Ebook Advanced cardiovascular life support (16/E): Part 1

(BQ) Part 1 book Advanced cardiovascular life support has contents: Introduction, systems of care, affective high-performance team dynamics, the systematic approach.

l.r tI, ddllUt6 b,E d.Elop.d ol,]b maua]

Mi.nad W Dddm MD; kmndh Ndm, MB, Lpl

Jull C,idq PnDi Mry F@ Uarru*i, FN, MSN: n'e

a, N€dbr, FN, PhD, rNs sdrb Johns pnmD, acpsi

\tsnu M8m, Dj 3s Msr6, BNr P

MiiEr shr&i MDr D.vrd s.tuy, Mol

E To lind eJr abdn &y updabs or cotr ctions to tn6 tsxt v,3

Tota.e th6 studei I&bera iq rhis c.ue, so ro wwiE t oqr'.ccmrd*r and 6fl1€r thrs code:

Pan I

lnbodrrcdon

co.m o otdon rE oo.,

Co.@ Frlrlo!'brb5 ed ArpaEtb,

Ef,G mlhh lntdFrllato ld c* Aos FrnrnB

&.r ACLS c'lus .nd Pn@togy Kmrt.dg6ACtS PB,fir M&ud

Po.L{ R.l@@ Cad3

PM A€pMia Cref!, F.qiffi ,br &r dt, CorE CdrPe.l

ACIS PEld M rd,ah6.v&tbn

bt-dC4r@.Uhs@rt odhy Alsssn, B.vr.r ard TdEldmr &dE

22

R.gind@t.n or St k c*

Po8,-adthc,,6iCa.

Targolod T.mpdtu6 M.n.!mmlHer.dynMic and \ennhid Oplih zslion lmm€d* Cdmary B€fldtsM Wu! PCI

N€uEloq'c Ce and Foonclidllon

eldtdt, hd.narrr^h, at t l*tu

It€ N.€d lor Tffi

cddiac arur Ied (|.-HordLl)

2S 31Fdn a

tl,din.*ig utd lt*O lktd.,Yig C4

CdrdllG ad MorEeEMi

caldbc Md Pur0on ry cadfiore

DruS O'€dGB or Toxic E&oec

BadcAl ay oP.n n0 T&hnlqu6

ArMy iltr.g.ml

P'ardir, g b ltn&i.rbr

S.O.Md v.i lr.to

T t'rihr ot Ot'A hsrlro

Batc ettyNln* Nt,lPltrytDal ALtq

Ieh.'qE ol NPA ln*rlio.

Solr s Rigid C€thd6

Oropharyns@l Su6limin9 P@oduE

Eidol@h.al Tubo Sdidi.q Ptuedu6

appiication ol lh Acs algdithm

lctdttra.ddt a, C& Dir,/tdsl4E rdr6oar.dre&

hn&lutt EO A@,t.n, tBti.4l

'IlE Fi6! l0 Minut6

CLdy M A.@nlnr b gr-S.!mrO.iado,

crsfy lnro 3 G,oup6 B6.d on sr-s.gm.t oovl.lon

5555

d,

67

6€

o

cdriel TliE Pdiod.

Appflc.dio ot tE si!p&i.d srrro lrlcdi0rd

,d.idlt6don ots&l,a! orft ibb S_t!&

w' ing StgE std Syirrffi

&livar Eils sysrd rdfod'aLry

SrDk A @ner Ter!

C.idc., Ar9 &rsr,' rd,a.tb,t

cnticrl EMS a!d6m.nl3 Md ,allMt

ttslroribl , n d.i,O.rird^rsmarrd$.at lro.r

lnmd.b G.d,l Alrgssn.nd Sirr$tsl d

,r,n dri.,ll rrbCcrEE a .'stla t ln do tE

E3r!$!h Symp16 On.€i

ClSe,La'Errn raq$ot@.

