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PAIN THEORIES
- SPECIFICITY
- AMONUT OF PAIN IS RELATED TO AMOUNT OF TISSUS DAMAGE
- DOES NOT ACOUNT FOR PSYCHOLOGICAL PART OF PAIN
- GATE CONTROL
- DEVELOPED TO EXPLAIN THE COMPLEXITIES OF THE PAIN PHENOMENON
- GATES IN THE SPINE AND THALALMUS
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NOCICEPTORS
- BARE NERVE ENDINGS IN BODY THAT RESPOND TO CHEMICAL, MECHANICAL , AND TEMP
- THIS NERVES ARE NOT DISTRIBUTED EQUALY IN BODY
- DEPENDS ON HOMUNCULUS
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PAIN FIBERS
- ALPHA
- LIGHTLY MYELINATED (FAST AND RAPID)
- MED SIZED
- CARRY WELL LOCALIZED PAIN INFO
- C FIBERS
- UNMYELINATED
- BURNING ACHING
- SLOW TO RESPONED
- HARD TO BLOCK
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LAMINA
- ARE LEVELS OF THE DORAL ROOT
- THERE ARE 10 AREAS
- THE MOST IMPORTANT FOR PAIN IS LAMINA 2 (PAIN GATE IN SPINE)
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LAMINA 2
- HAS THRESS CLASS
- 1. PROJECTION CELLS- CARRY INFO TO BRAIN VIA SPINOTHALAMIC TRACT
- 2. EXCITATORY INTERNEURONS
- THEY RELAY INFO TO
- - PROJECTION CELLS
- - MOTOR CELLS (TO PULLWAY)
- - OTHER INTERNEURONS
- INHIBITORY INTERNEURONS
- WITH WHAT TO HIT THIS IN OR
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SPINAL AND EPIDURAL
- SPIN- BLOCKS ROOT AND LAMINA
- EPIDURAL- JUST ROOTS
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NT PAIN INHIBITORY
- GABA (BLOCK SUB P)
- SEROTONIN
- ENDORPHINS, ENDROMORHINS
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PAIN THRESHOLD
POINT TO WHICH STIMULUS IS PERCEIVED PAIN
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PERCERPUTAL DOMINANCE OF PAIN
- PAIN AT ONE LOCATION MAY CAUSE AN INCREASE IN THE THRESHOLD IN LOCATION
- AFTER ABD SURG THE PT JUST THINKS ABOUT PAIN OF NG
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PAIN TOLERANCE
- ALL PSYCHO
- TIME OR LIMIT OF PAIN THAT A PERSON WILL ENDURE BEFORE INITIATION OF PAIN RESPONSES
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NEUROPATHIC PAIN
- FROM THE NERVE SYSTEM (CUTTING, STRECHING, HITTING OF NERVE)
- PERIPHRAL NERVES
- CENTERAL (IN BRAIN HARD TO TREAT)
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S/S OF ACUTE PAIN
- ALERT US THAT SOMETHINGS IS IMMEDIATELY HURTING THE BODY
- SIGNS OF SNS
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ACUTE SOMATIC PAIN
- FROM SKIN CONNECTIVE TISSUE MUSCLE BONE
- HAS A AND C PAIN FIBERS
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ACUTE VISCERAL PAIN
- PAIN OF INTERNAL ORGANS AND ABDOMEN
- POORLY LOCALIZED TO THE LESS NUMBER OF NOCIEPTORS
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REFERRED PAIN
- PAIN THAT IS PRESENT IN AREA REMOVED OR DISTANT FROMTHE ITS POINT OF ORIGIN
- LIKE MI HAVE BACK AND SHOULDER PAIN
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CHORNIC PAIN
- STATE OF EXISTENCE
- SUDDEN INSIDIOUSLY
- LASTING AT LEAST 3 MONTHS
- CHANGE IN BEHAVOIR AND PSYCHOLOGICAL (PAIN REWIRE PT)
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MECH OF CHRONIC PAIN
- PERIPH AND CENTRAL MORE SENSITIVE
- NEUROPATHIC PAIN
- ALTERATIONS IN DORSAL ROOT
- LOSS OF PAIN INHIBITION IN SPINAL CORD
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TYPES OF CHRONIC PAIN
- MOST COMMON LOWER BACK PAIN
- MYOFASCIAL MUSCLE (NEED DEEP MASSAGE OR MARCAINE TO KILL MUSCLE TO REFORM IT RIGHT)
- PORT OP CHRONIC PAIN CUTING NERVES, AMPUTATION
- CANCER PAIN
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NEUROPATHIC PAIN
- FROM TRAUMA OR DISEASE OF NERVE
- CHRONIC
- S/S SHOOTING, BURNING, PARETHESIA, STABBING PAIN.
