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By O. Brant. State University of New York College at Old Westbury.

The mites were identified by microscopic ex- there will be shallow burrows in which the adults will amination of material collected from the thickened be stationed near the entrance discount metoprolol 12.5mg fast delivery. Mites were identified in adult and imma- ture birds but only the adults developed clinical Young birds are commonly affected order metoprolol 50mg line, but adults may signs metoprolol 50mg online. A selective immunosuppression may also be canaries, finches (especially Lady Gouldians), para- a predisposing factor, but has not been documented. The larva, nymph and adult In canaries, Knemidokoptes infections on the feet and forms of the parasite can be found in the respiratory legs may cause large proliferative masses frequently tract of affected birds, suggesting that the entire life referred to as “tassel-foot” (see Color 24). Clinical signs in- koptes and giardiasis are most commonly seen in clude dyspnea, coughing and sneezing. Infections can be mild to severe with resulting As an example of the highly specialized nature of death by asphyxiation. These small black mites can feather mites, two species that frequently infect be identified by transillumination of the trachea, or budgerigars were studied. Mite-free Society Finches Myialges (Metamicrolichus nudus) were demon- can be used to cross-foster Gouldian Finches to pro- strated in a Grey-cheeked Parakeet with sinusitis, duce mite-free flocks. The skin was hyperkeratotic (several mil- Numerous feather mites have been described in birds limeters thick), and the parasite was demonstrated (Figures 36. Six species have been in pits within the stratum corneum and feather cav- described in African Psittaciformes and three to four ity. The females of this parasite generally attach to species have been described in Australian Psittaci- the exoskeleton of lice or hippoboscid flies for ovipo- formes. The source of infection in this bird was unde- described in New World Psittaciformes. In general, feather Myialges was diagnosed by finding eggs in a skin mites are apathogenic in their host-adapted species, scraping taken from an Amazon parrot with a one- but can cause clinical problems in non-host adapted week history of scratching around the eyes. The skin species, or with heavy infestations when the mites around the lores was dry and flaky and the head, cere move from the feathers to the skin. They infect lems (eg, pruritus, anemia, poor feather condition) the bird only at night and spend the daytime in they can be controlled with a light dusting of pyre- crevices within the aviary. The mite protectors sold in most pet can be recognized as rapidly moving dark brown supply stores have no effect on common external spots. Free-ranging birds can serve as a source of avian parasites and may cause liver disease. The use infestation and should not be allowed to nest or roost of these products is discouraged. This para- Other mites that have been associated with occa- site completes its life cycle on the bird. Dusting with sional skin or feather disease in birds include: Der- pyrethrin should be effective for controlling the manyssus spp. The mites can be demonstrated by examin- mites and quill mites (Syringophilus spp. Proc Assoc host spectrum in a Sarcocystis spe- nematodiasis in free-ranging birds. J Parasit 68:668-673, Am Vet Med Assoc 183:1089-1090, Vet Med Assoc 172:1212-1214, 1978. Flammer K: Preliminary experiments sent in some avian species in South wernaarti n. J Vet Diagn Invest 3:167-169, dana and a key to avian filariid gen- North Island Kaka,Nestor meridion- atoxoplasmosis in canaries. Acta Parasit Polnonica 23:361- matodiasis in cockatoos due to Comp 56: 123-130, 1981. Schweiz Arch Tierheilk Baylisascaris procyonisas a cause of forme: Trypanosoma bakerin. Comp Anim Prac 1:36-39, tomiasis in a sulphur-crested cocka- caridia columbaeinfections in budg- conirmus (Mallophaga: Philopteri- 1987. Capillaria Zeder 1800 from the collec- al (eds): Cryptosporidiosis in Man 183:1089-1090, 1983. Shoshana R: Knemidokoptes: Mites Granulomatous encephalitis caused parasite membrane - membrane in- control. J Am Vet Med assoc 181:384- on feathers of the red-fronted para- by schistomiasis in swans. Gastroenterology 90:583-594, in psittacine birds: apparent in- schistosomiasis in Atlantic brant 1986. J Am Vet Med Assoc 175:359- complexa: Sarcocystidae) in the budg- cal observations on the sequence of Memorial University, St John’s, New- 361, 1979. Miltgen F, et al: Parahaemoproteus imported birds at postmortem exami- tions of canaries and pigeons. Many of the B items that birds may encounter during these quests can be dangerous. Contact with or consump- tion of certain plants, cleaners, pesticides and house- hold disinfectants may cause acute or chronic intoxi- cation. Based on their size and physiology, birds are more prone than mammals to intoxication by some compounds, such as volatile chemicals and fumes. It has