Your Blog

Included page "clone:utopianrubbish596" does not exist (create it now)

Texas coral snake (Micrurus tener) bites. - 30 Aug 2016 17:42

Tags:

[[html]]Background: The clinical features of bites from Texas coral snakes<br><br>(Micrurus tener) have not been well studied. Our goal was to review the<br><br>largest number of victims of Texas coral snakebites to determine their<br><br>characteristics, effects, treatment, and outcome.<br><br>Methods: Retrospective case series of Micrurus tener exposures&#13;<br><br>reported to the Texas Poison Center Network from 2000 to 2004.&#13;<br><br>&#13;<br><br>Results: Eighty-two patients were included in the analysis. Most&#13;<br><br>(57.3%) were 18 to 49-year-old men. Almost 90% had local swelling, pain,&#13;<br><br>erythema, or paresthesias. Only 7.3% had systemic effects, and none of&#13;<br><br>these were severe. Over half received coral snake antivenin, and 15.9%&#13;<br><br>were given opioids for pain. No patient died and no patient required&#13;<br><br>mechanical ventilation due to hypoventilation from the snakebite.&#13;<br><br>&#13;<br><br>Conclusions: There were more local findings and less severe&#13;<br><br>systemic effects than previously reported. Antivenin is not needed for&#13;<br><br>most of these patients, and opioids may be administered safely.&#13;<br><br>&#13;<br><br>Key Words: coral snake, snake bites, Micrurus tener, Micrurus&#13;<br><br>fulvius tenere, Texas, venom&#13;<br><br>&#13;<br><br>&#13;<br><br>&#13;<br><br>In the United States, bites from coral snakes account for less than&#13;<br><br>2% of the total reported snakebites to people. (1-4) The majority of&#13;<br><br>venomous snakebites are by pit vipers (rattlesnakes, cottonmouths, and&#13;<br><br>copperheads). (3) Coral snakes differ from pit vipers in appearance,&#13;<br><br>venom-delivery apparatus, venom composition, and venom effects. They can&#13;<br><br>be identified by their black noses and the bright red, yellow, and black&#13;<br><br>circumferential bands. (5) Their venom produces much less local tissue&#13;<br><br>damage and hematological abnormalities than that of the pit vipers.&#13;<br><br>However, peptides in the venom block postsynaptic acetylcholine&#13;<br><br>receptors (4) and may produce severe delayed systemic effects, including&#13;<br><br>paralysis, respiratory depression, and even death. (3,5-8) Coral snakes&#13;<br><br>produce less venom than pit vipers, but the venom is more potent than&#13;<br><br>that of all of US snakes except the Mojave rattlesnake (Crotalus&#13;<br><br>scutulatus). (8)&#13;<br><br>&#13;<br><br>Coral snakes are in the family Elapidae and are found in the<br><br>southeastern United States, Mexico, Central and South America. (9)<br><br>However, only two species (each having multiple subspecies) are<br><br>responsible for all coral snake toxicity in the United States: Micrurus<br><br>fulvius fulvius (Eastern coral snake) and Micrurus tener (Texas coral<br><br>snake). (7) These two coral snakes were previously classified as<br><br>subspecies of the same species. They have a similar appearance, but<br><br>there are morphologic differences between them. The other coral snake in<br><br>the United States does not envenomate people: Micruroides euryxanthus (Sonoran, Western, or Arizona coral snake). (5,7) It is estimated that<br><br>the Eastern and Texas coral snakes together bite less than 150 victims<br><br>every year. (4) The Eastern coral snake lives east of the Mississippi<br><br>river in many southeastern states. The Texas coral snake is found only<br><br>in parts of three states: southern and eastern Texas, southern Arkansas,<br><br>and in Louisiana, west of the Mississippi river. (4) Most of the<br><br>published coral snakebite knowledge has been limited to those pertaining<br><br>to Eastern coral snakes. (4,6,7,9,10) No large case series of patients<br><br>with Texas coral snake bites have been published. A review of the<br><br>medical literature found less than twenty Texas coral snake victims.