B ABG 6arnplira hohnige?

Rlood ija Commonly yad charoe

gas anabis
pareial preune ofgis
tool -do evaluato -lhe ding
boye Conder :Uncoron
tn blood and ocid jrvide
gos analyis erables
blood
and uing) ciouladoryond
b éndenpned revpirodorg
repiradong,
mestabolio dyondery.
eds blood
go4 rgliot
An aodenial blood
Haken fpom an

Bood Drau) poinda kn ABGr :

4.Sorachial Ardeny

ond nan Andery

2. Sladisl

8. Femoral Ardery)
and procedte
bpeoimen Requinemera
Jequned speeimen
onan
hhole blood áthe
blocd gas Jomple.Thespeeimen
Onerial puneue
through an anderial
adheten.
d oblaied orerial
Qequited eom on onduellirg
erowelirg Somple should
adkrialblood oy on as posible
ice and anayed
Oree obloined,the
be plaoed
o
on
-the possibild
heduce
o
enroneouy Jlejuds.
blood
ofthe
aeid bose balornge
pH Meayuned
ogen
pardial pneyute
of
pao)
paco,
HCo3- Calauade
paryial
Conoerd nodon
o bcorbo nae
eroay on
nelgdive
Calouade
dehoi!
Baye exoe»/ defoil

Oygen Golurodion
Bao, gen
a Allenia Ted
Alen'a -lesd Ày a medi
sominodion o oderiolcal 3gn uyedan
phpical
blood
Method -tiooHo-the hand.

AThe hond selevoded ondthe padien

Ho oleroh
thei tid fon aboud 20 abed
the second).
2.pnesMe y
ppied oven leoh adial and
ulna auderie) 30 a to oolude both o them.
3.94delevaded,the hand is then open ed.H
shoud appeon blanehed (paUon may be observel
ad the frgen naiy).
4. Olnan pneyue áy neleayed cwhile nadial

pnese ay ,
maindained andthe oolow hould

eun cuithin 5do 15 becond,

1 cobun fnetunn a
deeribed, Alen'a
Congidened to benomal.
coloun foiynedun,
ed

and suggerd
congiered abnomsl
the -ledy hand
had -the uhn aderýupothe
lmay no be
ênciootes thod
the sadial aey.
ho Jutoiert.thu
3ate to Cannulode on needle
 Caye
The leading ofT81 enelud:
Couyes
he ceneny
aly According) do dada-from
pneverdion,aly ane the
on lheaje Condrolond
cawe of1 and 0Cl
mo aues common
mo fmequeny among)the younget and
alderd

•Clunt rauma aooidend -

an
Acofden -tatnvoe

objeet paxdieulandy
beina uek hy on ogoind
anea maion Qaujej of en

pora selaedenue,,
Sponds
pedestrain -fnvolved
• Vehiole Jeloed trjuniey
moton
acciden,ay cwell ay acofdeny
nvolving

ane the thind mo common

Vehicle gnd byeyle
Qaye o TB1.
selale
•AsauddsVblenae fAouds thadnesuld
Albuye
eon domeytie
TG1 Qne head anmuniey
bab yndeome and qushot
Vsblenee on shaten
Cuounds to the henc.

noadide bomb became commnon a

trauma reom en miliy
erjwy do senvioe membery
Diagnasis8
1 the mord
Heohnolog to ates
commond
uyed
people Emaging
moderade to 8evere T people atth
aith.
guypecea
MALproduee, dedoiled
be cyed aAen émage of bosky doe.H
the &niial
ayesmer and
Hnealmen ay d a
mone 3engilive detand
psid 3uole Choange, önthe brain picks

a Ges the mod widely uyed-ool

tonayeyirg)
thelevel of conoioyne oen 181.
hemer:
Mild:

D Bome people cith mild TB1 Buch ay concajion

negmend oen thadn edond
mag notsrequine
Tneaemen! shou
yen he couren pain
nelievery,

and"breain ned!
Monitoruing)
fou,
oous on npom
elieP
jimpordant to nole
ahea lbhoane pracionan
on new One.
any cuongenirg aynpom asord,-freladed
Dchildnen and eens cuho have
should dop playing mm ediolely
Concuyion beirg opproved
Ond etn to ploy onaften
err specialiyt.
a aon augion while
pneverirg) hne
oreitcal
concuion

o1 peope pecoven fy fomafistconcusion

tream
toih aRin eoa henate peeover
genora la
of
ouwen.
ens on -hird coneuion
regole erinely people

oden Byonpbmg
ven
d nondherdaib) octv4fe anadkaall
h adocon.
penmiyan
te given
 Sevene TGI
)Tmmediade dneadmen on 3orne one who has
Buffened o gevene TBI toeuje, on pneverina
dleadh,tabil ing)-he peruon'3 spiral cond,
heaeng)and ohen vidal organ aneiog,
ensuwing ropen ozgen celiveng ond bneadhing
Conlreolirg blood prieuNe ond pneverling
fardhen brain damage. Emergen
tmergen
ey
healdh Cane

providen twill monon -he flo) oofblood o

the

brain, brain demp. pneNe anside the kul ph

and the brain's oxgen Supp

may be needed to on emergeney
cane and do nead econdau damage'hoi

2•Aelieving) prewe éngide the shull

$•Removing) brain dead iue
-Aemovina) hematomas
e-hepainin Bkul hachune
93In hoypital slnadegje fon managing) paple
Sir

wtth &evene TeT aimdo pe

vent condlion
ôncluding:
• Irfeekon ,pardieula pmeumoria
• Deep Vein thrombos
people wih T81 may needed nudritional
Supplemer o
minfnme the efecd thot vil
rnfneral ond othen dieary dettoi encie
mag Caye oven ime.
 JaehoKilodon
.Alen -the arude caie peniod of n hogdal
Hreadmel, people wtth 8eee e ofer
141
nehahilolion Cerlen tahene
-Iraryfenue
a multdiyeiplirar
-to'a
eom heath o Cane

providery help uth fiecoyerp

.The ehabtlladion
nwye, pphologid, nudrliorisis
,voeaioralapoeh
,
deom Aroluey eunalogisl
ay well ag
ord
phtcal oupodioral
thenapids.
neipinadorg

lempoua) pocemokens
Indicalion;

3gmpiomaie badcardia
, medioal
gocandial drtaclton.
nefrac

en
on a cage d aeude
of
cwith inuy arseydSiok
Sinuy bradjcadia blok
block, bundle brorch
Heart
Sinuy byndrome, blook
ard bi oL ri taiculon

Taahjarhgthmia
JneeuEr 5VT, PSVT, VT.
Theodment on

Torgodo de pointes
with sick gu ziny yndrome.
•Condioverion
bradyoarndia
pod dofbriladion
ailune
penmanerd poomaker
oudpud ofon Cordise bungerg)
ndine oulpud
Sappord condise
 (

apes:
1. lransvenouy Temporcar) focing Cathoden on
de
an eleetrro
bubelavian
a vein(femoral,
faeing wine throgh odrium on
erlo-the right
jugulan)
On erdennal
Jusht Venrlriele.
Temponarg pairg
2. Iranseudaneouy
apoliendy
Aia ernporcan meany poeing
sabilizing
head duing) on emergeneyand mean) of
unil a mone perumanend
-the paier b detbrillodon
achieved. Qanbe done
paeng) 6ef odheive
poeing devices with
on exdernal
pad.
rianythoraeie
3. lemponag poingt
rangthorooie pocing tnvolve
the dineet
a wine on neele
érdradueton of poaino) tuire
dndo the venirieulan Covity
thnough the thornaz

by usirg aSubphoid pproach.

Epianaial Tenyporar Pooing:

Ih-thij caje, the uuines ane attaehed to-the

epicandium and ane brgughi throuha

Buafcal enliion n the thorax. Thee cuiteg

aneconneced to an exdernal puye genezlot.

Thi te okmporary pocing mmonly
been ofien cardiae susgerny
 Corgioveryion?
on abhormal
Aproceduneohio hea rade
a
A Conveted to nonmal nhthm using elecried
or drus y knounas Cardiovergion.