FHlot rtc ,laA,

Ewrul lor FlMnolyd Ihd!!l/

P.nrnid Adw Eie1,

P.$rn l csdda.ld Fit*in lylb lhEoy

B.gin srEk P.rhway

Mon lor Bl@d Gll,e

Ms[d ld ConlolLabdE ol Stdo rn nb.ieidc Irepy

Shek and &liarrnyrhmia

CadL An€d Tc.tMt S.qum*

Ptrrrogi: Monnd,,r{ Cn i.O CPF

Flu'd Adnini$.iion

v&.01*,s U.d Lbi"s Crn hc A,Ern

@rnnc&ab

lr.onsilm surtrr

Erts.poE r Msh"e Oxyleralid

lrtu,,,t d it EI A* W rttfr.PeAl

U[E@nd Us ln C.di* ArE l

Cr{.G ari.n Arb.r- !.c*., /lcii,f Cr

BMhIB iO PEA

WldPa

NNet'4 PFl* flE Nt C.rlec M Alodfthd

Iltr PEA PathwEy ot lh6 CE dl6 A,i*i Abpitt\m

D.chrM Poinr Rh)4hm ch&k

Admrl]llr Ep'^.phd€

t{ddrodrbL Rityttn

0.dd6 I,oi.( snodabl Ftry'hm

asyibr md PEA T,6hEr S.qM@s

Baffi@t6 Md c6En or t rd.,ttE c{@

csrE a,'r'/h ,.t .cla cu

Paliftts Wilh DMA Odm

Arlddc 6 o Ed Pon'r

Ad![ cad! aEr Ahqfihm

tt5

r15

116

113 116

,a

1A

tqdh.l*o R.ruxllrttoe Efiot,,

TmiEUng ln.Soqital R eitdw Efiort!

Tmidtns our-ottkr.{ftd a6ratrai$ Eilo.r6

ouhrim or F@it6ri€ Enoi

nat tt tr Brrd'r-nbt 7,Ir @ r./'o,ran

Ianrlnr s€quq@; Atopitu

ll4lne $qu6nc.: P&r.o

TE'ml S€qu*.: Epmphinq Dopsitu

ftyrhm ror UrullbL lfthrEri.

lruls t( UErabL r*hya'di,

,?'r /lpprodr to urlr.Db tdl@rd.

P.irtopnysbqy ol trr6r.br T*nyE di.

Fapid Rsosnflio lr lh K.y 10 Manag.h.nl

lndic.liffi ro Cad@q.iM

,rdqta |&'i'il llfivcdr,4 fti rW r,ts'ro,n

Md ol dD rH/ttI E,.ttrvitrr, ro & ar,.r.Db P.t, t

A@s &p.opnab@ lor cllnioal c.ndlilo

oeilad Polit l! lh€ P**'M L.tvarnvlhmia

C&tns ssnir@t SigE r symr{oft?

Pridm lf,rn di.r s!ft:lldi2€d cad'o61o.

Dd.him th6 !\ridn ot $ OHS Cqnobx 135

ta

un$ncrmized 6 sy*hmE€d sn6l.

pd€rnd Pmt*ntt w[h srrctroid@

eE !y Dos for c6dlcerCo

139

,a9

141

112 142

rrn gdreS_i.6b trcrrr.El,a tl'.lrd,,Ei,.,hd B

w.tb, ot lh tl.,l,atb /ltdid*D b dp $.oa P.6 t

Parrdr Agse*trdn

BLs sl(' rcLS Asns'ls

DeM Point si!b& d Lr,Erau.

lv aec and 12-1 d EcG

D€.dd Fbll*: Nrrcw or wid

wd+Cdi9L, T*htsrdB

flaM ORS, R€uIt Rltt s

r*hyc.dr Aoofthm: Adsnc.d M@gffil Sr.p

h d.nHa.r{ aEiC-Cr

ffit/nm ld PGr-crdiac arcd c{6

DugB for Posrt.rdi* ArEt crE

Muhipl Syslm App@h lo PoBl-C{de ArBt C@

r,.r,rat, fr.r-Crt e rr.d C.E t r tu

r-Ca.tuc krqr C*c Nqfrth

AM1 ot or nD,eb W ,,D.t Ci &dfi ,n

oprimE \&rriErs rn orygduto

T6ri xypol6si6 (SBP LN 1lEn s nm Hs)

SItMr b P,gr q lltgn S{.rici.^ oi AMr

fDD.rdh t35

tdD CW dtd L,,daA S-blto Cii.ctlrr.

