lots of drug names sound similar (e.g. We can figure a lot of things out … ringing in the ears, think aspirin … but it’s nice if we don’t have to play Sherlock Holmes. What was it? This is your starting point. Here’s what the nice folks at the Poison Control Center, or at 9-1-1, or the nice EMTs who come to your house, or the nice nurse at the ED, will want to know: This can be medicines (your classic is a nice young lady who breaks up with her boyfriend, swallows every Tylenol in the house, pukes, decides the boyfriend wasn’t worth it, and dies a month later of liver failure), or rat poison, or lye, or what may have you. If you’re an artist working with arsenic-based pigments, don’t put the brush in your mouth. Please don’t leave the chicken lying out on the kitchen counter at room temperature for a couple of hours. Please put a carbon monoxide detector in your bedroom. Please don’t put the bleach into an old Pepsi bottle and store it where Junior can get at it. The best treatment for all kinds of poisoning is prevention. Let’s classify acute poisoning, then see what to do about it. NOTE: If the patient collapses, or stops breathing, or starts convulsing, or you can’t wake him/her up … skip Poison Control. If you suspect poisoning, call the National Poison Control Center at 1-80. What’s the recommended dose of hydrogen cyanide? Zero? Did someone get more than that? Woo! Overdose! ![]() You might think of any poisoning episode as an overdose. We remember poison from Altered Level of Consciousness, when O=Overdose was one of the items in our mnemonic. Your friends at 9-1-1 are waiting to hear from you!) (For the others: direct pressure, high volume oxygen, treatment for shock, and rapid transport to the closest appropriate facility are the keys. Two, maybe three, of those things can be classified as poisons. What cheerful thing shall we talk about today? How about poison! ![]() Upon arrival at the ED, her examination reveals temperature of 38☌, heart rate of 120, respiratory rate of 16, blood pressure 85/56 mm Hg, pupils 5 mm equal and reactive, and dry skin.Poison: It Isn’t Just For Breakfast Any More She was unattended for several minutes when she went through her grandmother’s bag containing bottles of bethanechol, clonidine, diphenhydramine, and fluoxetine.
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Dryness morning and of throat, so that it took away her breath D., with swelling of throat. side of palate towards cervical muscles raw and sensitive, so that he not eat or move anything hard in mouth, and acid and salt things cause smarting. Tongue coated white in centre, with dark streak along edges. ![]() Painful soreness on chewing.Ĭlinical Abscess at the root of a tooth, with external swelling dental fistula. Pustule above a hollow tooth like a dental fistula. Blister black, hollow, sensitive to water and cold air, by lower molar, the tooth pains even on opening mouth. Inflammation between lower incisors, with sticking and burning pain. seem too long in morning all of lower and some of upper seem too long, and pain as if ulcerating. Drawing pain in upper incisor, with coldness. lower jaw extending to ear and posterior cervical muscles. molars with swollen cheek, preventing lying on it at night ulcerative, with throbbing pressure in r. Aching after breakfast if open air enters them in r. Stitching jerking every evening till 11.30 P.M. Tearing i hollow, from evening till midnight, with sore, painful gum. Sticking, (<) night, so that he could not remain in bed S. articulation of jaw easily dislocated in morning in bed, with pain. Swelling of lower jaw, painful on stooping and on pressure. Papules in corners of lips, with sticking. Ozaena, with formation of scabs, discharge of purulent mucus, and crack in nostrils. Bleeding.Ĭlinical Nasal catarrh, with obstruction of the posterior nares. Stoppage of mucus necessity to blow out small masses at night. Sneezing towards evening, with sleepiness with catarrh in throat that provokes cough. Tensive pain in root, extending from one brow to the other, with ulcerative pain on touch. Pustules, with red areola, internally on lower part of septum. Pain in the Eustachian tubes, with noises in the ears and deafness. 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The dazzling of our eyes for the first time symbolizes difficulty of denies the material world. The outer world of the light symbolically suggests the world of spiritual reality, which we achieve by breaking the chains that are used to tie us. The chains symbolize our limitation in this material world so that we cannot know the reality to know reality we have to break the material world. The shadows represent such photocopy and, the reality is possible to know with the spiritual knowledge. Plato as an ideal philosopher says that the appearing world is just the imitation or photocopy of the real world. In his opinion, the appearance is false and reality is somewhere, which we cannot see. The raised wall symbolizes the limitation of our thinking and the shadow symbolically suggest the world of sensory perception which Plato considers an illusion. The dark cave symbolically suggests the contemporary world of ignorance and the chained people symbolize ignorant