The sugar – phosphate linkages form the backbone of the polymer to which the variable bases are attached generic super levitra 80mg amex erectile dysfunction treatment miami. The sequence of the polymer is written in the 5’ to 3’ direction with abbreviations to different bases e buy 80 mg super levitra amex erectile dysfunction what age. The bases of one strand pairs with the bases of the other strand of the same plane such that adenine always pairs with thymine with two bonds. The negatively charged phosphate group and the sugar units expose themselves to the outside of the chain. The purine, pyrimidine bases are on the inside of the helix, the phosphate and deoxyribose groups are on the outside. Ribonucleotide differs from deoxyribonucleotide in that ribonucleotide contains “O” in the carbon 2’ sugar ribose. Site Nucleus, mitochondria Nucleus, ribosome, cytosol, but never in cytosol Nucleolus, mitochondria 4. According to their sedimentation rates, the subunits are referred as 30S, & 50S, together they form 70S unit. Since uric acid has a precipitation character, excess uric acid in kidney causes kidney stone and in joints causes gout. In prokaryotic cell the primer length is about 10 - ribonucleotides, but in Eukaryotic cell it is about ’ 30. This occurs by addition of 7 - methyl Guanine to the 5’ end and may be associated by further methylation of the adjacent sugar moiety of the next nucleotides. Similarly erythromycin inhibits translocation Diphtheria toxin: Corny bacterium diphtheria produce lethal protein toxin. The sequence of amino acids in the polypeptide chain, from the amino terminus to carboxyl end corresponds to the base sequence of a gene (from 5’ to 3’end). When protein is synthesized we see the translation of genetic information into the universal language called protein. Allosteric regulation The regulation of enzymes by small molecules that bind to a site distinct from the active site, changing the conformation and catalytic activity of the enzyme. Amphipathic A molecule that has both hydrophobic and hydrophilic regions Antibody A protein produced by B-lymphocytes that binds to a foreign molecules Antigen A molecule against which the antibody is directed. Chitin a polymer of N-acetylglucosamine residue that is the principal component of fungal cell walls and exoskeleton of insects. Codon The basic unit of genetic code; one of the 64 nucleotide triplets that code for an amino acid or stop sequence. A small lipid –soluble molecule that carries electrons between protein complexes in the mitochondrial electron transport chain. Low molecular-weight organic molecules that work together with enzymes to catalyze biological reactions Collagen The major structural protein of the extracellular matrix. Cytochrome oxidase A protein complex in the electron transport chain that accepts electrons from cytochrome c and transfer them to O2. Peptide bond The bond joining amino acids in a polypeptide Phagocytosis The uptake of large particles such as bacteria by a cell. Protein phosphatase An enzyme that reverses the action of protein kinases by removing phosphate groups. Proteins Polypeptides with a unique amino acid sequence Proteoglycan A protein linked to glycosaminoglycans Proteolysis Degradation of polypeptide chains Quaternary structure The interaction between polypeptide chains in proteins consisting of more than one polypeptide Receptor mediated endocytosis The selective uptake of macromolecules that bind to cell surface receptors. We have a full staff of Inside Sales Representatives calling on hospitals and surgery centers around the country. By avoiding Professional Anesthesia Handbook the expense of having a 1-800-325-3671 salesman in a suit calling on hospitals, we are able to pass on significant savings directly to you. Disclaimer The material included in the handbook is from a variety of sources, as cited in the various sections. The information is advisory only and is not to be used to establish protocols or prescribe patient care. The information is not to be construed as offcial nor is it endorsed by any of the manufacturers of any of the products mentioned. These recommendations may be adopted, with face mask ventilation of the upper airway, modiﬁed, or rejected according to clinical needs difﬁculty with tracheal intubation, or both. Recommendations: The use of practice guidelines cannot guarantee At least one portable storage unit that contains any speciﬁc outcome. Practice guidelines are specialized equipment for difﬁcult airway subject to revision as warranted by the evolution