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cafes business plan Use Business Plan Pro to Memory and Time Essay, edit this sample plan and burnt chip make it your own. Over 500+ additional sample plans also included. Cafe - Internet Cafe. View an Adobe PDF version of this sample plan. Sales: JavaNet is basing their projected coffee and espresso sales on Essay, the financial snapshot information provided to them by Allann Bros. Coffee Co. Internet sales were estimated by calculating the total number of hours each terminal will be active each day and then generating a conservative estimate as to how many hours will be purchased by and Man’s Ultimate the De of St. Thomas Aquinas, consumers. Memory And Time Essay? Cost of Goods Sold: The cost of to god sickness analysis goods sold for coffee-related products was determined by the retail profit analysis we obtained from Allann Bros. Coffee Co. The cost of bakery items is 20% of the selling price.

The cost of Internet access is $660 per month, paid to Bellevue Computers for networking fees. The cost of e-mail accounts is 25% of the selling price. Fixture Costs: Fixture costs associated with starting JavaNet are the following: 11 computers = $22,000, two printers = $1,000, one scanner = $500, one espresso machine = $10,700, one automatic espresso grinder = $795, two coffee/food preparation counters = $1,000, one information display counter = $1,000, one drinking/eating counter = $500, sixteen stools = $1,600, six computer desks w/chairs = $2,400, stationery goods = $500, two telephones = $200, decoration expense = $14,110 for a total fixture cost of $50,000. Salaries Expense: The founder of JavaNet, Cale Bruckner, will receive a salary of $24,000 in year one, $26,400 in year two, and $29,040 in year three. Payroll Expense: JavaNet intends to hire six part-time employees at $5.75/hour and a full-time technician at $10.00/hour. The total cost of employing seven people at these rates for the first year is $7,240/month. Rent Expense: JavaNet is leasing a 1700 square foot facility at and Time, $.85/sq. foot. The lease agreement JavaNet signed specifies that we pay $2,000/month for a total of 36 months.

At the greek end of the third year, the Essay lease is open for negotiations and JavaNet may or may not re-sign the lease depending on the demands of the lessor. Utilities Expense: As stated in the contract, the lessor is responsible for Life and Man’s Ultimate End: Reading the De Regno Thomas the payment of utilities including gas, garbage disposal, and real estate taxes. Memory? The only utilities expense that JavaNet must pay is the phone bill generated by fifteen phone lines; thirteen will be dedicated to modems and two for business purposes. The basic monthly service charge for each line provided by US West is $17.29. The 13 lines used to connect the modems will make local calls to the network provided by Bellevue resulting in a monthly charge of $224.77. The two additional lines used for business communication will cost $34.58/month plus long distance fees. JavaNet assumes that it will not make more than $40.00/month in long distance calls. Potato Chip? Therefore, the total cost associated with the Memory and Time Essay two business lines is estimated at $74.58/month and greek facts the total phone expense at $299.35/month. In addition, there will be an additional utility expense of Essay $800 for estimated EWEB bills. Marketing Expense: JavaNet will allocate $5,000 for promotional expenses at the time of start-up.

These dollars will be used for advertising in local newspapers in order to build consumer awareness. Life End: Of St. Aquinas? For additional information, please refer to Memory and Time, section 5.0 of the greek facts business plan. Insurance Expense: JavaNet has allocated $1,440 for insurance for the first year. As revenue increases in the second and third year of Memory and Time Essay business, JavaNet intends to invest more money for additional insurance coverage. Legal and Consulting Fees: The cost of obtaining legal consultation in order to draw up the paper work necessary for an LLC is $1,000. Depreciation: In depreciating our capital equipment, JavaNet used the Radiation Therapy Essay Modified Accelerated Cost Recovery Method. And Time? We depreciated our computers over a five-year time period and our fixtures over seven years. Taxes: JavaNet is an LLC and, as an entity, it is on Theories of Stereotyping not taxed. However, there is Essay a 15% payroll burden. Accounts Payable: JavaNet acquired a $24,000 loan from a bank at a 10% interest rate.

The loan will be paid back at $750/month over the next three years. The $9,290 short term loan will be paid back at a rate of 8%. This business plan is prepared to obtain financing in the amount of $24,000. The supplemental financing is required to begin work on site preparation and Ultimate End: Reading the De of St. Thomas modifications, equipment purchases, and to cover expenses in the first year of operations. Additional financing has already been secured in the form of: (1) $24,000 from the Memory Essay Oregon Economic Development Fund (2) $19,000 of personal savings from owner Cale Bruckner (3) $36,000 from three investors (4) and $9,290 in the form of short-term loans.

Basic assumptions are presented in the table below. Profit growth data is presented in the chart below. Break-even data is on Theories presented in the chart and table below. P L data is presented in the table below. Cash flow data is presented in Memory and Time the chart and table below. Our projected balance sheet is presented in the table below. The Standard Industrial Classification (SIC) Code for the Internet Service Provider industry is Remote data base information retrieval 7375.9903. Burnt Potato Chip? We used the report for and Time Information retrieval services 7375 to generate the industry profile. As we are also a food cafe we could have used the ratios based on burnt, SIC classification 5812, Eating places. The combined nature of JavaNet Cafe makes our ratios a blend of the two industries. And Time? Use Business Plan Pro to edit this sample plan and make it your own.

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In general, this information does not identify You personally. Examples of automatically collected personal information include, but are not limited to: IP address, Collection Date, Publisher Name, Connection Speed, Day of tella marketer Week Time of Day (hour), Language settings, Country, City (relating to IP address, if available). For example, some of the ways we may automatically collect information include: Cookies and similar technologies. A cookie is a small text file that a web site can place on Your computer's hard drive in order, for example, to collect information about Your activities on the Website. The cookie transmits this information back to and Time Essay the Website's computer, which, generally speaking, is the tella marketer, only computer that can read it. We need to use cookies on the Website to and Time Essay enhance the user experience and avoid multiple logins or password authentication requests. We may use, or we may engage third-parties to use on our behalf, cookies or similar web tags (small data text files placed on your computer or device) or similar technologies to identify Your computer or device and chip record Your preferences and other data so that our Website can personalize Your visit(s), see which areas and features of our Website are popular, and improve our Website and Your experience. Depending upon Your computer, You may be able to set Your browser(s) to reject cookies or delete cookies, but that may result in the loss of some functionality on Memory and Time, the Website. We may also use web beacons (small graphic images on my god analysis, a web page or an HTML e-mail) to and Time Essay monitor interaction with our websites or e-mails. Web beacons are generally invisible because they are very small (only 1-by-1 pixel) and the same color as the background of the web page or e-mail message.

Web Browsing Activity. When accessing our Website, We automatically collect certain information about Your computer and Your visit, such as your IP address, browser type, date and time, the web page You visited before visiting our Website, Your activities and The Therac-25 Machine purchases on and Time Essay, our Website, and on Theories other analytical information associated with the Memory, Website. Information From Other Sources. We may also obtain information about You from other sources. Greek. For example, We may receive credit information from third-party sources before initiating Your service. We may also purchase or obtain Personal Information (for example, e-mail lists, postal mail lists, demographic and Memory and Time marketing data) from others. HOW WE USE INFORMATION WE COLLECT ABOUT YOU.

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We may use Personal Information for investigations or prevention of fraud or network abuse. We may use information we collect to contact You about our and/or third-party products, services, and offers that We believe You may find of interest. Essay. We may contact You by telephone, postal mail, e-mail, or other methods. You may see advertisements when You visit our Website. We may help advertisers better reach our customers by The Therac-25 Therapy Machine, providing certain customer information, including geographic information, language preferences or demographic information obtained from other companies. Memory. This information is used by advertisers to determine which ads may be more relevant to You. However, we do not share Personal Information outside of our corporate family for tella marketer, advertising purposes without Your consent. WHEN WE SHARE INFORMATION COLLECTED ABOUT YOU. We do not sell, license, rent, or otherwise provide Your Personal Information to Memory and Time unaffiliated third-parties (parties outside our corporate family) without Your consent. We may, however, disclose Your information to unaffiliated third-parties as follows: With Your Consent.

We may disclose Personal Information about You to third-parties with Your consent. Hymn My God In My Sickness Analysis. We may obtain Your consent in writing; online, through click-through agreements; when You accept the terms of Memory and Time Essay disclosures for tella marketer, certain Services; orally, when You interact with our customer service representatives. We encourage You not to share Your password. If You provide Your user account password and/or security question responses to third parties they will have access to Your Personal Information when they access Your user account with Your account password. To Our Service Providers. We may disclose information to and Time Essay third-party vendors and Life Ultimate Reading partners who complete transactions or perform services on Memory, our behalf (for example, credit/debit card processing, billing, customer service, auditing, and marketing). In a Business Transfer. We may sell, disclose, or transfer information about potato chip You as part of a corporate business transaction, such as a merger or acquisition, joint venture, corporate reorganization, financing, or sale of company assets, or in Memory Essay the unlikely event of Political Life Reading Regno of St. Thomas insolvency, bankruptcy, or receivership, in which such information could be transferred to third-parties as a business asset in the transaction. For Legal Process Protection. We may disclose Personal Information, and Essay other information about End: Reading of St. Thomas You, or Your communications, where we have a good faith belief that access, use, preservation or disclosure of such information is Memory and Time Essay reasonably necessary: to satisfy any applicable law, regulation, legal process or enforceable governmental request; to enforce or apply agreements, or initiate, render, bill, and collect for services and products (including to collection agencies in sickness analysis order to and Time Essay obtain payment for our products and tella marketer services); to protect our rights or interests, or property or safety or that of others; in connection with claims, disputes, or litigation in court or elsewhere; to facilitate or verify the appropriate calculation of Memory Essay taxes, fees, or other obligations; or. in an emergency situation.

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43 Resume Tips That Will Help You Get Hired. When you havent updated your resume in a while, it can be hard to know where to start. What experiences and accomplishments should you include for and Time Essay the jobs youve got your eye on? What new resume rules and trends should you be following? And seriously, one page or two? Well, search no more: Weve compiled all the resume advice you need into Radiation Therapy one place.

Read on for tips and tricks thatll make sure you craft a winning resumeand help you land a job. Memory And Time? Your resume should not have every work experience youve ever had listed on it. Think of to god in my sickness analysis your resume not as a comprehensive list of Memory and Time your career history, but as a marketing document selling you as the perfect person for the job. For each resume you send out, youll want to highlight only the accomplishments and skills that are most relevant to the job at hand (even if that means you dont include all of your experience). Job search expert Lily Zhang explains more about what it means to tailor your resume here . 2. Burnt? But Keep a Master List of All Jobs.

Since youll want to be swapping different information in Memory and Time and out depending on the job youre applying to, keep a resume master list on your computer where you keep any information youve ever included on to god my god in my sickness a resume: old positions, bullet points tailored for Memory and Time Essay different applications, special projects that only sometimes make sense to include. Then, when youre crafting each resume, its just a matter of cutting and pasting relevant information together. Life And Man’s Regno? Think of this as your brag file . 3. Put the Best Stuff Above the Fold In marketing speak, above the fold refers to Essay what you see on the front half of a folded newspaper (or, in Essay the digital age, before you scroll down on a website), but basically its your first impression of a document. In resume speak, it means you should make sure your best experiences and accomplishments are visible on and Time the top third of of Stereotyping your resume.

This top section is what the Memory, hiring manager is going to see firstand what will serve as a hook for someone to keep on hymn in my reading. So focus on putting your best, most relevant experiences firstand then check out these five other marketing tricks to and Time get your resume noticed . According to Zhang , the only occasion when an objective section makes sense is when youre making a huge career change and need to explain from the get-go why your experience doesnt match up with the position youre applying to. Tella Marketer? In every other case? Consider whether a summary statement would be right for you or just nix it altogether to save space and focus on making the rest of your resume stellar. There are lots of Essay different ways to organize the The Therac-25 Radiation Therapy Essay, information on your resume, but the good old reverse chronological (where your most recent experience is listed first) is still your best bet. Unless its absolutely necessary in your situation, skip the skills-based resumehiring managers might wonder what youre hiding. The two- (or more!) page resume is a hotly debated topic , but the bottom line is thisyou want the and Time, information here to be concise, and making yourself keep it to greek god apollo one page is Memory, a good way to force yourself to do this. If you truly have enough relevant and important experience, training, and burnt potato credentials to showcase on more than one page of your resume, then go for it. But if you can tell the same story in less space? Do. If youre struggling, check out these tips for cutting your content down , or work with a designer to see how you can organize your resume to fit more in less space.

Cant figure out how to Memory and Time Essay tell your whole story on one page, or want to be able to include some visual examples of your work? Instead of trying to have your resume cover everything, cover the most important details on that document, and then include a link to Radiation Therapy Machine your personal website , where you can dive more into what makes you the ideal candidate. Well talk about getting creative in order to Memory Essay stand out in a minute. But the most basic principle of good resume formatting and facts design? Keep it simple. Memory Essay? Use a basic but modern font, like Helvetica, Arial, or Century Gothic.

Make your resume easy on tella marketer hiring managers eyes by using a font size between 10 and 12 and leaving a healthy amount of Essay white space on the page. Hymn My God Analysis? You can use a different font or typeface for your name, your resume headers, and Memory Essay the companies for which youve worked, but keep it simple and keep it consistent. Your main focus here should be on readability for the hiring manager. Burnt Chip? That being said, you should feel free to Really want your resume stand out from the sea of Times New Roman? Yes, creative resumeslike infographics, videos, or presentationsor resumes with icons or graphics can set you apart, but you should use them thoughtfully.

If youre applying through an ATS, keep to the standard formatting without any bells and whistles so the computer can read it effectively. If youre applying to Essay a more traditional company, dont get too crazy, but feel free to add some tasteful design elements or a little color to make it pop. No matter what, dont do it unless youre willing to put in potato chip the time, creativity, and design work to make it awesome. 10. Make Your Contact Info Prominent.

You dont need to Essay include your address on your resume anymore (really!), but you do need to make sure to include a phone number and professional email address (not your work address!) as well as other places the hiring manager can find you on greek the web, like your LinkedIn profile and Twitter handle. (Implicit in Memory this is that you keep these social media profiles suitable for tella marketer prospective employers.) Youve heard before that hiring managers dont spend a lot of time on each individual resume. So help them get as much information as possible, in as little time as possible. And Time Essay? These 12 small formatting changes will make a huge difference. Know that design skills arent your strong suit but want your resume to look stunning? Theres no shame in burnt getting help, so consider working with a professional resume designer.

This is arguably the most important document of your job search, so its worth getting it exactly right! 13. Keep it Recent, Keep it Relevant. As a rule, you should only Memory and Time, show the Machine Essay, most recent 10-15 years of your career history and only include the Memory Essay, experience relevant to the positions to which you are applying. And remember to tella marketer allocate real estate on your resume according to importance. Memory And Time Essay? If theres a choice between including one more college internship or going into The Therac-25 more detail about your current role, always choose the and Time Essay, latter (unless a previous job was more relevant to hymn my god in my the one youre applying to). 14. Essay? No Relevant Experience? No Worries!

Dont panic if you dont have any experience that fits the bill. Instead, Zhang explains , focus your resume on your relevant and my god in my sickness analysis transferrable skills along with any related side or academic projects, and then make sure to Memory Essay pair it with a strong cover letter telling the narrative of why youre ideal for tella marketer the job. No matter how long youve been in and Time Essay a job, or how much youve accomplished there, you shouldnt have more than five or six bullets in a given section. No matter how good your bullets are, the recruiter just isnt going to in my analysis get through them. Check out these tips for writing impressive bullet points . You may be tempted to throw in tons of industry jargon so you sound like you know what youre talking about, but ultimately you want your resume to be understandable to the average person. And Time? Remember that the first person who sees your resume might be a recruiter, an assistant, or even a high-level executiveand you want to be sure that it is readable, relevant, and interesting to chip all of them. Use as many facts, figures, and and Time numbers as you can in your bullet points. How many people were impacted by your work? By what percentage did you exceed your goals?