<br><br>(2,5,11) The effects from Texas coral snakebites are believed to be<br><br>similar to, but not as severe as those from Eastern coral snakes. (5)<br><br>Our goal was to review a series of patients to determine the<br><br>characteristics, effects, treatment and <a href="http://www.myhuckleberry.com/business-listing.aspx?id=25731654">wildlife control</a> outcome of Texas coral<br><br>snakebites.<br><br>Methods&#13;<br><br>&#13;<br><br>This was a retrospective case review of patients with a bite from a&#13;<br><br>coral snake referred to any of the six poison centers that make up the&#13;<br><br>Texas Poison Center Network: Central Texas, North Texas, South Texas,&#13;<br><br>Southeast Texas, Texas Panhandle, and West Texas Poison Center. A&#13;<br><br>medical record is created for each human exposure and is stored in a&#13;<br><br>secure electronic database. Follow-up telephone calls are made by the&#13;<br><br>poison center specialist in poison information to the treating&#13;<br><br>healthcare facility or to the patient.&#13;<br><br>&#13;<br><br>The Texas Poison Center Network database of medical records was&#13;<br><br>searched for all human exposures to coral snakes. Study inclusion&#13;<br><br>criteria included human exposure, envenomation, coral snake regardless&#13;<br><br>of subspecies, and occurrence between January 1, 2000, and December 31,&#13;<br><br>2004. A case was secondarily excluded if there was no follow-up call&#13;<br><br>recorded, no treatment information or if the snake was later identified&#13;<br><br>not to be a coral snake. Coral snakes were positively identified only by&#13;<br><br>an expert, a treating physician, or by the detailed description told to&#13;<br><br>the poison center staff. Local findings were defined as pain, swelling,&#13;<br><br>erythema, paresthesias, and fasciculations. Systemic effects were&#13;<br><br>defined as nausea, vomiting, dizziness, lethargy, salivation, euphoria,&#13;<br><br>tremors, slurred speech, ptosis, diplopia, dyspnea, dysphagia, muscle&#13;<br><br>weakness, respiratory depression, or seizures. A disruption of the skin&#13;<br><br>was defined as a puncture wound, abrasion, or scratch. Local&#13;<br><br>Institutional Review Board review was obtained before the study. The&#13;<br><br>Wilson score method without continuity correction was used to calculate&#13;<br><br>95% confidence intervals for the main outcomes.&#13;<br><br>&#13;<br><br>Results<br><br>Patient Demographics&#13;<br><br>&#13;<br><br>There were 96 records regarding human exposure to coral snake venom&#13;<br><br>in the Texas Poison Center database that met the inclusion criteria.&#13;<br><br>This represented only 2.3% of all snakebites in Texas. Of these,&#13;<br><br>fourteen calls were excluded due to duplication, misidentification of&#13;<br><br>the snake, or no follow-up information. The medical records for the&#13;<br><br>remaining <a href="http://tupalo.com/en/gettysburg-pennsylvania/mid-atlantic-wildlife-control">coral snakes</a> 82 patients were analyzed. The number of calls for each of the&#13;<br><br>study years from 2000 to 2004 was 16, 8, 20, 22, and 16. Over 85% of the&#13;<br><br>bites occurred during the seven months from April to October (Fig. 1).&#13;<br><br>Most patients were male (85.4%). There were 17 (20.7%) children (Fig.&#13;<br><br>2). The calls usually came quickly after the bite occurred. Most (90.2%)&#13;<br><br>of the calls had the time of the bite recorded, and all were within 24&#13;<br><br>hours of the bite. Of these, 70.3% were within 1 hour of the bite, and&#13;<br><br>91.9% were within three hours.&#13;<br><br>&#13;<br><br>Snake Factors&#13;<br><br>&#13;<br><br>In 22 cases (26.8%), the snake was positively identified as a coral&#13;<br><br>snake by the study criteria. Half (n = 11) received antivenin. Of those&#13;<br><br>60 without a positive identification, 50 (83.3%) had some local effects&#13;<br><br>(pain, swelling, or paresthesia). Only 24 (29.3%) had the snake biting&#13;<br><br>behavior noted. Ten (41.7%) of these stated the snake held on for a few&#13;<br><br>seconds or more. Fourteen (58.3%) stated the snake let go quickly after&#13;<br><br>the strike and did not "hang on" or "chew." Of those&#13;<br><br>14 who received only a quick strike, 13 (92.9%) had a mild local&#13;<br><br>reaction, and one patient had a moderate local reaction. Four of these&#13;<br><br>14 patients received coral snake antivenin.