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YouTube TV Now Available
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Is Ted Danson in a Good Place? | AARP - Duration: 2:52.
You are all, simply put,
good people, but how do we know that you are good?
I just finished shooting "The Good Place."
It deals a lot with ethics and philosophy,
and it asks that question:
"What does it mean to be good?"
"What's the right thing to do right now?"
And it involves being kind to yourself
as well as those around you.
We're talking about really,
genuinely important things, but it's, like, wrapped
in a 9-year-old's sense of humor,
sprinkled with all this visual magic.
I love it when mothers or fathers come up and go,
"We're watching this with our kids."
What I do now is I look
for the most creative people in the room,
ask them very nicely if I can be part
of whatever it is they're doing.
Just be around writers
who have this scream inside of them
that they have to get out,
and then be part of that,
because the odds are
it'll be something authentic.
Since about the mid-'80s,
I have been involved with ocean issues.
Please join American Oceans Campaign and help save…
The biggest threat facing the oceans
at the time was, and still is,
overfishing. One-third of the world's catch
is thrown overboard — dead, gone, wasteful.
Let science set quotas so you know
how many fish you can take out of the ocean
and still have a sustainable fishery.
If you do that,
you could conceivably have 1 billion fish
meals a day, forever, to feed this planet.
That's huge.
Here's my philosophical thought
that is so liberating.
Give a smile.
If you succeed and lead the perfect life,
save the planet, save the oceans,
eat all the right foods,
be the sweetest person in the world
and then you die.
So, you know, go for it, do the best you can.
Yeah, that's funny…
These are the kind of, on a good day,
my guiding principles.
By the way, as soon as the plane hits a little bump,
a little turbulence, I'm in total fear,
all philosophy goes flying out the window.
And you immediately, you know,
get up and step into a pile of karmic dog poo.
O-hoooo, easy, boy.
Is there any, like, dog poo around?
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How to make a Savile Row Suit (Part 1) – with Anderson & Sheppard | FASHION AS DESIGN - Duration: 9:38.
Oh hi, Michelle.
It's Colin Heywood from Anderson & Sheppard.
Very well, thank you.
How are you?
Yes, it's going very well, thanks, and just want to say how honored we are to be involved
and thank you for selecting us to showcase our suit.
Can I just run through the details with you?
So, it's going to be a three-piece, single-breasted suit, isn't it?
In a plain navy blue hopsack material.
And I've got the fabric here in front of me.
So, it's a Smith fabric, which is one of the companies we use a lot.
Yes, it's a nice classic blue, so it's going to, you know, really showcase
our sort of cut.
–Four.
–Four.
–Eighteen and a half.
–Eighteen and a half.
–Thirty two.
–Thirty two.
–Forty three.
–Forty three.
I'm looking for the length of the coat.
But what we're also doing is we're going to find
out the natural waist.
–Relax please, sir.
You just have to press and if someone is standing right
what'll happen is their center of gravity
it's like a see-saw, you can just press it and it starts to topple forward naturally.
So, on Matthew, we're probably going around 18 1/2.
Then down to the length of the coat.
42.
We go to the back of the knee, which on the measurements is 43.
For me, I'd probably just come a fraction longer, sir.
The cuff on the shirt looks a little short.
If the shirt were a little longer, I'd bring the cuff down.
Just a fraction.
Once again, we can have a look at the fitting stage and determine if need to make any adjustments.
–Twenty five.
–Twenty five. –Right.
At the end of the day, our customers could be wearing a suit all day long.
It needs to obviously look and fit beautifully.
But at the same time, we want it to be practical.
We want that practical elegance.
So, throughout the day, you're wearing a suit for twelve hours
you feel like it's a second skin.
You can move about it in.
You can function in it.
It is comfortable to wear for twelve hours
every business day.
We're probably looking at about four weeks for a fitting
And I'll see you and we'll slip your jacket on.
We'll see you in four weeks.
My colleague, Mr. Malone, will come in and take some trousers now.
Thank you very much, sir.
–John Malone.
–Pleasure to meet you. Matthew.