ACIIS Phafifi.dqy Aum.ty t *

ED.rr y .tnhv:{r @ ir a dyMrc &ire Adv.i.e in Mmd .nd dn€ sapr6 (xur dpElr.

F.ad6 +dld @ tr iolrowllr! ffis to chek ior cni.€* in l&mmH&d dle lndldroE, .nd odElr6lcdiN: *r ECc Handhok Milahl€ s ods.r ppbnanry tut rr.r, a.d rh pek a hd E dud l.{or.1.lr

!t'.d Ir dh &i9 an n!dh! da,ie

Al tEt4@n lhtn As6lm k riflleode lo *Oer6.i horc ol ilr! r6M mme,Ils Tnars

r^frymwiBdebenerl].lnardtr@heaordlllls isr$r!l!relmnmm idIoex.?otral

ran i0 llE ar 0l bdngin! rca$iErir si{tre lD rilFrh@uot qsu're panBnn'p wlh y@ o.ry lhrcoqh

Llnl fierel a @r d [e dl hedd drsm a]d slrdke ire Ane,u$ tuan l6sc al oo w r be thfre @!nq

w lh }!! 1o maka a hsllh er rmqs li,e posib e ld weryoie

UhbtlirtsaekbGimollre A!4rr€yerDowed! alMrlotEqBlMol"tyksntuEa

bo lreaihy

'n rrea( and m id I a]$ e&raB sty w do f,tul*e do Llwvn9rc Eery day

I fuou0houl |!Ur studenl ma@] y.tr w l i nd domal on thal .orelals w,rat ]or e eamnq nhs ms ro LIi b vrlrt dd l,\! mponaice ol.ardlovascLl sre Ldk lor lie

tit hwrykln lshMarrl0h0 d refleniber lrBl {har y4 e eannqroday

hA an frpa.1 0n he m slon ol llie Amd an Hcad Asffialioi

\,!e en.olaoe y@ lo d6cMr tou f,|ry and snare

'l wllr ofiss lsk y@ell wrrar

are llre rommls peopb aid exporieicBs r w 10? !vh3T hfiqs mejoy wmder.

and lrapp ns? Wry am panod n0 wm he AJ1A ro rElo se vsrwhys

dd ovasla €e ro@nad Io met Tne answ lo nts qEstus s ,!d tlv,

Pe*lllx]@rhebarkolrhsNaqeacharcetu,!rloDandoan( $EAHAS

mi$ on and Un h Wiy €mpaiqi C.ndete tis el v! bl lli0 i re lrhrk

w h ha wq'd fiar de*r b6 yer $!n

Sh&omu I It lit'wh lhe ospe you low and4k$emrcdscmr

rre dnlt$.[ltP tttjlilt {llhLrhf lcrf,$dt a 6 Heart

t

lnstructions

Etrtr@8tr8tr

llE L,'d'o.d crlto@ra Ul sreo.r Acr$ Pia/n cda a .lan!.€d fr,

n€dl.ap.oi.,'s},Edih.t,lddp.dcp.| 0ErEl.g'enoloniopirre

nary dd 6 otE.n dB&I, dElard- IrE4n did.clb i,firlro rtd drlv!

pddpnb h .[nJ!r6d c!s, .b&na },1l oh.d thdr rt lh ]n trs kosrrtdr lld

Itrr46 on ol Edio,urddll} rur, ]mo€dLl€ pd<,nu e.l Br ahrrnrit,

3t!rc d !qr cd!@ lridM6 lacs]

n* !.6r ot oE acls Pro d caa E to imp.or dtu r.{ .d'n ,.n-tt ot sdir:

orBr .rld o$, €rdi.adra!, d!F.B IB)gn -.jy 6.9iEr !d tr 'dr6

t F .,rc *i dna&noi ol

'la ijae 3il&il! ,&ld h ,al to

Apdy nE Bet [,{ sr4r.rl lBls), &n@y, d setdtv Agsdiqar

L $.t rndh d.Ir.td o, adi Pafirn!

