Les Milieux "Naturels" Du Globe by Jean Demangeot

By Jean Demangeot

Alors qu’aucun livre ne considère les problèmes de l’environnement naturel à l. a. fois dans leur globalité et dans leurs particularités régionales concrètes, l. a. présente 10e édition corrigée de ce manuel d’écogéographie a l’ambition de combler cette lacune. Si l. a. globalité écologique se manifeste bien dans l’écosystème, il y manque souvent les sociétés humaines qui depuis le Néolithique ont adapté los angeles nature à leurs besoins et façonné les paysages. Notre Terre est fortement infl uencée par près de eight milliards d’humains : on ne donc peut écrire « naturels » qu’entre guillemets. Pratiquer une écologie réaliste oblige à l. a. régionalisation des « milieux » naturels. C’est pourquoi le géographe intervient en replaçant les écosystèmes dans leur spécifi cité régionale et dans leur contexte historique autant que body. Le milieu « naturel » est donc partie intégrante d’une géographie complète et globale, d’autant plus à l’heure du changement climatique.

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2. 25 mg IVP (over 2-5 min) q6h, then increase up to 5 mg q6h. Reduce dose in azotemic patients. Contraindicated in bilateral renal artery stenosis. E. Esmolol (Brevibloc) is a non-selective beta-blocker with a 1-2 min onset of action and short duration of 10 min. The dose is 500 mcg/kg/min x 1 min, then 50 mcg/kg/min; max 300 mcg/kg/min IV infusion. F. Hydralazine is a preload and afterload reducing agent. It is ideal in hypertension due to eclampsia. Reflex tachycardia is common. The dose is 20 mg IV/IM q46h.

Physiologic maneuvers. Changes in an outflow murmur with the Valsalva maneuver may help diagnose hypertrophic cardiomyopathy. E. Abnormal neurologic findings. Unilateral abnormalities found upon neurologic examination may reflect a cerebral vascular accident. F. Gastrointestinal bleeding. A positive stool guaiac indicates gastrointestinal blood loss, which can result sequentially in anemia, hypovolemia, and syncope. G. Carotid sinus massage. Carotid sinus hypersensitivity, which is responsible for the carotid sinus syndrome, can be demonstrated by careful carotid sinus massage, preferably with simultaneous electrocardiographic monitoring.

G. Drug therapy 1. Statins are commonly used in the treatment of hypercholesterolemia. They are the most powerful drugs for lowering LDL cholesterol, with reductions of 20 to 60%. Fluvastatin (Lescol) is somewhat less potent, decreasing LDL by 20-25%. Atorvastatin is the most potent, reducing LDL by 29-61%. An additional benefit of atorvastatin is more effective triglyceride lowering (14 to 33%). Adverse reactions occur less frequently with the statins than with other lipid-lowering agents. 2. Cholesterol absorption inhibitors - Ezetimibe (Zetia) modestly lowers the LDL cholesterol when used alone, but may have its greatest use in combination with statins.

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