–Alright.
How are you going to support them?
–Umm.
–With side straps?
–I'd say so, yeah.
–Cut high in the waist?
–Yeah, I'm having a waist coat.
–You're having a waist coat, okay.
–Forty-five.
So a couple of things we'll always do.
Make sure the cloth is flat.
Make sure the edges are together.
Okay.
Shears.
All the cutters and all the tailors have their own shears.
Obviously, our cutting shears are quite large, quite weighty.
We know our own shears.
First line of polish in the cutting room is
I'd be able to pick out my shears blind-folded.
Obviously, tape measure, which we always have.
String is not.
And then the other main...it's very simple really.
We are not overly reliant on technology.
This little symbol here just means it's also a jetted pocket.
You'll find all sorts of customer requests.
One customer used to have a pocket in the back of his jacket and the reason for it was
when he was on a plane he could put his passport in and his ticket.
So it was always easy to get his tickets
and he didn't have to go fumbling.
That's the beauty of what we're doing.
Being bespoke
the customer can ask for these requests
and we will try and sort them out
these little details and these quirks.
And that's the beauty of it.
That's why it's bespoke.
This is what the cutters do at this stage.
This is where the cutter is deciding where to take shape and stuff.
At the next level is where the tailor will also then do what he does, and he'll start
to shape it by manipulating the cloth.
Because what it's all about with the cutters and the tailors
is putting the necessary marks
to shape the suppression and manipulating the cloth
to turn something that's two-dimensional
and flat into a three-dimensional object to place over the individual.
Alright.
What we do, we check the balance.
Armhole pitch, waist, suppression, waistline throughout...
You see the bottom of the coat
and this is our little marking signal for slits at side.
At this end here are the sleeves.
So, we start to parcel it all up.
What will happen is once I've put these together...
So you've got the fundamental
building blocks of the garment.
This is where nothing goes to waste.
So we've got the top collar, what we call the top collar.
I'm obviously marking directions
of the grain of the cloth
just to help and aid the tailor
again.
You've got to think, there's gonna be the flaps.
There's gonna be jettings.
Job ticket.
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Drain Cleaning Brea CA 800-538-4537 Brea Drain Cleaning - Duration: 1:06.
Drain Cleaning Brea CA. Are you sick of having your drains or sewer line clogged and having to pay a plumber every
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20 Tips for Instructors about Making Online Learning Courses Accessible - Duration: 17:50.
[Music]
>>Narrator: Sheryl Burgstahler shares historical highlights
and tips to create accessible online learning activities.
[Music]
>> Sheryl Burgstahler: I'm going to share with you
a little bit about access to online learning,
what instructional designers and faculty members need to know.
Often when I'm talking about this topic,
faculty members will say, "I don't have enough time,"
and then, if it's not that, "I don't have enough funding."
That gets some support.
"And I don't have enough technical support for me."
Well, what I can come back with, politely, of course,
is there are some things that we can all do.
We don't need to do them all at once.
We can do them incrementally but make our courses accessible.
That led to this particular publication called
20 Tips For Teaching An Accessible Online Course.
And so I'm going to go through that a little bit.
It's part of our AccessCyberlearning project,
one of our resources for other projects.
And I'll just step back for a minute, back to 1995.
I actually taught the first online course
here at the University of Washington.
That's kind of a little known fact about me.
It was in 1995 and I'm still shocked to this day
that they hired an 18-year-old girl
to be offering these courses!
[Audience laughs]
But I was quite precocious so I offered the class
with Dr. Norm Coombs at the Rochester Institute of Technology.
He and I had been giving talks on accessible technology
around the country
and the University of Washington had a very extensive
distance learning program, all based on the postal mail system.
And so they mailed out things including videos to students.
And they proctored their exams in proctoring centers around the country
so it was pretty elaborate what we had here.
And I wanted to make sure, my kind of somewhat hidden agenda was
I wanted to make sure these online courses
would be accessible to individuals with disabilities
but I also was kind of curious if you could really deliver a class online
that was anything close to what you could do onsite.