! F.rio6 prfpr F sh.qdr'ry BLs, ftd'! rdtzno €dy dl6r Mp'Ms sd

hEsEdn! dt &tn ld d6rEr dsflnilhw (]\Eo) u5

Ir ol cn trddn, tnr.drra PGr

Ev,ld 6u*haliE .ltft dutinq , !rdl.o a4ar $6u$ di.uou -s.sd

n enpm-q re,u* tcpF, ouhv @nrqrs s p.'r-r! phFio.et:

lt.m,,|ddis.mEdhl db*llolh.t4n

R.e9,larErr{$.1t5.\Mi6o@Jll3nF.id'm

Cou6e Dcrign

Course PrEr€quisites and Preparation

ww'fu.n'or9/eccatdenir

ll.l ttt b Tt idd.t 01.dm€d lir.3uppdr b nd€ Bts cdlL Yo! mB pa rh hEh-qd'

[y Bls I4riic sldro ro mpr6r€ ih acLs 6ue i&i6 sE ttr y& @ p!,x i' n ,,

E wei tu Hbrr4rariry Bts srdrr vrrho n {1'd q }E srudor r&&ira

Fwrr-trir' axkd, FftB iE Hi€rrord,ry Bls sall 1€5lr's

oEddBr b.r!.d in tr &pd'di!.

aco',{/4,r,'|

loe eat ACIS

E Ydr lll .d ro drglde r1I AcLs P@ sdl-Al !.Gr *t'hh 6r u

ECc

'hytrn d6r'f€rd, 6 th s1lddn \i/.brb fmn-tdyEt, ts

ar th .rld ol lh ec.rn y.! *lll ,w }o, * M t €dbd( b r!19

,u id.nriry

'@ .{ shn!$ arE w.dl@ R.nt€dH sy q.t h yor kwLd!.

b.io6 r,tdim tr M l'lJlno lh @u6 y.u mBr b au lo ]a.rniv {'d tnsP6t

tr4nhBddino pE nc.awer edu ng fi€ final I'it $.nd v.|!lon ti.!on

E \60 rrd dd r en re rh acts ftM s.{ a.!d'lgi $irr cdn 6

prsln@h{y qlclldB, d rE studdrt !\&hciu (tr*rr.n rv-di 'r)

ar ln .rd ol rhs e3.ffinL }!u {lll r*lv }6u sG .nd h€dbo.k ro h.lp,d idedity .B r dcn{th arz w41ru, Fqndbb ev 9.p6 lh vor knovdod9o

Tlt b6ic 6r!k

'61 8nd pdrrrgl ca [nm Equhs st]dtu to eogila the

r ,&id rb ilo &n tuflt

' rho€nMl, (Al1 blod(

Pllsal6 dGrrb.l

'c1iv[y PE4

r \6nricur& r*hycrdia (w

vdrai.ll& rb1{5rron (vR

n cocs mardi.r oonsLrr ol lh 4cls Alyrdrl M.tu r, srudmr vi!b6{

l*Rhddd!/*6trd.n0, 2 Pnkd R.r.|!@ c,n1 and PE.@

ftEpararion Cher(ll3r Th io m th rlt dkr! y@ io .ddiridd 3&!i.tui y

^Cl.' ?twir.' IIE,AC|S Frri,

^r&aic

6rts dE ba* t drn tid'sn.d h ll.di€ !d!.{c

'mp br n€rdiar ind'n6 dE ly4runc 40rDodr to clde

oulmonary sE!*y, fi.ciE irgi-p€rlolr]@ tM @mmr.lim, ald $

F.n a tha Svn halc &F.r.r'