Candioverion ye hoek deliveng snehonied

on Ja- wave onthe ECoh.
wth te gRS Complezes

A.Che mnteal (phaanmaeologiea)a

nefery do the ye fandi
of
ahtmie medicaions
heard's nonmal hthm.
Ho seybne -the

2. Eleedriasl( De):
Hja procedune uheneby) a yrnchrca nived

shoek throughthe cheyt

áydelivened
eleclrioal
eleerodeson
to the headthrcougheolal
Ho -he skin ofthe che
Cuall
paddle -thad ane applied
and boek

Mechaniym
delivey snchonized shoek
1.Candiaveryion
enline mgocandium. ayo
Cohiah depalariaes inluis
en ne. erlrar
2- 1iyue
dnvolved
depolarized netracto
-he neerr rart cLeuid
3.Thà makes
b ardhen depooniodion.
snotorgen able
neerleand cinouid
4.Thuy the neenlruy)
b propaaod on guain
 5,Thy Henminades 3
freom
arhthmial neuldig
ne erlrart
3ingle CúnCuid Gueh J:
•A4AndAialfutlen
FHrio ver rioutan no dal ne entrarl
toehgoandia
•Ainiovenrieubn e errrand doehy cardia.

IMoragmonphia Verlrioulan oehandia

Indieadion8
1. Emergena
4. neeoablisment ofan organiztd
elecral nrgthm?
•Hemoderammcally nlable polynonphe
• Narrow on tuide gAS Complex tochyaraa
as0eiaded with
-Hemodeyramie cnydakiid
cherd pain

Tpulnonan) cdema
2- Eleeive ne-eyhblihmer o inyrhthm
• Alrialftbriaion
• Arial Puten
• Hemodyramicalay) abie retraclon) VT
 Condraindicodion
Digoli
!
nduced taoharxthmiay cuetonil
olsnolnding verhioulon

uroinuy toccandia
ahygthy unespongive -to elecdnie shoek
) 6loble odrialdulen twitth cdniol olol.

Glable odrial tbrillaion cwith arial ool.

ochorce dincolive
bpecifie suoh ay cbnol
neuycidade ondery.

Eleclrode posílion

4.. Andero lacleral ouierladion on sderno apical

approch
-The anerion podale placed jud o the
night of-the sennal edge onon the 2nd on 3rd
e'rolenoovol gpoae on rught ntreaelavioulan ngion.

The loderal paddle s pdaced on the de4fth

on sth eleroodal spooe on-the mid -azilan)
Rineon peecordum.
2·Arlero - porlerion Ouertodion
the let
he anterio padde as plaeod in

poraenral onea
-The poxderior paddle és plaCed an thele
dower zoopulan neaion coith -the poddlo edge
loto -the pinal @olumn The Rong aziy poddle
md he Orrieoted n-the oQ nioaudal dirteelion
ton hodh eleorocke paxiion.
 Elecdiol dos age?
nehronied Condiovergion :
4.Alrialabrulaion:
-
120 - 200 biphaie

200J monophosie
2.Ariol huten and p5VT:
- 80-1003 biphasie

3. VT with puye: on
- 1003 ineneajed an se puide fashi

•VF e pwyeley VT?

dase
eco defebnillodion
-Unsynchronized
monophoie
2003 biphaie e. 8co3
pediariey:
1. 6ynchronized Candioveryion :
dehbrallabon
2.Cnsynohronized

Daddle 6i2e
Adubd 13 Cm

childen-8 em
 rladon Monual
Doddle on 8e
adheie
: inionky
dekbrilaion.
oubnde
pod.
Conduetive gel on gel pody
paeing tuire ?
Treangvenouy and
Reyerllion equpme ranpudenesu
Sag and mayk devite

.
•Aixwag)dey
. Suelion
v
iee

Cannulaion
-Emengeneg) chgs.
Mioniloning:
pule ogmelng
ECG:obain 12 dead Feh beton and afen delivery
of shook
 Cenral Venou pnegue

Cvp n Onidicaly
alpaliend
DMonidorng)
and afden mojorn gunger
dnugsthad may damag
>Bmale
Infusion efinidor
Veirg.

Tnserelion of poeing winey

9aeral neplacemer -herap

Verouy aces
Emengeney
feedirg)
ponerrleral
arlravayculatl
Reuyethdion o podierds auho ane

depleled.