Particularly something like assistive technology,
which usually people touch things and manipulate things.
So I recruited Norm Coombs to teach this class with me,
Adaptive Technology for People With Disabilities.
Now back then, for those of you that are old enough to remember,
people communicated using email and we had discussion lists, email-based,
and we had a Gopher server - Gopher from the University of Minnesota, of course.
It was kind of an online catalogue system, all text-based.
We'd get into a little outline of your resources,
and then it would link to resources around the country.
And we actually received an award for having the most comprehensive Gopher server
for people with disabilities in the world.
And I don't know if we had any competition.
But anyway, that was our course library.
Then we used Telnet,
which allowed us to log onto NASA and other big computing systems.
The students had to actually learn a different language
to correspond with these systems, with each one,
because they developed their own interface.
And then we used File Transfer Protocol to move files around,
to get images, whatever, that we wanted to move around.
So it was pretty basic technology.
All the materials that we had we put in text format.
You kind of had to. It was on Gopher.
So we did that.
We did use postal mail.
We mailed out publications, we mailed out videos.
DO-IT was around.
We had already made some DO-IT videos on VHS tapes
and they were captioned and audio described, believe it or not.
And we mailed those out to the participants in the class.
We kind of got the class pretty much together.
I gave them Norm Coombs' resume
and they approved him as an instructor here at the University of Washington.
And then it sort of came out in the meeting one time
when we were talking about proctoring exams
and I said, "Well, we really can't do proctoring exams
in these different locations because people write those out longhand
and Norm Coombs is blind so he won't be able to read those
if they're not in electronic form and I'll have to grade all those myself
and I'm really not interested in having to do all that work.
Or we have to hire somebody to go over to RIT and read to him."
Now I have to say that the program people were not amused
by the fact that I kind of dropped this idea,
this piece of information about Norm Coombs being blind.
I thought it was a little bit humorous and I really didn't think
it had anything to do with them accepting him as an instructor
even back in those days.
And so they allowed us to go forward with this
and we offered this course to be fully accessible
and the distance learning program kind of the end of the first time we offered
it
she said, "Well tell me, Sheryl, I mean after all this work,
how many people with disabilities even took this course?
So how do you even know if it's successful?"
And I said, "Well I am proud to say we have absolutely no idea
how many people with disabilities took this course.
Because we just designed it to be fully accessible."
No one had to disclose.
So they weren't exactly amused but we continued to teach that class.
But I'm happy to say our first class was fully accessible.
In applying universal design to online learning,
we provide multiple ways to gain knowledge, interact, and demonstrate knowledge.
We have this publication that we've created on
20 tips for teaching an online course that is fully accessible
to people with disabilities.
Nine of the tips are about webpages and documents, images, videos;
and the other 11 are instructional methods.
And when I'm working with faculty who are reluctant to admit
that they might be able to adopt some accessible technology practices,
I ask them to really take the challenge of selecting a few of these
to make their courses accessible.
And it really points out how the faculty need
to work with the technology people
but also the designers in developing their online courses.
And I'm going to go through these fairly quickly.
But just to kind of give you an idea
of what things we tell faculty members and designers
to look for in online learning.
Providing clear and consistent layouts and organizational schemes.
That is something that every instructor should do
to present their material clearly.
Of course those layouts should be apparent to someone who is blind.
So we structure the headings to make sure that someone can access them
using screen readers and see organization of the content
rather than just dumping a bunch of text that would have to be read
from the beginning to the end.
So this faculty member would also use descriptive wording for hyperlinks.
Since someone using a screen reader might want to tab through
and go to each one of the web resources on a page
so they could see where they want to start
or whether they want to go to those resources at all.
And so if you use the wording on each of your underlined text,
"click here,"
that person is going to be able to read all those no problem
but what they will read is
"click here, click here, click here, click here."
In contrast if you provide descriptive wording that's underlined,
that link might say "DO-IT website."
Then, that person would know what they're going to be linking to
and can decide then if that's where they want to be.
A very simple thing.
This doesn't take any more time than putting the "click here" there.