2015 S.iE HAtuqtu ol2o15 !d 8 dwro6 h ih.lcrs pro,id

Fdn&td rndor Pd{6 m* rs, ub,Er! 6 b ro

c.dtova6id, p.ct.'9)

IE A|IA roqotr

'6 s&d b 6'Erd d e t! p'ej* sdr

Ag.sd told 6 r! Sl{, n lnr6&i od prt okgcr6s.6d&.1 loth€irAcrshltwId.]rEP'@s.,.As! @idbEsddlbl.

und.d.nd s€p6

'n klwr.d!€ Equi,ld ro p.ructp.r ]n &d p6 rh6 {N.

Supp .mni!4 !opi6 ie.bd n th studod \r&b!t1 @ ustut hr not M .t ror uocostur @mprdim ofih @ue,

ft rCLs Provi.r.7 Marr, conbins

Pay Mculeatt lon lo 1iu G d c.@rr b6rdhar apps ln rh.lcrs Fbvda'Ma Dl In*

c.ut}onersfrpnaszesps.ificnsksaswid.d

m 1015 odd.nM boE 6nLli tE @ 2015

Ah GuietuB UNd tat CPR di EnasdEY

cllloveu/.r c,E (Ecq i,nolmtM

Llrc k 9E ur b |{nY bd6 dsrE $h, hrins

EI rne acls sirded lr/Ebs re l'w.hEn orcr'€€dlddr) coiiains rh€ ro owins

s.ras*mordd*pp]edalyAdrcos:

I

lEr6r)

nd_aron6 ed! p&kaq€d s {i lh ACLS PD,ib/

in ymr pekd ior qulck €ia5e !n rh6 io owing

Raquiremanta lot Succea3lul CouEe Complc$on

.AdUhcard&ArclAlsol]iim

r IaAs with druss ed dosse

'6m ndm

r Adurt hm.diaro Pd-c diac arest cd Algoi$m

Adu r Bdd,ta.dra w[h Purs Also'idrm

.AdUlTa.hycadiavy'lhaPurseA9orthm

aculo c@n y slndlc,Jo.rllrtm

Fr!.noldc ch€ddEl l* SIEMI

Fibndyrl coitshd@lh.E loi sTEMr

' addr swp-rod sbks Ahonrnn

sh{€ A*sr@r-CtErnarl Prr.?t lst lr sdh

rkd e dFArbra4t l&h.ni sLr*.

li/pdr.n hi M.Nomfn h AorL l&hldc Sfok

lffi,h{ns!r'.6tuddn) Prsa*

plded piepelion 1( sach secri6.

ACLS Ptovider llenua, Abbreviarions

Advanced Cardiovascular Life Support

Opiimizalioo ol ACLS

C.,1ttc.l C.orrc.pt' M'nimi,e Intemphons in Compressrons

Closing lhe Gaps

Ataiay Aset dent,

,lentl.tlon.l Sci.n@

Systems of Care

CardlopuldonaT, Raauscitadon

I $/.a.rr lrpn ct

dm'n6 rk iBEih or Mh r.k and rhe cM n ara*i.]€,3yc*6ni'M,Esy9sd

Slrucllre Process Syslem Outcome

C o nti n! ous O Gt it t h pmwn E nthtoqt.L.r Catabataton Meas!'eapht Ben.hna r.o Fedbact

d* comp@ion and cu6r daM.6 olten pidi

rib $a &dr ot f.€dbacr( bry us ol a isid alsoihm in a mann* rhd may nol b€ opim

d BarEr c (oe o edaomds c nor m6ME d€prh if Ihd€ is 1@ mEh rmrnq, $

lhe da ca wirr EieirEe f6€dbac( to conE i ldnino b.lorc comiino deplh) A[hesh

$n6 sottwde la'xomar6d sLsor rhms) and hardy* (.man bekbdrd, duar

ad.rmr-6lm fttorc ma'*m and oltpE) sdd ons cuftnl v exisr, conrinusd d.*ropmml of

