RhoGam is given to the mother when

the mother is Rh negative and the baby is Rh positive

GBS (group beta strep) is

the leading cause of perinatal infections

treated with antibiotics at 28 weeks

a benign infection seen in newborns

NOT transmitted from mother to baby

when the placenta partially or completely covers the cervix

when the placenta is in the fundus of the uterus

is more likely if the woman had a previous c section

has a lower incidence now than in previous years

Risk factors for placental abruption

preeclampsia/hypertension, cocaine, trauma

heart disease, stroke, hypertension

Complications of Pregnancy 1

Complications of pregnancy 3

Complications of pregnancy 2

Complications of parathyroid surgery

Diabetes for paramedics, pathophysiology, types, presentation, clinical management of hypoglycemia, complications of diabetes

When Europeans met American Indians in the late 15th century, the people of two continents exchanged many beneficial customs and goods. Europeans received New World crops such as potatoes and corn. American Indians acquired cloth and horses. However, besides the beneficial exchanges, Europeans and American Indians often traded deadly germs–bacteria and viruses–for which they had no immunity. Smallpox and Indians Image 1: Smallpox epidemics helped Europeans conquer the Aztec and Incan Empires of Mexico and South America. North American Indians quickly concluded that contact with Europeans often resulted in devastating diseases that caused widespread death. This drawing, made in the 1500s in Mexico, shows how the disease was passed from a European to an American Indian through simple contact. Many of the diseases that were common in Europe were entirely new to the peoples of North America. Diseases such as tuberculosis and measles could be fatal, but Europeans had developed resistance to the disease, so many people survived. However, when European diseases infected American Indians with no previous exposure, the people suffered terribly. The most devastating of these diseases was smallpox which is caused by a virus (Variola major). Smallpox, like many other diseases, had a latent period of about one week between the time the person was exposed to the disease and the time when signs of the disease became apparent. During this time, the sick person might begin a journey and carry the germs along with him. Anyone the person met would be exposed to smallpox. Anything the victim touched including clothing, bedding, or unwashed dishes carried living germs of smallpox. Cotton Mather Image 2: Cotton Mather was a Boston minister. When smallpox threatened Boston, he remembered reading about how the Turks inoculated people with dried material from smallpox blisters. The inoculation usually gave the person a mild case of the disease and future immunity. The procedure was highly controversial, but it helped save the lives of 274 people who were inoculated during the Boston smallpox epidemic of 1721. Symptoms of the disease began with fever, chills, and aches. The fever might raise a person’s temperature from the normal 98.6o to a dangerous 106o. After four days of misery, the victim entered the second stage when large pustules (fluid-filled bumps) appeared on the body. The rash made the person feel as if their skin were on fire. After suffering with the rash for nine days, the victim entered a new stage-if he or she had survived this long. The pustules opened and dried up. Each pustule formed a scab that turned into a scar that marked the person’s face for the rest of his or her life. Complications of smallpox for those who survived might include loss of vision or damage to the lungs, heart, or liver. Waterhouse Image 3: Dr. Benjamin Waterhouse of Harvard University brought Jenner’s smallpox preventative to the United States. It was called vaccination and used cowpox as the infective material. This much milder form of pox gave immunity to smallpox with fewer complications. Dr. Waterhouse encouraged President-elect Thomas Jefferson to promote vaccination. Jefferson responded, “Every friend of humanity must look with pleasure on this discovery, by which one evil more is withdrawn from the condition of man.” (T. Jefferson 12/25/1800 to Benjamin Waterhouse, December 25, 1800) Historians have found evidence of smallpox as far back as 1157 B.C. when the Egyptian pharaoh Ramses V apparently died of smallpox. From Egypt, where scientists believe smallpox began, the disease spread to Asia. Europeans began to experience periodic epidemics of smallpox in the14th century when Crusaders returning from the Middle East brought smallpox to Europe. People who survived the disease were immune and could not get smallpox again. This fact explains why epidemics struck periodically and the disease was not a constant threat to European societies. Smallpox Vaccination 1803 Image 4: Dr. Edward Jenner’s new smallpox vaccination (from cowpox) was widely accepted. This medical image was published by a Spanish physician to teach colonial doctors how to apply the vaccine to native Mexicans. The scratches were supposed to go through several stages of development as evidence that the vaccine had given the patient immunity. Vaccination was very effective in preventing smallpox epidemics among those who received the vaccine. In 1520, while Cortés was trying to conquer the Aztecs, smallpox broke out among the Spaniards and was transferred to the Aztecs. By 1527, the disease had migrated through Central America to Peru where it helped Pizarro conquer the Incas. (See Image 1.) In 1633, smallpox infected American Indians living near the English colony of Plymouth, Massachusetts. The disease traveled very quickly to tribes living far inland from the English colonies. In 1721, a smallpox epidemic threatened the English colonists of Boston. (See Image 2.) Cotton Mather, a Boston minister, wanted to inoculate people against the disease. He knew that Turkish healers took material from a dried smallpox scab and injected it into the body of a healthy person by scratching the surface of the skin. The patients developed a mild form of the disease from which they recovered. The procedure was highly controversial in Boston where about 280 Bostonians accepted inoculation. The epidemic infected more than half of the people living in Boston at the time. About 15% of those who got sick died of the disease. Among those who were inoculated, only six (2%) died of smallpox. The practice of inoculation spread to other English colonies, but not to the American Indian tribes living near the colonies. Late in the 18th century, British doctor Edward Jenner recognized that people who milked cows never came down with smallpox. They had already been infected with cowpox, a similar, but much milder disease that gave them immunity to smallpox. In 1796, Jenner inoculated a young man with cowpox virus he had collected from a milkmaid. The young man had a mild infection for less than 24 hours and recovered. Jenner’s efforts resulted in a widespread acceptance of vaccination (vaccine comes from Latin words meaning “taken from a cow”). By 1800, many Americans were receiving smallpox vaccinations. (See Image 3.) President Thomas Jefferson supported and encouraged the vaccination program in major American cities. (See Image 4.) By the middle of the 19th century, smallpox was under control, but broke out from time to time among unvaccinated people. Bismarck, Dakota Territory, experienced a small outbreak of smallpox in 1882. American Indians, however, were still subject to the disease in its most dangerous form.