management should be readily available. They provide basic recommendations that are supported by analysis of the current literature and by a synthesis of expert opinion, open forum commentary, and clinical feasibility data. Rigid laryngoscope blades of alternate design and size from those routinely used; this may include a rigid ﬁberoptic laryngoscope 2. Examples include (but are not limited to) semirigid stylets, ventilating tube changer, light wands, and forceps designed to manipulate the distal portion of the tracheal tube 4. Examples include (but are not limited to) an esophageal tracheal Combitube (Kendall-Sheridan Catheter Corp. The contents of the portable storage unit should be customized to meet the specifc needs, preferences, and skills of the practitioner and healthcare facility. The intent of this communication is to provide the patient (or responsible person) with a role in guiding and facilitating the delivery of future care. The information conveyed may include (but is not limited to) the presence of a difﬁcult airway, the apparent reasons for difﬁculty, how the intubation was accomplished, and the implications for future care. Notiﬁcation systems, such as a written report or letter to the patient, a written report in the medical chart, communication with the patient’s surgeon or primary caregiver, a notiﬁcation bracelet or equivalent identiﬁcation device, or chart ﬂags, may be considered. The anesthesiologist should evaluate and follow up with the patient for potential complications of difﬁcult airway management. These complications include (but are not limited to) edema, bleeding, tracheal and esophageal perforation, pneumothorax, and aspiration. The patient should be advised of the potential clinical signs and symptoms associated with life-threatening complications of difﬁcult airway management. These signs and symptoms include (but are not limited to) sore throat, pain or swelling of the face and neck, chest pain, subcutaneous emphysema, and difﬁculty swallowing. This curve is molded directly into the tube so correct insertion is easy without abrading the upper airway. The Aura-i is pre-formed to follow the anatomy of the human airway with a soft rounded curve that ensures fast and easy placement and guarantees long-term performance with minimal patient trauma. The curve is molded directly into as single unitwith built-in, and rigid at the connector for easy, the tube so that insertion is easy, without anatomically correct curve atraumatic insertion and removal abrading the upper airway. Moreover, the Practical clear “window” curve ensures that the patient’s head re- to view condensation mains in a natural, supine position when the Reinforced tip will resist bending mask is in use. Verify bulb stays fully collapsed for at least to current and relevant standards and includes 10 seconds. Open one vaporizer at a time and repeat ‘c’ following monitors: capnograph, pulse oximeter, and ‘d’ as above.
It is considered an of the patient and the eventual inexpensive diagnostic test able to diagnosis of the problem are often identify patients with urinary tract at variance cheap super levitra master card erectile dysfunction unable to ejaculate. Videocystourethrography is used in advanced centres and is the Urodynamic tests have been gold standard of the investigation developed to confrm the of female urinary incontinence discount super levitra american express impotence 40 years. Their use is sometimes debatable, Increasingly, ultrasound imaging is since grade A evidence supporting also being used to measure both the general use of urodynamics in bladder neck descent and bladder the investigation of incontinence, wall thickness. However, at present which involve flling and its widespread use as a routine voiding cystometry (the latter urodynamic tool is questionable being a so – called ‘pressure – and it should only be used in fow’ study). Depending on the sophistication of the apparatus used, either a leak Basic tests which should be – point pressure measurement, or performed on patients prior to urethral pressure proflometry may urodynamic testing include a be performed additionally as a test urine microscopy and culture, of urethral function. Urodynamic and a measurement of residual testing can either be static or urine volume, either by catheter ambulatory. They also require a patient suffering from urinary considerable expertise and access incontinence is not adequately to sophisticated equipment. Failure to recognize concomitant detrusor overactivity and / or Clinical Indications