oplimar a'd wid€ly avaiabl cPB mdb'in! is a k6y ompoBn 10 i p.otd pslom 6

LriL b WW Hish-Qudlity CPB 13 why

Eany re.osnirkr ad cPH 3E cruo.r ftlr su va ftn c.rd ac .resi sy r€minq high_

quariq cPu, y@' h.ve rhe ability Io impEva parHt otums dd ev moE h6.

D.la 3hdrd be sysrfuicall, revFwod and cmp8€d .lornarrv ro prid p€rtm @ 6nd

eneroIy b srmlts syslems Exisrlf,! r.oi3l,r6 @n facilirds rhi bschma*ins efion.

r G.rwlhThe G ddin*!'Ba@brion p.oqm io' lHcA

simply

'@*dno .nd benchmdi ns @ Gn pcitivaLv iniunm dcffi Howa4

r lmGasd byshd, CPF EP.e da

t mp@od cPR p€dom@o

s-rro'1sEd rim ro d.rlbnlraton

c zs and hs lhoee lbkdond edudim 5nd rdn nq

Acutc CorDmrt SYndomc.

over th6 pa€l 50 yss, $! md€m_M BLS tund.mdids oI €'lv l@snitim andeuvali6, €dy cPB, a.d 4iy detiti

lives ,ound rh6 wodd Hmet w6 strl Mvs a lonq mad b ii.ver ir w€ aE ro tuf]ll t''

p<n.nuar oftr€d b.y he cha ol suru val s!ru val dispd r 6 p@nled a g€nsEti@ aso

sdned by n1€ crE n ol sudivar ro addEs manv ol s6s cft sap6

md limdi! dhd cadrNeurd mpliat ore

madlquadeva*ulafuton

3, r@r *d., rGrhrdshs mmplicafons oI Acs, such as venhcurar fibindim (v1')

ftompl diagn6B nd rEatm on€E lh oEar.sr pot{lrrr b6.€fr ior riy@ardiar s

.aG prcvld$ @osnrze parienls wM potelniar acs1o tiaro ovaruafon .ppoprd t ag6 .nd m.nag6mm s .xp€dirioGry E pcsib e.

r Noliricdion o, the @o'vln{ leirily of a parid s rh pGrbre sI $smed ddalion

myd,n ar nrdim rsrEMr atdl")

o^ltslodho,renmpglusionlre.coitlnuoc6viswdqudityme.owmml

,,{lva|ono,ih6cadi&calhdgiat]onlabqalory

Oudiry ssuEn.6, Ea iitu ta€dback, aftd h€[hca6 pdidar .dEri,

pmride cporixlon snd6qy

Tnehoallhercsyjemhsach'6vad:ignilani]mpoEtrpllsnslrokocm$d]ghde

y disparch, p.eh6p(ar .j6rdion ad bao., h6p!

ra sroko sydsm deveropftnl, and noke un mnaodmd Nd on y hav rhe E6 oi

also np6v6d, in pd rhrcuqh th cr*r

icdDsqd*6'ldsbke'eombinadiig6D]6-minosfi divard lnF4 r at.! dr ctu

r Pat er aducarion ofoft ft msr

a6.y,6p,re368;

r €MS ep.is6 psGonn.rra red n shke r@s.[im

strok&preparcd hosptbrsrdma-y srEko c.frm

.Ao.*lodmkeelpe]seVal€l€

Po.!+rrdl.c Arr.d Calt

rh tErr@ s}!m stqk hptut a ffpirBre trrdftd- m'rld !r'iEy rcm of ce 6 @cBbd lllaB ls tE tudn ot pd-cdi* od pdiriil