people in this ignorant world. The allegory of the cave has also allegorical meaning because so many symbolic suggestions are used in this writings. If he attempts to persuade the people inside the cave saying that the outer world is the real world, and the cave world is unreal, his ignorant friends kill him. ![]() Even though, he does not want to go back to the cave world, his eyes dazzle more if he is taken back to the cave world, and he can’t count anything inside darkness. He thinks that it is better to be the slave in the outer world rather than being the king inside the cave. He gives pity and sympathy over the cave people who are lost in darkness. He becomes gratified with himself and remembers the other people in the cave. But if he stays in the outer world, slowly and gradually he begins to identify everything and he becomes to realize that the outer world is the real world and the cave world is the unreal world. If one of the chained people is released from the cave world, and if he is taken to the outer world he cannot see anything at first because his eyes dazzle in the light. In the outer world, there is light and everything is clearly visible. The people inside the cave cannot raise their head completely so that they can only see the shadows like illusion, which they believe, as real but it is just their illusion. On the wall, many other people move with different things on their hands and their shadows fall in the cave world. Similarly, there is also another world out of the cave world, but between these two worlds, a wall is raised. There are some chained people on their necks as well as feet, these chained people cannot move easily. The cave is very dark because there is little light inside it and hardly seen the objects. ![]() In the Allegory of the Cave, Plato has given a description of the cave of the cave world. In allegorical writing characters, actions and setting are used as symbols and they should be interpreted to make the allegorical meaning. Time taken to upgrade a building depends on the building's current level so that upgrading buildings is fast in the beginning and extremely slow on later levels. This means that starting a construction, research or an upgrade takes either Coins or Elixir (never both) as well as time to finish the task. Roughly put everything that has to do with building consumes Coins while everything that has to do with troops consumes Elixir. Secondly, the automated farming mechanics encourage new players to visit the game more often as the resource facilities reach their max pretty quickly in their early stages.īuilding & Training - everything is interdependent Firstly it's always rewarding to return to the game as you can harvest all of your resources at the start of every session. The resource production is perfectly done in Clash of Clans. Nevertheless, not all of the parts of the core loop are equally important as the importance of each part is influenced by player's ongoing goal in the game, which creates different style game play styles from resource gathering and building heavy to active battling. There are three major parts in Clash of Clans' core loop: Collecting Resources, Building & Training and Battling. Despite being extremely polished and reworked on the basis of the genre benchmarks Clash of Clans has plenty of room for improvements in some key game play mechanics as well as in the virality and even monetization features. Once it's polished and the KPIs look solid it's time to come out with a bang and take app charts by storm.īut even though Clash of Clans is the best there is it's still not the best there could be. Finally, you polish the game to perfection with a limited beta launch by making the game available only in Canada. Sprinkle a new and improved game play twist and dress it up in stunning graphics. ![]() You follow up by building a game around that solid core loop. Then you benchmark and reverse engineer the best titles in that genre in order to create a strong and natural feeling core loop. First, you take an existing social game theme. What makes Clash of Clans a great game is the trademark Supercell winning formula approach to game development. 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Scalable Vector Graphics (SVG) is an XML-based vector image format for two-dimensional graphics with support for interactivity and animation. MNG is an extension to PNG that does it was designed by members of the PNG Group. PNG itself does not support animation at all. PNG was created as an improved, non-patented replacement for Graphics Interchange Format (GIF), and is the most used lossless image compression format on the Internet. Portable Network Graphics (PNG) is a raster graphics file format that supports lossless data compression. Click icon to show file QR code or save file to cloud storage services such as Google Drive or Dropbox. The output files will be listed in the "Conversion Results" section. ![]() It will automatically retry conversion on another server if one fails, please be patient while converting. Click the "Convert Now!" button to start batch conversion. You can either upload a file or provide a URL to an image. 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