)
Contraindicodion
Uheonec
congulapahy
Tiombocytgpenia
kin anteeion oven -the8ie ofoeee
L) obsowne anadomieal lordmarles
)Haemo on pneumothorax on the
Con-naladeral side

Recer- Sugery do othen snuenes

Sueh ay corodidendordecom

Side
)6ubelavian Vein

Todenal gugulon Vein

Femoeal Vein
Compication: 6
Vajoulan
D Ain embaluy
B Arcderiol punctune
ola
Arcleriovenouj

lematoma

Teleliory
bepsis , ,
Celluits

ovleogyelitis
seplie ordhnidiy

Dyangthmia
knoing) on malpoilion
Cacthete

a Nenve injugy
9pneunohoreax ,hemomediolinum

Wave-torm!
3poxilive Waves > a,e, v(peaka)

X, (Derera)
2 Neg adive Wavej

a'arual conireoocion.
Closune o driQuspid Vale

v Venoy nesurn

2 adrial nelxalion
 Ihe central venouy compardgmerdond
bathe ruight adriam
Ioandthe to volumne enolose
gneal veiny én tho
-hora.
-he
CVp ig
thorcaeie
he onlrayacular pressune
Veins ,meowed nelotive
,
én hegnead
admoher
adhe
meajuwL
Preswe. A Convendionalty

) Jight adrium.
Pravices

Wave
an
buperior Veno
etimade

The mod
ofthe right adril

prominent wave ishe

contraeion tollawing
Qava jurneionond
prey
O Wova

the

A Neudirg) from adrial

ECGL PWove ad the end diaytole(Verririoulan
eWave Airial pneyune Ceeneage Bloinghe
Thy dealine én
a Wove,ay the orium neloze).

adrial pneyurte énrleruprles b the e Wovea

S he boginnir o Verlrioulan ytole Thi wave

prroduad
ja

ransie incne)ean arial preyune

e ria sight Vendricular corlracin
bg iyovolum
closey-the riospe
TheVerrioulan Cortralion
rightoriumn
Vave and dupacey d towand-he
in clrial
early loleprocuoing) andneneaje
presune. As an eayolie evert,-the @ Wave

mu tolow onye of theaas on Rwove

onthe Et

X X descend & AHrial pnee orrlinue, ls decline

curing Verlnizulor 3rylele

ya Con3 equenee
od

Corlinued oadrial neoalion and charge abrial

in odhia

geomelr praduced b Vedniouon 0orra elon D

1hy -theoeyeen on oli cal

ejeeton
pneue.The x deseen) conyiceres
in odrta
adrial
bethe sgdolie deeline on collopse,in
prese.
 peak j-the Vuave
pneyne
lart odriod
The la
VNave
the sugtt odriuum du ing
tilling of
auyed b Venouy
clasad.
4rúcuspid
Valeemain
-he
ade &yole tuhile u oten the FlG
FenTwave.
TheVwave peaka
ay he
deereayes
preyune -then
Y Decerd: Arial operny and bloocd ious
from arim
Vabe on dioolie
-Irieuspid y
o verriole. Thiy
the
jorejwe.
deyeerrl

blope dn ocrisd
 E3rain Deodh
Caues:
brain
-rom a dvayading
Jorain dog:h neuld,
rgu, commonl) due 4o head lrauma
bleedirg
tou) to-the
,
of bood
the
én brain,roke on loy
arues)
broin afen the heod slops(Candiae

Conseguences 9
o paierha
diagn.sed, opaient
Onece bnain deadh hay been
dedh ezarninadion.,
lecleaned dead. A 6inale hrain
minimumandard
dinghe oprea ted, the
diagoying bnain deoth en aduy.
Howeven,
for
eommend 2
en ei childnen, ecert guideines
ahe minimu
ne

beparode brain deoth examinodions

Mandard. Organ suppord
Verltlaion and
,
dncludirg mechaniaal
medicodiong 4o maindain adaak

preune, may be orlinued afern

olood deeloraion.

brain death fhe padiert j a Qan didode-ton

Orgon dona-lion on y pnegnant and a deciyion

made -o Corinue Suppord-Br-the tety.

Monagemend#
)Dalier-l shoutd be comodose and on Ven-deladord

)
Bupporel.

he Cauye provide propen Sucioning) ot

-tube to pre nemove gecnei on from the
EH

airung
 clean all body pards ,
espeaiall the fsoe,

baek and perúneal

open twounds ond
cavent
dreindo
propon
pieoes.
themcwith gauge
eveng 2houg Ho preed
charge the padierd pouilion
bedsone
bn nehey and Joelirg)
TV Cannula sides
cheek
ond
of podientdrescner
provide

Prasnois ,J
viualiodion
wel ay cougellir
daily.