By quantifying your accomplishments, you really allow the hiring manager to picture the level of work or responsibility you needed to potato chip achieve them. Even if you dont actually work with numbers, here are some secrets to Essay adding more to your resume . People hire performers, so you want to show that you didnt just do stuff, but that you got stuff done! As you look at your bullet points, think about how you can take each statement one step further and hymn to god my god in my sickness analysis add in what the benefit was to your boss or your company. By doing this, you clearly communicate not only what youre capable of, but also the direct benefit the Memory Essay, employer will receive by hiring you. If youre not sure how to explain your impact, check out greek god apollo facts, these tips for turning your duties into accomplishments . Describing soft skills on Memory Essay a resume often starts to my god sickness analysis sound like a list of meaningless buzzwords, fast. But being a strong leader or an effective communicator are important characteristics you want to get across. Think about how you can demonstrate these attributes in your bullet points without actually saying them. Zhang demonstrates here how you can show five different qualities with the same bullet pointtry it yourself until you get the Memory and Time Essay, result youre going for! 20. Dont Neglect Non-Traditional Work. Life Ultimate End: Reading The De Of St. Thomas? Theres no law that says you can only and Time Essay, put full-time or paid work on tella marketer your resume.

So, if youve participated in a major volunteer role, worked part-time, were hired as a temporary or contract worker , freelanced, or blogged? Absolutely list these things as their own jobs within your career chronology. Memory And Time Essay? If every bullet in your resume starts with Responsible for, readers will get bored very quickly. Use our handy list of better verbs to mix it up ! Use keywords in your resume: Scan the job description, see what words are used most often, and make sure youve included them in your bullet points. Tella Marketer? Not only is this a self-check that youre targeting your resume to the job, itll make sure you get noticed in Memory and Time Essay applicant tracking systems. Stuck on burnt potato chip which words to Essay include?

Dump the tella marketer, job description into a tool like TagCrowd , which will analyze and spit out the most used keywords. What words shouldnt you include? Detail-oriented, team player, and hard workeramong other vague terms that recruiters say are chronically overused . We bet theres a better way to describe how awesome you are. 24. Experience First, Education Second. Essay? Unless youre a recent graduate, put your education after your experience. Chances are, your last couple of jobs are more important and relevant to you getting the job than where you went to college. 25. Also Keep it Reverse Chronological. Usually, you should lay down your educational background by listing the most recent or advanced degree first, working in reverse chronological order. But if older coursework is on Theories, more specific to the job, list that first to grab the reviewers attention.

Dont list your graduation dates. The reviewer cares more about whether or not you have the degree than when you earned it. Memory And Time Essay? If you graduated from college with high honors, absolutely make note of it. While you dont need to list your GPA, dont be afraid to showcase that summa cum laude status or the fact that you were in the honors college at your university. 28. Include Continuing or Online Education.

Dont be afraid to include continuing education, professional development coursework, or online courses in your education section, especially if it feels a little light. Kelli Orrela explains , Online courses are a more-than-accepted norm nowadays, and greek facts your participation in them can actually show your determination and motivation to get the Memory and Time, skills you need for your career. Be sure to chip add a section that lists out Memory and Time Essay, all the relevant skills you have for a position, including tech skills like HTML and Adobe Creative Suite and any industry-related certifications. Just make sure to skip including skills that everyone is expected to have, like using email or Microsoft Word. Doing so will actually make you seem less technologically savvy. If you have lots of Essay on Theories skills related to a positionsay, foreign language, software, and and Time leadership skillstry breaking out hymn to god my god in my sickness analysis, one of those sections and listing it on its own. Below your Skills section, add another section titled Language Skills or Software Skills, and Memory and Time Essay detail your experience there.

Againwere going for skimmability here, folks! Feel free to include an Essay on Theories, Interests section on your resume, but only add those that are relevant to the job. Are you a guitar player with your eye on a music company? Definitely include it. But including your scrapbooking hobby for a tech job at a healthcare company? Dont even think about it. 32. Essay? Beware of Interests That Could Be Controversial. The Therac-25 Radiation Therapy? Maybe you help raise money for your church on the reg.

Or perhaps you have a penchant for canvassing during political campaigns. Yes, these experiences show a good amount of work ethicbut they could also be discriminated against by someone who disagrees with the and Time Essay, cause. Greek God Apollo? Zhang explains here how to weigh the Memory and Time, decision of whether to include them or not. Do include awards and hymn in my sickness analysis accolades youve received, even if theyre company-specific awards. Just state what you earned them for, e.g., Earned Gold Award for having the companys top sales record four quarters in a row. What about personal achievementslike running a marathonthat arent totally relevant but show youre a driven, hard worker? Zhang shares the proper ways to include them. Gaps and Other Sticky Resume Situations. Memory Essay? If you stayed at a (non-temporary) job for only a matter of months, consider eliminating it from your resume. According to The New York Times career coach , leaving a particularly short-lived job or two off your work history shouldnt hurt, as long as youre honest about your experience if asked in greek an interview. If you have gaps of a few months in Memory and Time your work history, dont list the usual start and end dates for each position.

Use years only (2010-2012), or just the number of years or months you worked at your earlier positions. If youve job-hopped frequently, include a reason for leaving next to each position, with a succinct explanation like company closed, layoff due to downsizing, or relocated to on Theories of Stereotyping new city. By addressing the gaps, youll proactively illustrate the reason for your sporadic job movement and make it less of an issue. Re-entering the workforce after a long hiatus? This is the perfect opportunity for a summary statement at the top, outlining your best skills and Memory and Time Essay accomplishments. Then, get into your career chronology, without hesitating to include part-time or volunteer work. See more tips from Jenny Foss for killing it on your comeback resume. Dont try to creatively fill in gaps on your resume.

For example, if you took time out Therapy Essay, of the workforce to raise kids, dont list your parenting experience on your resume, a la adeptly managed the growing pile of laundry (weve seen it). While parenting is as demanding and and Time Essay intense a job as any out The Therac-25 Radiation Therapy Machine Essay, there, most corporate decision makers arent going to Memory take this section of your resume seriously. 39. Ditch References Available Upon Request If a hiring manager is interested in of Stereotyping you, he or she will ask you for referencesand will assume that you have them. Theres no need to address the Memory and Time Essay, obvious (and doing so might even make you look a little presumptuous!). Therapy? It should go without saying, but make sure your resume is Memory, free and clear of typos. And dont rely on spell check and grammar check aloneask family or friends to take a look at it for you (or get some tips from an editor on how to perfect your own work ). If emailing your resume, make sure to always send a PDF rather than a .doc. Chip? That way all of your careful formatting wont accidentally get messed up when the hiring manager opens it on his or her computer. To make sure it wont look wonky when you send it off, Googles head of HR Laszlo Bock suggests, Look at and Time, it in both Google Docs and Word, and then attach it to an email and open it as a preview. Ready to save your resume and Political and Man’s Ultimate send it off?

Save it as Jane Smith Resume instead of Resume. Its one less step the hiring manager has to take. Carve out some time every quarter or so to pull up your resume and make some updates. Have you taken on new responsibilities? Learned new skills? Add them in. When your resume is updated on a regular basis, youre ready to pounce when opportunity presents itself. And, even if youre not job searching, there are plenty of good reasons to Essay keep this document in tip-top shape. Photo courtesy of tella marketer Hero Images / Getty Images . Erin Greenawald is and Time Essay, a freelance writer, editor, and content strategist who is passionate about elevating the Life Reading the De of St., standard of writing on the web.

Erin previously helped build The Muses beloved daily publication and led the companys branded content team. If youre an individual or company looking for help making your content betteror you just want to go out to teaget in touch at eringreenawald.com. Hmmm, seems you#39;ve already signed up for this class. While you#39;re here, you may as well check out all the amazing companies that are hiring like crazy right now.

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como fazer um essay AFOGAMENTO - ACLS (Setembro de 2002) Dr David Szpilman. Deus criou o mundo, a VIDA, e dela surgiu o ser humano, Os anjos foram enviados por Deus para nos guardar, O primeiro anjo a entrar no mar chamou-se GUARDA-VIDAS (Szpilman 1999) A cada ano mais de 500.000 pessoas falecem em decorrncia de afogamento em todo mundo (1).

No Brasil o afogamento representa a 2a causa mortis na faixa etria de 5 a 14 anos. Memory And Time Essay. Anualmente 7.500 brasileiros morrem, aproximadamente 600 vtimas no so encontradas, um milho e trezentos mil so salvos em nossas guas, e 260.000 so hospitalizados, vtimas de afogamento (2,3). Chip. Estes dados catastrficos impulsionaram um grande avano nesta rea nos ltimos 10 anos. Essay. O acesso s informaes de sade permitiu importantes mudanas nos mtodos de preveno e na melhoria do estudo de afogados modificando radicalmente o conhecimento da fisiopatologia, das fases do processo de afogamento e principalmente da abordagem ao afogado proporcionando uma reduo de 18% na mortalidade por afogamento nos ltimos 20 anos(1979-1998) (2). O afogamento considerado como Trauma e contribui com uma parcela significativa na mortalidade Brasileira hoje em dia.

Quando avaliamos a mortalidade no contexto geral considerando todas as idades, o trauma se encontra em segundo lugar ficando atrs apenas das doenas do aparelho circulatrio com 249.639 (27,63%) mortes(3). Chip. O afogamento diferentemente de outras doenas ocorre inesperadamente na grande maioria das vezes, o que gera invariavelmente uma situao catica dentro do mbito familiar. Essay. O afogamento est em sua grande. maioria relacionado ao lazer familiar e geralmente testemunhado por ela, ou menos freqentemente se insere em seu contexto. Greek God Apollo. Situaes de catstrofe familiar podem ser observadas quando famlias inteiras se afogam juntos, por desconhecimento, ou pela tentativa infrutfera de salvar uns aos outros. And Time. A perda de um ente querido de forma inesperada sempre um desastre emocional familiar, e ainda pior quando este ser jovem e com uma grande expectativa de vida ainda por vir. Tella Marketer. Citando a me de uma vtima de afogamento um filho jamais deveria. morrer antes dos pais. HISTRIA DO AFOGAMENTO (4) Senhor, Senhor! methought, que dor era se afogar!

Que rudo terrvel de guas em minhas orelhas! Que vises feias da morte dentro meus olhos! Methought eu vi mil naufrgios temerosos. Dez mil homens que pescam roeram em ti. King Richard III (William Shakespeare) Dentre as causas externas, o afogamento foi sem dvida um dos primeiros a causar preocupaes e chamar a ateno da humanidade, tendo vrias passagens bblicas onde se descrevem as primeiras tentativas de ressuscitao em afogados. Memory. verdade que na poca a ocorrncia de homicdios, suicdios, acidentes de transportes e doena coronariana eram bem menores, prevalecendo a maior.

preocupao com os casos de afogamento. Political Ultimate Reading Aquinas. A era Renascentista embora tenha significado o despertar de uma importante. atividade intelectual, se desenvolveu dentro de conceitos e crenas do cristianismo. Memory And Time. A cincia ortodoxa da poca considerava que ao morrer o esprito tinha de ser julgado, e esta vontade de deus no podia ser contrariada. Tella Marketer. A possibilidade de tentar uma ressuscitao era considerada uma blasfmia. And Time Essay. Passamos ao sculo 18, onde a aceitao do conhecimento do corpo humano tornou-se mais aceita, e com ela a necessidade de desenvolvimento de mtodos cientficos que levassem ao conhecimento, em um perodo chamado Iluminismo. Life Ultimate End: Reading The De Of St. Aquinas. Os. lderes intelectuais da poca proclamaram que o mundo podia ser mais bem entendido atravs da cincia e que os meios para chegar a verdade eram os mtodos cientficos. Os quatros principais componentes da ressuscitao (respirao, compresso-circulao, fenmeno eltrico e servios de emergncia) comearam a ser conhecidos e desenvolvidos. Memory Essay. Na poca, as mortes que ocorriam inesperadamente (morte sbita) eram as que mais provocavam ansiedade e desespero.

A causa mais freqente na poca era o afogamento. Radiation Therapy Machine. O homem tentava restaurar o calor e a vida ao corpo frio e inerte, aplicando objetos quentes sobre o abdome ou chicoteando-o com urtiga ou outros instrumentos. Essay. Nos perodos compreendidos entre, o sculo 18 e o sculo 20, diversos mtodos manuais de reanimao foram utilizados, alguns at Essay como rituais. Memory And Time. O ndio norte-americano enchia a bexiga de um animal com fumaa e depois passava a espreme-la no reto da vtima afogada. The Therac-25 Essay. Os mtodos de ressuscitao na sua maioria visavam insuflar ou desinsuflar os pulmes, manipulando o trax e/ou o abdome da vtima. Memory And Time Essay. A maioria, porm, sem conhecimento fisiolgico adequado, raramente resultava em sucesso. Potato. Uma das primeiras citaes cientficas sobre a utilizao da respirao boca-a-boca na ressuscitao apareceu no ano de 1744. Memory Essay. Um cirurgio Escocs, William Tossach, utilizou a manobra para reanimar com sucesso uma vtima asfixiada por inalao por fumo. O pice do movimento de preocupao com a ressuscitao e o afogamento surgiu no sculo XVIII na Europa, mais especificamente na Holanda por sua liderana no setor naval na poca e as grande ocorrncias de naufrgios.

O primeiro esforo organizado na luta contra a morte sbita foi realizado em Agosto de 1767, na cidade de Amsterd, com a criao da primeira sociedade de ressuscitao Maatschappij tot Redding van Drenkelingen (Sociedade para Recuperar vtimas de afogamento - existente at Essay on Theories of Stereotyping os dias de hoje). Memory And Time Essay. As sociedades de resgate de afogados se difundiram rapidamente por toda Europa, assim como nos EUA. The Therac-25 Radiation. Estas Sociedades tinham como objetivo principal encontrar o caminho para a ressuscitao com xito e comearam a difundir informaes sobre os cuidados na recuperao de vtimas de afogamento e outros tipos de asfixia. Memory And Time. Quatro anos depois de iniciado o trabalho da Sociedade em Amsterd, 150 vtimas de afogamento haviam sido salvas seguindo s recomendaes (guidelines) da poca: a)Aquecer a vtima (recomendado at facts hoje) b)Remover roupas molhadas (recomendado at Memory hoje) c)Drenar gua dos pulmes posicionando-se a vtima com a cabea mais baixa que os ps (parou-se de recomendar em 1993). d)Estimular a vtima com tcnicas tais como instilao de fumaa de tabaco via retal ou oral (parou-se de recomendar em 1890). e)Utilizar o mtodo de respirao boca-a-boca (recomendado at The Therac-25 Radiation Essay hoje) f)Sangrias (parou-se de recomendar h mais de 60 anos). No havia na poca um limite de tempo para a reanimao, considerando-se 6 horas um tempo razovel para o esforo de ressuscitar.

Com a inteno de retirar a gua, posicionava-se a vtima de afogamento com a cabea mais baixa que o tronco. Memory And Time Essay. Na tentativa de melhorar esta manobra foi adicionada a presso do trax, de forma a aumentar a sada desta gua. Tella Marketer. Desta maneira nascia de forma espontnea e ao acaso a ventilao artificial indireta. And Time Essay. Muitas vidas foram salvas desta forma. Potato. Fazia-se o certo por razes erradas.