But it makes it accessible to people using screen readers.
PDFs, kind of tricky.
We can make them accessible but you have to ask yourself,
why again was I creating that PDF?
Sometimes you're forced to do it
because it's a PDF that's out on the internet.
But if you're creating a lesson or even your syllabus in your online class,
do you want to include that as a PDF file
or do you want to cut and paste the content right into the
learning management system itself into that window so it is text
and then use the features within Canvas or what other system you're using
to structure the headings so you've made it accessible that way.
That's what I do.
The text descriptions of the content when images are provided.
Whenever there is an image that's presented, you just describe that text.
And some learning management systems actually prompt you to do that.
So you're reminded but even if it doesn't,
you can put that in.
So sometimes people will say,
"Well, but it's just a little logo here.
It doesn't mean anything.
Why do I have to have the text description?"
Well the person who's blind and trying to access your course
doesn't know that that image doesn't include anything really meaningful.
For our DO-IT website, we have on our logo on our website we have "DO-IT logo"
as an alternate text for that image.
Some people say we should describe what it looks like.
Other people would say it doesn't really matter what it looks like
but it's important that a person who is blind knows that it's a logo
that they do or don't need to pay attention to.
Using large bold fonts on uncluttered pages with plain backgrounds.
With the PowerPoints we're using, we're assuming that their vision is such
that it's difficult for them to see the content
and so we just automatically provide large bold fonts
on uncluttered pages with plain backgrounds.
High contrast color combinations.
You usually can figure this out on your own.
Sometimes you go to a website and it's light green on dark green.
It's like what were people thinking about that?
And to avoid the problematic ones for those are colorblind,
so red and green, for instance.
There are resources on the web actually that you can test some of these things
so it's not hard to find.
Content and navigation is accessible using the keyboard alone.
Sometimes there's not a lot you can do about that
if it's the product that you're using is the problem.
But if there are things that you have control over,
then you need to be aware of that.
But it's important to kind of remember that, that issue,
and to continually work like say
in this Canvas work group that we have going nationwide
to give input to Canvas creators and others about the inaccessibility of something.
So it's good to kind of know that.
Make sure that the videos are captioned and audio described.
Captioning first. Audio described is important, too, but as I said
if you're creating your own video, often you can create it in a way
that it's fairly accessible for people who are blind right from the beginning.
That is going to take some technical support probably.
You can read the content on our Accessible IT website
but you might have to have somebody help you do that.
Make sure that your course is designed for a wide range of technical skills.
This is another thing that doesn't take a rocket scientist to figure out how to do this
but so often we're used to using the technology that we're using
and we don't tell students how to use it.
We have to remember that even if you have some tech savvy students in your course,
they might never have used that product.
This might be the first Canvas class that they've taken.
So providing a little overview of the technology you're using
to deliver that class and where they can get help,
just include that in the syllabus or in early instruction in a lesson or two.
Make sure the content is presented in multiple ways
and so if you're using a video in the class,
make sure it's captioned.
A transcript is nice but I also recommend
that you provide sort of a different version of it
because we present content differently when we're writing
than is presented in a video.
So many of our videos have a handout connected with them online.
I guess it's not a handout but it's a publication with that content.
But it's written in a way that you normally would write that content.
And so just because you have a video doesn't mean you shouldn't do that other,
and that can be within your lesson in a class or it can be a separate document.
So that's providing that content in multiple ways.
Acronyms and jargon, we talked about that.
Make sure you spell them out or don't use them. And define them.
Instructions and expectations.
Make sure that they're really clear.
Sometimes putting content in the syllabus
that maybe years ago I would've maybe given later.
I'd think maybe this assignment's only going to take a week
so I'll give it in the middle of the class.
Well maybe it's going to take somebody longer than that
so give them the assignment at the beginning.
They shouldn't be penalized for actually working ahead.
Even if they can't do all parts of it they can at least be thinking about it
in terms of what you're teaching. And make the expectations clear.
Use a rubric or use other techniques
to make sure they know what they're supposed to be able to produce.