&#13;<br><br>&#13;<br><br>[FIGURE 1 OMITTED]&#13;<br><br>&#13;<br><br>Bite Location&#13;<br><br>&#13;<br><br>Of those who had the bite location recorded (89.0%), most (94.5%)&#13;<br><br>were bitten on the upper extremity. Forty-six (56.1%) were bitten on a&#13;<br><br>finger. Four patients (5.5%) were bitten on the foot or ankle. Only 29&#13;<br><br>cases recorded whether or not the victim was handling the snake before&#13;<br><br>the bite. Of these, 79.3% were handling the snake.&#13;<br><br>&#13;<br><br>Local Signs and Symptoms&#13;<br><br>&#13;<br><br>Examination of the bite site revealed ten patients (12.2%) who had&#13;<br><br>no visible skin disruption at the bite site. Three of these ten patients&#13;<br><br>had local effects and one had systemic effects. For the 68 patients&#13;<br><br>(82.9%) who had a wound at the bite site, 86.8% had local effects and&#13;<br><br>7.4% had systemic effects. Only eleven (13.4%, 95% CI: 7.7-22.4%) of the&#13;<br><br>82 patients had no local or systemic signs or symptoms. Seventy (85.4%,&#13;<br><br>95% CI: 76.1-91.4%) of the 82 patients had some abnormal finding at the&#13;<br><br>bite site. Thirty-eight patients (46.3%, 95% CI: 36.0-57.1%) noted&#13;<br><br>localized swelling, and 3 (3.7%) had significant swelling. Thirty-five&#13;<br><br>(42.7%, 95% CI: 32.5-53.5%) patients reported some pain, and 13 (15.9%)&#13;<br><br>reported more than mild pain that required multiple doses of medication.&#13;<br><br>This pain frequently radiated up the arm or to the chest. Twenty-four&#13;<br><br>patients (29.3%) were noted to have both pain and swelling, and two&#13;<br><br>patients (2.4%) had both significant pain and significant swelling.&#13;<br><br>Other local findings were erythema, paresthesia, numbness, and a small&#13;<br><br>area of ecchymosis (Table 1).&#13;<br><br>&#13;<br><br>Systemic Effects&#13;<br><br>&#13;<br><br>Only six patients (7.3%, 95% CI: 3.4-15.1%) had systemic effects.&#13;<br><br>These were all men from 17 to 51 years old who were bitten on the hand&#13;<br><br>or finger. Four of the six stated the snake "held on" for a&#13;<br><br>few seconds. They all received antivenin. All except one of these also&#13;<br><br>had local effects (pain, swelling, or erythema). The exception was a man&#13;<br><br>who went to the hospital almost 12 hours after being bitten because he&#13;<br><br>was having joint pain and generalized fatigue but had no skin disruption&#13;<br><br>at the bite site. Another patient, who had a chronic seizure disorder,&#13;<br><br>presented within 30 minutes of the bite with status epilepticus. He had&#13;<br><br>endotracheal intubation at arrival to the healthcare facility. The next&#13;<br><br>day, he was extubated and discharged home. The systemic effects of these&#13;<br><br>two patients were probably not the result of the snakebite. The other&#13;<br><br>four patients presented with one or more of the following symptoms: mild&#13;<br><br>shortness of breath, fatigue, nausea, vomiting, facial flushing, muscle&#13;<br><br>jerking, weakness and dizziness. All these systemic effects occurred&#13;<br><br>within three hours of the bite. None of these four patients had a severe&#13;<br><br>systemic reaction to the snakebite, although all (except the late&#13;<br><br>presenter) received coral snake antivenin within eight hours of the&#13;<br><br>bite.&#13;<br><br>&#13;<br><br>[FIGURE 2 OMITTED]&#13;<br><br>&#13;<br><br>Hospital Length of Stay&#13;<br><br>&#13;<br><br>Seventy-nine (96.3%) were treated in a healthcare facility such as&#13;<br><br>a hospital emergency department. Hospital observation was the most&#13;<br><br>common treatment. Seventy-two had their hospital discharge time recorded&#13;<br><br>or estimated. For those who were hospitalized for a known time, 66.7%&#13;<br><br>were discharged within 24 hours (Fig. 3).