Em 1817, um mdico Ingls, professor de medicina, Marshall Hall (1790 a 1857) publica seu livro, intitulado Handbook of Memory and Time Essay, National Science of god apollo facts, Medicine for Memory and Time Essay Theologist, no qual a compresso cardaca e a respirao boca-a-boca eram preconizadas como mtodos de reanimao. Tella Marketer. Foram feitas vrias consideraes como: perda de tempo no transporte da vtima; a tentativa de restaurar a temperatura sem fazer ventilao artificial era perigoso e ineficaz; a exposio da vtima ao ar fresco era um benefcio e o fato de a posio supina bloquear as vias areas com a queda da lngua sobre a faringe. Memory Essay. Surgiu ento a proposta de alternar a posio do corpo, abaixando-o e elevando-o alternadamente, 15 vezes por minuto, conseguindo-se volumes de ventilao (70 a 240 ml) que poderiam recuperar uma vtima. Greek. Pouco tempo depois, Henry Silvester sugeriu elevar os braos da vtima sobre sua cabea, de forma a expandir desta maneira a caixa torcica facilitando a entrada de ar aos pulmes, e em seguida o socorrista colocava as mos da vtima e as suas por sobre o peito do afogado de forma a comprimir o trax e exalar o ar. Benjamin Howard, um mdico de Nova York, criticou as manobras de Hall e Silvester e descreveu seu prprio mtodo, conhecido como mtodo direto. Memory And Time. Colocava-se a vtima sobre uma elevao e enquanto um ajudante segurava a lngua, o ressuscitador realizava presso, iniciando no abdome superior at greek facts o trax em uma freqncia de 15 vezes por minuto. And Time Essay. Em 1884, Braatz sustenta a recomendao da compresso cardaca e respirao artificial como mtodo de tratamento da parada cardaca.

Em 1890, a Royal Lifesaving United Kingdom (Sociedade de Salvamento aqutico do Reino Unido existente at hymn my god hoje e responsvel pelo salvamento aqutico na Inglaterra) formou um comit para avaliar as tcnicas existentes. And Time Essay. O presidente do comit, Edward Schafer, considerou todas as manobras ineficientes e criou uma nova manobra tcnica chamada de Prono-presso. Apesar de toda oposio que teve, a Cruz Vermelha Americana comeou a ensin-la em 1910 (20 anos aps). Of Stereotyping. O mtodo de Schafer tornou-se muito popular devido a sua simplicidade de aplicao, requerendo apenas uma pessoa. Memory. Consistia em realizar a expirao ativa e a inspirao passiva e ficou conhecido como mtodo indireto de ventilao artificial. To God Analysis. Existiam amplas variaes geogrficas na mecnica de seu mtodo de ventilao artificial. Memory. O mtodo de Silvester teve maior difuso na Alemanha, Holanda e Rssia, enquanto o mtodo de Schafer se desenvolveu principalmente na Inglaterra, Frana e Blgica e os pases Americanos.

Na Dinamarca, em 1932, o Coronel Holger Nielsen desenvolveu seu prprio mtodo que combinava as melhores partes das duas tcnicas. No Brasil, com seu grande litoral em praias e com o turismo desenvolvido na Cidade do Rio de Janeiro, o processo de desenvolvimento da ressuscitao acompanhou de forma semelhante o que ocorreu em todo mundo (Entra foto 6). Radiation Machine. Todos os mtodos de ventilao indireta (Schafer, Holger-Nielsen, Marshall Hall, Howard, Silvester, e outros) foram idealizados com dois propsitos principais: a ventilao artificial e a retirada de gua do pulmo nos casos de afogamento. Essay. Todos tiveram grande sucesso no princpio do sculo e certamente ressuscitaram muitas vtimas da morte. Burnt Potato Chip. Todos eles utilizavam o princpio contrrio a fisiologia do organismo, onde a inspirao era passiva e a expirao era ativa, desta forma o volume corrente produzido era geralmente inferior ao necessrio. Memory Essay. Estes mtodos so extremamente cansativos para o socorrista e difceis de serem mantidos alm de 5 minutos. Radiation Machine. Foram baseados na idia de retirar gua do pulmo do afogado, o que hoje em dia se mostra desnecessrio e at Essay prejudicial. Essay. Foram idealizados antes da noo da compresso cardaca, sendo possvel ainda sim sua realizao conjugada, porm com grandes dificuldades em casos de PCR. Memory Essay. Nos casos de trauma cervical impossvel a sua realizao. Burnt Chip. Nos casos especficos de afogamento estes mtodos indiretos de ventilao no podem ser realizados dentro da gua, o que hoje em dia uma prioridade. A partir da metade do sculo 20, com a melhor compreenso da fisiologia aliada a pesquisa, os mtodos de ressuscitao foram aperfeioados.

Diversas conferncias sobre reanimao foram realizadas, entre elas a pioneira de 1948, realizada pela National Academy of Essay, Science - National Research Council (NAS-NRC), promoveram a divulgao e o debate amplo entre sociedades e autoridades mdicas, na tentativa da padronizao de condutas. Em 1949, Archer Gordon realizou trabalhos de investigao em estudantes anestesiados, curarizados e entubados. The Therac-25 Radiation Therapy Machine. Faz meno a respirao boca-a-boca, mas no a realiza. Memory And Time Essay. Conclui que, nenhum dos mtodos propostos at potato o momento, nem mesmo suas combinaes, ofertam quantidade suficiente de ar (100/500 ml). Memory. James Elam foi o primeiro investigador contemporneo que demonstrou que o ar expirado atravs do boca-a-boca era suficiente para manter uma adequada oxigenao. Political Ultimate Regno Of St.. Isto foi durante uma epidemia de Poliomielite em Minessota no ano de 1946. Memory And Time Essay. Em viajem de automvel a Kansas para um congresso mdico, foi acompanhado por outro mdico que se interessou por sua experincia. Burnt Potato Chip. Este mdico dedicou sua vida a investigao da ressuscitao Dr Peter Safar. Memory And Time Essay. Realizou experincias em voluntrios anestesiados que lhe permitiram chegar em 1957 a trs concluses principais sobre a respirao boca-a-boca: 1. Greek God Apollo. Simplesmente inclinando a cabea da vtima para trs se pode abrir as.

2. Essay. A respirao boca-a-boca fornece uma excelente respirao artificial. 3. Reading Of St.. Qualquer pessoa pode aplic-la facilmente e de forma efetiva. Memory Essay. O mtodo boca-a-boca foi adotado pelo exrcito dos EUA em 1957 e pela Associao Americana de Medicina (AMA) em 1958. Essay. Nesta poca, o mdico Brasileiro Dr John Cook Lane, contribuiu efetivamente para a pesquisa e difuso destes mtodos em nosso pas. No ano de 1883 o Dr. Memory. Franz Koenig prope em seu livro, a compresso torcica como tcnica para ventilar um paciente de forma artificial. Embora na posio correta para a compresso cardaca, ele a descreve para outro fim. On Theories. Seu assistente, Dr. Memory And Time. Friederich Maass, durante a cirurgia de um jovem de 18 anos que havia tido uma parada cardaca durante a induo anestsica, inicia as manobras antes descritas, a princpio lentamente, simulando o ritmo ventilatrio. Machine Essay. Diante a falta de resposta aumenta a freqncia, chegando a 120 compresses por minuto, e observa que o pulso carotdeo se recupera, e em alguns minutos o paciente se encontra bem.

Em 1901, Kristian Igelsrud recuperou uma paciente com massagem cardaca interna ao final de uma anestesia, com recuperao em 1 minuto. Memory. O primeiro caso Americano de massagem cardaca (como era denominado at burnt potato chip poucos anos atrs) fechada ocorreu em 1904, quando o Dr George Crile ressuscitou uma mulher de 28 anos de idade cujo corao parou durante o ato cirrgico. Memory Essay. No se tem conhecimento do porque as tcnicas de compresso cardaca no foram mais difundidas. Potato. Talvez porque, a parada na respirao a princpio, parecia mais evidente e por esta razo deve ter sido mais investigada. Memory Essay. Na realidade a tcnica de compresso torcica na circulao artificial foi simplesmente ignorada at Life Ultimate Reading of St. Thomas o incio dos anos 60 quando foi redescoberta. O redescobrimento parece ter sido acidental no laboratrio do Dr. And Time Essay. William Kouwenhoven na universidade John Hopkins em Baltimore. Greek God Apollo Facts. Junto com os Drs.

Guy Kinckerbocker e James Jude, descrevem a massagem cardaca aps uma srie de observaes. Memory And Time Essay. Publicam seus resultados sobre 20 casos de parada cardiorrespiratria intra-hospitalar no ano de 1960 na revista JAMA. Tella Marketer. Entre os anos de 58 e 61, a respirao se combinou finalmente com a circulao artificial (compresso cardaca): Nascia a Ressuscitao Crdio-Pulmonar - RCP. Iniciasse assim uma nova poca onde a campanha anuncia qualquer um, em qualquer lugar, pode iniciar a Ressuscitao Crdio-Pulmonar - RCP. And Time. Houve ento um perodo de demonstraes por todo mundo onde, Safar, Kinckerbocker, e Jude explicariam que as duas tcnicas no deviam ser consideradas como unidades separadas e sim que ambas formavam parte de um mesmo procedimento salvador. Therapy Machine. No ano de 1962, Gordon e Adams produzem um filme de treinamento de 27 minutos chamado O pulso da vida. Essay. Este filme foi utilizado em cursos de RCP por todo mundo e visto por milhes de estudantes. The Therac-25 Essay. Para aumentar o aprendizado foi utilizada chave mnemnica para a ordem das manobras. And Time. Estava criado o ABC da Vida. Facts. A Abrir as vias areas (Airways), B Boca-a-boca (Breath), e C Circulao (Circulation) explicando a seqncia completa da RCP (o Dr Peter Safar faleceu em Julho de 2003). Por volta de 1960, Laerdal desenvolveu um manequim de treinamento em RCP.

O rosto da manequim foi inspirado no busto de mulher desconhecida que morreu afogada em 1930 no rio Sena. Memory Essay. O nome da mulher nunca foi identificado, e a manequim recebeu o nome de ANNE, sendo mundialmente conhecida como resusci-anne. Burnt. No ano de 1966, as recomendaes so reconhecidas pela American Heart Association AHA e Cruz Vermelha Americana, e finalmente publicada em definitivo, e de forma completa, na JAMA. A histria do afogamento no Brasil se iniciou na Cidade do Rio de Janeiro, na poca capital do Pas, privilegiada por belezas naturais incomparveis, com grande destaque as suas praias e favorecidas por clima de natureza tropical funcionaram como a principal fonte de lazer e atrao turstica, determinando um fluxo permanente e intenso de banhistas de todo o mundo durante o ano inteiro. Memory And Time. Entretanto, as belezas de seu litoral na maioria das vezes escondem que suas praias, com ondas e correntezas fortes, podem tornar-se potencialmente perigosas com risco de afogamentos. Life The De Of St. Thomas Aquinas. Estas caractersticas tornaram a cidade do Rio de Janeiro uma das regies com o maior ndice desta forma de acidente no pas. Memory. Sensvel a esta realidade, em 1914, o Comodoro Wilbert E. Political And Man’s Regno Of St. Aquinas. Longfellow fundou na cidade do Rio de Janeiro, ento capital da Repblica, o Servio de Salvamento da Cruz Vermelha Americana. And Time Essay. Nesta poca, o objetivo era o de organizar e treinar Guarda-Vidas voluntrios, que atuariam em postos de salvamento, no apenas no Rio de Janeiro, mas por todo pas, supervisionando praias desguarnecidas. God Apollo. Sentindo a ineficincia de tal estratgia, adotou uma campanha a nvel nacional, cujo slogan foi: Toda Pessoa deve saber nadar e todo nadador deve saber salvar vidas, na tentativa de despertar a populao para o problema da segurana nas praias de todo o Brasil. Memory And Time. Each person should know how to Essay, swim and Essay each swimmer should know how to greek facts, save lives. O Corpo Martimo de Salvamento (CMS) teve suas razes no Servio de Salvamento da Cruz Vermelha, criado por Decreto do Prefeito Amaro Cavalcante, em 10 de maio de 1917, funcionando no Dispensrio da praia de Copacabana. Em 1939, o Dispensrio de Copacabana foi transformado no Posto de Salvamento Ismael de Gusmo, em homenagem ao seu organizador.

Naquele tempo foram construdas 18 torres fixas de salvamento ao longo da costa da Cidade do Rio de Janeiro. Memory And Time Essay. Um total de 120 guarda-vidas trabalhavam nas praias com o auxlio de barcos motorizados, ambulncias, carros para transporte e uma equipe mdica equipada com o que havia de mais moderno em tecnologia de ressuscitao. A vtima resgatada era trazida estao principal Ismael Gusmo aonde a equipe mdica dava continuidade aos primeiros socorros realizado na praia. Tella Marketer. Nesta poca o banho era restrito a algumas reas da orla em frente s torres e a algumas horas do dia. And Time. Em Maro de 1961 este posto de Salvamento foi subordinado ao Departamento de Assistncia Hospitalar do S.A.A, passando em agosto deste mesmo ano responsabilidade do Departamento de Segurana Pblica.

O crescimento demogrfico explosivo, a intensa emigrao para a cidade do Rio de Janeiro e a melhoria das condies de vida da populao a partir dos anos cinqenta, provocaram um aumento do contato do homem com o mar, alertando as autoridades da poca para a necessidade da criao de um servio de salvamento e resgate especializado em acidentes aquticos. Tella Marketer. Criou-se, ento, em 1963, o Corpo Martimo de Salvamento - Salvamar, subordinado Secretaria de Segurana Pblica, que iniciou suas atividades com um grupo pequeno de amadores recrutado entre pessoas com afinidade e experincia para este tipo de socorro na praia. Em 1967, foi aprovado e criado dentro da estrutura da Secretaria de Segurana Pblica, o Centro de Instruo de Salvamento e Formao de Guarda-Vidas. Memory Essay. Do total de 60 praias, apenas 27 eram guarnecidas pelo servio de salvamento utilizando 40 torres e 200 salva-vidas. In My Analysis. Neste ano foram realizados 4.032 resgates na orla com apenas 17 bitos. Em 1968, em razo da necessidade de um atendimento mdico mais rpido e eficiente, foram inaugurados os primeiros Centros de Recuperao de Afogados (CRAs), em nmero de 3, localizados estrategicamente na orla do Rio de Janeiro, nas praias de Ramos, Copacabana e Barra da Tijuca, com a finalidade de dar assistncia mdica de urgncia aos casos de afogamento.

Estes CRAs existentes at Memory and Time os dias de hoje possuem instalaes mdicas para atendimentos de emergncias e funcionam com uma equipe de Mdicos e Enfermeiros que se utilizam de ambulncias, barcos e helicpteros para o acesso aos locais dos acidentes. Therapy Machine Essay. Com o passar dos anos foram se modernizando e se adaptando s novas necessidades e hoje representam locais de referncia em todo o Brasil para qualquer tipo de acidente aqutico. Em 1975, por determinao da Secretaria de Segurana Pblica, o Corpo Martimo de Salvamento ficou vinculado ao Departamento Geral de Defesa Civil, cujo Diretor seria automaticamente o Comandante do Corpo de Bombeiros. And Time Essay. Em 1984, o Exmo. Life Ultimate Reading The De. Sr.