What do an ancient Greek philosopher and a 19th century Quaker have in common with Nobel Prize-winning scientists? Although they are separated over 2,400 years of history, each of them contributed to answering the eternal question: what is stuff made of? It was around 440 BCE that Democritus first proposed that everything in the world was made up of tiny particles surrounded by empty space. And he even speculated that they vary in size and shape depending on the substance they compose. He called these particles "atomos," Greek for indivisible. His ideas were opposed by the more popular philosophers of his day. Aristotle, for instance, disagreed completely, stating instead that matter was made of four elements: earth, wind, water and fire, and most later scientists followed suit. Atoms would remain all but forgotten until 1808, when a Quaker teacher named John Dalton sought to challenge Aristotelian theory. Whereas Democritus's atomism had been purely theoretical, Dalton showed that common substances always broke down into the same elements in the same proportions. He concluded that the various compounds were combinations of atoms of different elements, each of a particular size and mass that could neither be created nor destroyed. Though he received many honors for his work, as a Quaker, Dalton lived modestly until the end of his days. Atomic theory was now accepted by the scientific community, but the next major advancement would not come until nearly a century later with the physicist J.J. Thompson's 1897 discovery of the electron. In what we might call the chocolate chip cookie model of the atom, he showed atoms as uniformly packed spheres of positive matter filled with negatively charged electrons. Thompson won a Nobel Prize in 1906 for his electron discovery, but his model of the atom didn't stick around long. This was because he happened to have some pretty smart students, including a certain Ernest Rutherford, who would become known as the father of the nuclear age. While studying the effects of X-rays on gases, Rutherford decided to investigate atoms more closely by shooting small, positively charged alpha particles at a sheet of gold foil. Under Thompson's model, the atom's thinly dispersed positive charge would not be enough to deflect the particles in any one place. The effect would have been like a bunch of tennis balls punching through a thin paper screen. But while most of the particles did pass through, some bounced right back, suggesting that the foil was more like a thick net with a very large mesh. Rutherford concluded that atoms consisted largely of empty space with just a few electrons, while most of the mass was concentrated in the center, which he termed the nucleus. The alpha particles passed through the gaps but bounced back from the dense, positively charged nucleus. But the atomic theory wasn't complete just yet. In 1913, another of Thompson's students by the name of Niels Bohr expanded on Rutherford's nuclear model. Drawing on earlier work by Max Planck and Albert Einstein he stipulated that electrons orbit the nucleus at fixed energies and distances, able to jump from one level to another, but not to exist in the space between. Bohr's planetary model took center stage, but soon, it too encountered some complications. Experiments had shown that rather than simply being discrete particles, electrons simultaneously behaved like waves, not being confined to a particular point in space. And in formulating his famous uncertainty principle, Werner Heisenberg showed it was impossible to determine both the exact position and speed of electrons as they moved around an atom. The idea that electrons cannot be pinpointed but exist within a range of possible locations gave rise to the current quantum model of the atom, a fascinating theory with a whole new set of complexities whose implications have yet to be fully grasped. Even though our understanding of atoms keeps changing, the basic fact of atoms remains, so let's celebrate the triumph of atomic theory with some fireworks. As electrons circling an atom shift between energy levels, they absorb or release energy in the form of specific wavelengths of light, resulting in all the marvelous colors we see. And we can imagine Democritus watching from somewhere, satisfied that over two millennia later, he turned out to have been right all along.

MICROVASCULAR COMPLICATIONS

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