CAUSES DIABETIC NEUROPATHY, DEAFFERENTATION (CUT NERVE), SYPATHICTICALLY (LOSE BLOOD FLOW AND REPERFUSTION, CENTRAL PAIN, PHANTOM LIMB PAIN)
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PEDS PAIN
- BABYS HAVE PAIN
- EXPRESSION OF PAIN; FACIAL, CRYING, BODY LANG
- KEEP RR > 20
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TEMP REGULATION
- PERIPHERAL THERMORECEPTORS
- SKIN
- SPINE
- EAR
- HYPOTHALAMIC CONTROL
- RELEASE TSH-RE -TSH- T4-EPI TO INCREASE META THAT INCREASE HEAT PRODUCTION
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HOW IS HEAT PRODUCTED AND CONSERVED
- MAKE HEAT
- META
- CONTRACTIONS (SHIVERING)
- CHEM THERMOGENESIS (BROWN FAT)
- CONSERVE
- VASOCONTR
- FETAL POSTIONS
PEOPLE ARE SHORTER IN COLD AREAS AND TALLER IN HOT AREAS
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RADIATION
- MOST COMMON
- TRANEFER OF HEAT FROM AN OBJECT THROUGH SPACE (LOST TO AIR) TILL ABSORBED BY OTHER OBJECT
- LOSES 80% OF HEAT VIA HEAD
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CONDUCTION
TRANSFER OF HEAT FORM SOLID TO SOLID
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CONVECTION
TRANSFER OF HEAT BY CIRCULATION OR MOVEMENT OF LIQ (VASODIL)
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EVAPORATION
LOSS OF HEAT BY EVAPORATION OF WATER
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BENEFITS OF FEVER
- KILLS MANY ORGANISMS
- DECREASE SERUM IRON, COPPER, ZINC
- DEPRIVES BAC OF FOOD
- PROMOTES LYSOSOMAL BREAKDOWN AND AUTODESTRUCTION OF CELL
- INCREASE LYMPHOCYTIC TRANSFORMATION AND PHAGOCYTE MOTILITY
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HYPERTHERMIA
- 41C NERVE DAMAGE
- 43C DEATH
- FORMS HEAT CRAMPS, EXHAUSTION, STROKE
- MALE HOTTER THAN FEMALES
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HEAT CRAMPS
- HEAT CRAMPS ABD AND EXTREMITIES
- PROLONG SWEATING AND LOSS OF NA
- PEOPLE NOT USE TO HEAT
- INCREASE HR BP AND FEVER
- TX WITH FLUIDS AND COOL DOWN SLOWY
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HEAT EXHAUSTION
- COLLAPSE DT LONG HIGH CORE OR EXTERNAL TEMP
- PROLONG VASODIL LED TO DEHYDRATION, LOW PLASMA VOL, LOW BP AND CO AND UP HR
- S/S DIZZINESS, WEAK , NV
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HEATSTORK
- TEMP OF >40.5
- CAN'T SWEAT
- GET CEREBRAL EDEMA, DEGENERATION OF THE CNS, SWOLLEN DENDRITES, AND RENAL TUBE NECROSIS
- DON'T COOL SKIN TO RAPIDLY SINCE IT WILL CAUSE VASOCON LIMITING CORE COOLING
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MALIGNANT HYPERTHERMIA
- GENETIC (BLONDE HAIR BLUE EYES)
- PERCIPITATED BY VOLATILE GAS
- UP CA RELEASE OR LOW CA UP TAKE WITH CAUSE UP IN MUSCLE CONTRACTIONS
- LEADING TO UP META= CO2, AND LACTIC ACID
- TREAT WITH DANDROLIN 2.5 MG, (INHIBIT CA, HAS BICARB IN IT, AND MANNITOL) VENT, AND VENT
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HYPOTHERMIA
- TEMP BELOW 35C
- PRODUCE VASOCON, COAGULATION, TISSUE DAMAGE, ICE IN CELL, INCREASE BLOOD VISCOSITY,
- ACCIDENTAL HYPO- FALL IN COLD WATER
- THERAPEUTIC- FOR SURGERY TO LOW META
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NREM SLEEP
- 75-80% OF SLEEP TIME
- HAVE 4 STAGES
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REM SLEEP
- 20-25% OF SLEEP TIME
- PARADOXIC SLEEP
- OCCURS Q 90 MINS AFTER 1-2 HOURS OF SLEEP
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SLEEP DISORDERS
INSOMINIA
- BREATHING
- UPPER AIRWAY
- OBSTRUCTIVE SLEEP APNEA
- OBESITY HYPOVENT SYNDROME
- SLEEP/WAKE
- PARASOMNIAS- SLEEP WALKING
- SOMINAMBULISM
- NIGHT TERRORS
- ENURESIS
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BLEPHARITIS
INFECTION OF EYELIDS
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HORDEOLUM
- STYE
- INFECTIONS OF SEBACEOUS GLAND OF EYELID
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CHALAZION
INFECTION OF OIL SECRETING GLAND
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KERATITIS
- INFECTION OF CORNEA
- NOT WEAR CONTACTS IN OR
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CONJUNCTIVITIS
- INFECTION OF CONJUNCTIVA
- PINKEYE
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VISUAL DYSFUNCTIONS
- PAPILLEDEMA (UP ICP) NO NO FOR SPINAL AND EPIDURALS
- GLAUCOMA
- MACULAR DEGENERATION
- STRABISMUS (FIX EARLY)
- COLORBLINDNESS (X LINKED TRAIT)
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OTITIS EXTERNA
- INFECTION OF OUTTER EAR
- SWIMMERS EAR
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OTITIS MEDIA
PRESSURE OF MEMBRANE THAT CAN CAUSE SCARING
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OLFACTION
- CN 1 AND 5
- MOST OF TASTE (SOUR, SWEET, SALTY, BITTER)
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PROPRIOCEPTION
- WHERE BODY IS AT DEPENDS ON INNER EAR, VISION, RECEPTORS OF JOINTS AND LIGAMENT
- CAUSE VESTIBULAR NYSTAGMUS. VETIGO, MENIERE DISEASE
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