Make sure that examples and assignments are relevant to a diverse audience.
And so just sit back and think about it. You don't have to survey your students.
You can just think of a variety of people that might be accessing that class.
It might be an older student. You've got male and female students.
You might know that people from a lot of different disciplines take your course
whatever it happens to be on, so try to have a few examples
of a concept that might appeal to a different audience.
Make sure that outlines and other scaffolding tools are provided
so that's what would apply to online learning.
Be sure to provide adequate opportunities for practice
so in an online class sometimes I would have something required like required reading
and then if I think some people might want to have more instruction
or it might be just a little diversion of what we're talking about,
then I put in all caps the name of that lesson
and in parentheses "optional"
and so that is a cue for someone who wants to do a little bit more,
feels like they need more practice or a little more information.
But I'm not requiring that all the students do that.
People have different levels of knowledge coming into your course
but also different learning styles
and it might take them longer or a shorter period of time
to learn something
but also people require, some require more practice than others.
Provide adequate time for activities and projects and tests.
A lot of this as I said can be solved by just putting it in the syllabus.
Another thing that I've done in teaching online learning
is asked the program managers
if I can open my class a week before it really starts.
And I've always gotten permission for that.
It makes it more difficult for the instructor, I'll say that,
because you've got students who start early and move forward.
Well, I figure that's my problem.
And so I don't want to discourage people from moving forward.
Maybe they're going to be really busy in a couple of weeks.
So they want to get ahead but
I make it real clear what discussion we're on
and when we're discussing certain topics
so they have to kind of stay with the class in that regard.
And I always send out a notice to the whole class
saying "I opened this class a week early so you people can get started.
If you haven't started you're not behind.
We're starting today."
And so I kind of don't let the class get away from me
even if I'm letting some students work ahead.
Providing feedback on parts of an assignment
and corrective opportunities
and so if you're assigning a big project for a class
to at least invite students
to give you a draft of what they're going to do
and you can give feedback on it or part of it say you're open to that
or you can actually build it into the assignments
and say everyone has to turn in an outline or whatever
by such and such a date.
So the students don't have that experience
where they finish the whole project and then you look at it and say,
"Oh they didn't understand what I was asking for."
And for options for communicating and collaborating
and for demonstrating learning so sometimes you can just give students options
and say the test is going to be three different choices.
You can present your knowledge in three different ways.
Or projects - the same thing.
You can give them options for what project they want to do
or another way to do it is to have just multiple things throughout the course
so because sometimes you want everybody to do things in a certain way.
So you want projects and you want to have short answer tests
and you want to have true and false and multiple choice and whatever it is,
or students creating videos or whatever you have in the class.
Just make sure there's a variety so that if someone isn't very good
at one of those things, they can still end up doing well in the class.
So that's just a simple overview of what you can do in an online course
to make it more accessible to students with disabilities.
Not too difficult and not too technical.
And what I challenge faculty members to do then,
particularly the ones that say, "Well, I just don't have time to do this,"
is to look through here and circle a few things,
circle a few numbers of things that they can do like right away.
And no one has trouble finding them, but even if you just did a few of these things
given you aren't doing them already, it would make a better class.
-------------------------------------------
HIGH CALCIUM VEGAN FOODS - Duration: 5:20.
For more infomation >> HIGH CALCIUM VEGAN FOODS - Duration: 5:20. -------------------------------------------
Shock - causes, symptoms, diagnosis, treatment, pathology - Duration: 10:14.
So when we talk about ischemia, we're usually talking about this lack of blood flow to a
specific area of tissue, so maybe like with a heart attack, a coronary artery in the heart
gets blocked that supplies the left ventricle with blood...so that localized area of heart
tissue doesn't get enough blood and oxygen and that damage is localized to that left
ventricle.
Shock is like ischemia...but on a global scale, in other words it's a whole body circulatory
failure, where blood flow to tissues is dangerously low, leading to cellular injury, possibly
damaging multiple organs and even leading to multiple organ failure if not treated immediately.
Ok, so with shock, the body's tissues aren't getting enough oxygen via the blood, right?
