History[ edit ] The earliest documentation of critical thinking are the teachings of Socrates recorded by Plato. Socrates established the fact that one cannot depend upon those in "authority" to have sound knowledge and insight.
Table 1 — Etiologies of Epistaxis2,7 A Brief Anatomy Review Clinically, epistaxis is classified as anterior or posterior according to the anatomic source of bleeding. The vascular supply of the nose originates from the ethmoid branches of the internal carotid arteries, and the facial and internal maxillary divisions of the external carotid arteries.
If the patient is actively bleeding, but protecting his airway and hemodynamically stable, he should be placed in a seated position leaning forward so as to avoid increasing the flow of blood to the posterior oropharynxand instructed on the application of direct pressure to the bilateral nares for approximately minutes.
Onset, activity undertaken prior to onset digital traumaduration, and laterality of the current bleed. If the patient has sought care for episodes of epistaxis previously, inquiries regarding methods utilized to obtain hemostasis should be made. After removing his anterior packing, and once again clearing the blood and clots from the nares and oropharynx, a number of management options may be chosen: Analgesia should be provided prior to the application of nasal packing.
It is also advised that after packing is placed, pulse oximetry be maintained to monitor for hypoxia. Commonly composed of cotton or foam, numerous models of nasal tampons are available in the US for the control of epistaxis.
Merocel manufactures one such model, composed of foam, designed for insertion along the septal floor, parallel to the hard palate, and offering direct mechanical pressure upon expansion secondary to absorption of blood in the nasal cavity.
In order to place the Rapid Rhino activate the CMCthe device is submerged in sterile water for approximately 30 seconds prior to its insertion along the septal floor, parallel to the hard palate. A 20cc syringe is then used to inflate the balloon until the pilot cuff is rounded and firm to the touch.
Despite their equivalence in obtaining hemostasis, randomized control trials have demonstrated the Rapid Rhino as superior to the Rhino Rocket in terms of pain upon insertion and ease of extraction.
The Foley balloon is then filled with approximately cc of saline and traction is applied until the balloon sits firmly against the posterior nasal choana.
Anterior traction is maintained with the placement of an umbilical or c-clamp at the nasal ala.
Neither the umbilical clamp nor the c-clamp should be affixed directly to the nasal ala. Figure 5 — Application of a Foley Catheter in Posterior Epistaxis14,15 A quick tutorial on the placement of anterior packing as cited by Kucik and Cleney, Figure 6 — Application of Anterior Packing.
Gauze impregnated with petroleum jelly is gripped with forceps and inserted into the anterior nasal cavity. With a nasal speculum not shown used for exposure, the first packing layer is inserted along the floor of the anterior nasal cavity.
Forceps and speculum are then withdrawn. Additional layers of packing are added in accordion-fold fashion, with the nasal speculum used to hold the positioned layers down while a new layer is inserted. Packing is continued until the anterior nasal cavity is filled. The device is inserted until the posterior balloon enters the posterior nasal cavity, inflated with cc of saline, and then pulled forward until snug.
The anterior balloon is then filled with cc of saline and secured with an umbilical or c-clamp at the nasal ala.
Figure 8 — Application of Posterior Nasal Packing. After anesthesia is obtained, a catheter is passed through the affected nostril and through the nasopharynx, and drawn out the mouth with the aid of ring forceps.
A gauze pack is secured to the end of the catheter using umbilical tape or suture material, with long tails left to protrude from the mouth. The gauze pack is guided through the mouth and around the soft palate using a combination of careful traction on the catheter and pushing with a gloved finger.Evolution of management thought.
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5. Case Study. Two organisations Tourism Australia and Fujitsu Australia have benefited from implementing Portfolio Management. The steps include conducting an inventory of projects, defining portfolios, defining criteria for evaluation, scoring all the projects against the evaluation criteria and allow management to prioritise projects for execution.
Evaluation is entering an exciting period – one that will challenge us all to think in new ways and to focus on new things. This blog post is the first in a series aimed at highlighting some of the most interesting considerations for evaluation in an era where the Sustainable Development Goals will be one of the main forces shaping “development” around the world.
As a program manager, you’re a senior-level practitioner on the forefront of advancing your organization’s strategic goals. You manage multiple, related projects in a coordinated way, achieving benefits that could not occur if the projects were handled separately.
Evolution of Management Thought Pre-scientific Management Period The advent of industrial revolution in the middle of the 18th century had its impact on management. The Evolution of Management Thought is a well-respected, seminal work in the field of Business Administration.
Written in a clear, interesting, and easily readable manner, it covers the historical development of management theory from the pre-industrial age through the current era/5(17).