for voiding dysfunction may also Urodynamics Investigations affect the outcome of appropriate There are many etiological factors surgery. Certainly the most Table 1 lists the most important common problems are urodynamic indications for urodynamic studies. Medico – legal cases must be emphasized that many 14 Clinical Diagnosis versus History, clinical examination and basic tests urodynamic diagnosis Over the past 35 years there have In the ongoing search for an uncomplicated and cost – effective been ongoing discussions in the approach to the pre – operative literature on how best to evaluate evaluation of a patient for patients with incontinence. The accuracy of history alone Most of the early papers looked In summary the addition of other clinical parameters and simple at the discriminatory value of a pure history of either stress offce tests do enhance the sensitivity of a history. In summary, it is clear In South Africa, Urogynaecology as from the majority of studies that a subspeciality is still in its infancy. The symptom of stress incontinence may be very sensitive, and this is an area which urgently but is so nonspecifc as to render it requires development, particularly of little diagnostic value. Medical practice is increasingly History is best used as a guide to becoming dogged by litigation and the subsequent evaluation process and to serve as a measure of practitioners have to be able to disease severity. They are often also run by staff who are not properly trained to provide good quality results and interpretation. It is these practitioners who should be at the forefront of attempts to develop mechanisms which are aimed a providing the best possible service for their patients. Where a Gynaecological surgical intervention is planned, Examination the responsible surgeon should determine exactly what may It is impossible to perform an be required at operation – so adequate urogynaecological that the appropriate consent examination without using a can be obtained and the correct Sims speculum and in some intervention planned. The vulva and vagina are inspected for any The women’s mobility and general lesions, atrophy or excoriation. The woman is then asked to cough or valsalva while the clinician observes for any stress Neurological incontinence. She is then asked to turn onto her left side and the examination Sims speculum is used to inspect the anterior and posterior vaginal The spinal segments S2,3. It is imperative be assessed by testing the tone, that the middle compartment is strength and sensation in the 17 also adequately assessed for any Grade I: Descent halfway to the uterine or vaginal vault descent. It does are not adequately explained by not give a quantitative impression the fndings at examination, it may of the severity of the prolapse. This length, perineal body size or the is accomplished by asking her to length of the urogenital hiatus. She is then asked these issues and it supercedes the to cough again in the standing previous systems used to describe position. The new objective assessment allows a clear and unambiguous description of prolapse, facilitating Classifcation and better objective assessment, management and surgical grading of prolapse comparison. The most commonly used Terms used in the past such as for grading system is the Baden- example small, medium or large, Walker halfway system which cystocoele or rectcoele, are no grades prolapse as follows: longer applicable. Six specifc vaginal sites (points Aa, Ba, C, D, Bp and Ap) and the vaginal length (tvl) are assessed using centimeters of measurement from the introitus. They gh, pb, and tvl measurements will always represent the extent of prolapse, have a positive value be it above the introitis ( ie All measurements, except for tvl, are made negative) or below the introitis ( ie while patient is bearing down positive) 20 Point Aa Point Bp If an imaginary small man walked Again, this point describes more from the introitis up the anterior extensive prolapse beyond the vaginal wall and made a mark once 3 cm mark of Ap similar to Ba. This point is therefore for example, is 7cm above the never more than 3 and represents introitis, this point is then -7, if it is the bottom 3cm of the vagina. Point Ba Point D This point describes additional This describes the descent of the prolapse of the anterior vaginal posterior fornix again similar to wall that goes beyond the frst the cervix. It can therefore be Total vaginal Length greater than the +3 described for This is the measurement of point Aa. It is usually Because