Normally, blood perfuses through tissue and delivers oxygen because there's enough pressure
in the circulatory system to push it through; so blood pressure's a major determinant
for the amount of blood perfusing through tissues.
Now blood pressure's determined by two components, the resistance to blood flow in the blood
vessels, things like vessel length, blood viscosity, and vessel diameter, and the cardiac
output which is the volume of blood pumped by the heart through the body per minute.
And you can break that into heart rate, the number of beats per minute, times stroke volume,
the amount pumped out each beat.
Going further, the stroke volume is found by taking the total volume of blood left over
after contraction, the end-systolic volume, and subtracting it from the total volume in
the heart after filling, the end-diastolic volume.
Alright, now keeping those in mind, shock can be caused by whole bunch of different
things, but we can categorize the different types of shock into the three main categories,
along with some subcategories here and there.
The first category is called hypovolemic shock.
Hypo- means "low", -vol- refers to "volume", and -emia refers to the blood, so hypovolemic
shock is shock induced by a low fluid volume of blood, and this could be either non-hemorrhagic
or haemorrhagic.
Non-hemorrhagic means that the loss of fluid volume isn't from bleeding, so this could
be like if you were stranded in a desert and suffered severe dehydration, eventually your
loss of fluid in sweat would reduce blood volume to where it wouldn't be enough to
supply your body's organs and you'd develop hypovolemic shock.
Hemorrhagic hypovolemic shock on the other hand is loss of blood volume through ruptured
blood vessels, in other words, from bleeding.
A loss of about 20% of your total blood volume, roughly one liter, can be enough to induce
hypovolemic shock, and when that liter of blood leaves the circulation, the total volume
filling into the heart goes down, meaning the end-diastolic volume goes down, this means
stroke volume goes down as well, which causes cardiac output to go down, and finally we
see blood pressure goes down.
When cardiac output goes down, catecholamines like epinephrine and norepinephrine, ADH,
and angiotensin II are released, all of which cause vasoconstriction of blood vessels which
increases of vascular resistance, and increased heart rate, which, increases cardiac output,
and these combined effects increase blood pressure.
A super important indicator of tissues not getting enough oxygen due to hypovolemia,
is a decreased mixed venous oxygen saturation, or MVO2.
MVO2 is the amount of oxygen bound to to hemoglobin in blood coming to the right side of the heart,
from the tissues.
So it's like the amount of oxygen left over, or not extracted and used by the tissues.
So if blood volume's down, that means oxygen's down, and there's going to be less left
over, right?
So MVO2 will be down with hypovolemic shock.
Since blood flow provides heat to the tissues as well, when it's down, the skin starts
to feel cool and clammy; and so hypovolemic shock is considered a cold shock.
A second main category of shock is cardiogenic shock, cardio - genic means produced by the
heart, right?
So this is when something happens to the heart such that now it can't pump enough blood
to the body's tissues.
The most common cause is acute myocardial infarction, or heart attack.
Hold on a second, though...didn't I say at the beginning that was more along the lines
of localized ischemia?
Well, the heart attack itself reflects ischemia, right?
But the effects of the initial cardiac damage eventually leads to a state of shock.
When the heart's muscle cells die, it can't contract as hard, which means the amount of
blood pumped out, or stroke volume, goes down, and therefore cardiac output goes down as
well.
In the same way as with hypovolemic shock, the body releases vasoconstrictors to increase
vascular resistance help maintain blood pressure.
Also, as with hypovolemic shock, MVO2 will be down since there's less oxygen being
pumped out, and so less will be left over.
Sometimes there might be an obstruction that doesn't allow the heart to fill properly
with blood.
For example, we might have the pericardial sac fill up with fluid from an infection or
blood from a traumatic accident like getting stabbed in the chest.
If this sac fills up, it physically constricts the heart from expanding and contracting normally
and also reduces the stroke volume.
This is sometimes "sub" classified as obstructive shock, but you can see that the
cause is still due to the heart's inability to do its job, right?
