![]() In a follow-up phone encounter five days after the convulsive syncope episode, the patient reported that his headache symptoms improved overall. The patient did not have any strict activity restrictions except for driving and lifting heavy objects. At discharge, the patient was advised to maintain adequate hydration and to report to the emergency department if he experienced recurrence of seizure-like episodes or other concerning symptoms including fever, abdominal distention concerning for hematoma, cool or clammy skin, and hematemesis or hematochezia. A computed tomography (CT) scan was obtained of the lumbar spine, which did not reveal any procedural-related complications. No abnormalities were found in serological studies including complete blood count and electrolytes. The patient was observed in the recovery unit for 2.5 hours and was then transferred to the emergency department for further workup and observation for another four hours. For these reasons, an electroencephalogram was not ordered. The neurology service was consulted, and this spell was diagnosed as a convulsive syncopal episode given gradually progressive prodromal symptoms that were vagal in nature, lack of rhythmic movements, and rapid recovery of mental status. Further history and medical chart review revealed no prior history of seizures, seizure disorder, or syncopal episodes. Physical exam revealed no focal neurologic deficits. The patient was transferred to the recovery unit for close observation, and no neurological symptoms, hypotension, or bradycardia was observed. No benzodiazepines or antiepileptic medications were administered. His bradycardia (heart rate in 40 beats/minute) and hypotension (systolic blood pressure in upper 80 beats/minute) resolved over the next 10 minutes. He was oriented and able to answer questions appropriately but did not recall the episode. The spell lasted 15 seconds, after which the patient spontaneously regained consciousness and appeared flushed and was warm to palpation. The procedure was immediately aborted however, the patient promptly lost consciousness, followed by nonrhythmic shaking of his upper extremities and sustained, nonrhythmic upward deviation of both eyes. When epidural injection of autologous blood was resumed, he complained of feeling worse after injection of another 3 mL. The procedure was paused for one minute, with symptomatic and hemodynamic resolution. He quickly became diaphoretic, lightheaded, and bradycardic (i.e., heart dropping from 80 to upper 40 beats/minute), and his systolic blood pressure dropped from 110 mmHg to 90 mmHg. After slow epidural injection of 13 mL of autologous blood, the patient complained of nausea. The patient was asymptomatic during blood draw from the left antecubital space. His international normalized ratio (INR) was 1.0 (normal range = 0.9–1.1), and the platelet count was 201×10 9/L (normal range = 150–450×10 9/L) thus, a repeat epidural blood patch was scheduled.Īfter subcutaneous infiltration with 3 mL of 1% lidocaine, the epidural space was accessed at the L4-L5 interspace on the first pass, with placement confirmed by contrast injection. An epidural blood patch had been performed 10 days previously, utilizing a right paramedian interlaminar approach at the L4-L5 interspace, resulting in 30% pain reduction in his frontal orthostatic headache. Case PresentationĪ 37-year-old male with a history of chronic headaches from hemicrania continua, congenital scoliosis status-post extensive hardware instrumentation, and an undifferentiated familial connective tissue disorder status-post aortic root and aortic valve replacement on chronic anticoagulation presented to the Pain Clinic for consideration of repeat lumbar epidural blood patch to ameliorate headache related to spontaneous cerebrospinal fluid (CSF) leak. The secondary objective is to review other reported cases of seizures and seizure-like episodes following epidural blood patch. The primary objectives of this case report are to describe a patient with a history of cardiac comorbidities who experienced convulsive syncope after an epidural blood patch and discuss the implications for management of periprocedural seizure-like episodes. Erroneously diagnosing convulsive syncope as a seizure disorder may have serious ramifications, as seizure treatment is not benign and syncope related to an unrecognized underlying cardiac condition has been associated with 30% mortality at one year. Although patients may experience convulsions secondary to a seizure, 12% of patients with syncope may also have seizure-like convulsions. ![]() Convulsive syncope may mimic seizures and can be clinically challenging to differentiate.
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Elaine MaynardĪ series of ransomware threats leads to an overabundance of emergencies for the 118, including a medevac helicopter crash at a hospital and an air-traffic control tower system failure. ![]() Vanessa Estelle Williams as Claudette Collins.Marsha Warfield as Antonia "Toni" Wilson.Gavin McHugh as Christopher Diaz (9/18).Marcanthonee Jon Reis as Harry Grant (9/18).Rockmond Dunbar as Michael Grant (7/18).Aisha Hinds as Henrietta Wilson (18/18).Jennifer Love Hewitt as Maddie Buckley (11/18).Athena will be dealing with her attacker, the serial rapist she caught and arrested at the end of Season 3. ![]() Albert Han's journey into becoming a firefighter.The exploration of Maddie's struggle with postpartum depression, and it leading to major complications.Another crossover with its spinoff series has been confirmed to happen sometime in 2022.The blackout emergency will span the