&#13;<br><br>&#13;<br><br>Antivenin&#13;<br><br>&#13;<br><br>Forty-five (54.9%) patients were treated with "North American coral snake antivenin. The antivenin administration time was noted in&#13;<br><br>86.7% of the cases. Seventeen had antivenin given within three hours of&#13;<br><br>the snakebite. All but three patients (51.2%) had the antivenin&#13;<br><br>initiated within eight hours of the bite. One person received antivenin&#13;<br><br>16 hours after the bite. One patient was administered only half a vial&#13;<br><br>of antivenin due to an adverse reaction. Thirty-nine patients (86.7%)&#13;<br><br>received three to five vials of antivenin. The maximum dose was six&#13;<br><br>vials. Five patients (11.1%) had an adverse reaction to the antivenin.&#13;<br><br>Three patients had lip and/or tongue swelling, one had a pruritic rash,&#13;<br><br>and one had anaphylaxis.&#13;<br><br>&#13;<br><br>Thirty-seven (45.1%) victims did not receive antivenin. Nine of&#13;<br><br>these (24.3%) were bitten by a confirmed coral snake and had skin&#13;<br><br>breakage. Thirty-one victims (83.8%) who did not receive antivenin had a&#13;<br><br>local reaction (pain, swelling, erythema, or paresthesias). Two patients&#13;<br><br>had severe pain. None of these patients had any systemic reactions. All&#13;<br><br>thirty-four patients treated in a healthcare facility were discharged&#13;<br><br>within 36 hours.&#13;<br><br>&#13;<br><br>[FIGURE 3 OMITTED]&#13;<br><br>&#13;<br><br>Other Treatments&#13;<br><br>&#13;<br><br>Thirteen patients (15.9%) received opioid medication (usually&#13;<br><br>morphine) for pain, 14.6% had antihistamines, and 8.5% had antibiotics.&#13;<br><br>Other treatments included steroids, nonopiate pain medication,&#13;<br><br>anti-emetics, and benzodiazepines. Local wound care and IV fluid&#13;<br><br>administration were common treatments.&#13;<br><br>&#13;<br><br>Outcome&#13;<br><br>&#13;<br><br>Patients were followed by the poison centers after the bite to&#13;<br><br>determine outcome. Over 92% were followed for six hours, and 78.0% were&#13;<br><br>followed for 24 hours or more. Most (84.1%) had no effects or only mild&#13;<br><br>effects from the snakebite. This included those with only minor local&#13;<br><br>effects (swelling, pain, erythema) and those with minor systemic effects&#13;<br><br>(nausea, fatigue, dizziness, other). No patient had severe local or&#13;<br><br>systemic effects. No patient had paralysis, diplopia, or required&#13;<br><br>intubation due to paralysis, and there were no deaths (0%, 95% CI&#13;<br><br>0-4.5%).&#13;<br><br>&#13;<br><br>Discussion&#13;<br><br>&#13;<br><br>Before the introduction of the North American coral snake antivenin&#13;<br><br>in 1967, there was about 1 death every few years from the Eastern coral&#13;<br><br>snake. (1,7,8,10,12) The number of deaths from Texas coral snakes during&#13;<br><br>this time is unknown. Although the coral snake antivenin is indicated&#13;<br><br>for both the Eastern and Texas coral snake regardless of symptoms, (3)&#13;<br><br>it is believed that the bites from the Eastern are more severe than&#13;<br><br>those of the Texas. (5) There have been no reported deaths from coral&#13;<br><br>snakebites in the United States from 1967 to 2005. (4) Only a few&#13;<br><br>descriptions of patients bitten by Eastern coral snakes have been&#13;<br><br>published. (4,6,7,9,10) They have described the following&#13;<br><br>characteristics: swelling, paresthesias, nausea, vomiting, dizziness,&#13;<br><br>lethargy, salivation, euphoria, tremors, slurred speech, ptosis,&#13;<br><br>diplopia, dyspnea, dysphagia, muscle weakness, respiratory depression,&#13;<br><br>and seizures. There are even fewer published reports of Texas coral&#13;<br><br>snakebites. In 1960, Stimson and Engelhardt (11) stated none of the nine&#13;<br><br>coral snake patients in Texas had serious effects from a coral&#13;<br><br>snakebite. Parrish and Khan (5) reported that none of the five patients&#13;<br><br>bitten by Texas coral snakes had any serious symptoms, but at least one&#13;<br><br>had "minimal swelling." Norris and Dart (2) reported on a&#13;<br><br>patient bitten by a Texas coral snake who had only paresthesias.&#13;<br><br>&#13;<br><br>Our study confirms many characteristics of Texas coral snakebites&#13;<br><br>that have been based on Eastern coral snakebite studies. Very few&#13;<br><br>snakebites occurred in late fall and winter. (6) Most bites occurred on&#13;<br><br>the finger or hand, probably due to the small size of the snakes'&#13;<br><br>mouths. (5,6,8) Many occurred while the victim was handling the snake.