Governador do Estado do Rio de Janeiro passou a competncia e atribuies do Corpo Martimo de Salvamento para o Corpo de Bombeiros do Rio de Janeiro (CBERJ). And Time. Em 16 de outubro de 1984, foi ativado o Grupamento Martimo GMAR -, com uma base operacional em Botafogo e 3 Sub-grupamentos principais, mantendo em suas estruturas os CRAs anteriormente criados, de forma a estabelecer um atendimento integrado entre o resgate realizado nas praias e o atendimento mdico. Esta transio de gerncia do servio de salvamento foi um trabalho rduo e vagaroso, pois havia necessidade de treinar todo o pessoal militar nesta atividade altamente especializada, e o pessoal do extinto Corpo Martimo de Salvamento transferiu-se quase integralmente para outra Secretaria. Essay On Theories. Alguns profissionais, entretanto, permaneceram no atual GMAR com a finalidade de treinar os militares para esta nova funo. Memory And Time Essay. Os primeiros anos foram de muito sacrifcio para Instrutores e Alunos Guarda-Vidas e o nmero de salvamentos e bitos nas praias no sofreu alterao significativa.

Com o passar dos anos o nmero de salvamentos cresceu e o nmero de bitos reduziu nas praias do Rio de Janeiro, o que comprovou o acerto na deciso da mudana no sistema de Salvamento Aqutico no Rio de Janeiro e o alto grau de profissionalizao adquirido por seus homens. Com o enorme litoral brasileiro de 7.408 Km, natural que o fenmeno ocorrido no Rio de Janeiro se faria sentir mais cedo ou mais tarde em outras regies. Greek. O servio de salvamento Aqutico adquiriu conhecimento e experincia com o passar dos anos, tornando-se um centro de formao de pessoal especializado em todos os nveis, no somente Guarda-Vidas e Instrutores, mas tambm na formao de pessoal mdico especializado, servindo de padro para todas as unidades da Federao e um exemplo para o mundo todo. PREVENO E ESTATSTICAS EM AFOGAMENTO. A preveno tem se mostrado o grande fator de reduo na mortalidade entre as causas externas e principalmente nos casos de afogamentos. Memory. As campanhas de preveno informam, por exemplo, que 85% dos afogamentos nas praias ocorrem nas correntes de retorno local de aparente calmaria que funciona como o retorno da massa de gua proveniente das ondas para o mar aberto indicando este local como perigoso para o banho. On Theories. Embora o ato de prevenir possa aparentemente no transparecer a populao como herico, so eles o alicerce da efetiva reduo na morbi-mortalidade destes casos. Memory And Time Essay. Embora sejam grandes os esforos para melhorar o atendimento ao paciente afogado, com a preveno feita pelos guarda-vidas nas praias e piscinas e principalmente com campanhas de preveno atingindo crianas em fase escolar que obteremos o maior xito (5). Political Regno Thomas Aquinas. Nestes anos de trabalhos do Grupamento Martimo, a mortalidade de 0.3% dos resgates realizados nas praias do Rio de Janeiro se mostrou muito baixa (6), demonstrando que a preveno e a interveno precoce do guarda-vidas o caminho certo para reduzir o nmero de bitos neste tipo de acidente. Prevenir fundamental e prioritrio no caso de afogamento.

A cada ano mais de 500.000 pessoas so vtimas fatais de afogamento em todo mundo, entretanto o seu nmero exato ainda desconhecido em razo de um grande nmero de casos no notificados por desaparecimento sem confirmao de bito (5,6). Memory. Ironicamente, parece que nos EUA 90% de todos os casos de afogamento ocorrem a 10m de uma medida de segurana instalada (7). God Apollo. Estimativas indicam que 40-45% ocorrem durante a natao demonstrando desconhecimento do perigo iminente. Memory And Time Essay. Na prtica de esportes nuticos, os afogamentos so responsveis por 90% dos bitos (8). Greek Facts. Em 1998 a populao brasileira atingiu 161 milhes de habitantes, dos quais 7.183(4.44/105 habitantes) faleceram em virtude de afogamento (2).

As estatsticas mostram grande variabilidade entre os estados (entra grfico 1). Em nmeros absolutos observamos em ordem decrescente no ano de 1997, os cincos estados com os maiores nmeros absolutos de bitos: So Paulo (1.822), Minas Gerais (900), Bahia (507), Rio de janeiro (502) e o Rio Grande do Sul (447) correspondendo as maiores populaes. Essay. Quando analisamos o nmero de bitos pela populao observamos os estados de Roraima (9.8), Acre (8.6), Mato Grosso do Sul (6.8), Amap (6.7), e Esprito Santo (6.7) como os de maior nmero de bitos relativo (por 100.000 habitantes) mostrando que estados no banhados pelo mar tem um maior risco de morte por afogamento. Essay. O Sudeste a regio de maior nmero de bitos relativo (5.0) e a menor a regio Nordeste (3.4). And Time. Na Avaliao de bitos por afogamento de 1996 para 1997 observamos uma reduo percentual no nmero de bitos relativo de 45.74% no estado do Amap, 35.2% em Sergipe, 22.6% no DF, 18.9% em SC, e 17,8% no Rio de Janeiro, enquanto outros estados aumentaram o seu nmero percentual: Paraba 251.8%, Tocantins 58.3%, Gois 45.7%, Mato Grosso do Sul 22.7% e o restante dos estados no tiveram alteraes significativas(2,3,5). Life And Man’s Ultimate End: The De Regno Of St. Thomas. fato que grandes acidentes aquticos, como inundaes ou naufrgios em um estado podem elevar drasticamente estes nmeros de forma isolada no demonstrando um perfeito espelho da realidade. And Time. Nos EUA existem oito casos de afogamentos para cada caso fatal notificado (9). Tella Marketer. Nas praias do Rio de Janeiro temos aproximadamente 290 resgates para cada caso fatal (0.34%), e um bito para cada 10 atendimentos no Centro de Recuperao de Afogados (10.6%) (10). Os afogamentos em gua doce so mais freqentes em crianas, principalmente em menores de 10 anos. Memory And Time Essay. Estima-se que existam mais de 4.500 casos de morte por ano s nos E.U.A (53% em piscinas)(9), onde 50.000 novas piscinas so construdas por ano, somando-se a 2.2 milhes de piscinas residenciais e 2.3 milhes no residenciais(11). Political Ultimate End: Of St. Thomas. Nas reas quentes do EUA, Austrlia e frica do Sul, 70 a 90% dos bitos por afogamento ocorrem em piscinas de uso familiar (12). And Time. No Brasil, onde o nmero de piscinas domsticas infinitamente menor, o afogamento em gua doce ocorre mais em rios, lagos e represas perfazendo a metade dos casos fatais(13).

A faixa etria de maior ocorrncia de bitos no Brasil de 20 a 29 anos, sem distino entre os estados banhados ou no pelo mar. Potato Chip. O homem morre em mdia 5 vezes mais por afogamento que a mulher, no havendo distino quando menor do que 1 ano e sendo 8.7 vezes mais freqente na idade de 20 a 29 anos(2). Memory And Time Essay. Nos municpios do estado do Rio de Janeiro o maior nmero relativo de bitos se encontra em locais no banhados pelo mar (1). Nas praias do municpio do Rio de Janeiro, aproximadamente 86% dos casos situam-se na faixa etria entre 10 e 29 anos(idade mdia de 22 anos). Tella Marketer. Em mdia, 75% das vtimas so do sexo masculino sofrendo variaes conforme a idade, 83% so solteiros, 83.5% ingerem alimentos 3 horas antes do acidente, 46.6% acham que sabem nadar, e 71.4% moram fora da orla martima (6,14).

Como podemos deduzir, a maior parte dos afogados so pessoas jovens, saudveis e produtivas, com expectativa de vida de muitos anos, o que torna imperativo um atendimento imediato, adequado e eficaz, que deve ser prestado imediatamente aps ou mesmo quando possvel durante o acidente, ainda dentro da gua. grande a confuso da definio do termo afogamento na lngua inglesa. Memory And Time. O uso do termo near-drowning traduzido como quase-afogamento ainda hoje erradamente utilizado e significam afogados que no falecem at Essay 24 h aps o incidente e o termo drowning as vtimas que falecem em at Memory Essay 24 h. Greek Facts. Esta nomenclatura subestima o nmero total de bitos por afogamento nos pases da lngua Inglesa resultando em um grande erro no perfil epidemiolgico. Memory. Vrios autores demonstraram sua preocupao quanto a esta definio imprecisa em uso, mostrando que ela esta em desacordo com os parmetros prognsticos internacionais definidos em Utstein-style. Facts. Em Agosto de 2000, com a edio dos novos Guidelines da American Heart Association aprovados pelo ILCOR (17), e com a realizao do Congresso Mundial de Afogamento em 2002 realizado na Holanda, o termo quase-afogamento caiu definitivamente em desuso.

Apresentamos abaixo a nova definio de afogamento. @ Afogamento (Drowning): aspirao de lquido no corporal por submerso ou imerso. @ Resgate: Pessoa resgatada da gua sem sinais de aspirao lquida. @ J Cadaver: morte por afogamento sem chances de iniciar ressuscitao, comprovada por tempo de submerso maior que 1 hora ou sinais evidentes de morte a mais de 1 hora : rigidez cadavrica, livores, ou decomposio corporal. CAUSAS de AFOGAMENTO (14). a - AFOGAMENTO PRIMRIO - o tipo mais comum, no apresentando em seu mecanismo nenhum fator incidental ou patolgico que possa ter desencadeado o acidente. b - AFOGAMENTO SECUNDRIO a denominao utilizada para o afogamento causado por patologia ou incidente associado que o precipita. And Time. Ocorre em 13% dos casos de afogamento, como exemplo; Uso de Drogas (36.2%) (quase sempre por lcool), crise convulsiva(18.1%), traumas(16.3%), doenas cardio-pulmonares (14.1%), mergulho livre ou autnomo(3.7%), e outros (homicdio, suicdio, lipotimias, cibras, hidrocusso) (11.6%). Radiation Machine Essay. O uso do lcool considerado como o fator mais importante na causa de afogamento secundrio.

TIPOS DE ACIDENTES NA GUA E FASES DO AFOGAMENTO(9) Os trs diferentes tipos de acidentes na gua e as fases do. afogamento so sintetizadas na Figura 1(18). Memory And Time Essay. A Sndrome de imerso(Immersion syndrome)(19) ou vulgarmente chamado de choque trmico uma sncope (provocada por uma arritmia do tipo bradi ou taquiarritmia) desencadeada pela sbita exposio a gua com uma temperatura 5C abaixo da corporal. Hymn In My Analysis. Pode ocorrer portanto em temperaturas da gua to Memory and Time, quentes quanto 31C freqentemente presente no litoral tropical ou em piscinas. To God In My Analysis. Quanto maior a diferena de temperatura, maior a possibilidade de sua ocorrncia. Essay. A sncope promove a perda da conscincia e o afogamento secundrio. To God My God In My Sickness. Nenhuma explicao tal como estmulo vagal levando a sbita assitolia, fibrilao ventricular por grande descarga adrenrgica pelo frio ou exerccio, ou outras razes menos provveis foram comprovadas cientificamente como causa ou como sndrome comprovada (20,21). Memory. Estudos mostram que a ocorrncia deste acidente pode ser reduzida se antes de entrarmos na gua, molharmos a face e a cabea(22). FISIOPATOLOGIA DO AFOGAMENTO. Existem variaes fisiopatolgicas entre os afogamentos em gua do mar e gua doce.

Apesar de cada um ter especificamente suas caractersticas, as variaes so de pequena monta do ponto de vista teraputico. Burnt Potato Chip. As observaes feitas por MODELL e cols.(23,24,25,26,27), demonstraram que as mais significativas alteraes fisiopatolgicas decorrem de hipoxemia e acidose metablica. O rgo alvo de maior comprometimento o pulmo. Memory And Time Essay. A aspirao de gua promove insuficincia respiratria e conseqente alterao na troca gasosa alvolo-capilar, e distrbios no equilbrio cido-bsico (12,27). Therapy Machine Essay. As alteraes fisiopatolgicas que ocorrem dependem da composio e da quantidade de lquido aspirado. And Time Essay. O mecanismo de alterao na ventilao aps aspirao de gua doce diferente daquele em gua do mar. Radiation Essay. Estudos(14,33,34) demonstraram que os afogamentos em gua do mar no alteram a qualidade, somente comprometendo a quantidade do surfactante pulmonar, diferentemente dos afogamentos em gua doce onde ocorrem alteraes qualitativas e quantitativas produzindo maior grau de reas atelectasiadas(34). And Time Essay. A aspirao de ambos os tipos de gua promovem alveolite, edema pulmonar no cardiognico, e aumento do shunt intrapulmonar que levam hipoxemia (14,34,35).

Alguns autores descrevem uma maior gravidade na leso pulmonar em gua doce(14,33,36,37) outros estudos no apresentaram maior mortalidade do que os casos em gua do mar(10,38) ficando a questo ainda em aberto. Radiation Therapy. A reversibilidade total das leses com a terapia apropriada o usual (9,21,39). Em animais de laboratrio, a aspirao de 2,2ml de gua/Kg/peso faz a PaO2 cair para aproximadamente 60 mmHg em 3 minutos(31,40). And Time. Em ces, a mesma quantidade provoca uma queda na PaO2 para aproximadamente 40 mmHg (26). Life Of St. Aquinas. Em seres humanos parece que aspiraes to and Time Essay, pequenas quanto 1 a 3 ml/kg resultam em grande alterao na troca gasosa pulmonar e reduo de 10% a 40% na complacncia pulmonar (26,31,33,34). On Theories Of Stereotyping. FULLER(41)demonstrou que em 70% dos bitos h evidncias de aspirao de partculas de natureza diversa como areia(39), algas e lama, e em 24% h presena de restos de vmito.

Estudos realizados em ces afogados em gua doce, demonstraram que a fibrilao ventricular(FV) era secundria a distrbios no potssio srico(42,43). And Time. Entretanto, isto raramente relatado em seres humanos, provavelmente porque estes raramente aspiram quantidade de gua suficiente para provocar distrbios eletrolticos to tella marketer, importantes(27). Essay. A FV nos seres humanos esta relacionada a hipxia e acidose e no a hemodiluio, hemlise e hiperpotassemia(27), uma vez que 85% daqueles que falecem no aspiram mais de 22 ml/Kg/peso(40), e como o volume crtico para a FV provocada por hemlise parece ser de 44 ml/Kg/peso, provvel que ela ocorra em menos de 15% dos casos(28,40). Hymn To God In My Sickness Analysis. As alteraes como a diminuio do dbito cardaco, a hipotenso arterial, o aumento da presso arterial pulmonar e o aumento da resistncia vascular pulmonar resultam da hipxia e da acidose(10,33). And Time. Freqentemente observamos intensa vasoconstrico perifrica, devido hipoxemia, liberao de catecolaminas, hipotermia, reflexo de mergulho ou, provavelmente combinao destes fatores(44). God Apollo Facts. Nos afogamentos por gua do mar, a perda lquida para o pulmo no contribui para a hipotenso arterial que secundria a depresso miocrdica provocada pela hipxia(10,33). Memory And Time Essay. A taquicardia, o ritmo de galope e as extrassistolias so as alteraes cardacas mais freqentes, e so reversveis com a administrao de oxignio(10,44). As alteraes eletrolticas podem ser observadas nos afogamentos de seres humanos, embora clinicamente sejam pequenas(27,28). Tella Marketer. Em trabalho recente com 187 aferies dentre 2304 casos (14), nenhum deles necessitou correo eletroltica inicial, confirmando os achados de outros trabalhos(27, 28, 29). Essay. No existe portanto, diferenas entre gua doce ou mar quanto ao tratamento a ser empregado. Therapy. Afogamento em, gua salgada no causa hipovolemia, e em gua doce no causa hipervolemia, hemlise ou hipercalemia.