ETrdea aordie baloon pump8

Indtaaion:
Cardiae tailune

Cardiogenie shock
Aeude MI

Uhabk Angina
ouypud ndeome
pol sungjoa koo Candiae

prophyoclie suppore
Condiae-raryplaraion
Romplioalion.3
Limb isehaemia

Bleling fromeand endernal

Thrumboid
Aondie valve ruplunte

neion]bepis
 Teohoigue
Peroudareou}
- Sheath Aess

- With heath

-Femoral oud doun

-Trany-thoraoie

)
Wearings

d
Weanirg) should be Conidened ifpali ent
hemodynamically able
> Jaeuced -Arolropie
sugpond
Guraduall deoneaje the aystwdance
1:1) 1:2)14)1:3 radio

u Then TAGP

)
oud withiin 20 min
SResueing Baloon
volume
Discortinue hepasin 4hn befone
TABP nemovalof
Catheten

heep on Bordby
mode and gay dreive ine
dy eonneeled ond
bloor baloon delated
)TABP cadheden nemoved
 pes,suacierd
detned a norteajed én
the pH 4odey
than 7.35.
to deereaye
enough
Caye? o dnuas
Hapo verrlialion
whioh may be becaye
overdose
and anesthediey

Dijondens
o
of neuromuyeulan
junclon.eteling

nepiraion
myoles of
aCerral depneion
oCNS.
like CoPD,ele.
Lung diyeaye hypendhema
eg mnalignarl

Excesive
Co proouclion..

5Ommt)
Tneacdment? peo, a high
verlilalion,
Mechons cal aloaly
tneodead
should be
Aidoi
of -the tunden
Treatmert

en pe)Buscierdto
THi deined as decreaje 45.
en cneae the ptl o
more than

Caye: yual oaye during

Thiy ásthe
D Hypenvenrilaion: generalanevheyia.
Sadragonie
9pregrancy
9Salicale poagoning
Tneatmend:
seting and nenicayirg
D Autmend of verliladon

the riohnehirg
Co, onhalaion
Caye.
3 Thead the undenlyig

BMetabolio Acidois 3
Defne ay deeneae on pH <435.
Cauye:

linculalor ailne(shoo)loading -to

Qeeumuloion oaetia aoid.

tb Dianvehen widh lo bioarbonade

ygride goiming
Arion Grap 3
ormalia anion gop y corlituded b suHodes,
phosphodes,organie aeida and plasma proleins.

Arion gap mainby titded poyra ollumin

Anion gap- bodium oorncendnation-(ehioride

+ bicarbonade concentroion)

Nonmal Anian gop- g-lc mML(ovocge 12mM9

 wdh Nomal Arson Grap:
Condidion Fociated
bicarborao
ayocialed with
Condiionu primariby
y rúye
equivaler-l
nChonido
Lo, iy 0e0pnpanied These conditionsane.
aronmal aniong0p.
Ond hene
Diannhea

foderanomies turopothies,
-lubulan neeroyis, chdnucdtve kidney
Aeral
theye condidiony is
hronio pelonephriis.Dnnode bul ehloride
laše, hioorbo
primoril
chlorit
nelained. Ommconiaum
Or
Admintxlrodton
of hydragen

) Carbonio onhdroye enhibiory.

Increayed Aniongap
DDiobeie kebaeidor anvalion
aneoiaded ctth
keloaeidosis of metaboie
mod common au3e
Laedie acidois hpoxia
anoelhesia
andyduetodisgue
B 0Qidosi; en

Bbalieylade poiyaning poisoning)

ond elhylene glycl of
Me-tharol
Reral oilune
,keading) o
decneajed exenelion

and aukdes
Qeid, phasphade,

Deneayed Aráongp
DHgpoolbuminemia
 45
Tnealment:
)
Sodiun bicarbo nade:

Dose - Sodium bioaicbonade (rnfa)

=0-2y body
wbaje defoil
weigti

Hal of the olouloded é

dose to be given émmediadel
next
ofen geirg-the
doge only
nd -the ie mainirg)
repord.
do have
ies mandadory
blood ga9anali dium bicarbo
befone given Bo
adeguade ven-liladion
nade

Inest the undenbyin auye.

