By T. Renwik. Nazarene Bible College.

Moreover purchase 500 mg lincocin, because medicine is a dynamic and fast-changing profession cheap lincocin 500 mg free shipping, what was good medical practice yester- 25 Cal. Chapter 2 / Litigation 29 day may no longer be the case now; and an “expert” must be up on current medical advances and standards of care. The personal injury bar used to complain of a “conspiracy of silence,” a tacit agreement amongst or common reluctance by doctors not to testify against their colleagues in medical negligence cases. Whatever truth there may have been to this accusation, a quick glance of the copious advertisements for “forensic medical experts” in the pages of magazines published by and for the personal injury bar shows that this is no longer true. WHY IT IS CRITICALLY IMPORTANT TO “SEIZE THE TIME” WHEN SUED Time can be critical to the outcome of litigation, a fact underscored by the often used legal phrase that “time is of the essence. Usually, the period for filing an answer or other response is 30 days, a window by which, if your attor- ney acts promptly and intelligently, can give you a decided advantage over your adversary. If you waste or allow any of this time to pass in the belief (indisputably true) that you don’t have to respond until the end of that 30 days, or that your attorney can probably get an extension of time by which to respond (almost always true), you could lose valu- able opportunities to seize important advantages. The Importance of Time in the Discovery Process To illustrate the importance of time in litigation, consider the proce- dural device of discovery, the means by which parties are to find out from each other what evidence is known to that party or others in support or derogation of the lawsuit. One of these discovery mechanisms is the right to compel a party to appear and answer relevant questions under oath from your lawyer. The answers given to these questions often reveal facts that will determine whether the plaintiff has a viable claim against you or whether you have a defense against liability. Absent a showing to the court of “good cause,” a plain- tiff must normally wait 20 days after serving summons before noticing the defendant’s deposition; however, the defendant need not wait any period of time after being served to notice the plaintiff’s deposition. Hence, it is possible for a defendant to get the jump on the plaintiff and smoke out his or her case early regarding the extent of damage suffered and why the plaintiff believes the defendant is responsible for it. The longer you wait to take the plaintiff’s deposition, the greater the likelihood that “facts” will be revealed or become “known” to the plain- tiff that strengthen his or her case.

Both the muscle pump and the respi- The sympathetic activity following a fall in blood pres- ratory pump increase the pressure gradient toward the sure results in increased heart rate and contractility cheap lincocin 500 mg online, heart and increase venous return and central blood vol- which raises myocardial metabolism and coronary ume buy lincocin 500 mg free shipping. Going into space is similar to lying down, plays a significant role in enhancing the diving response in that the force of gravity on blood is removed and by enhancing peripheral vasoconstriction and brady- blood is not held in the leg veins when a person is up- cardia. Pe- ripheral chemoreceptors are located in the aortic and Chapter 19 carotid bodies. Pleural pressure is the most negative ercise are characterized by increased sympathetic tone at total lung capacity because of the elastic recoil of the and decreased parasympathetic tone. At residual volume, pleural pres- sponse is associated with increased parasympathetic sure would be the least negative. The cold pressor response is tion because pleural pressure is positive during a forced characterized by increased sympathetic activity to the vital capacity maneuver. The hemorrhage has decreased arte- alveolar pressure minus pleural pressure. The outward recoil of the chest wall would result in a fall in central blood volume, right and the inward recoil of the lungs reach equilibrium at ventricular end-diastolic volume, and cardiopulmonary FRC. Carotid baroreceptor activity would chest is the greatest and the inward recoil of the lung be lowered in the presence of a low mean arterial pres- is the smallest. The resulting sympathetic activity would cause of the lung is the greatest. Transairway pressure is pressure with a lowered arterial pressure, splanchnic blood flow across the airways and is measured by subtracting pleu- 720 APPENDICES ral pressure from airway pressure (Pta Paw Ppl). Vascular resistance is high at the apex be- Transairway pressure is most negative in the condi- cause alveolar pressure exceeds capillary pressure. In the supine position, the heart is in most positive in the conditions described in choice D. Emphysema is an obstructive disor- less than venous pressure in a healthy individual, we der that leads to highly compliant lungs, while pul- have the situation that Pa Pv PA, or a zone 3. A drop in venous pressure has the stiff lungs with decreased compliance.

