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Propranolol is a first-generation beta-adrenergic receptor antagonist that is widely used for the treatment of hypertension and arrhythmias. Torsades de pointes (TdP) are a potentially fatal manifestation of this medication. They have been reported in up to 10% of patients treated with beta-blockers, and the majority are in the setting of multiple additional risk factors. A 68-year-old male with hypertension presented with palpitations and chest pain and was found to have sustained second-degree atrioventricular block. Following its reversal, the patient developed TdP refractory to external cardioversion and temporary pacemaker implantation. Propranolol was withdrawn and later discontinued. When used in the correct dosage, propranolol can cause complete heart block and TdP. This should be managed by discontinuing the drug in the presence of these symptoms, and, if necessary, with external cardioversion or temporary pacemaker insertion. FILED
NOT FOR PUBLICATION MAY 30 2012
Episode 1: Separation
Episode 2: Havoc
Episode 3: Awakening
Episode 4: Awakening (final mission)
References
Category:Deus Ex
Category:Deus ExThis invention relates to the field of gas turbine engines, and more particularly to an apparatus for diverting air from the bypass stream in the fan of such a turbine engine.
The conventional gas turbine engine, as used for example for an aircraft, includes a fan driven by a turbine engine. The fan creates a generally high speed stream of air which is directed as a bypass stream around the turbine section. The turbine section, which is not driven by the fan, converts the energy of the air moving through the turbine into work which can drive the fan or some other device as may be necessary for the normal functioning of the turbine engine.
The fan provides the necessary high speed air to the turbine through a pair of converging sidewalls located at the exit end of the fan. The exit end of the fan is faced toward the turbine section and the fan is generally streamlined to permit rapid flow of air. This streamlined air is directed along the outer surface of the engine and exits the engine through a diffuser, in the conventional form, on the engine. The diffuser, as its name implies, provides a relatively uniform velocity and pressure distribution of the air moving from the engine. The diffuser is relatively large, since the function of the diffuser is to provide a uniform exhaust velocity and distribution. Thus, the span of the diffuser is of relatively long length. This exhaust diffuser, which has provided the engine with a relatively high power output, makes the engine difficult to install or service because the engine must be located well forward from the center of gravity of the aircraft.
While the exhausting air of a turbine engine flows, under certain conditions, in an essentially laminar flow pattern, it is known that turbulence may be generated in the flow of engine exhaust at certain critical points. For example, it is known that a vortex may be formed in the engine exhaust air as it passes from the turbine section into the diffuser, particularly if the flow rate is high and the speed of the exhaust air is relatively low. The vortex can create an aerodynamic instability, since the flow separation off the wall of the diffuser can be significantly higher than the separated flow shear layer on the outside. Vortex shedding may also occur as the air flows outwardly through the diffuser and contacts the outer surface.
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