&#13;<br><br>(5,6) As in previous studies, most victims were adult men. (5,6) Visible&#13;<br><br>wounds (puncture, scratches, or abrasions) from the bite are common.&#13;<br><br>(5,6) However, a wound does not have to be present to have envenomation.&#13;<br><br>(2) None of our patients had the severe tissue damage seen with pit&#13;<br><br>viper bites, but not seen in previous coral snake studies. In fact, some&#13;<br><br>patients (13.4%) had no local or systemic signs or symptoms. (6)&#13;<br><br>Previous studies report minor swelling and no pain. (5,10) The majority&#13;<br><br>of our patients did not have swelling noted, and most of the remainder&#13;<br><br>had only minor swelling. Most patients had no pain reported. No patient&#13;<br><br>died or had permanent neurologic sequelae. These are the same results&#13;<br><br>reported by Kitchens and Van Mierop (6) in the largest Eastern coral&#13;<br><br>snake study published to date. Of note, 35% of the patients from that&#13;<br><br>study that received antivenin developed a drug reaction, including one&#13;<br><br>with anaphylaxis. Only 11% of our patients had an adverse drug reaction to the antivenin. This low rate is probably due to the frequency that&#13;<br><br>steroids and antihistamines were administered prophylactically before&#13;<br><br>the antivenin.&#13;<br><br>&#13;<br><br>This study contradicts some findings from other studies of the&#13;<br><br>Eastern coral snake. These studies state that most Eastern coral snakes&#13;<br><br>hang on to their victims for several seconds. (5,6) Although this factor&#13;<br><br>was not well recorded in our study, more than half of the patients who&#13;<br><br>noted the bite characteristic stated the snake let go of the skin&#13;<br><br>immediately. Apparently, these snakes can inject enough venom with a&#13;<br><br>quick strike to cause a moderate local reaction. Our patients were older&#13;<br><br>than those of previous studies. (5,6) Several authors report the death&#13;<br><br>rate for coral snakebites that do not receive antivenin is 10 to 20%.&#13;<br><br>(2,4,5) This seems extremely unlikely for victims of Texas coral&#13;<br><br>snakebites since none of our 37 patients who did not receive antivenin&#13;<br><br>developed any systemic findings. Neurologic findings are common with the&#13;<br><br>Eastern coral snake. (3,5,6,9,10) None of the Texas coral snakebite&#13;<br><br>victims developed neurologic findings other than paresthesias.&#13;<br><br>Respiratory paralysis requiring mechanical ventilation occurs in some&#13;<br><br>patients bitten by the Eastern coral snake. (6,9,10) This has not been&#13;<br><br>recorded with the Texas coral snake. Some authors have suggested that&#13;<br><br>over 20% of Eastern coral snakebites are "dry bites" causing&#13;<br><br>no envenomation to the victim. (6,13) However, only about 6 to 13% of&#13;<br><br>victims of Texas coral snakes have dry bites, depending on the&#13;<br><br>definition used. We found a much higher fraction of patients with local&#13;<br><br>pain and swelling than have been reported for the Eastern coral snake.&#13;<br><br>(2-8) Others have stated that all coral snake victims should be&#13;<br><br>hospitalized for 48 hours, and none should receive morphine. (5,6) About&#13;<br><br>70% of our patients were discharged from the hospital within 24 hours of&#13;<br><br>the bite, and 15.9% received opioids for pain.&#13;<br><br>&#13;<br><br>Our study verifies many concepts pertaining to Texas coral&#13;<br><br>snakebites. These bites produce less severe effects than bites from the&#13;<br><br>Eastern coral snake. (5) They seldom, if ever, cause death or paralysis.&#13;<br><br>(5) Our study contradicts many previous beliefs about Texas coral&#13;<br><br>snakes. Texas coral snakes frequently do not chew or hang on when they&#13;<br><br>bite. However, they may envenomate without chewing. Frequently, there&#13;<br><br>are local minor signs and symptoms (pain, swelling, erythema, or&#13;<br><br>paresthesias). These rarely may be more than minor, but the pain and&#13;<br><br>swelling resolves within 24 hours. The paresthesias may last for weeks.