In order to explain the physiological characteristics of the sleep±waking cycle order lincocin 500mg amex, as well as how this might be controlled by different neurotransmitters and modified by drugs order lincocin 500 mg on line, we need to know which areas and pathways in the brain are vital to the induction and maintenance of this rhythmic behaviour. Essentially, these brain systems can be resolved into two interacting networks. One is responsible for the basic circadian rhythm and ensures that our sleeping and waking periods normally occur at regular intervals. A second system fine-tunes this process and ultimately determines our precise functional status on the sleep±waking continuum. THE NEURAL BASIS OF CIRCADIAN RHYTHMS It is most probable that sleep and waking stem from an inherent cycle of neuronal activity that can be influenced dramatically by changes in sensory stimulation. This is demonstrable not only in humans and laboratory animals, but also in invertebrates. Thus, while we cannot be sure that other animals sleep in the same way that we do, they do show a circadian cycle of motor activity. In some (nocturnal) species, such as the rat, this activity is actually highest during darkness. Even aplysia, the sea hare, has such a rhythm but this is more like that of humans in being maximally active during daylight (diurnal). These rhythms seem to be innately programmed although they can be adjusted. Interestingly, when humans are in a time-free environment, the change in the rhythm of Neurotransmitters, Drugs and Brain Function. Webster &2001 John Wiley & Sons Ltd 478 NEUROTRANSMITTERS, DRUGS AND BRAIN FUNCTION body temperature does not follow the change in the sleep±waking cycle. Generally, it becomes shorter (to as little as 20 h), rather than longer, which suggests that these cycles are regulated in different ways. Entrainment has also been shown in aplysia which, after exposure to a normal dark±light cycle, retains a cyclic pattern of activity for a number of days even if subjected to continuous light.

Visceral re- flexes help control the body’s many involuntary processes such as Components of the Reflex Arc heart rate best 500mg lincocin, respiratory rate generic lincocin 500 mg, blood flow, and digestion. A ing, sneezing, coughing, and vomiting may also be reflexive, al- reflex arc implies an automatic, unconscious, protective response though they involve the involuntary action of skeletal muscles. Peripheral Nervous © The McGraw−Hill Anatomy, Sixth Edition Coordination System Companies, 2001 428 Unit 5 Integration and Coordination Spinal cord Axon of sensory neuron Cell body of sensory neuron Effector (quadriceps femoris muscle) Dendrite of sensory neuron Axon of Dendrite of motor neuron motor neuron Cell body of motor neuron Femur Patellar ligament Tibia FIGURE 12. The receptor and effector organs are on the same side of the spinal cord. The knee- jerk reflex is also a monosynaptic reflex because it involves only two neurons and one synapse. Somatic Reflexes reflex is initiated as a person encounters a painful stimulus, such as a hot or sharp object. As a receptor organ is stimulated, sen- Somatic reflexes are those that result in the contraction of skele- sory neurons transmit the impulse to the spinal cord, where asso- tal muscles. The three principal kinds of somatic reflexes are ciation neurons are activated. Here, the impulses are directed named according to the response they produce. Simultaneously, antagonistic muscles are inhibited (re- synapse in the pathway; it is therefore called a monosynaptic reflex laxed) so that the traumatized extremity can be quickly arc. Slight stretching of the neuromuscular spindle receptors (de- withdrawn from the harmful source of stimulation. In an intersegmental reflex arc, ron occurs in the anterior gray column, and activation of a motor motor units from several segments of the spinal cord are acti- unit causes specific muscle fibers to contract. In an tor and effector organs of the stretch reflex involve structures on intersegmental reflex arc, more than one effector organ is the same side of the spinal cord, the reflex arc is an ipsilateral re- stimulated.