first three episodes of the season.The crisis to strike LA at the beginning of the season will be a blackout, revealed by its first teaser trailer on July 19, 2021.Meanwhile, Athena deals with a family emergency, Maddie’s postpartum depression worsens, Eddie suffers a health scare, and a new call center operator takes charge. ![]() Then, a massive city-wide blackout causes havoc in L.A. As the fifth season of 9-1-1 opens, the first responders race into action when a series of ransomware attacks target computer systems, air traffic control towers and hospitals. Keep reading for some tops tips from the experts to make the process easy and stress-free. We've rounded up the best-rated dog clippers available to help you begin your claw clipping journey. Related: The best pet cooling mats for dogs and cats Long claws also make it uncomfortable for your dog to walk, which may cause issues for their joints later down the line. If your dog's nails are too long, they can get caught on furniture or in carpets, which can be really painful and might result in a visit to the vets. However, if your dog spends most of its time on soft surfaces, the tips of the nails aren't worn down sufficiently and having overly long nails can lead to problems. ![]() If your dog often walks on hard surfaces, you may find that you never need to trim the claws yourself. Related: review: Is a dog food subscription box worth it? Why do we need to trim our dog's nails? ![]() If you've never trimmed your dog's claws yourself before, there's a lot to learn to make sure the experience is as comfortable as it can be for you and your dog. Domesticated dogs though, often live a life of luxury in comparison, running on cushy grass, some pavements and indoors, which generally isn't enough to keep their claws in good shape. When the ancestors of our dogs used to roam in the wild, their claws would be worn down by running, hunting and other activities. ![]() So a lot of that just comes from being patient, it comes from knowing when we want to say something and when to fall back.”Īnyone can’t put a bow on a conversation regarding Atlanta’s current cultural impact, without having a conversation on who belongs on the city’s rap Mount Rushmore. And we move quickly, but we move with intention behind it. ![]() And I think even with Butter, again, one thing we always talk about is moving content at the speed of culture. “So you move with intention for the future, we’re paying attention about the present, right? And with having kids, I think that’s the ultimate manifestation of that, right? We do things with our kids now, with the intention of who they’re going to be when they grow up and get older. “I always say, there’s intention and attention,” Butler explained. He says having children forced him to move with patience and intentionality and it forced him to carry those lessons into the board room. Also, Butler is the father of a nine-year-old daughter and a four-year-old son. He’d later get his MBA from Georgia Tech. And I said, ‘What I don’t want to do is come up with a template on how we’re going to handle police shootings.’”īutler spent one year at Morehouse before attaining his Bachelor’s degree from Georgia Southern. ![]() And so we had a really interesting conversation, because I have a very diverse team, all types of folks on the team, and they all came in, we all came together. “We have an obligation to talk about certain things that are going on, but also we’re not in this for popularity. And, once again, I was shook up a little bit, because again, like, how do you talk about something like that,” Butler explained. “And I remember the next morning, I called an emergency meeting with the team. “And so that was when it kind of struck to me, that’s when it hit home, these things were coming even to my personal doorstep that I was going to have to process.īutler said he wanted Butter to be a source of truth during times of crisis. “You know, when the Rashard Brooks shooting happened, I actually knew people in line at Wendy’s that night, and they were actually sending me videos live from the event to my person texting, texting them, to me, not even DM-ing them,” Butler said. However, for this pop-culture company, they had to get serious after Rayshard Brooks was killed by Atlanta Police at a Wendy’s on University Avenue on June 13, 2020. But in 2020, the social justice movement took off, everything that was going on, they launched the Atlanta text line, a number that people could text to get information about different protests, some social justice movements, even stuff like voting in elections. The fans like, post, and share their content every day. Most of the time, Butter creates content that highlights the fun parts of Atlanta, pokes fun at people that reside outside of Interstate 285, and highlights the neighborhoods inside the perimeter.īutter has the support of celebrities such as Killer Mike, Usher, and Jermaine Dupri. It is a testament to the level of consistency, and high performance that Butter and its partner, Dagger, has received as an advertising agency that is powered by African-Americans in a predominantly White space. Butler also was featured in AdWeek’s Creative 100: The Most Inspiring Talents of 2021.