&#13;<br><br>Bites from Texas coral snakes do not produce severe systemic symptoms,&#13;<br><br>even without the administration of antivenin, and antivenin is not&#13;<br><br>needed for every bite.&#13;<br><br>&#13;<br><br>This retrospective study of patients reported to Texas poison&#13;<br><br>centers has several limitations. Not all coral snakebites in Texas were&#13;<br><br>reported to the Texas poison centers. Victims who did not seek medical&#13;<br><br>care may not have called the local poison center. In addition, treating&#13;<br><br>physicians may not have called the poison center, allowing that some&#13;<br><br>patients with serious envenomations not be included in this study.&#13;<br><br>However, this is the largest study of North American coral snakebites,&#13;<br><br>and the findings should remain valid, even if additional patients are&#13;<br><br>later found. Since this study was retrospective, only the data collected&#13;<br><br>for routine poison center use was reviewed. If the data was not&#13;<br><br>reported, collected or recorded accurately or completely, the results&#13;<br><br>could be invalid. Only 22 of the snakes involved were positively&#13;<br><br>identified as coral snakes by the study's criteria. Some bites&#13;<br><br>could have been from snakes other than the Texas coral snake. The&#13;<br><br>scarlet king snake (Lampropeltis triangulum elap-soides), which looks&#13;<br><br>similar to the coral snake ("Red on Black, Venom Lack" and has&#13;<br><br>a red snout), is nonvenomous. However, since none of the victims had a&#13;<br><br>serious systemic effect, the removal of a few patients bitten by&#13;<br><br>nonvenomous snakes would not affect the major results. Some of the&#13;<br><br>snakes could have been other venomous pet snakes such as a different&#13;<br><br>species of Micrurus (Eastern coral snake or Mexican coral snake). Since&#13;<br><br>these are thought to have more serious effects than the Texas coral&#13;<br><br>snake, this limitation should not affect the major results. The major&#13;<br><br>limitation of the study is the fact that over half of the patients&#13;<br><br>received antivenin. This was not done randomly, and the patients that&#13;<br><br>received the antivenin were likely more poisoned than those who did not&#13;<br><br>receive it. The administration of the antivenin may have prevented&#13;<br><br>serious progression of the effects of the venom in this group. But it&#13;<br><br>remains remarkable that in this study, none of the patients (with or&#13;<br><br>without antivenin) developed serious neurologic or respiratory problems.&#13;<br><br>&#13;<br><br>Conclusion&#13;<br><br>&#13;<br><br>Poison Center data of 82 patients with bites from Texas coral&#13;<br><br>snakes were analyzed and revealed that most were men, age 18 to 49 years&#13;<br><br>old, bitten on a finger. A skin disruption at the bite site was noted&#13;<br><br>for over 80%, and almost 90% had local swelling, pain, erythema, or&#13;<br><br>paresthesia. Only 7.3% had systemic effects, and none of these were&#13;<br><br>severe. Over half received coral snake antivenin, and 15.9% were given&#13;<br><br>opioids for pain. No patient died and no patient required mechanical&#13;<br><br>ventilation due to hypoventilation from the snakebite. This review of&#13;<br><br>Texas coral snakebites found more severe local findings, and less severe&#13;<br><br>systemic effects than previously reported. Antivenin is not needed for&#13;<br><br>most of these patients, and opioids may be given safely.&#13;<br><br>&#13;<br><br>References&#13;<br><br>&#13;<br><br>1. Parrish HM. On the incidence of poisonous snakebites in Florida:&#13;<br><br>analysis of 241 cases occurring during 1954 and 1955. Am J Trop Med Hyg&#13;<br><br>1957;6:761-764.&#13;<br><br>&#13;<br><br>2. Norris RL, Dart RC. Apparent coral snake envenomation in a&#13;<br><br>patient without visible fang marks. Am J Emerg Med 1989;7:402-405.