O hematcrito e a hemoglobina esto usualmente normais aps afogamento em seres humanos(24, 28). Memory And Time Essay. A hemlise s aparece com aspiraes maiores de 11 ml/Kg/peso, o que raramente ocorre (30,31,32). Essay On Theories Of Stereotyping. A Leucocitose esta presente em mais de 50% dos afogados, em geral com elevao das formas jovens, em decorrncia provvel do estress traumtico a que foi submetido, e no infeco (33,34). Cerca de 22% podem apresentar albuminria transitria, cilindrria ou ambos, o que provavelmente secundrio hipxia renal(35). Essay. A insuficincia renal aguda rara(28,36,37). Os afogamentos grau 3 a 6 cursam com hipxia importante embora somente no grau 6 ocorra leso potencialmente irreversvel do SNC (14,38)(ver classificao de afogados adiante). Afogamento tipo seco provavelmente no existe Se a necrpsia no evidenciar gua no pulmo, a vtima provavelmente no estava viva quando entrou na gua. Tella Marketer. Nem todas as pessoas que se afogam aspiram gua em quantidade.

Aproximadamente menos de 2% dos bitos parecem ocorrer por asfixia secundria a laringoespasmo, portanto sem aspirao de lquido importante. Memory And Time Essay. O termo afogado seco muito utilizado no passado foi recentemente extinto da nomenclatura, j que todos os afogados aspiram alguma quantidade de liquido (39). CLASSIFICAO DE AFOGAMENTO (14, 38) A classificao clnica de afogamento baseada em estudo retrospectivo de 41.279 casos de resgates na gua, registrados por guarda-vidas no perodo de 1972 a 1991. Burnt Potato. Deste total, 2.304 casos (5.5%) foram encaminhados ao CRA.

Os 38.975 casos restantes no necessitaram de atendimento mdico e foram liberados no local do acidente com o diagnstico apenas de resgate sem afogamento. Memory And Time Essay. Dentre o total de 2304 casos avaliados, a classificao foi baseada em 1831 casos que apresentaram uma mortalidade de 10.6% (195 casos). The Therac-25 Radiation Therapy Essay. Considerando a avaliao destes parmetros clnicos, e a demonstrao de sua diferente mortalidade, apresentamos no algoritmo 1 (14,40) um resumo prtico de seu uso que esta de acordo com o ltimo consenso de Suporte Avanado de Vida (ACLS) da American Heart Association(AHA) de 2000(17). A classificao de afogamento leva em considerao o grau de insuficincia respiratria que indiretamente esta relacionado a quantidade de lquido aspirado, determinando a gravidade do caso. Memory. A parada respiratria no afogamento ocorre segundos at on Theories of Stereotyping minutos antes da parada cardaca (14,41). Memory And Time. O quadro clnico do afogamento altamente dinmico, com piora ou mais freqentemente com melhora clnica, seguindo-se um perodo de estabilizao com uma fase de recuperao mais lenta. Life And Man’s Ultimate End: Reading Of St.. A classificao do grau de afogamento deve ser feita no local do acidente. Memory And Time. Embora nem sempre possvel, esta conduta demonstra a real gravidade e indica a teraputica apropriada e o prognstico mais preciso.

A presena de patologia pregressa ou associada(afogamento secundrio) representa um fator de complicao na hora de classificar o grau de afogamento e deve ser bem avaliada. A gasometria arterial no considerada na classificao, embora seja um exame complementar de extrema valia como veremos adiante(14,40). A hospitalizao deve ser indicada em todos os graus de afogamento de 2 a 6 (9, 14, 28) (ver algoritmo 1 ACLS em afogamento) (14,17). Essay Of Stereotyping. A tabela 3 mostra a mortalidade geral para cada grau de afogamento, a necessidade de hospitalizao e sua mortalidade pr e intra-hospitalar(14). And Time. Como a classificao muito importante para profissionais que trabalham na cena do acidente como Tcnicos em Emergncias Mdicas (TEM), socorristas, guarda-vidas, guardies de piscina ou leigos que necessitem ou queiram aprender sobre primeiros socorros em afogamento apresentamos o algoritmo 2 em linguagem mais simples para o Suporte Bsico de Vida em afogamento (BLS)(40). Para os casos grau 6 ressuscitados com xito, recomendamos a utilizao das tabela 4 e figura 2 (41,42,43,44) para classificao prognstica. Tella Marketer. Em todos os casos de afogamento em que o lazer na gua precede o quadro de afogamento em algum tempo ocorre Hipotermia(14,40). Nos pacientes hospitalizados, 60 a 80% no apresentam complicaes,e 15% tem mais de 5(36,46,47). Sistema Nervoso Central(grau 6): Convulses(15%), Edema cerebral(30 a 44% -diagnstico clnico), e encefalopatia anxica(20%)(48,49). Aparelho respiratrio(grau 3 a 6): Broncopneumonia ou pneumonia (34% a 40% dos pacientes que fazem ventilao mecnica), edema pulmonar (28% - diagnstico clnico), pneumotrax e/ou pneumomediastino (10%), atelectasias lobares (20%), ARDS (5 %)(28, 50,51). Metablico(grau 2 a 6): Acidose metablica (31%), alteraes eletrolticas (K, Na)(23%)(14, 24).

Outras complicaes: Necrose tubular aguda (2%)(37), Hematria (4%)(52), Cardiomiopatia anxica (2%), hematmese e/ou melena (4%), Sindrome de secreo inapropriada de ADH (2%)(7), e Outras (7%)(7,14). Sepsis - Casos de choque sptico irreversvel tem sido descritos na literatura nas primeiras 24 horas aps o acidente(observao pessoal - Szpilman). EXAMES A SEREM SOLICITADOS(14, 40) (ver algoritmo 1 ACLS) Grau 2 - Gasometria arterial e radiografia de trax. Grau 3 a 6 - Gasometria arterial, hemograma completo, eletrlitos, uria, creatinina, glicemia, elementos anormais no sedimento da urina, radiografia de trax, e tomografia computadorizada de crnio(se houver alterao no nvel de conscincia). Gasometria arterial antes do tratamento(9, 23, 28): Grau 1 normal; grau 2 hipoxemia leve, PaCO2 normal ou baixo e acidose metablica leve ou ausente; grau 3 PaO2 50 mmhg, SaO2 90% e acidose metablica moderada; grau 4,5 e 6 - PaO2 50 mmhg, SaO2 90% e acidose metablica ou mista severa. Radiografia de trax(9, 39): As alteraes radiolgicas variam desde a presena de hipotransparncia localizada at Essay o edema pulmonar difuso.

Na evoluo radiolgica observada estabilizao ou at tella marketer piora nas primeiras 48 horas com resoluo em 3 a 5 dias quando no h complicaes. Memory. As alteraes na radiografia de trax no devem ser interpretadas como sinal de pneumonia e sim do preenchimento inicial dos alvolos e brnquios com o lquido aspirado. PR-HOSPITALAR com Suporte Bsico de Vida (guarda-vidas) Algoritmo 2. Para a utilizao da classificao e abordagem teraputica por pessoal tcnico em suporte bsico de vida(SBV) com utilizao de equipamento de. oxignio (guardies de piscina e guarda-vidas) apresentamos o algoritmo 2, uma adaptao da classificao e tratamento em linguagem de fcil compreenso e treinamento. Hymn To God Sickness. Nota adicional sobre o algoritmo 2 (BLS): O fato da aspirao de gua ter predileo pelo segmento superior do lobo inferior direito, em razo da maior verticalizao do brnquio fonte direito, levou a indicao de colocar a vtima de afogamento viva em decbito lateral direito melhorando provavelmente a relao V/Q do pulmo esquerdo resultando em melhora na oxigenao. And Time. Embora sem comprovao cientfica, no parece causar nenhum malefcio a vtima de afogamento. Essay On Theories. Em praias inclinadas a vtima deve ser colocada em posio paralela gua, de forma que o tronco e a cabea fiquem na mesma posio horizontal, permitindo o incio da checagem da respirao e a RCP se necessrio. And Time Essay. A classificao de afogados ir ento determinar qual a melhor posio de colocar o afogado.

Grau 1 a 3 posio com a cabea mais alta que o tronco em decbito lateral direito; Grau 4 a 6 paralelo a praia at god apollo facts que a ressuscitao seja efetiva no grau 5 e 6 e at and Time que a hipotenso seja corrigida no grau 4 e ento coloca-se como nos graus 1 a 3 se no houver hipotenso arterial(53). PR-HOSPITALAR com Suporte Avanado de Vida e HOSPITALAR Algoritmo 1. O casos de Resgate e graus 1 e 2 tem seu tratamento bem descrito no algoritmo 1(14,40). Os Graus 3 e 4 necessitam de internao em centro de terapia intensiva por um perodo mnimo de 48 horas(14,40). Hymn To God My God Sickness Analysis. A assistncia respiratria nestes casos o mais importante.

Inicie a ventilao usando oxignio a 15 litros por minuto sob mscara facial, e dependendo do grau de insuficincia respiratria e a disponibilidade de recursos no local realize a entubao oro-traqueal e a assistncia respiratria invasiva sob ventilao mecnica(14,40). And Time Essay. O paciente em Grau 3 e 4 reage muito entubao sendo necessrio o uso de drogas que promovam sedao (preferencia pelos de curta ao - midazolan), por vezes associado aos relaxantes musculares que s devem ser utilizado se houver certeza de boa ventilao mecnica controlada. Political End: Reading The De Of St. Thomas. A C-PAP (Continuous Positive Airway Pressure) associada a ventilao mecnica um recurso importante(54). Memory And Time Essay. A C-PAP permite a manuteno de uma presso positiva durante todo o ciclo respiratrio, o que aumenta o recrutamento alveolar reduzindo as reas de atelectasias e de alvolos funcionalmente colabados, aumentando com isso a relao V/Q(diminui o shunt intrapulmonar)(25,55,56). Tella Marketer. A PEEP (Positive End Expiratory Pressure) semelhante em sua funo a CPAP. Memory And Time. O uso precoce de ambos (C-PAP ou PEEP) encurtam o perodo de ventilao mecnica e hospitalizao(9,12,57).

A ventilao mecnica nestes casos deve ser iniciada imediatamente aps entubao e sedao, com FiO2 a 100% e PEEP de 5 a 7 cm/H2O. Hymn My God In My Analysis. A gasometria arterial (PaO2) indicar o quanto se pode reduzir a FiO2 aps os primeiros 30 a 40 minutos. Memory And Time. Os alvolos so recrutados de forma lenta, razo pela qual devemos aguardar uma resposta teraputica gradual(57). The Therac-25 Radiation Therapy. No h provas de que o seu uso possa diminuir o lquido no pulmo, mas sabe-se que ocorre redistribuio da gua para o interstcio, tendo boa utilidade no edema pulmonar do afogado(30, 54, 57). And Time Essay. Nunca retire o PEEP ou C-PAP antes de 48 horas mesmo que a FiO2 indique ser abaixo dos parmetros convencionais a sua indicao. Political Of St. Thomas Aquinas. A retirada do PEEP s deve ser iniciada aps um mnimo de 48 horas, de forma lenta, j que o edema pulmonar pode recidivar rapidamente em caso de retirada precoce. Essay. O desmame dos pacientes afogados em gua salgada 1.8 vezes mais rpido do que os de gua doce. O acesso venoso perifrico satisfatrio para os estgios iniciais do suporte hemodinmico. Sickness Analysis. Nos casos de afogamento grau 4 a 6 onde ocorre instabilidade hemodinmica, o suporte hemodinmico extremamente necessrio embora em uma grande parte dos casos somente a correo da hipxia o suficiente para retornar a normotenso(14,40).

No hospital, o paciente deve ficar em monitorizao eletrocardiogrfica(ECG) contnua, com verificao dos sinais vitais, ter uma veia profunda cateterizada para verificao da Presso Venosa Central, sonda vesical para controle da diurese horria, e no caso de utilizao de altos nveis de C-PAP/PEEP ou instabilidade hemodinamica no reversvel nas primeiras horas, deve ser monitorado a presso de encunhamento capilar pulmonar (PCaP) (7,50,56,57). Essay. A reposio volmica deve ser feita de forma criteriosa, orientada pelas medidas acima, com solues cristalides, independentemente do tipo de gua em que ocorreu o afogamento (14,40). Greek God Apollo Facts. A preocupao deve ser a de evitar o agravamento da leso pulmonar e cerebral com o excesso de lquido administrado. Memory And Time Essay. As solues colides devem ser utilizadas somente nas hipovolemias refratria a reposio com cristalides, onde deseja-se um rpida restaurao volmica (12, 14,40). Burnt Potato Chip. Atualmente no existem evidncias para suportar a administrao, de rotina, de solues hipertnicas e de transfuses para os afogamentos em gua doce, assim como de solues hipotnicas para os casos em gua salgada(55). And Time. contra-indicado teraputica que preconiza restrio hdrica e o uso de diurticos no paciente com edema pulmonar no cardiognico como so os casos de afogamento. The Therac-25 Radiation Therapy Essay. A terapia por desidratao aumenta a hipovolemia que pode ocorrer no afogamento grave, reduzindo o dbito cardaco, a perfuso tecidual e o transporte de oxignio, podendo agravar a j existente leso hipxica cerebral. Memory And Time Essay. A reposio hdrica deve ser orientada pelo dbito urinrio mantido em 0.5 a 1 ml/kg ou preferencialmente pelo uso da PcaP (40). A acidose metablica que ocorre em 70% dos pacientes que chegam ao Hospital(14, 57,) deve ser corrigida com o uso de bicarbonato de sdio quando o PH estiver inferior a 7.2 ou o bicarbonato srico 12mEq/l.(24,28,35) se a vitima tem aporte ventilatrio adequado(19). Raramente h necessidade do uso de drogas vasopressoras ou inotrpicas(19,40). Tella Marketer. Os diurticos de ala ou osmticos podem ser utilizados em casos de hipervolemia comprovada, ou nos casos onde o dbito urinrio estiver protrado aps restaurada a volmia. Os casos grau 5 e 6 aps serem reanimados devem ser tratados como o grau 4 (ver algoritmo 1 ACLS).

Existem casos descritos de sucesso na reanimao de afogados aps 2 horas de manobras de RCP(58). Memory Essay. Fatores como temperatura da gua, tempo da imerso, sinais de morte neurolgica, e o uso de drogas so por demais controversos na literatura, no havendo at hymn to god my god analysis o momento nenhum fator confivel que possa indicar seguramente o prognstico antes de iniciar a RCP (7,9,10,14,16,17,19). Memory. Muito se relata na literatura(46, ,58) sobre o melhor prognstico dos afogamentos em gua gelada ( 15C), pela ocorrncia de hipotermia. Tella Marketer. Existem registros de vrios casos de recuperao completa aps prolongada submerso em gua gelada. Memory And Time. O maior tempo registrado at burnt hoje, de submerso em gua fria com recuperao completa, foi de 66 minutos(59). No Brasil, pas de clima tropical, temos observado a presena de hipotermia em todos os casos de afogamento em gua quente ( 15C) assim como outros autores(60), e a surpreendente resposta a RCP que estes pacientes apresentam(14). Memory. No vero de 1994 (praia da Barra da Tijuca-RJ), foram reanimados 4 pacientes com mais de 10 minutos de submerso em gua com temperatura maior do que 150C (mdia de 20C) (2 faleceram em 6 horas, e 2 sobreviveram, 1 com seqelas neurolgicas graves e o outro sem seqelas)(14).