![]() Like many silk fabrics, shantung is crisp, and its lightness causes it to drape elegantly. Shantung is a high end, best in class type of silk fabric with characteristic irregular ridges known as slubs running through the fabric. cotton fabric, are less eco-friendly than others because some plants require more water. They also usually have a smaller environmental impact than synthetic fibres because natural fibres do not use as many chemicals during the production process. They have an incredibly high absorbency, as the fibres, both plant and animal, have a strong affinity for water. Natural fibres are our choice within the Rampley & Co tie collection. All our handmade ties are made from natural fabrics to keep our design quality & sustainability focus intact. Natural fibres such as cotton, silk, wool and linen are popular for many different reasons as the fabric is generally more environmentally friendly and durable. Both types have pros and cons natural fibres come from plants and animals, while synthetic fibres are made from chemical compounds and are artificial. Today, the new standard tie width is 3.5 inches and 150cm in length, but it’s straightforward to find sizes, patterns and fabrics across a wide range of tie options to suit your needs.Īll fabrics in menswear can be characterised as either natural or synthetic fibres (or a blend of the two). It is rumoured that ‘skinny’ ties were invented in the 1950s as the makers were running short of fabric, so they used the last bits to form a tie! Then, during the disco era of the '70s, neckties became super wide and bold in colour and pattern, groovy indeed. A square silk scarf was tied around the neck and held in place with either a square knot or a tie ring with ends pointing to the sides.ĭuring the 1950s, 60s and 70s, the width of the necktie was played with & explored. ![]() Solid colours and striped designs were preferred in most ’50s business attire, while mod art designs reigned in the ’60s. The 1970s tie saw the rise of the neckerchief. The tie became a statement for plays on colour, shape and creative flair vs traditional hobby use.īy the 1960s, ties got the narrowest they have ever been, when the ultra thin 2 inch skinny tie came in vogue to go with skinny suits. The hand painted tie continued to be popular in the early ’50s, with the designs becoming more abstract, cubist, modern, and artistic. Bow ties were reserved for formal occasions, scarf ties for artistic and flamboyance, whilst neckties were the predominant choice for gentlemen in everyday wear.īy the 1930s, scarf ties and bow ties were out of fashion, leaving only the now traditional silk necktie to dominate, in an array of pattern clash and colour mix. This led to the creation of different tie knots. In 1920 a tie maker named Jessie Langsdorf invented a new way of cutting the fabric when constructing a tie. Outside of their functional usage, they offered a decorative effect, a look that King Louis became quite fond of hence the term we now see common in menswear, "La Cravate", was made in honour of the Croatian soldiers.ĭuring the 20th Century, the world saw a decline in formal cravats as men's fashion became less about the look and more about comfort, functionality and fit. The necktie originated in the 17th Century, whereby King Louis XIII hired Croatian mercenaries who wore a piece of cloth around their neck as part of their uniform, used to tie the top of their jackets. From the hand-painted ties of post-WWI to the wild and wide ties of the 1970’s, to the skinny ties of the late 1950’s, the necktie has remained a constant staple of men’s fashion. The necktie we know and love today has been around for more than 150 years. SHOP THE RAMPLEY & CO HANDMADE TIE COLLECTION As we are known for our bespoke range of handmade silk, wool and cashmere ties, we thought it best to give our community the official Rampley & Co guide to all things ties. Often associated with office wear, the tie can also be used in more ways than one to glamourise your outfit. It adds a degree of sophistication and elegance to finish off your suit and shirting combination. Every gentleman knows, no modern smart outfit is complete without a treasured tie. Exposure to parasites (ie: fleas, ticks).Some animals difficult to handle (scratches, bites).Must be checked often (especially in extreme weather).Some animals (ie: feral cats) may injure themselves trying to escape.Non-targeted species may be caught in seasons where food sources are scarce.Easy and safe to release captured animals.Safer way to handle feral or rabid animals.They are often used for relocation by conservation departments, as well as for wildlife sampling and tagging. These traps are often used for larger animals than pitfall traps, such as foxes, possums or feral cats and dogs. Cage traps can be entered from one side or both, depending on the trap. The animal applies pressure to a tray on the floor of the trap, which sets off a spring-loaded mechanism, releasing the door over the trap entrance. Bait can be olfactory (urine, meat, animal droppings), visual (feathers, lures) or auditory (field attraction phonic device). It coaxes the animal into the trap using bait. Place board or slate to cover trap (keeps out rain and predators)Ĭage trapping is another form of live trap.Container should fit snugly in hole without gaps.Dig a hole the width and depth of the container.Can not be used to determine accurate population sizes.Many factors influence effectiveness (weather, activity level).Do not prevent conflict between trapped animals.Daily behavioural patterns and community interaction can also be studied using pitfall traps. Pitfall traps are useful in studying distribution patterns of different species, especially when comparing microhabitats. Barriers, such as a drift fence, can be used to coax animals toward traps.Bait can be used to attract a certain group of individuals.When used in wildlife surveys, animals are typically trapped randomly, and stumble into the pit accidentally.Animals can become trapped by various mechanisms. Prolonged cool rain during emergence also helps control numbers.Discussed are three types of trapping: Pitfall, Cage, and Elliot traps.