been suggested that the con- sumption of foreign bodies (eg, metal, wood, jewelry), over-consumption of grit and coprophagy may all be mediated by malnutrition (Gerlach H, unpublished). Genevieve Dumonceaux Therefore, birds on a formulated diet would be ex- pected to chew less on plants, perches and toys than Greg J. Treat seizures and shock as or anyl substituent damage needed groups Drain cleaners Sodium hydroxide, Caustic to skin and mucous membranes, Flush affected areas with water or milk. Do not sodium hypochlorite irritation, inflammation, edema, necrosis, use emetics or lavage. Treat for shock and pain burns in mouth, tongue, pharynx Fireworks Nitrates, chlorates, Abdominal pain, vomiting, bloody feces, Crop or gastric lavage. Use methylene blue or mercury, antimony, rapid shallow respiration, chlorates may ascorbic acid for methemoglobinemia. Avoid gastric hydrocarbons, necrosis, mucosal irritation, aspiration or lavage or proceed with caution. Antibiotics and supportive care Matches Potassium chloride Gastroenteritis, vomiting, chlorates may Treat symptomatically. Use methylene blue or induce methemoglobinemia with ascorbic acid for methemoglobinemia cyanosis and hemolysis Paint/varnish Benzene, methanol, Dermal irritation, depression, narcosis, See “furniture polish. Provide fresh air if strong fumes are present Overheated non-stick Polytetrafluoroethylene Sudden death, dyspnea, depression, Fresh air or oxygen, fluids, steroids for cookware, drip pans, pulmonary hemorrhage pulmonary edema, antibiotics, supportive care heat lamps, irons, ironing board covers Poor grade peanuts, Mycotoxins: aflatoxin, Gastrointestinal irritation, dermal Clean feed, antibiotics for secondary peanut waste, moldy ochratoxin, irritation, oral necrosis, secondary infections. Brodifacoum, treat for 28-30 days Rodenticides Cholecalciferol Causes hypercalcemia and renal failure, Activated charcoal, fluid therapy. Do not give bicarbonate orally for necrosis from chewing on pencils acid poisonings Many of the therapeutic recommendations for the above products have been taken from small animal sources. Toxin-contami- nated water, air and food supplies can affect birds through direct contact or through poisoning of com- ponents in the food chain.

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Medical care should never be withheld from those who request it or in those prisoners who have lingering effects buy 50mg metoprolol amex. To limit injury or potential liability generic 100 mg metoprolol amex, many police forces regulate the use of chemical crowd-control agents by establishing Crowd-Control Agents 191 policies to guide their use metoprolol 25 mg. Words are used first, followed by more defensive actions (such as chemical agents), then batons, and finally firearms. Use of these agents is monitored, and formal reports are filed when they are used. These agents afford control of violent offenders with much less risk to life and limb than do firearms, explosives, and battering. Nervous system degeneration produced by the industrial solvent methyl n-butyl ketone. Neurobehavioral effects from acute exposures to methyl isobutyl ketone and methyl ethyl ketone. Capsicum and capsaicin—a review: case report of the use of hot peppers in child abuse. Quantitative analysis of capsaicinoids in fresh peppers, oleoresin capsicum and pepper spray products. Pepper-spray induced respiratory failure treated with extracorporeal membrane oxygenation. The effect of oleoresin capsicum “pepper” spray inhalation on respiratory function. Clinical effects of oleoresin capsicum (pepper spray) on the human cornea and conjunctiva. Effects of oleoresin capsicum pepper spray on human corneal morphology and sensitivity. Riot control agents: biomedical and health aspects of the use of chemicals in civilian disturbances. Acute pulmonary effects fromO-chlorobenzylidemalonitrile “tear gas”: a unique exposure outcome unmasked by strenuous exercise after a military training event. Tear gas—its toxicology and suggestions for management of its acute effects in man. Medical Issues of Restraint 195 Chapter 7 Medical Issues Relevant to Restraint Nicholas Page 1. Forensic phy- sicians’ involvement with these issues involves many of the core attributes needed in the practice of high-quality forensic medicine, includ- ing the need for good history taking from as many involved parties as is prac- tical to clearly establish events, and a precise examination recorded clearly and contemporaneously. Objectivity must be maintained in the light of dif- fering histories, and there is a need to keep abreast of developing restraint techniques that may bring new clinical problems. However, regardless of how careful police officers may be, there is the potential for serious injury requir- ing further medical intervention, and the real possibility of being a witness in a legal process, such as police disciplinary procedures. During restraint, any force used must be proportionate to the threat faced, lawful, and necessary. The restraint process is particularly