&#13;<br><br>&#13;<br><br>3. Gold BS, Barrish RA, Dart RC. North American snake envenomation:&#13;<br><br>diagnosis, treatment, and management. Emerg Med Clin N Am&#13;<br><br>2004;22:423-443.&#13;<br><br>&#13;<br><br>4. German BT, Hack JB, Brewer K, et al. Pressure-immobilization&#13;<br><br>bandages delay toxicity in a porcine model of eastern coral snake&#13;<br><br>(Micrurus fulvius micrurus) envenomation. Ann Emerg Med 2005;45:603-608.&#13;<br><br>&#13;<br><br>5. Parrish HM, Khan MS. Bites of coral snakes: report of 11&#13;<br><br>representative cases. Am J Med Sci 1967;253:561-568.&#13;<br><br>&#13;<br><br>6. Kitchens CS, Van Mierop LH. Envenomation by the Eastern coral&#13;<br><br>snake (Micrurus fulvius fulvius). JAMA 1987;258:1615-1618.&#13;<br><br>&#13;<br><br>7. McCollough NC, Gennaro JF. Coral snake bites in the United&#13;<br><br>States. J Fla Med Assoc 1963;49:968-972.&#13;<br><br>&#13;<br><br>8. Wingert WA, Waisnshel J. Diagnosis and management of&#13;<br><br>envenomation by poisonous snakes. South Med J 1975;68:1015-1026.&#13;<br><br>&#13;<br><br>9. Ramsey GF, Klickstein GD. Coral snake bite: report of a case and&#13;<br><br>suggested therapy. JAMA 1962;182:949-951.&#13;<br><br>&#13;<br><br>10. Mosely T. Coral snake bite: recovery following symptoms of&#13;<br><br>respiratory paralysis. Ann Surg 1966;163:943-948.&#13;<br><br>&#13;<br><br><img style="float:left;margin:10px;border:none;" src="http://wildliferemovalshreveport.com/wp-content/uploads/2012/05/bossier-city-raccoon-removal1.jpg" width="305" /><br><br>11. Stimson AC, Engelhardt HT. The treatment of snakebite. J Occup&#13;<br><br>Med 1960;2:163-168.&#13;<br><br>&#13;<br><br>12. Parrish HM. Deaths from bites and stings of venomous animals&#13;<br><br>and insects in the United States. Arch Intern Med 1959;104:198-207.&#13;<br><br>&#13;<br><br>13. Russell FE, Carlson RW, Wainschel J, et al. Snake venom&#13;<br><br>poisoning in the United States experience with 550 cases. JAMA&#13;<br><br>1975;233:341-344.&#13;<br><br>&#13;<br><br>David L. Morgan, MD, Douglas J. Borys, PharmD, Rhandi Stanford,&#13;<br><br>PharmD, Dean Kjar, BS, and William Tobleman, MD&#13;<br><br>&#13;<br><br>From the Central Texas Poison Center, the Department of Emergency&#13;<br><br>Medicine, Scott and White Memorial Hospital, Texas A &amp; M System&#13;<br><br>Health Science Center, Temple, TX.&#13;<br><br>&#13;<br><br>Reprint requests to David L. Morgan, MD, Department of Emergency&#13;<br><br>Medicine, Scott and White Memorial Hospital, 2401 South 31st Street,&#13;<br><br>Temple, TX 76508. Email: gro.ws.liamws|syrobd#gro.ws.liamws|syrobd&#13;<br><br>&#13;<br><br>Preliminary data from the study was presented at the North American&#13;<br><br>Congress of Clinical Toxicology annual meeting in Orlando, FL,&#13;<br><br>September, 2005.&#13;<br><br>&#13;<br><br>Accepted June 9, 2006.&#13;<br><br>&#13;<br><br>RELATED ARTICLE: Key Points&#13;<br><br>&#13;<br><br> Only a few studies have described the clinical effects of coral&#13;<br><br>snake bites in the US, and most of these were limited to the Eastern&#13;<br><br>coral snake.&#13;<br><br>&#13;<br><br>** Texas coral snake bites frequently produce local effects in many&#13;<br><br>patients.&#13;<br><br>&#13;<br><br>** Texas coral snakes bites rarely produce systemic findings. Texas&#13;<br><br>coral snakes require antivenin only in the unlikely event of severe&#13;<br><br>systemic effects.&#13;<br><br>&#13;<br><br>** This study is limited by its retrospective nature and reliance&#13;<br><br>on nonprofessional identification of the snake.&#13;<br><br>&#13;<br><br>RELATED ARTICLE: Recommendations for Texas Coral Snake Bites&#13;<br><br>&#13;<br><br>1. Attempt to identify the snake ("Red on Yellow, Kill a&#13;<br><br>Fellow", black snout).&#13;<br><br>&#13;<br><br>2. Do not incise the wound or suck venom from the wound.&#13;<br><br>&#13;<br><br>3. Provide wound care and fluids. (These bites will not have the&#13;<br><br>severe local tissue damage and ecchymosis seen with pit viper bites.)&#13;<br><br>&#13;<br><br>4. Use pressure-immobilization bandage on the extremity. (4)&#13;<br><br>&#13;<br><br>5. Administer pain medication (opioid or other) as needed.&#13;<br><br>&#13;<br><br>6. Observe for 8 hours to assure no anaphylaxis to the venom and no&#13;<br><br>worsening signs and symptoms of envenomation.