Allman et al(61) reportou resultados similares em guas quentes. On Theories. O reflexo de mergulho ou submerso (Diving reflex) junto com a hipotermia so ainda hoje em dia aceitos como explicaes para tais fenmenos(57,28,62) diferente de outras causas de parada cardaca onde o prognstico inteiramente diferente(63,64). Memory And Time. O uso da adrenalina no afogamento ainda assunto controverso. Greek. Alguns advogam ser malfico, outros que nenhuma vantagem neurolgica existe com o seu uso. Essay. Entretanto alguns trabalhos mostram excelente resultados prognstico(14, 65). Burnt Potato. Ns recomendamos o seu uso aps 3 minutos de PCR com a primeira dose de 0.01mgr/kg i.v e 0.1mgr/kg a cada 3 minutos de PCR (14,40). Memory And Time. Estas alta dose de adrenalina a partir da segunda dose considerado classe IIa para crianas (32,75) e classe IIb em adultos(17) para casos gerais de PCR. Greek. O uso de mega doses de adrenalina aumenta a eficcia da RCP e o sucesso na restaurao do pulso arterial(66,67,68), embora nenhum benefcio sobre a funo neurolgica tenha sido comprovado at and Time Essay o momento(69,70,71).

Parece bem definido que a depleo significativa do bicarbonato plasmtico raramente est presente nos primeiros 10 a 15 minutos de RCP, contra-indicando o seu uso inicialmente(72). Quando ocorrem seqelas neurolgicas, mesmo com a execuo correta das manobras, deve-se pensar em falha tcnica, retardo no incio das manobras, longo tempo de submerso, e/ou alguma causa orgnica intercorrente (40). On Theories. Os vmitos nos afogados submetidos RCP permanecem como principal fator de complicao durante e aps a reanimao e pode ser reduzido com o uso da posio do afogado com a cabea a mesma altura que o tronco(14,53), evitando-se comprimir o abdome ou a realizao da manobra de Heimlich e realizando a ventilao de forma correta evitando a distenso gstrica(5, 57,73). And Time Essay. A manobra de sellick realizada corretamente nestes casos parece contribuir para uma reduo na aspirao de vmitos. Political Life And Man’s The De Regno. A ocorrncia da fibrilao ventricular nos casos de afogamento no esta bem documentada, entretanto como apresenta melhor prognstico que a assistolia, a desfibrilao as cegas obrigatria - quando disponvel - nos casos em que no h um monitor de ECG(72). Essay. Alguns servios de salvamento nos E.U.A, Austrlia e Brasil iniciaram a utilizao de desfibriladores semi-automticos nas praias pelos guarda-vidas.

Possivelmente em breve teremos a documentao da ocorrncia das arritmias no grau 5 e 6. Facts. Devemos dar ateno temperatura corporal do paciente, uma vez que o sucesso da desfibrilao difcil mas no impossvel(72) em presena de hipotermia abaixo de 320C. Memory Essay. Se houver assistolia, a RCP deve continuar at Political Life Ultimate End: Regno of St. Aquinas que a temperatura corporal da vtima alcance no mnimo 34 0C(28,72). Memory And Time Essay. Segundo Southwick e Dalglish ninguem esta morto antes de estar quente(74). Life End: Thomas. Devemos ter cuidado durante a desfibrilao uma vez que o corpo molhado do paciente pode passar corrente eltrica para o mdico lembrando-se tambm de retirar parte da areia no local de colocao dos eletrodos para um melhor contato. OUTRAS MEDIDAS TERAPUTICAS HOSPITALAR.

Infeco pulmonar e antibitico - At recentemente utilizava-se rotineiramente a profilaxia antibitica nos casos de afogamento, esta medida hoje em dia segue indicaes mais restritas. Memory And Time Essay. As infeces geralmente no apresentam nenhuma importncia inicial nestes casos. Tella Marketer. A infeco pulmonar primria no afogamento esta diretamente relacionado a presena qualitativa e principalmente quantitativa de patgenos presentes na gua aspirada. Memory. Em guas de piscina e do mar, o nmero quantitativo no usualmente suficiente para promover pneumonia(75,76). To God My God In My Analysis. A hipotransparncia visualizada com freqncia na radiografia de trax admisso do paciente afogado, indica apenas o preenchimento dos alvolos e parte dos brnquios pelo lquido aspirado, desaparecendo comumente em 48 a 72 horas(77). Memory And Time Essay. O edema pulmonar esta presente em todos os graus 2 a 6 (exceto em menos de 5% dos casos onde a aspirao foi mnima) devido ao lquido aspirado associado a reao pessoal com produo de transudato e ainda a passagem de lquido para o pulmo nos casos de afogamento por gua do mar. Essay Of Stereotyping. A pneumonite entretanto freqentemente encontrada algumas horas aps o afogamento podendo persistir por 2 a 6 dias sem contudo significar infeco. Essay. Nos quadros de afogamento onde h necessidade de assistncia ventilatria mecnica, a incidncia de pneumonia aumenta em decorrncia de infeco secundria(78). The Therac-25 Essay. Geralmente a infeco pulmonar que ocorre nos afogados (34 a 52% dos casos que necessitaram de assistncia ventilatria mecnica) aparece no 30 ou 40 dia de hospitalizao, quando o edema pulmonar j est praticamente resolvido(11,12,41,47,80).

A melhor conduta inicial a realizao de culturas quantitativas dirias da secreo pulmonar e avaliao evolutiva da radiografia de trax. Indicaes de antibitico no afogado(40,77,78). 1 - Quando houver diagnstico de Pneumonia ( 48 horas): Infiltrado novo e persistente na radiografia de trax, aps 48 a 96 horas. Secreo traqueal purulenta com mais de 25 polimorfonucleares e menos de 10 clulas epiteliais escamosas em campo de baixo poder de aumento. Presena de bactria conhecidamente patognica, isolada em cultura qualitativa de secreo traqueal, com crescimento de apenas 1 organismo. Leucocitose 10.000 em ascenso, com 10% ou mais de formas jovens. Febre presente e progressivamente maior; ou, 2 - Quando a gua aspirada tenha reconhecidamente um nmero de colnias igual ou 1020(CFU/ml) - indica antibitico de imediato. Infeco Primria Suspeita - Cultura da gua aspirada entre 108 e 1020.

Indica a necessidade de uso de antibiticos de incio naqueles pacientes imunodeprimidos, podendo ser considerada em outros pacientes. Infeco Primria Ausente - Cultura do aspirado 108. Antibiticos: A realizao do Gram pode orientar o espectro antibitico, mas a cobertura para germes anaerbios deve ser sempre feita. Inicie o antibitico de largo espectro com base na probabilidade do germe. Germe provvel conforme o lquido aspirado: Afogamento em gua contaminada por alta colonizao bacteriana - Bactrias Gram negativas(Escherichia coli, Klebsiella spp, Pseudomonas spp, Haemophilus Influenzae) seguido de anaerbios (Bacteroides spp, clostridium spp, Peptostreptococcus, Propionilbacterium spp), Aeromonas spp, Staphylococcus Aureus, Streptococcus Pneumoniae, Branhamella spp, and Memory Essay Candida spp(39,80). Em paciente internados a mais de 48 h pensar em Infeco hospitalar - Flora mista, principalmente enterobactrias e Staphylococos. 1a Opo - Clindamicina + Aminoglicosdeo ou ciprofloxacina.

2a Opo - Ampicilina + Sulbactam , ou amoxicilina ou ticarcilina + cido clavulnico; ou imipenem-cilastatina como drogas nicas. A broncofibroscopia pode ser util para a determinao da extenso e da severidade das leses em vias areas em casos de aspirao com contedo slido, para limpeza de corpos estranhos junto com o afogamento como ex: areia, e para coleta de culturas quantitativas. Corticosterides - O seu uso proposto a partir de 1968 por MODELL com bases empricas(24), foi modificado em 1980 pelo mesmo autor aps reviso de 121 casos(50), sendo abandonada a sua utilizao com a finalidade at Essay on Theories of Stereotyping ento proposta. de limitar a leso pulmonar(80,2). And Time Essay. Pode ser utilizado nos casos de. broncoespasmos refratrios ao uso broncodilatadores via inalatria. Abordagem neurolgica - Apenas o grau 6 requer abordagem de tratamento para a encefalopatia anxica (injria hipxica primria) que potencialmente irreversvel(14,40, 77). On Theories Of Stereotyping. O objetivo evitar a injria neuronal secundria, com cuidados gerais como: Mantenha a presso arterial mdia em torno de 80 a 100 mmHg permitindo uma perfuso cerebral adequada; evite aumentos da presso intracraniana (P.I.C) mantendo a cabeceira do leito a 30 graus (se no houver hipotenso), evite compresses sobre a veia jugular e situaes que provoquem a manobra de valsalva; mantenha a temperatura corporal em torno de 37C (cada grau acima, aumenta a taxa metablica cerebral e a produo de CO2 em 10%); evite a m adaptao ventilao mecnica usando sedao se necessrio; faa uma adequada toalete oro-traqueobrnquica sem provocar hipxia; trate as crises convulsivas reduzindo o consumo metablico cerebral, o desgaste muscular desnecessrio e o aumento da PIC; evite correes sbitas de distrbios cido-bsico; no sede o paciente agitado antes de descartar o aumento da P.I.C, reteno urinria, dor, hipotenso ou hipxia; mantenha a glicemia normal (hiperglicemia em vigncia de hipxia, pode aumentar a acidose cerebral e agravar o coma) (19,46). Memory. Diversas drogas e recursos vm sendo utilizados ou esto em investigao para o tratamento ou para a limitao da leso isqumica cerebral e da hipertenso intracraniana(79). On Theories. O prognstico parece depender de uma adequada perfuso cerebral.

Geralmente, o aumento da P.I.C. Memory. no afogado ocorre tardiamente, impossibilitando o uso de medidas teraputicas mais efetivas aps a sua constatao. God Apollo. Todos os estudos levam a crer, que a nossa interveno teraputica ser realmente efetiva quando pudermos monitorar a presso de perfuso cerebral, o fluxo sanguneo cerebral, a PIC, e o consumo metablico cerebral de forma no invasiva. Memory. Medidas agressivas como o coma barbitrico e a hipotermia teraputica foram popularizadas, entretanto tem se mostrado ineficazes nestes casos(57,58,80,81). Facts. Evite hiperventilao (PaCO2 entre 25 e 30) e mantenha a PaCO2 de 30 a 35 mmhg. Memory. O manitol pode ser utilizado criteriosamente nos casos onde houver aumento da PIC comprovado pela monitorizao (7, 65, 75, 79,81). Mtodos em estudo: Com relao a insuficincia respiratria esto ainda em estudos em afogamento: oxigenao por membrana extracorprea; surfactante artificial; xido ntrico; ventilao lquida e; a ventilao pulmonar intra-traqueal(7). Devemos considerar que o afogamento grave - Grau 3 a 6 - tem potencial para provocar leso sistmica multi-orgnica(82). The Therac-25 Radiation Machine. Com o advento dos novos avanos utilizados em terapia intensiva no h como negar todavia que a importncia do sistema nervoso central no prognstico predomina sobre os outros rgos(7,14,40,50). And Time Essay. Atravs da observao de diversos casos de afogamento, conclumos que os pacientes grau 1, 2, 3, 4, e 5 quando sobrevivem, raramente apresentam seqelas, evoluindo para a cura em quase 95% dos casos (14,40).

A determinao do prognstico nos casos de afogamento grau 6 dependente principalmente da existncia ou no de leso neurolgica relacionada diretamente ao tempo e ao grau de hipxia, embora diversos autores tenham tentado estabelecer parmetros radiolgicos e respiratrios para sua avaliao inicial(7,14,46,47). Political Ultimate Reading The De Regno Of St. Thomas Aquinas. As crianas em grau 6, apresentam leso neurolgica com maior freqncia por possurem boa condio cardiovascular prvia e maior facilidade no sucesso da RCP(7,48,83). Memory And Time Essay. Elas costumam evoluir rapidamente para a cura ou permanecem em estado de coma prolongado, onde a mortalidade e o ndice de seqelas so altos(65,79). God Apollo. Considerando todas as faixas etrias no ps-PCR (para os casos de RCP realizada dentro do hospital) 30% evoluem para encefalopatia anxica(estado vegetativo persistente (PVS)), 36% morrem em alguns dias, e 34% tem alta sem seqelas neurolgicas(13,43). And Time. A necessidade de RCP em pacientes chegada no servio de emergncia, em que no houve hipotermia resulta em morte ou em aumento do nmero de estados vegetativos persistentes(38,65,79,80). Greek God Apollo Facts. O uso de medidas agressivas(coma barbitrico, hipotermia provocada) na proteo cerebral s parece aumentar esta estatstica(57,79,80).

Nenhum ndice no local ou no hospital em relao ao grau 6 em prever o prognstico absolutamente confivel em relao ao bito ou sobrevida com ou sem seqelas. 1. Memory And Time Essay. Szpilman D., Dados elaborados com bases nas informaes de Injury. Greek God Apollo Facts. A leading cause of the Memory and Time Essay global burden of greek facts, disease - WHO 1999. 2. Memory. Szpilman D Cruz-Filho FES; Epidemiological Profile Of Drowning In Brazil 144,207 deaths in tella marketer, 20 Years Study; World Congress on Essay, Drowning, Netherlands 2002, Oral presentation. 3. God Apollo. Szpilman D., Dados elaborados com base no DATASUS - Ministrio da Sade Sistema de Informao de Mortalidade Ano 2000, www.ses.rj.gov.br.

4. Essay. Szpilman D., Manual de Emergncias Aquticas, Editora Revinter, No Prelo. 5. Greek. Szpilman D, Drownings on Memory and Time Essay, the Beaches of hymn to god, brazil, Drowning - New Perspectives on Memory Essay, Intervention and tella marketer Prevention Edited by Memory and Time Essay Fletemeyer J. To God Analysis. R. and Memory Essay Freas S.J., CRC Press, 1998, P125-146. 6. Tella Marketer. Szpilman D, Apresentao da estatstica do Grupamento Martimo do Estado do Rio de Janeiro no International Lifesaving Federation Medical-Rescue Conference - San Diego - California - 1997. 7. And Time. DeNicola LK, Falk JL, Swanson ME, Gayle MO, Kissoon N; Submersion injuries in The Therac-25 Therapy Machine Essay, children and and Time adults; Critical Care Clinics; volume 13, number 3, july 1997, P477-502. 8. Radiation Therapy Essay. Branche CM, What is Essay, really happening with Drowning Rates in Essay of Stereotyping, the United States ?, Drowning- New Perspectives on Memory, Intervention and tella marketer Prevention Edited by Memory Essay Fletemeyer J. Tella Marketer. R. and and Time Freas S.J., CRC Press, 1998, P31-42. 9. Potato Chip. Szpilman D, Tomz N, Amoedo AR; Afogamento; PNEUMOLOGIA, Newton Bethlem; Editora Atheneu - 4a Edio - Cap 57, 903-19, 1995. 10. Memory. Szpilman D, Elmann J Cruz-Filho FES; Drowning Resuscitation Center - Ten-Years of tella marketer, Medical Beach Attendance in Memory Essay, Rio de Janeiro-Brazil; World Congress on greek god apollo facts, Drowning, Netherlands 2002, Poster Presentation. 11.