it essentially defnes more measured with the marked spatula extensive prolapse, when there inserted to its maximum into the is no prolapse, by convention we vagina. Urogenital hiatus Point Ap The measuring spatula is placed Again our imaginary man makes anteroposteriorly along the the 3cm trip up the posterior wall introitis and measures from the where he marks off point Ap. The diagnosis in women two separate catheters are used with urinary incontinence based for flling and pressure recording. There is a large intra-abdominal pressure (Pabd) overlap between symptoms and and this pressure could therefore examination and urodynamic also be obtained by inserting the fndings. The cystometrogram usually gives 3 pressure tracings: becomes essential, in a number Pves (bladder pressure), Pabd of women, to enhance diagnostic (abdominal) and Pdet (detrusor accuracy and therefore enable us pressure). The Urodynamics system comprises two catheters, one placed in the The Procedure bladder and another in the rectum, a computer and the urodynamics The test comprises three software and pressure transducers, phases. Free fow phase are measuring appropriately, The woman is asked to arrive when the women coughs, there at the investigation with a full should be no deviation of the bladder. She is then asked to Pdet – only on the vesical line and void on the fowmeter, which is the abdominal line since these usually mounted on a commode, in are both under the infuence privacy. In other part of the test differs from the words, when there is a rise in voiding cystometry, which is done abdominal pressure with coughing, after the flling phase once the the same pressure is transferred bladder is full and the lines are in to the bladder. The patient is asked to report on her frst desire as well as the moment she has a strong desire to void. Filling phase include asking the woman to heel The bladder and rectal lines are bounce, wash hands and cough. The women trace by a fowmeter but if this is asked to cough to check that modality is not available on the the Pdet measurement is correct. If tolerate any more flling, the pump both the vesical and rectal lines is stopped, this is the maximum 24 cystometric capacity. Voiding Cystometry the voiding cystometry phase This is done by asking the patient and therefore parameters such to void while the pressures are as PdetQmax, the detrusor recorded. If the Detrusor pressure curve rises slowly during the flling phase, this would suggest poor compliance. The prevalence increases with The term “overactive bladder” increasing age being 4 percent in was proposed as a way of women younger than 25 years and approaching the clinical problem 30 percent in those older than 65 from a symptomatic rather than years. While not take into account the individual’s life threatening, it can have a lifestyle and any appropriate considerable adverse impact on interventions that can be the quality of lives of those who employed to minimize symptoms. In the past, clinical results investigations are undertaken to of treatment have often been ensure that the correct problem disappointing due to both to poor is being addressed.
Protective device piece of equipment order super levitra 80mg fast delivery impotence workup, most often a vest or a belt generic super levitra 80mg online erectile dysfunction in 20s, used to ensure the safety of the client ()ie, helping client to remain in a chair without falling); also called a client reminder device. Protective isolation attempts to prevent harmful microorganisms from coming into contact with the client; also called reverse or neutropenic isolation Pulse The beat of the heart felt in the arteries. Recumbent lying down Rotation process of turining about an axis, as rotation of the hand of the fetus in preparation of delivery. Rectal of the rectum Retention enema An injection of fluid that is retained in the rectum for absorption into the blood stream. Splint A device for immobilizing part of the body Spore The seeds of microorganisms, which are resistant to drying, heat, and disinfectants Standard precaution precautions designed for the care of all clients regardless of diagnosis or infection status. Sterile Specially treated so that all microorganisms are destroyed 361 Stethoscope Instrument for magnifying sound Specimen A small amount of body excretion or body fluid that is sent to a laboratory for examination. Suppository Rectally administered cones containing a medication in the base that is soluble at body temperature. Systole Blood pressure period during the