Deined a pHy4:45
Coyeg
Vomiting
ofHe)
Aydes dobe aspinadton(loy
Diwnelicy

Hypovalemia
Diarvehea with lo o ehloride

Tneadmerd:
Tread the underbying Cage
) v resion of ammoniumooride
mone
on

than
(nod
0-1N hydrochorie 0eid
Aruyrthmia
cefined aon abnonnalityaignalof heasd

oceued, twhen
he eleclrieal
(ohieh is
cwonking praperg
Hthe heand ay nod

moy bead oo
heand
In Pngthnia the
(Bradytandia
oo eay emase
Carndia), too -low onlaten)
febrillaion
on Žsnegulan
Cordracion

Cayes?
Condiagenie
Siruelral
head

Arclerg
.
defee!

diyeaje
lorconary
diteae
Vablan head
heard diyeaye
Corgentlal

Candio mepothy

2 Non Candigenio -
on melobolie djonde.
D Electralyde
Tracheal idubadion
Layngoseopie
>lsehemia, Hypozis, hypendarbia
Dug neaotion

Local Fneylbelie (Erg lox 2-)

TRnee-feom)
Th prerenvaive Cauyeyon TV
pngevadv
Caiae onnefaminiaton
Claiaon.g
STachyarngthmia
o Wde complez

•Prial fibnlton • ,VF

•Snuy tochycondia Toryade -de point
• Alrialutten
(MA)
(MpJ
.Matlbal Airial Tachyjcondia
(svT)
Tochycndia)
•PšvT(peraymal bupralerinioulan
(AvAY
entry Tachyeandia
• Ario Verrioalon Ae
•Ario Vengriculan nodal neentr Tachyandia (AVNE

>)Toradycandia (aradyoengrhmia)
D Wide Complex ONarow Compler

• Right on de4 Bundle

brcaneh bloek
.. Biny JBrad,curndia
6inu ornert

Heard Block

1d degnee 2nd degnee Brnd degnee

Mobite pes Complede
hesud bloek

Tachybgthma:
Monogemen: tape and severid of
on -he
Tpeadreod deperd,
some coye ,noneomert
4
neceyar)
oytthmia.In

Non phanmacological-ineamerl:
Lfestyle charge? level
3uaet
DrMoraging Gp andblod

) Avoidina)

Cutlirg baek
9Avoid Coien
•Devicesg
-oboeg
on alchol
ond dnulands

dekibrilladon
cordioverder
DImplorablepoeemaken
> penmanal
pooemaken
giveriniautar

-Therapiey :
Coredioerion

latheden ablaon

pumona)vein ijolal'on

bypoy sugongy)
(CAGL
D Coranang andery
Mage pro Cedune

poeemaken engendion
Jhanracslatoal tnealmeot:
Cla Aetiony Druas
Quin dine,
TA Na- channel
Blacken dyoggeamiäe

Lidocaine,
Na channel
Glocker mexileline

Fleeainide,
Na chamel
blocken prgpofiron

B- bloekey propartanolol,
emalol

111 k-channel amiodarone,

blocken Dofeiide

Ca- chonnel Verapomil

bloeken ddazem

Unknawn
Digozin.,
mechanim Adenaine
 Cenebro Vascula Accicend :
Risk fooors:
oNon-modbiabie
o Modifiable
Hhpedension
Heand diyeaje Grendlen.

bmoking
4 Fxeeive alcoholConsumplion )Fami hislor
Flenedity
Obesty
Sleep opnoea

Melabolia pchome
> Look of phyical exenoye
pon diet

to Draa) abuye

Cowes
o Dschenie roke
blos
ofa bloocl veyelbla
Thromoi Obueion

dueHo embalyrom
Emblim: obrruedton
ehewhene dn body

Syese typopenleion: Bupp)

Grene ral)ceoneayed blod

Mlral valve alettieation

 )
oflemonhagie
Heocl trouma
Hyperderion
roker

Meaaiebrain tumon

Cogolapothy
Aneun

pes
}Tschaemio noke

•Acwde ischemiorrake
Irorsierl esehemie atdoek (1In)

temanudhagierove(a/. ofol types ofatnok)

• Cenebrolhemonse hage
6ub arachonotd
hemorshage

ahophiolbay o Tachenie hoke3

Oeeluion o4 an rrea-eronial
Veyel b an embo
thad ariye -from a
unee Bueh ayarial
danite thadcardiogenio
from coro-ed athero Pibrillaion on Qnemboli
golenotte oague
Lange nlra creaniol veyel. oen
at4eelir

Threomb0si an elracnanial veyel tapialy

aecinghe gmall oeeriesthadanntves en themoyo.
endrra ranial oderuie

Hypo penResion Chuyed b hoo imidina) >xderasin ofe

majon exdrra Cranial veNel(indernal Cotid ado

A deerteased enebral blood-o) Cauye brain do