Similarly to hypovolemic shock, a reduction in cardiac output leads to lowered blood flow,
so the skin gets cool and clammy and so cardiogenic shock is also considered a kind of cold shock.
Alright, the third main category of shock is called distributive shock, where there's
typically "leakiness" of blood vessels and an excessive amount of arteriole vasodilation,
or widening of the peripheral blood vessels, which remember is one of the components of
vascular resistance.
If arterioles dilate, vascular resistance to blood flow goes down and blood pressure
goes down, leading to less perfusion and distribution of blood to organs and tissues.
Now the most common type of distributive shock is septic shock, from pathogens in the blood.
What happens with septic shock is endotoxins, these large clunky lipopolysaccharide molecules,
sometimes just called LPSs, found in the outer membrane of gram-negative bacteria causes
a crazy cascade of events.
that ultimately leads to lowered perfusion.
First these guys directly damage endothelial cells and cause them to release vasodilators
like nitric oxide.
They also activate the complement pathway in the blood, which stimulates mast cell release
of histamine, another vasodilator.
The LPS molecules also activate immune cells like macrophages and neutrophils, which help
create a bunch of pro-inflammatory cytokines like tumor necrosis factor and interleukin
1.
These help the immune system destroy the invaders...but also stimulates the endothelial cells to release
more inflammatory molecules like platelet activating factor and reactive oxygen species.
All of these inflammatory chemicals damage the endothelial cells and increases their
vascular permeability, making the blood vessels "leaky".
Also, endothelial cells express a procoagulant called tissue factor, procoagulants are molecules
that increase blood coagulation, or blood clotting; this, in combination with an overall
decrease in anti-coagulants, which usually decrease clotting and seem to often be depleted
or used up during sepsis, leads to this net increase in coagulation and clotting in the
microvasculature, and of course clotting and blockages in the blood vessels further decreases
perfusion, right?
Okay so this widespread vasodilation means very little vascular resistance, and blood
can't get the chance to unload as much oxygen as it cruises through the vasculature, and
it gets back to the right side of the heart with leftover oxygen, so in this case, as
opposed to cardiogenic and hypovolemic shock, MVO2 can be normal or even increased.
In contrast to hypovolemic and cardiogenic shock—now there's an increase in flow
in the peripheral blood vessels, and the skin becomes warm and flushed, so distributive
shock is a kind of warm shock.
The overall combined effects of widespread vasodilation, increased vascular permeability,
and microvascular blood clotting, all contribute to decreased perfusion of blood to vital organs.
Now two kind of sub-types of distributive shock are anaphylactic shock, which is an
allergic reaction causing dangerously low blood pressure, and neurogenic shock, where
the nervous system gets damaged and can't control the body's blood pressure.
The treatment of shock depends on the cause.
In general, the goal is to stabilize blood pressure so that vital organs like the heart
and the brain are perfused with blood.
In order to stabilize blood pressure, fluid replacement and medications that increase
heart contractility, cause vasoconstriction, and retain fluid can be administered.
Oftentimes a person might need supplemental oxygen or have their airway protected, for
example with intubation.
Alright, as a quick recap.
Shock is ultimately a failure in tissue perfusion, and it affects the whole body, putting tissues
and organs at risk for injury and ultimately organ failure.
Hypovolemic shock happens when dehydration or hemorrhage reduce the volume of blood in
the blood vessels.
Cardiogenic shock happens when a direct injury like a heart attack or an obstruction like
a pericardial effusion prevents the heart from pumping blood efficiently.
Distributive shock happens when something like an allergic reaction or damage to the
nervous system - called neurogenic shock causes the blood vessels to vasodilate and become
leaky which reduces the resistance and lowers the blood pressure.
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When our goodbye's sign
Can be heard across the dark sky
Someday, from a very far away place
I'll think of you as you go away
From your left side I looked at your face
While you were turning to me
Were you smiling?
Or were you crying?
Your long hair wouldn't let me see it
When our goodbye's sign
Can be heard across the dark sky
He will beam a bright light
That will reunite our paths again one day
So I can see you again
-------------------------------------------
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