beating phase of the heartbeat during which blood is expelled from heat. Synergism joint action of agents in which the combined effects is greater than the sum of the individual parts. Tachypenea conditions in which breaths are abnormally rapid, more than 20 per minute Thermometer An instrument used to measure temperature. Traction exertion of a pulling force ; an apparatus attached to the client to maintain stability of 362 a joint or aligned fracture or to exert a pulling force elsewhere, as in the lower back, to relieve pressure. Transimission-based- precaution: precaution designed for clients with specific infection or diagnoses Tympanic membrane eardrum. Elizabeth College of Nursing Government Higher Secondary School Chengalpet Medical College Ottanchantram. Special recognition and due acknowledgement is hereby made to the Director of School Education and the Joint Director of School Education Chennai. Nursing is a major component of the health care develivery system and nurses make up the largest employment group within the system. Nursing services are necessary for every patient seeking care of various types including primary, secondary, tertiary and restorative. As nursing is an important part of health care delivery system, the nurses need to have a sound knowledge about nursing as a profession and common professional activi ties. With the present introduction of Vocational courses such as nursing in the academic stream as one of the options, it is believed that it will contribute towards the basic nursing care of individuals, families and community for health and happiness. In this edition a new chapter on “Bio Medical Waste Management” have been added in view of the fact that these knowledge will be essential for the students to learn before entering into the profes sional course. The subject contents has been developed, refined and reconstructed at several points as per the current perspectives. Anatomy and Physiology: 50 Definition of anatomy & physiology 19 Anatomical positions 19 Cells & Tissues 20 Musculo – skeletal system 22 Nervous system 33 Cardio – Vascular system 37 Blood 38 Digestive system 40 Respiratory system 46 Excretory system 49 Endocrine system 51 Sense organ 55 Reproductive system 61 3. Definition of Learning 74 Characteristics of learning by insight 76 Observation, Attention, &Perception 77 Emotion 80 Personality 83 Defence mechanism 87 4. Principles and practice of nursing 60 Definition of Nursing process 91 Steps in Nursing process 91 Admission of a patient 92 Orientation to the ward 93 Care of belongings 94 Discharge of a patient 94 Bed & Bed making 94 Therapeutic environment 96 Psycho social environment 96 Body Mechanics and Positioning 96 Hygienic Needs –Personal hygiene 98 Safety & Comfort Needs 99 Activity & Exercises 100 Moving, shifting & lifting patients 101 Oxygen Need 102 Elimination Needs 104 5. Medical & surgical Asepsis: 20 Definition of asepsis 126 Principles of asepsis 126 Types of asepsis 126 Basic principles of surgical asepsis 127 - Use of gloves 127 - Use of Aprons 127 - Use of Masks 128 Sterilization and disinfection 128 - Definition 128 - Methods of sterilization 128 Handling of sterile articles 133 Biomedical Waste Management 134 - Classification of waste 134 - Segregation, Packing and Transporting 135 - Categories of biomedical waste 135 7. Each part is specially constructed to carry out its own function, and to work as a whole with the other parts. Look at a person standing with arms at the sides, palms turning forward, this is called the ‘ana tomical position’. The body is seen to consist of the head, neck, trunk, upper limbs (the arms) and lower limbs (the legs). Cavities of the body and their contents: Some body parts form spaces called cavities, in which important internal organs are protected. Just as many kinds of materials may be used in the construction of a large building, in the same way many different kinds of cells are found in the body. The human skeleton is wonderfully made in such a way, that it can support the body in the erect position and enable the body to move freely. Structure and Functions of the Skeleton: The skeleton is composed of 206 separate bones in the adult, and the cartilages and ligaments, which help to unite the bones at the joints. The Parts of the Skeleton are: (1) Skull, made up of 29 bones in all ( including middle ear bones and the hyoid). The end of the nose, and of its ribs 4) Ligaments are made of strong fibrous tissue and they hold bones together at the joints, allowing some movement. The Skull consists