ENDOTRACHEAL INTUBATION
Endotracheal
intubation is a lifesaving procedure that requires familiarity with anatomy,
physiology, pharmacology, and the necessary equipment required to perform the
procedure.
Choice of the correct size of endotracheal tube is fundamental. The average man will accept a cuffed tube with an inner diameter of 8.0 or 8.5 mm. For women, the tube diameter is 0.5 to 1.0 mm smaller. Smaller tubes have more resistance to airflow and may not allow passage of a bronchoscope, but larger tubes may increase injury to the glottis and lower airway.
Although commonly viewed as a single event, ejaculation is actually two separate processes, termed emission and ejaculation. During emission, the semen is “loaded” into the prostatic urethral chamber. After this, ejaculation is the forcible expulsion of semen from the penis in a series of spurts caused by rhythmic contractions, about 1 second apart, of the pelvic muscles. Ejaculation is different from orgasm or climax, the latter being an event that is centered in the brain that is closely associated with ejaculation.
CARDINAL MOVEMENTS
NORMAL BIRTH
Labor generally begins between the 38th and 42nd week of gestation. Prior to the onset of labor, physicochemical changes occur in the cervix and are collectively called “ripening.” When this is combined with the increasingly frequent and strong uterine contractions of late pregnancy, the cervix begins the process of effacement. In a proposed self-perpetuating process, effacement of the cervix results in the production and liberation of more prostaglandins, further stimulating uterine contractions (Ferguson reflex). Cervical effacement is common before the onset of true labor.
UTERINE INVERSION
Rarely, the uterus can be turned inside out immediately following the delivery of the placenta. Uncommon and most often iatrogenic, this may be associated with catastrophic bleeding and cardiovascular collapse. Incomplete uterine inversion may also occur. (Rarely the condition has also been reported in nonpregnant patients with intrauterine pathology such as a pedunculated leiomyomata or large endometrial polyp.) The prevalence of uterine inversion is estimated to be about 1 in 6500 to 25,000 deliveries.
