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This magical material has interesting physicochemical properties and a complex composition, largely consiting of: The amniotic fluid is slimy, yellowish white or pale yellow, and cloudy like soap water (rarely clear) it almost always contains much mucous flocks and has a peculiar odor. A sopering realism is introduced by Doke Uyeno (1919) who described its properties in horriic detail. Now, amniotic fluid is not some sort of crystal-clear mountain stream straight from some sanitised fairytale description of pregnancy. Amniotic fluid will very likely choose a path of least resistance, and funnel massively into the inferior vena cava. Imagine then if the uterus contracts while the uterine blood vessels are open. Amniotic fluid pressure during pregnancy is usually positive anyway (5-10mmHg). In labour, it can increase substantialy with uterine contractions. Ergo, occasionally during particularly deep inspiration the venous pressure may become negative (due to extremely negative intrathoracic pressure) entraining amniotic fluid through those breahed venules. This is exacerbated by the deep breaths characteristic of labour. Negative venous pressure: venous blood returns to the heart, and therefore there is a constant flow through this side of the circulation.Amniotic fluid will get into the venous circulation though this opening by a variety of mechanisms: Let's say that there is some sort of direct venous blood/amniotic fluid interface, at the breach of some venous blood vessel somewhere in the uterus. open wound on the uterus, such as a Caesarian incision) Other associated features are listed by Moore et al (2005):ĭifferentials are also offered by the same article, which is helpful:Īmniotic fluid gains access to the circultaion by a number of possible routes: The hypoxia hypotension and DIC are what you migth call "cardinal signs". This list likely represents the maximum expected of a candidate. The British AFE Register ( Tuffnell et al, 2005) used something very similar to identify cases for record-keeping purposes. Non-specific symptoms – chills, nausea, vomiting, agitation. The onset of the symptoms and signs of amniotic fluid embolism syndrome (AFES) most commonly occurs during labour and delivery, or immediately postpartum.The college answer listed the following features, making them canonically "important": Question 28 from the first paper of 2017 asked the candidates to outline the important clinical features of amniotic fluid embolism. Clinical features amniotic fluid embolism That would probably be enought to satisfy the requirements of the time-poor exam candidate who does not wish to pay UpToDate subscription fees. Potentially, vicious viva scenarios may in the future ask the candidates to make an echo diagnosis, or to manage the situation (which may or may not progress to cardiac arrest).Īs far as published literature goes, one cannot go past Moore's article from Critical Care Medicine (2005). The question specifically asked for clinical features and risk factors. Though Question 28 from the first paper of 2017 was the first time the college had asked for some detail about this condition, it comes up now and again as a differential in the lists of possible reasons for DIC (for example), or sudden peri-Caesarian cardiovascular catastrophe, or possibly as a part of a particularly vicious viva station. Death occurs typically due to circulatory collapse, or (if that doesn't get you) respiratory failure and severe hypoxia. Clearly that was an abnormal finding, but nobody really put two and tow together until a whole case series of sudden maternal deaths was linked to pulmonary embolism of amniotic fluid by Steiner and Lushbaugh (1941). It was discovered for the first time by Ricardo Juvenal Meyer in 1926, who was extremely surprised to find whole chunks of foetal tissue (skin cell, lanugo hairs, intestinal mucin) in the pulmonary vessels of dead mothers. Amniotic fluid embolism occurs when some amniotic fluid gains access to the maternal circulation, often in massive volumes and with catastrophic consequences. Slide the name of the note from right to left and tap the Pin icon when it appears. Replied on ApIn a quick scan, I don't see a sort function. What can we do to make our customers feel like they are getting the value for what they are spending? BIG. If you decide your table's no longer needed, you can still keep the text inside. Does Apple have access to everything in our Notes app (iCloud)? 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Violence: Twin Mirror displays a moderate amount of violence throughout its story, with blood splatters shown on clothing, walls, and floors in certain scenes. So, does Twin Mirror match the caliber of Life is Strange, or does it not quite meet the mark for Dontnod? When Twin Mirror was announced and looked as though it would have a similar aesthetic and gameplay mechanics to Life is Strange, I became intrigued and was looked forward to seeing if this would live up to its predecessors. I’m a big fan of the original Life is Strange game, and Dontnod has been on my radar ever since I had completed it. Life is Strange received an incredibly positive reception, as did the franchise’s second season in 2018. Players enjoyed exploring the inconspicuous town of Arcadia Bay as Max Caufield, interacting with a diverse cast of characters, and watching as the choices they made throughout the game resulted in unique consequences for the plot. 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That being said, both of these skills are relatively expensive, so one alternative is Spd Smoke. That being said, Atk/Spd Menace isn’t a bad option by any means since it can allow Legendary Eirika to increase the amount of damage she reduces with Storm Sieglinde. Rouse Atk/Spd is a good option as it’s easy to set up and doesn’t require being near foes. Any C Passive that increases Legendary Eirika’s overall Atk and Spd are going to be desired.No other B Passive comes close to mimicking a fraction of this power. Lunar Brace II is the only worthwhile B Passive for Legendary Eirika as it provides Null Follow-Up, meaning she can secure her own doubles and consistently trigger four-cooldown Specials, true damage based on the foes’ Def stat, meaning she can secure more kills, and Canto II, meaning that she can get in and get out of danger with relative ease.Of course, since this is an expensive skill, she can always stick with her innate Atk/Spd Solo 4 as it also provides a great amount of Atk and Spd to the user. This, in turn, means she’ll want to run high cooldown Specials, such as Astra, and will turn Legendary Eirika into a player phase nuisance as foes will have a hard time taking her down. The best A Passive for Legendary Eirika will undoubtedly be Surge Sparrow as it not only provides a great amount of Atk and Spd but also heals the user if their Special triggers based on the cooldown count of the Special in question.It also pairs really well with her innate Canto II. You could also run Galeforce since she can charge it up quite fast so long as she is able to attack twice and if the foe can counter. It may be a bit overkill, but it’ll mainly be in tangent with her A Passive. As such, the only Special that could be recommended is Astra. However, the options are rather limited given that her stats aren’t that high beyond her Spd. Because Storm Sieglinde has a Special Fighter-Esque effect, her best bet will be to run a four-cooldown Special.Even so, there are a couple of recommendations that can be made to help Legendary Eirika perform to the best of her abilities. That being said, she’ll mainly want to prioritize her Atk and Spd, especially the latter since she has damage reduction based on it. Because of how many effects she gains from her weapon and B Passive alone, it’s going to be hard to recommend much since she pretty much has everything she needs. 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