of two parts: 1) The cranium, which is like a box in which the brain is well protected. The cranium is made up of eight bones as follows: 1) Frontal bone: Which forms the forehead and helps to protect the eyes. It has a little seat for the pituitary gland, and some holes for blood vessels and cranial nerves pass through. All the bones of the skull except the lower jaw are joined firmly together by fixed joints called “Sutures”. Some skull bones have hollow spaces called “sinuses” which connect with the nose and are filled with air. The main sinuses are the frontal ones above the eyes, and large antrum sinuses, one in each of the upper jaw bones. It consists of 33 irregular bones called “Vertebrae” but some are fused together and so these are actually 26 separate bones forming the spine. Intervertebral Discs Between the bodies of the vertebrae there are thick pads of cartilage called discs. The vertebrae are also joint together by ligaments and muscles attached to the back and side processes. The Thorax: The thorax or chest is formed by the sternum (Breast bone) and costal cartilages in front, the ribs at the sides, and the twelve dorsal vertebral bones at the back. The next five pairs of ribs are called false ribs because they are joined by their cartilages to those of the ribs above and not directly to the sternum. Besides pro tecting the pelvic organs, the pelvis supports the abdomen and provides the deep sockets for the hip joints. In the female, the true pelvis (lower part ) is round so that the head, of the baby can pass through during delivery. Like the finger bones, they are small long bones, two in the big toe and three in each of the other toes. Bones are held together at the joints by other connective tissue such as fibrous tissue, cartilage, ligaments and tendons. Muscles are the means by which all movement in the body takes place, including the movements of bones at some of the joints.
Las trombosis venosas profundas son discapacitantes en el período tardío generic 80mg super levitra free shipping ritalin causes erectile dysfunction, porque pueden dar lugar al síndrome posflebítico con ulceración crónica y casi permanente en el tercio inferior de la pierna discount super levitra 80 mg without a prescription new erectile dysfunction drugs 2011. Las várices tienen una elevada prevalencia, con complicaciones que al llegar a la úlcera maleolar, producen gran discapacidad. Las linfangitis agudas siempre tiene una puerta de entrada que debe buscarse y tratarse. No se cumpliría el objetivo de esta conferencia si a partir de este momento ustedes, al realizar el examen físico de cualquier paciente no hacen énfasis en: - La localización de los pulsos en sus extremidades. Mencione las cuatro entidades que constituyen las principales enfermedades crónicas de las arterias. En cuáles graves enfermedades escondidas el médico debe pensar cuando diagnostica en un adulto mayor una flebitis superficial espontánea. Definir los 3 procedimientos básicos, necesarios para el diagnóstico de las enfermedades, incluyendo las vasculares. Enfatizar en la palpación de la línea media abdominal dado el frecuente aneurisma de la aorta. Enseñar la auscultación de las principales arterias y las heridas en trayecto vascular. Debemos empezar con este necesario momento en el proceso diagnóstico, no debemos precipitadamente pretender un examen físico y mucho menos, dispararnos a indicar complementarios, sin conocer en qué sentido dirigirnos, en los que no estaría claro qué pretenderíamos buscar. El interrogatorio brinda, digamos, 80 % de los elementos para acercarnos al diagnóstico de la enfermedad que aqueja a nuestro enfermo. De este racional esquema extraeremos para realizar el examen físico de las enfermedades vasculares periféricas tres aspectos fundamentales, que habitualmente escribimos aparte, en la llamada sección de Angiología: 15 1. Sistema arterial El examen físico aporta al proceso diagnóstico, sin ser matemáticos, alrededor de 15 %. Sólo deben surgir en el pensamiento del médico después de la conversación y el examen físico. Existe una desacertada tendencia de indicar estos estudios casi en el mismo momento en que el enfermo se sienta enfrente del médico buscando su ayuda. Esta práctica, un tanto generalizada dada la novedosa y cada vez más segura tecnología, de indicar complementarios antes que todo, es absurda y los convierte en “suplementarios”, porque de esa manera no complementarían nuestro pensamiento lógico, sino que lo suplirían. En la práctica diaria, en el consultorio, la mayoría de los enfermos no