PDsffi shourd iddB ie!ftd k^p l'i mn4m.d rn4, honodylma od

v.nrllarron opr'midion, immodiars .mn6'y Bpstudoi sltn FddaMu cmsy kn.r

vMlbn (Pcl) idr rrolbrs pdift ndolo!L ce &d pf.onelleld, md olhd str&

P.l*cwt &lro tudlpat re ci,qrds frosq.n dd& ar6r h a'ys€ .tcn4 cmpr.tmundonolp*r.pbForos.p,w.ksb.d6pd-

drme ,d ryidomo whioh includG pd'r6r b.dn lniwy, p.d.nsl myudjardystunciid, lrsr-drc r!.tr.mia or p.nu.bn Gpons, a.a p{!{ndn &ui .nd ch@iio

pqr*{y rhd mry h.E pr&Fih.d tr ccdiE ,r.d.' Fd-adi* n6i nldrft

prars a .ig.n rr 6b

'n pdirn mqr.8!

hdh/idud tGA,nl wih s hi$

'ltq'ey d h.n'g {d* ,d p.rrsG !rE, s

r6a&d rikdiho.d ol 6uRivd *rEn be rnbMntoB .6 pdid.d i r

,lrtEa.d funp.rdr,| rh.2015 a]+lcdddi6 upd t t @

'@hsiur cp e b wtd Mns'&) dx

parrB *i r trGsc .n5 Bda rct, by *l li'E d o6n idns .@1'n rdrp.6

hr b.l,en 32'c sd 36'c 13s.6'F 6M 95.2rD ld al r.61 24 hou6.

Arnou€h poid* ota u* 10096 oxnd *hrb pdlmhg th inrir.r @$ini , p.o_Mdr .tdrd ftn

'n:Fkd oxyla ddit! tE p.d .rte 'd phe b $E br.d

r.v.r Equk d r -ha{ s tui'l o4!- ffi or 9.x q sDdd, wb Ldibr In6 hdF to aqd sy polad.r csd@t.n d€er.bd *1r' or}!s rorr.iry.

Arcrd 0ic16 v.nulaion ol $€ pElr.n! be@ ot p.rdr6r .dv.e hnodyrumic

.liet! whs rnrdhmcr plsrE ft llm3.a dt bc!@ orrdmlE d*@

h orlord aood ne tts F,t.r p,!s 5t @t dodd l addi.l br&d lPacqJ

H nlEe peidd m.y $tr vd{llaro lfu d lUnin fJdnGrbi lpdirl pM

ot nndd €'bs diorBe tPEco?i oi 30 to 10 mm Hg or Psq o, 35 ro 45 mm Hg) mv

b€ E.&do cs unl6 p.tsi l&h pmpl m@ rndrvidu.lir.d ldrm.ii cd*

F!eo, Lg.ir nBy b rol'dsd ld !p.(r6c p'ri* rd spk, a hroh{ Pxq nBv

hypdrr.E nEh b @tur 6 a r.npdr, llEe *tld Mjns 6!b.r dsB bl,

hy!@6tlaid 6urd .'H *6Er vedndoi PEU<,€B lrElE rcL M whd

! p6r.nr! lsri!.'.iu6 L borow ffi.r, laboraro'v vd6 Eporcd ld P@r ml0fr b.hrgh, tE h dud vdu6

H $mpldi&!llbldMllluid.dfrili!fui]4.r(veli6d[d!pl.zldb

s n€€d.d ro optmiz bL.d BEgn, @de o4!1 d t dnt F.rrlM IrE

'pt_

.uE or 6s mm Ho d rdsr, B a EMiabl gdl

arie drdes or MErs or mpd aponse sysrems

dllmdmod!lyQl6S

rqen.y F.slome mproveie ream (MERII ra

F66 i;'q ou one5 .ada( itr4

"nd Q;o,

,_";,-.-_ "-*." =@*,d"";ir,.",,t _.

i1.creAe sd 0 v.idyav dd sF@ Dbeuiv dquddh6cmd€ne 6qGd!eddbdd,.