challenging where the potential detainee has a mental health problem or is intoxicated. In addi- tion, the officer, in retrospect and under close scrutiny, must be able to dem- onstrate that his or her actions were entirely appropriate. It must be recognized From: Clinical Forensic Medicine: A Physician’s Guide, 2nd Edition Edited by: M. As an independent doc- tor, excellent clinical management by the forensic physician throughout the case enables the doctor to act as a high-quality witness if needed. The doctor also has a duty to report any instance where excessive restraint appears to have been used, and such concerns should be communicated to the senior police officer on duty immediately. The forensic physician needs to be aware that equipment may be misused; for example, a long-barreled metal torch could be used as a striking weapon in some circumstances, and, indeed such lights were withdrawn in the United States to prevent this from happening. Although the basic principles of restraint are similar throughout the world, there are many variations both throughout countries and within individual states where there are no national police forces. It is also an evolving subject involv- ing research by organizations, such as the Police Scientific Development Branch in the United Kingdom, as well as the practical outcome of restraint tech- niques when used by officers. Rigid handcuffs, such as Kwik Cuffs, were first trialed in 1993 and have since become standard issue in the United Kingdom and the United States. Although the ratchet mechanism is the same as with the older cuffs, the fixed joint between the cuffs gives several distinct advantages. Holding the fixed joint allows easy application because simple pressure against the wrist enables the single bar to release over the wrist and engage the ratchet. The ratchet can be locked to prevent further tightening but can also only be released with the key, which requires the detainee to cooperate by keeping still. Correctly tightened cuffs should just have enough space for an additional finger between the applied cuff and wrist. The hands are usually cuffed behind the back one above the other, because handcuffing to the front may provide opportunities to resist detention. Even with only one wrist in the cuffs, control by the officer can be gained by essentially using the free cuff and rigid link as a lever to apply local painful pressure to the restrained wrist. Techniques allow a detainee to be brought to the ground in a controlled manner or the other wrist to be put within the cuffs. Medical Issues of Restraint 197 A gentle application, such as may be experienced by the forensic physician in a personal trial, will demonstrate that it is clearly an effective way of gaining control of most individuals. This may not be the case in those who are intoxi- cated, have mental health issues, or are violent. Cuffs should fit firmly but not tightly at the narrowest part of the wrist just distal to the radial and ulna sty- loid processes. Injuries From Handcuffs Injuries from handcuffs either reflect relative movement between the cuff and wrist or are the result of direct pressure from the cuff to the tissues of the wrist. It is important to remember that injuries may be unilateral, especially where there has been resistance to their application. The most common injuries found are erythema, abrasions, and bruis- ing, particularly to the radial and ulna borders of the wrist (2). The erythema is often linear and orientated circumferentially around the wrist following the line of the handcuffs, reflecting direct pressure from the edge of the cuffs. Bruising is commonly seen on the radial and ulna borders, with tender swelling often associated with abrasions or superficial linear lacerations from the edge of the cuff. However, it is not possible to determine whether this move- ment is from the cuff moving over the wrist or the wrist moving within the cuff, because either can produce the same skin abrasions. All of these soft tissue injuries will resolve uneventfully during the course of several days, and only symptomatic treatment with simple analgesia and possibly a cold compress is required. Although rare, it is possible to have wrist fractures from restraint using handcuffs. The styloid processes are the most vulner- able, but scaphoid fractures have been reported (3). Tenderness beyond that expected for minor injuries and especially tenderness in the anatomical snuff- box will need an X-ray assessment as soon as possible. The earliest reports of sensory damage to the nerves of the wrist first appear in the 1920s, with sensory disturbance often restricted to a small patch of hyperesthesia and hyperalgesia on the extensor aspect of the hand between the thumb and index finger metacarpals (4). This area reflects damage to the superficial branch of the radial nerve and subsequent studies confirm that this nerve is most commonly affected by compression between handcuffs and the dorsal radius (5).

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