necesitan ningún tipo de complementario. Un número relativamente pequeño de pacientes necesitarán unos pocos complementarios “habituales”, como un hemograma, un análisis de orina o una radiografía de tórax. Finalmente, un paciente en un grupo numeroso de enfermos, no completamente cuantificado, necesitará de algún complementario sustentado por alta tecnología, que no debemos desgastar innecesariamente por comodidad, superficialidad o complacencia. Para completar esta relativa cuenta, puede decirse que los complementarios aportan 5 % del proceso diagnóstico. En el caso de las inferiores debemos conocer que son las “dos columnas” en las que se erige “el edificio” corporal. El cuerpo humano es el único edificio levantado sobre dos columnas y la posición erecta no es para nada el resultado estático de dos cilindros sustentando uno mayor, sino una combinación sutil de estructuras y funciones que se ponen de acuerdo mediante contracciones agónicas y antagónicas que de forma imperceptible, automática y casi desconocida logran la bipedestación. En esta mirada general deben coincidir en altura y casi tocarse: tobillos, pantorrillas y rodillas. Luego precisamos los hallazgos de abajo hacia arriba: El pie El pie es una compleja estructura de sostén y marcha. Estos dedos mal denominados “artejos” por la práctica diaria, pueden estar en “gatillo”, engarrotados. En este caso la superficie de su última falange apoya con gran fricción sobre el zapato en ocasión de la marcha y la trastornan, al tiempo que se lesionan. Su base articula con la cabeza del primer metatarsiano que es el punto de apoyo común para ambos arcos del pie, el transversal y el longitudinal. Su base, al ser punto de apoyo, es particularmente resentida por las neuropatías, con mayor frecuencia la diabética. Proporcionalmente recibe menos sangre que los restantes que la reciben también desde los lados. Al estar en el extremo interno, los zapatos nuevos, o apretados, lo erosionan, en ocasiones gravemente. Los 3 puntos de apoyo son: las cabezas de los metatarsianos 1ro y 5to y el calcáneo. Los 2 arcos son: transversal entre las cabezas, longitudinal entre la cabeza del 1ro y el calcáneo. Esta configuración, de la que no dispone quien tiene el pie plano, asegura una marcha mullida, elástica y elegante. Aumento de volumen Si al examen físico una extremidad, solo una, está aumentada de volumen, entonces sin lugar a dudas, tiene: 1. Trastorno en el retorno venoso o linfático o ambos Si son las dos extremidades las aumentadas de volumen, entonces esta posibilidad pasa al quinto lugar: 1. Trastorno en el retorno venoso o linfático o ambos Cambios de coloración ¾ Palidez En una extremidad: sugiere enfermedad arterial. El sistema venoso de las extremidades tiene un componente profundo y otro superficial En los miembros inferiores, cuando se afecta el sistema profundo es en general por las trombosis. En las trombosis venosas profundas el aumento de volumen de la pierna o de toda la extremidad es el signo más frecuente y evidente. A partir de este párrafo hacemos nuestro juramento ético: “Juro por mi honor de médico que nunca más inventaré los pulsos arteriales” El sistema arterial se explora con el paciente acostado. La mano derecha del explorador sobre la pedia derecha, la mano izquierda sobre la pedia izquierda. La arteria pedia se busca en el dorso del pie, hacia su porción superior, por fuera del tendón del extensor del dedo grueso. Más bien es que su tronco se divide en las ramas terminales antes de alcanzar el dorso del pie. Arteria poplítea Es la estructura más profunda en el hueco poplíteo y resulta muy difícil su palpación. De todas maneras, con el paciente con su rodilla flexionada y el pie apoyado en la cama se intentará palparla en la profundidad del hueco, hacia el cóndilo femoral interno. Si resulta muy fácil su palpación debemos presumir que está dilatada, pues es la segunda arteria proclive al aneurisma, después del sector aortoilíaco. Arteria cubital Si bien tiene un calibre un tanto mayor que la radial es más profunda y más incierta su palpación, que se hará en la propia muñeca, hacia su porción interna. Dada esta circunstancia, Allen describió su prueba: ¾ Prueba de Allen El médico comprime la arteria radial sobre su latido. Luego comprime la arteria cubital en el lugar que se supone esté, después el paciente abre y cierra su mano, lenta y fuertemente una y otra vez. Si la palma de la mano recupera de inmediato su coloración normal, entonces la arteria cubital está permeable aunque no se haya podido palpa y la prueba de Allen es negativa.