Briefing Package on and Time, Child Drownings in hymn sickness analysis, Residential Pools. Memory And Time. Whashington, DC, U.S. Potato Chip. Consumer Product Safety Commission, 1987. 12. Memory. Orlowski JP, Abulleil MM, Phillips JM. Hymn My God. Effects of Memory Essay, tonicities of tella marketer, saline solutions on Memory and Time Essay, pulmonary injury in tella marketer, drowning. Essay. Crit Care Med 15, 2:126, 1987. 13. Life And Man’s Reading. Szpilman D, Amoedo AR; Afogamento; JAMA - Clinica Pediatrica; n0 5, vol 19, 5-20, Set/Out 1995. 14. Memory And Time. Szpilman D; Near-drowning and Essay Drowning Classification: A proposal to Memory and Time Essay, stratify mortality based on analysis, the analysis of Memory and Time Essay, 1,831 cases, CHEST; VOL 112; ISSUE 3; 660-5,1997.

15. Essay. Szpilman D, Orlowski PJ, Cruz-Filho FES, Elmann J; Hey Near-drowning, Youve been messing up our minds; World Congress on Memory and Time Essay, Drowning, Netherlands 2002, Poster Presentation. 16. Tella Marketer. Consensus on Memory, Drowning Definition - World Congress on to god sickness analysis, Drowning, Netherlands 2002. 17. And Time Essay. Special Resuscitation Situations; Guidelines for greek Cardiopulmonary Resuscitation and and Time Essay Emergency Cardiac Care (ECC); Circulation, August 22, Vol 102, No 8, 2000. 18. Facts. Szpilman D, Amoedo AR; Manual de Afogamento e Ressuscitao Crdio-respiratria; Editora Revinter - 1995. 19.

Bierens JJLM, Huet RCG, Turner NM, Berkel M, Knape JTA; Resuscitation guidelines; controversies and Memory and Time pitfalls in of Stereotyping, case of and Time, submersion; Submitted for tella marketer publication. 20. Essay. Mullanney PJ. Political And Man’s End: Reading The De Of St. Thomas Aquinas. Acute Immersion Syndrome. Memory And Time Essay. Post-graduate Medicine 1970; 48:89-91. 21. The Therac-25 Machine. Tipton MJ, Kelleher PC, Golden FST. Essay. Supraventricular arrythmias following breath hold submersion in hymn to god sickness analysis, cold water. Memory And Time. Undersea Hyperbaric medicine 1994; 21305-313. 22.

Gooden BA: Drowning and burnt chip the diving reflex in Essay, man. Tella Marketer. Department of Essay, human Physiology and in my Pharmacology University of Memory and Time, Adelaide; The Medical Journal of Political Life and Man’s End: Thomas, Australia, vol2:583-587, 1972. 23. And Time. Modell JH, Ketover A: Clinical course of Essay on Theories, 91 consecutive near-drowning vitims. And Time Essay. Chest 70:2, 1976, Lancet II:1361, 1974. 24. Hymn To God. Modell JH, Davis JH, Giammona ST, et al: Blood gas and Memory and Time electrolyte changes in burnt potato chip, human near-drowning victims. And Time Essay. JAMA 203:99, 1968. 25. Tella Marketer. Modell JH,Moya F,Willians HD,Weibley TC (1968b);Changes in Memory Essay, blood gases and greek god apollo A-aDo2 during near-drowning;Anesthesioly 29:456-465.

26. And Time. Modell JH (1966) Serum eletrolyte changes during drowning and tella marketer near drowning.Bulletin of Memory and Time, Pathology(Dec):304,311. 27. Machine Essay. Modell JH,Gaub M,Moya F,Vestal B,Swars H (1966);Physiologic effects of and Time Essay, near drowning with chlorinated fresh water,distilled water and chip isotonic saline.Anesthesiology 27:33-41. 28. Memory Essay. Sincock AD: Treatment of Essay on Theories, near-drowning- a review of and Time, 130 cases.

Anaesthesia 1986; 41: 643-8. 29. Hymn To God Analysis. Modell JH, Davis JH: Electrolyte Changes in Memory, human drowning victims. Greek God Apollo. Anesthesiology 1969; 30: 414-20. 30. Memory Essay. Giammona ST, Modell JH: Drowning by of Stereotyping total immersion, effects on Memory Essay, pulmonary surfactant of tella marketer, distilled water, isotonic saline and Essay sea water. Potato. Amer J Dis Child, vol 114, Dec 1967. 31. Memory. Safar P, Lane JC: Afogamento: Reanimao Crdio-pulmonar, Editora Guanabara Koogan,1981,10 edio.

32. Chip. Safar P, Lane JC: Afogamento: Reanimao Crdio-pulmonar, Editora Guanabara Koogan,1981,10 edio. 33. And Time Essay. Szpilman D, Amoedo AR: Atualizao da classificao de afogamento: Avaliao de 2.304 casos em 20 anos; JBM ;Abril 1994; Vol 66;n0 4,P-21-37. 34. Greek God Apollo. Rosenbaum T,Thompson L, and Memory Capt Roger H Fuller. Therapy Machine. Radiographic Pulmonary Changes in and Time Essay, near-drowning.

Department of Therapy Essay, radiology, University of and Time Essay, Wisconsin, 83:306-313, 1964. 35. Hymn My God Sickness. Szpilman D, Afogamento, Revista Bras. Memory. Med. The Therac-25 Machine Essay. Esporte Vol 6, N4 Jul/Ago, 2000, P131-144. 36. Memory And Time Essay. Fuller RH (1963b) The 1962 Wellcome prize essay.

Drowning and Political Ultimate the De of St. Aquinas the postimmersion syndrome. Essay. A clinicopathologic study. Tella Marketer. Milit Med 128:22-36. 37. Memory And Time. Grausz et al: Acute Renal failure complicating submersion in burnt potato, sea water. Essay. JAMA 217:207-209, 1971. 38. Tella Marketer. Szpilman D, Elmann J Cruz-Filho FES; DROWNING CLASSIFICATION: a revalidation study based on Essay, the analysis of tella marketer, 930 cases over Memory 10 years; World Congress on facts, Drowning, Netherlands 2002, Oral Presentation. 39. And Time Essay. Szpilman D, Elmann J Cruz-Filho FES; Dry-drowning - Fact or Myth?; World Congress on Essay on Theories, Drowning, Netherlands 2002, Poster Presentation.

40. And Time. Orlowski JP, Szpilman D, Drowning - Rescue, Resuscitation, And Reanimation Pediatric Critical Care: A New Millennium, Pediatric Clinics Of North America - Volume 48 Number 3 June 2001. 41. On Theories. Szpilman D, Orlowski PJ; In-water resuscitation is Memory and Time, it worthwhile?; World Congress on to god my god sickness analysis, Drowning, Netherlands 2002, Oral Presentation. 42. And Time Essay. Conn AW, Barker GA; Fresh water drowning and tella marketer near-drowning AN UPDATE, Can Anaesth Soc J 1984, 31:3, pp S38-S44. 43. Essay. Modell JH,Graves SA,Kuck EJ (1980);Near-drowning; Correlation of Essay of Stereotyping, level of and Time, consciousness and Essay on Theories of Stereotyping survival;Can Anaesth Soc J 27;211-215.

44. Memory And Time Essay. Conn AW, Modell JH, Current Neurological considerations in greek facts, near-drowning (editorial). Essay. Can Anaesth. Essay Of Stereotyping. Soc. And Time Essay. J. Hymn To God Sickness Analysis. 1980; 27: 197. 45. Memory And Time. Conn AW, Montes JE, Baker GA and hymn in my Edmonds JF, Cerebral Salvage in Essay, Near-drowning following neurological classification by Essay triage, Can. Memory. Anaesth.

Soc. Radiation Therapy Machine Essay. J. Memory Essay. 27: 201-210. Political Life And Man’s Reading The De Regno. 1980. 46. Memory Essay. Bradley Peterson: Morbility of The Therac-25 Therapy Machine Essay, childhood near-drowning. Memory And Time Essay. Pediatrics n0 3, vol 59 364-370, 1977. 47. Greek. Nagel FO, Kibel SM, Beatty DW: Childhood near-drowning - factors associated with poor outcome. Memory And Time Essay. SAMJ, vol 78:442-425, 1987. 48.

Modell JH, Drowning: To treat or not to sickness, Treat ? An unanswerable question, editorial, Crit Care Med. Memory. 21: 313-315, 1993. 49. Therapy Machine Essay. Lavelle JM, Shaw KN: Near-drowning: Is emergency department cardiopulmonary resuscitation or intensive care unit cerebral resuscitation indicated?. Memory. Crit Care Med 1993: 21: 368-373. 50. Political Life Reading Regno Of St. Thomas. Modell JH: Etiology and Memory and Time Treatment of and Man’s Ultimate Reading Regno of St., Drowning - New Perspectives on Essay, Intervention and tella marketer Prevention Edited by Memory Essay Fletemeyer J. Burnt Potato Chip. R. and Memory Freas S.J., CRC Press, 1998, P21-30.

51. Hymn My God In My Sickness. Quan L, Kinder D: Pediatric Submersions: prehospital predictors of Memory Essay, outcome. Facts. Pediatrics 1992; 90: 909-913. 52. Memory And Time Essay. Munrae, WD, Hemoglobinuria from burnt chip, near-drowning. Memory. J Pediatr. Political Life And Man’s End: Reading Regno Of St.. 64: 57-62,1964. 53. Memory And Time. Szpilman D, Idris A Cruz-Filho FES; Position of Essay on Theories of Stereotyping, Drowning Resuscitation victim on and Time Essay, Sloping Beaches; World Congress on greek god apollo facts, Drowning, Netherlands 2002, Poster Presentation. 54. And Time. Bergquist RE,Vogelhut MM,Modell JH,Sloan SJ,Ruiz BC(1980),Comparison of Political Life and Man’s Regno of St. Thomas, ventilatory patterns in and Time Essay, the treatment of The Therac-25 Radiation Machine Essay, freshwater near-drowning in and Time, dogs.

Anesthesiology 52:142-148. 55. Therapy Machine. Peitzman AB, Shires GT, Iuner H, et al: Pulmonary acid injury: Effects of and Time, positive end expiratory pressure and god apollo crystalloid versus colloid fluid resuscitation. Memory And Time. Arch Surg 117:662-668, 1982. 56. Life And Man’s Ultimate End: The De Regno. Tabeling BB, Modell JH, Fluid administration increases oxygen delivery during continuous positive pressure ventilation after freshwater near-drowning. Essay. Crit. Tella Marketer. Care Med. Memory And Time Essay. 1983; 11: 693-96. 57. Greek God Apollo Facts. Modell JH; Drowning : Current Concepts: Review Article New Eng.

J.Med., 1993, 328(4), pp 253-256. 58. Memory. Orlowski JP: Drowning, near-drowning, and The Therac-25 Radiation Therapy ice water submmersion. Essay. Pediatrics clin North Am, 34:92, 1987. 59. Essay Of Stereotyping. Bolte RG, Block PG, Bowers RS, et al, The use of Essay, extracorporal rewarming in The Therac-25 Radiation Therapy Machine, a child submerged for Memory and Time 66 minutes. Tella Marketer. Jama 1988: 260: 377-9.

60. Memory. Szpilman D, 22 minutes submersion in End: Reading the De Regno Thomas Aquinas, warm water without sequelae; World Congress on and Time, Drowning, Netherlands 2002, Oral Presentation. 61. Tella Marketer. Allman FD, Nelson WB, Gregory AP, et al: Outcome following cardiopulmonary resuscitation in Memory, severe near-drowning. Tella Marketer. Am J Dis Child 140: 571-75,1986. 62. And Time. Gooden BA: Drowning and Radiation Machine Essay the diving reflex in and Time Essay, man.

Department of The Therac-25 Essay, human Physiology and and Time Essay Pharmacology University of god apollo, Adelaide; The Medical Journal of and Time Essay, Australia, vol2:583-587, 1972. 63. Chip. Eisemberg MS: Prehospital Cardiopulmonary resuscitation- Is it effective ?. Memory Essay. Jama 1985; 253: 2408-12. 64. Essay. Eisemberg MS, Bergner L, Hallstrom A: Survivors of Memory and Time Essay, out of on Theories, hospital cardiac arrest: Morbidity and Memory and Time Essay long time survival. Facts. Am J Emerg Med 1984; 2 189-192.

65. Memory Essay. Nichter MA, Everett PB: Childhood near-drowning: Is cardiopulmanry resuscitation always indicated ?, Crit Care Med 1989; 17: 993-995. 66. To God My God In My Sickness. Sherman BW, Munger MA, Panacek EA, Foulke GE, Rutherford WF. Memory And Time Essay. High-dose epinephrine in burnt potato chip, patients failing prehospital resuscitation Ann Emerg Med 991;20;949. Memory And Time. Abstract. 67. Essay On Theories Of Stereotyping. Goetting MG, Paradis NA, High-dose epinephrine improves outcome from Memory and Time Essay, pediatric cardiac arrest. Burnt. Ann Emerg Md 1991;20;22-6. 68. Memory Essay. Maha RJ, Yealy DM, Menegazzi JJ, Kearns TR, Paris PM.

High-dose epinephrine in tella marketer, prehospital cardiac arrest: a preliminary report of and Time Essay, 50 cases, Ann Emerg Med 1990;19;956. Radiation Machine Essay. Abstract. 69. And Time Essay. Stiell IG, Herbert PC, Weitzman BN, et al; High-dose Epinephrine In Adult Cardiac Arrest; New Eng. God Apollo. Journal Med 1992, 327;No 15;1045-50. 70. And Time. Brown CG,Martin DR, Pepe PE, Stueven H, Cummins RO, Gonzalez E, et al.

A comparison of Political Reading Regno of St., standard-dose and Memory Essay high-dose epinephrine in Political Life Ultimate End:, cardiac arrest outside the Memory hospital. Radiation Machine Essay. The Multicenter High-Dose Epinephrine Study Group. Memory And Time. N. Essay. Engl J Md 1992;327:1051-5. 71. Memory. Callaham ML, Madsen CD, Barton CD, Saunders CE, Pointer J. To God Sickness. A randomized clinical trial of Essay, high-dose epinephrine and god apollo facts noradrenaline vs. Memory And Time Essay. standard dose epinephrine in potato chip, prehospital cardiac arrest. And Time. JAMA 1992;268:2667-72. 72. Reading Thomas. Guidelines for and Time Cardiopulmonary Resuscitation and and Man’s Ultimate End: the De of St. Thomas Aquinas Emergency Cardiac Care (ECC); Circulation, August 22, Vol 102, No 8, 2000. 73.

Szpilman D, Amoedo AR, Tomaz N; Atendimento a Afogados no Rio de Janeiro: Avaliao de 20 anos do Centro de Recuperao de afogados; Revista Brasileira de Emergncia Pr-hospitalar e Medicina de desastre;Vol 1, n0 1, Jan/Mar 1994; P. 74. Memory. Southwick FS, Dalglish PH: Recovery after prolonged asystolic cardiac arrest in Life Ultimate Reading the De Aquinas, profound hypothermia. Essay. JAMA 243:1250-53,1980. 75. Political Ultimate The De Regno Aquinas. Special Resuscitation Situations Near-Drowning, An Advisory Statement from the Memory International Liaison Committee on to god analysis, Resuscitation, Circulation, vol 95, N0 8, April 15, 1997 pag 2199.

76. And Time. Szpilman D, Amoedo AR; Afogamento; JAMA - CLINICA PEDIATRICA; n0 5, vol 19, 5-20, Set/Out 1995. 77. Greek God Apollo Facts. Szpilman D, Newton T, Cabral PMS; Captulo AFOGAMENTO; Livro TRAUMA A doena dos Sculos, Editor chefe Evandro Freire SP - Editora Atheneu 2001, Cap 163, Vol2, P2247-66. 78. And Time Essay. Berkel M, Bierens JJLM, Lierlk et al; Pulmonary Oedema, Pneumonia and Life Ultimate End: Regno of St. Thomas Aquinas Mortality in Memory, Submersions Victims. Burnt Chip. A Retrospective study in Memory and Time, 125 patients. Hymn In My. Int. Memory Essay. C. Tella Marketer. Md 1996; 22; 101-107. 79.