Ī pit or pitfall trap is a container that is placed into the ground so that the edge is level with the soil. Check the traps frequently and count needle midges to get an idea of population numbers. Place the traps with the jar side facing between rows so it gets as much light as possible. Placing five emergence traps per field of trees is good for monitoring a growing area. The degree-day models can help determine when to place traps. The needle midge is one of the few pests for which there are degree-day models to track emergence, which can vary by 4 to 5 weeks from year to year (Appendix E). Needle midges seem to prefer the “shady side” of trees, where there may be some vegetation however, in a fully stocked field, this could be anywhere. Pay particular attention to Douglas-fir fields that had Douglas-fir needle midge problems the previous year and to edge rows close to native Douglas-fir timber. See the section on Douglas-fir needle midge for suggestions on the design and timing of traps. The jar will contain other flying and crawling insects, so use a hand lens to help with identification. Place a moist towel inside the jar to catch the adult midges. As adults emerge from the soil, they fly towards the light (jar) to escape. Needle midge traps consist of a box with a jar inserted into the top edge of one side. (Photo by Jack DeAngelis, Living with Bugs.) Ground nests can pose hazards to shearing crews and visitors, so control is also beneficial for safety. Direct spraying of ground nests is allowed traps may be useful in finding these ground nests. There are currently no registered insecticides that may be used as toxic bait to eliminate the nest. Since the queen does not move outside the nest after this early period, later trapping only affects the worker population. Thus, early lure placement and trapping should help control some colony formation. The queen is the key to controlling population growth, and she only flies in March. Placing roughly 5 traps per 10 acres of field is sufficient for monitoring. Yellowjackets are the only Christmas tree “pest” for which there are specific chemical lures for attraction. They are useful for monitoring worker activity but not for control. These traps are less successful with German yellowjackets. Yellowjacket attractant traps include chemical lures, colors, and trap designs to attract western yellowjackets. (Photo courtesy of Oregon Department of Agriculture.) ![]() Opens the second week of December, weather-permitting Thaw out and ease slope-weary muscles in the poolside Jacuzzi or the sauna before dining by the fire. Splurge: Located at the base of Camelback Mountain, The Chateau Resort (300 Camelback Rd, Tannersville, PA 80, ) offers 152 modern rooms-including 39 loft-style, bi-level suites–and views of the Poconos. Save: Eleven of the rooms at the Days Inn Tannersville (Hill Lodge Rd, Tannersville, PA 57, ) boast perfect-for-aprs-ski Jacuzzis all 72 include a Continental breakfast and are just three miles from the mountain. OvRride (34, ) offers day trips to Camelback that include a round-trip bus ride from several locations in Manhattan and Brooklyn, and the option to add lift ticket, lessons and/or equipment rental. While the eight "advanced" (but often short and crowded) slopes are no match for hard-core skiers, boarders should fare better with the 20-acre revamped terrain park, which features a 50-square-foot airbag so you can try out Winter X tricks with a soft landing. Splurge: Choose between standard hotel rooms and one- to two-bedroom condos at the Winwood Inn (5220 Rte 23, Windham, NY 51, ) and you'll get access to the free mountain shuttle, not to mention a rec room stocked with throwback video games and a foosball table.Įven the Shaun Whites and Lindsey Vonns of the world had to start somewhere, and this easily reachable Poconos spot is a great place to test your chops on 34 snowmaker-covered trails. A basic complimentary Continental breakfast served each morning by the kitchen's wood-burning stove (and the fact that the motel is just one-and-a-half miles from the mountain) only sweetens the deal. Save: Rooms at the budget-friendly Cave Mountain Motel (10978 Rte 23, Windham, NY 51, ) have a lived-in, country-cabin appeal. There are several bus packages available through Windham ( /groups-weddings/tour-operators), including Urban Sherpa Travel, which picks up both in downtown and uptown Manhattan. The mountain also offers ice skating, snowboarding, tubing, cross-country skiing, snowshoeing and more. While terrain ranges from 12 novice-appropriate trails to seven satisfyingly steep double-black runs, nearly half the runs are rated intermediate, making the mountain a great place for those who know what they're doing but want to avoid frequent face-plants. This Catskills ski area offers Friday and Saturday night-skiing until 9pm on eight of its 49 trails, ensuring that you'll spend less time traveling to the mountain and more time on it. Open to season pass holders late November, others welcome starting early December, tickets must be purchased in advance These links have no influence on our editorial content. ![]() RECOMMENDED: The coziest Airbnbs near NYC ![]() RECOMMENDED: The best Airbnbs for ski getaways from NYC RECOMMENDED: The best Airbnbs near NYC with snowy views Once you're back in the city, keep that aprés-ski glow going in one of these NYC bars with fireplaces. 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