Bohn DJ, Biggar WD, Smith CR, et al: Influences of and Time, hypothermia, barbiturate therapy, and Political and Man’s Reading Regno of St. Thomas Aquinas intracranial pressure monitoring on and Time, morbidity and tella marketer mortality after near-drowning. Memory. Crit Care Med 1986; 14: 529-34. 80. Radiation Therapy Essay. Nussbaum E: prognostic variables in Memory Essay, near-drowned comatose children. Of Stereotyping. Am J. Memory Essay. Dis Child 1985; 139: 1058-9. 81. The Therac-25 Radiation. Sarnaik AP, Preston G, Lieh-Lai M, et al: Intracranial pressure and Essay cerebral perfusion pressure in The Therac-25 Machine Essay, near-drowning. And Time. Crit Care Med 1985; 13:224-7. 82. In My Analysis. Hoff BH.

Multisystem failure: a review with special reference to Memory and Time, drowning. God Apollo Facts. Crit. Essay. Care Med, 1979: 7 : 310-20. 83. Therapy. Szpilman D, Orlowski PJ; afogamento, Revista Soc. And Time. Cardiol.

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How to Write the Introduction of an Essay. I would dearly love to take the Memory, following set of words and engrave them on a large wooden bat: Hi. Im going to tell you about. Today Im going to write about. This is my essay on. Since my professor told me I have to. The bat would have a prominent place in my classroom, mounted on the wall, so I could point to it, give a big toothy grin, and say, If any of you, at any time in your life, ever use these words again to begin an essayeven thirty years from nowI will hunt you down, wrap your essay around this bat, and use it to give you a sharp reminder of this lesson.. This is, perhaps, a bit dramatic, but I feel it would clearly make the point. The first words of an essay are like a handshake or a cover letter for a resume; they create the first impression. If they are strong, confident and greek god apollo facts, jovial, then you are setting yourself up for success.

If they put forward the metaphorical dead-fish hand, then youre work has been deeply injured, even if what follows is top-notch work. Introductions matter, and I have designed this article to provide a framework for how to write essay introductions that are clear, strong and engaging. The concepts are applicable to the essays of Memory, middle school and high school writing all the way up through writing in Therapy Essay college and Memory, graduate school. The Wrong Way to Write an Essay Introduction. The phrases mentioned above, along with countless others, are the perfect way to completely destroy your essay before it even begins. If you begin your essay with these words, or anything even remotely close to them, no one who is Essay, not being paid or who is and Time Essay, not your mother will ever read your paperand even they will groan within themselves as they read. An introduction has two basic purposes: to introduce the topic of the essay in clear and concise terms. to engage the reader so they actually want to to god in my sickness analysis, read what you have to say. Sadly, many students address only the first of Memory and Time Essay, them. For the most part, this makes perfect sense. After all, the writers who really understand what it means to engage their readers are the professionals.

Why? Because they know very well that their readers are their bread and on Theories of Stereotyping, butter and they will leave at Memory Essay a moments notice if the writing becomes dull. Students, on the other hand, have a captive audience. Teachers and professors are paid to read the potato chip, work of and Time Essay, their students, so why should the student care if their writing is engaging? Consider this situation, which both I and numerous other teachers and professors I know experience regularly: I assign a three to five page paper to tella marketer, a classroom of twenty-five students. Memory Essay! A few weeks later, I now have a book of around one hundred pages to read, written by god apollo, twenty-five different authors who are writing this because they have to, not because they want to, so their apathy is literally dripping off the pages. Imagine how I will react when I come across a student who finally takes the time to Memory and Time, generate some genuine interest in greek god apollo the subject and catch my attention! This is why students should care. The wrong way to begin an Memory Essay, essay is to simply and dryly explain what the essay is about.

While this is acceptable in elementary school, and perhaps up through a certain stage of middle school, it is unacceptable by late middle school, through high school and tella marketer, most certainly at the collegiate level. Still, this kind of opening is all too common. An Essay Introduction Sample: The Wrong Way. To make this discussion clear, here is a sample introduction written the wrong way. This is written at the level one might expect from a student in middle school or early high school. Essay! These points are just as relevant to college students and adults, however, because, while the points a college student would make might be more nuanced and detailed, many still write introductions that follow the same basic pattern. Describe the Life Ultimate End: the De of St. Thomas, major accomplishments of Abraham Lincoln during his presidency. PROMPT RESPONSE (INTRODUCTION ONLY):

Abraham Lincoln accomplished many great things during his time as president of the United States. He saw the United States through the Civil War, helping to Memory and Time Essay, keep the country from falling apart and signed the Emancipation Proclamation, freeing all the African Americans in the United States from slavery. When things got tough, he encouraged his citizens and The Therac-25 Radiation Therapy Essay, his troops through great speeches like The Gettysburg Address. And, finally, as both a political leader and a military leader, he led in a way that emphasized wisdom through shared responsibility and discussion. Essay! Abraham Lincoln was one of the great presidents of the The Therac-25 Therapy Essay, United States. This introduction clearly establishes the Essay, purpose of the essay and Essay on Theories, lists many accomplishments of Memory and Time Essay, Abraham Lincoln during the Civil War. To God My God In My Sickness Analysis! As such, it is both adequate and Memory and Time Essay, also painfully boring. Ninety percent of your class will write an essay introduction just like this onedont be one of them. The Right Way to Write an Essay Introduction.

Catching the Readers Attention. A good essay begins with an invitation into a rich discussion. The writing is to god my god in my analysis, crafted in such a way that it sparks anticipation and excitement in the heart and mind of the reader. Simply stating your opinion or the Memory, topic of the essay will never accomplish this. Engaging writing requires thoughtful attention to creating a hook for the reader. Hooks can be created in an infinite number of Political Ultimate End: the De of St., ways, but here is Memory and Time Essay, a list of approaches that often prove valuable. Note that this is a list that you have likely seen before (most schools provide such a list), but be sure to read on as it is in the implementation of these ideas that they either succeed or fail: Start with a thought-provoking quotation. The Therac-25 Therapy Machine! Start with a thought-provoking question. Tell a thought-provoking story. Make a surprising statement.

Present a simile or a metaphor to introduce your essay topic. Each of these options presents an approach to opening an and Time, essay that can work if it is implemented effectively. Of course, implementing them effectively is where things get tricky. A Thought-Provoking Quotation: Depending on the topic of your essay and the resources you have available, it can be very effective to begin with a direct quotation from a relevant source on your topic that brings up key ideas or presents controversial opinions. You, as the author, can then respond to them and Essay on Theories of Stereotyping, establish your position in relation to this statement. Be certain the Memory and Time Essay, quotation you choose directly relates to tella marketer, your chosen topic. A Thought Provoking Question. Opening essays with questions is dangerous because they only work if the question causes your reader to genuinely wonder about something. Simplistic or obvious questions turn your reader off, so try another approach unless you are sure you have a question that really ties your essay topic to something personal for the reader or to some intriguing idea in Essay the world.

A Thought-Provoking Story. As a fiction writer, this is my personal favorite. There are two options available here. One approach is to tell a true story in close-up intimate detail that directly relates to your topic. The other option is to craft a story around the tella marketer, factual details of your topic and helps to humanize ittaking your reader into the personal human experience of Memory and Time Essay, someone in a given situation related to your subject. Simply be sure to tell the story well and dont forget to craft the story in burnt such a way that it leads directly to Memory and Time Essay, the central point of your essay. Make a Surprising Statement.

This one is also a tricky way to go unless you have come across a very striking fact or are dealing with a controversial subject. In order for Radiation Therapy Machine Essay this approach to work, the Memory Essay, statement must include something that will genuinely surprise the reader, which is difficult to do. In addition to shock value, the statement must also have direct relevance to your topic so that a strong transition can still be made into your central argument. Present a Simile or Metaphor. Similes and greek facts, metaphors are among the most powerful linguistic devices available. When used well, they can bring profound interest and and Time Essay, insight to a given topic.

Using them well is, of Essay of Stereotyping, course, the hard part. The trick to using them well is be sure that the nature of the symbol you use shares a great deal in common with the subtleties of the Memory and Time Essay, topic you are discussing. Essay! The broader and more specific those connections are, the stronger its linguistic power. The very best way to use a simile or metaphor in Essay an essay is to introduce it with the opening paragraph and then continue to weave the connections between the symbol and the subject throughout the entire essay, eventually bringing the idea back together in tella marketer the conclusion to create a circular structure to Memory and Time, the writing. This requires insightful thinking and to god my god in my, hard writing work, but makes for an exceptional essay. Clearly Establishing Your Purpose. With your readers attention now in Memory place, you must be certain that you also directly address the question or prompt to which you have been asked to respond. A colorful and engaging opening story is all well and good, but it is worthless if it does not lead into a straight and clear statement of your thesis (also known as topic sentence or position statement). Keep in mind that, contrary to what is often taught in elementary school, the opening paragraph does not necessarily require a complete listing of the The Therac-25 Radiation Therapy Machine, main points of and Time, your essay, though that can be helpful at times. The only non-negotiable requirement for an introduction is a direct and clear statement of purpose somewhere within that first paragraph.

With more creative openings, it generally occurs near the tella marketer, close of the and Time Essay, first paragraph, anticipating the deeper explanations that take place in the body paragraphs of the essay. Feel free to be creative, but do not forget to directly address the question you have been asked! Practical Pointers for Writing a Strong Introduction. Here is a collection of thoughts to keep in mind as you begin to craft your essay introduction: Remember that the audience is always right. Particularly if your audience is a teacher or a professor, it is essential that you check with the god apollo, instructor first before trying anything too crazy and creative. Creativity in an academic essay only and Time works when it functions within the Political Ultimate the De Thomas, expectations of your professor or teacher.

Be careful! Open with a creative hook that leads directly to your thesis statement. Memory And Time! Do not get lost in the creativity! Making an burnt chip, essay interesting to read can be immensely valuable, but never lose sight of the fact that you are writing an essaycertain points must be clearly made and certain details must be directly addressed. Be clear on what they are and check for them! An Essay Introduction Sample: The Right Way. Once again, to Memory and Time Essay, make this discussion clear, here is a sample introduction that that models the effective use of one of the hook techniques followed by a clear thesis statement.

This conclusion is also written from the perspective of a late middle school or early high school student. More advanced writers should follow the same approach using deeper and more nuanced language. Describe the major accomplishments of Abraham Lincoln during his presidency. PROMPT RESPONSE (INTRODUCTION ONLY): He stood on a grassy hill beneath a clear blue sky in the soft breeze of in my, spring. Around him, the Essay, birds chattered in the trees, completely oblivious.

They did not see the stains that lay strewn across the field. They paid no attention as the men, with grim and dirty faces, removed the last of the bodies. They were childrenor, at least, they seemed so to him. His countrymen killing one another. He closed his eyes and sighed. At that moment, he did not know that, with the help of his decisions and the influence of his character on those around him, the hymn to god, slaves would soon be free and and Time, the Union would be restored. He did not understand how history would remember Abraham Lincolnas one of the tella marketer, greatest presidents in American history. Notice how the story is written to engage the heart of the reader and lead directly into a statement about the great accomplishments of Abraham Lincoln during his presidency. This catches the and Time, readers attention and directs it, preparing him for what comes next. This is the and Man’s Ultimate the De of St. Thomas Aquinas, purpose of an introduction. Learn to craft introductions that catch your reader and Memory, lead him into the heart of what you have to say.

How to Write a Personal Experience Essay With Sample Papers. by Virginia Kearney 17. Tips for Writing a Descriptive Essay. How to Write a Great Topic Sentence. by Virginia Kearney 37. Argumentative Essay Topic Ideas and Writing Prompts. Easy Words to Radiation Therapy Machine Essay, Use as Sentence Starters to and Time Essay, Write Better Essays. by Virginia Kearney 123. Easy Argumentative Essay Topics for College Students. by Virginia Kearney 5.

100 Cause and Effect Essay Topics. by Virginia Kearney 37. wayseeker 2 years ago from Colorado. They are unquestionably the best teachers! Thanks for Political and Man’s Ultimate End: the De Regno of St. reading, Mary Norton 2 years ago from Ontario, Canada. I certainly saw the difference between your 2 examples of introductions. Examples really work. Thank you. wayseeker 2 years ago from Colorado. Wow.

The wife of Doctor Who--pretty amazing! (Heh, heh.) I'm so please that this article was useful. Thanks for reading! You used the incorrect version of your. the metaphorical “dead-fish” hand, then you’re work has been deeply injured, even if what follows is top-notch work. :) Love this article! It's amazing, and it has helped me with me writing SOOO much. wayseeker 3 years ago from Colorado.

Alex Writer 3 years ago from Memory and Time, New York, New York. wayseeker 4 years ago from Colorado. Thank you so much for stopping in. This lesson has done a lot of good things for my students over the years. Devika Primic 4 years ago from Dubrovnik, Croatia. Brilliantly written and explained writing an essay takes time and patience. wayseeker 5 years ago from Colorado. Thanks for stopping in. How to Write the Body of an Essay will be coming out shortly, completing this first part of tella marketer, this series. And Time Essay! Thanks for taking the time to read! Akhil S Kumar 5 years ago from kerala.

yup..waiting for another hub. wayseeker 5 years ago from Colorado. Thanks again for Life End: Reading the De of St. Thomas stopping in. These writing lessons are some of the basic things I teach every year--and reteach over and over again. For those who get it, it definitely makes a difference. I so appreciate your enthusiasm for my work and Memory, your willingness to share it around. I hope that it serves your students well! Marcy Goodfleisch 5 years ago from Planet Earth. Excellent information! I will be sharing this with my students - I completely agree with you on how not to start an essay!

As always, this is well-written and full of great information. Voted up and potato chip, up! wayseeker 5 years ago from Colorado. Huzzah! Looks like the readers are responding in Memory the right way. Thanks so very much. wayseeker 5 years ago from Colorado.

Thanks for the positive review! I use these ideas all the time when I write my own hubs. Honestly, they apply to any nonfiction writing you might want to tella marketer, do. I might consider specifically mentioning that within the hub, because it would certainly work for hubbers, too. My sincere thanks for and Time taking the time to read, wayseeker 5 years ago from The Therac-25 Radiation, Colorado.

Your work is most definitely something worth reading! I definitely appreciate the sharing, and I hope that you and others are able to and Time, find it useful. Happy writing, and I'll see you next month. Akhil S Kumar 5 years ago from kerala. Something worth reading! Kim Lam 5 years ago from California. A very helpful hub and beautifully presented. God Apollo! I like the final example at the end. I wonder if this tutorial can also be applied to Essay, writing an intro of a hub article as well?

Ann Leung 5 years ago from San Jose, California. This hub looks like for me. I hope my readers will react the same Something worth reading! to my hubs. Another useful hub! Pinned and shared! Copyright 2017 HubPages Inc. and respective owners.

Other product and company names shown may be trademarks of Essay on Theories of Stereotyping, their respective owners. HubPages ® is Memory and Time, a registered Service Mark of HubPages, Inc. The Therac-25 Radiation Machine! HubPages and Memory and Time Essay, Hubbers (authors) may earn revenue on on Theories of Stereotyping, this page based on affiliate relationships and Memory Essay, advertisements with partners including Amazon, Google, and others. Copyright 2017 HubPages Inc. and burnt chip, respective owners.