&#13;<br><br>&#13;<br><br>7. No antivenin is needed for only mild swelling and mild pain.&#13;<br><br>&#13;<br><br>8. No need to prophylactically treat the bite of a Texas coral&#13;<br><br>snake with antivenin.&#13;<br><br>&#13;<br><br>9. Consider 3 to 5 vials of coral snake antivenin for systemic&#13;<br><br>effects or progressive local effects.&#13;<br><br>&#13;<br><br>*These recommendations do not apply to those patients bitten east&#13;<br><br>of the Mississippi River.&#13;<br><br>&#13;<br><br>&#13;<br><br>Table. Local findings&#13;<br><br>&#13;<br><br>Puncture/scratches 68 (82.9%)&#13;<br><br>Swelling 38 (46.3%)&#13;<br><br>Pain 35 (42.7%)&#13;<br><br>Erythema 19 (23.2%)&#13;<br><br>Paresthesia 10 (12.2%)&#13;<br><br><object width="400" height="241"><param name="movie" value="http://www.youtube.com/v/RhiEWYoKqUw&hl=en_US&fs=1&"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/RhiEWYoKqUw&hl=en_US&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="400" height="241"></embed></object><br><br>Numbness 3 (3.7%)&#13;<br><br>Ecchymosis 1 (1.2%)&#13;<br><br>None 11 (13.4%)&#13;[[/html]] - Comments: 0

Mindfulness meditation: 8 ways it can improve your health - Page 2 - 13 Aug 2016 02:23

Tags:

[[html]]<img src="http://cbsnews1.cbsistatic.com/hub/i/r/2010/10/29/6ee35f58-a644-11e2-a3f0-029118418759/resize/620x465/353f22bad5696b01dbe95bd8f1cabd6c/back-pain-iStock_0000057797.jpg" alt="" srcset="http://cbsnews1.cbsistatic.com/hub/i/r/2010/10/29/6ee35f58-a644-11e2-a3f0-029118418759/resize/620x465/353f22bad5696b01dbe95bd8f1cabd6c/back-pain-iStock_0000057797.jpg 1x, http://cbsnews2.cbsistatic.com/hub/i/r/2010/10/29/6ee35f58-a644-11e2-a3f0-029118418759/resize/1240x930/382a54d7cf29d173fff87954edf876f4/back-pain-iStock_0000057797.jpg 2x"/><br><br>New research suggests mindfulness meditation eases low back pain better than standard treatment or cognitive behavioral therapy.<br><br>istockphoto <br><br><img style="float:left;margin:10px;border:none;" src="http://www.pregnancyihub.com/wp-content/uploads/2011/11/Remedies-For-Back-Pain-During-Pregnancy.jpg" width="314" /><br><br>A study out this week by Seattle researchers found that people who practiced mindfulness-based stress reduction — a combo of meditation, awareness of the body and yoga moves — had better outcomes when it came to low back pain relief compared to people who received standard treatments or cognitive behavioral therapy (CBT).<br><br>The scientists randomly assigned 342 adults, ages 20 to 70, with <a href="http://wooflesadoggydiner.com/tag/doctor-of-chiropractics/">chiropractor <a href="http://www.theoliverprogram.org/dealing-effectively-lower-back-pain/">maintaining good posture</a> reviews</a> chronic low back pain to receive either eight weekly two-hour sessions of group meditation training or CBT or standard medical care (which could include options like physical therapy or painkillers).<br><br>Six months later, the participants in the meditation group had an easier time climbing up stairs, pulling on socks, and getting up out of a chair and they were less likely to be bedridden. Sixty percent of patients in the meditation group showed a "meaningful" improvement in their daily activities. A year later, they were still doing better.<br><br><object width="400" height="241"><param name="movie" value="http://www.youtube.com/v/GpohzOLBN-w&hl=en_US&fs=1&"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/GpohzOLBN-w&hl=en_US&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="400" height="241"></embed></object>[[/html]] - Comments: 0

A list of top 50 Golf blogs by Blog Rank - 12 Aug 2016 12:45

Tags:

[[html]]#<br><br>Blog Title<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="RSS" width="17" height="17" onclick="sort_by('rss_points')" /><br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_compete.gif" width="21" height="21" border="0" onclick="sort_by('compete_points')" /><br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_alxea.gif" width="16" height="16" onclick="sort_by('alexa_site_rank_points')" /><br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_bing.png" width="16" height="16" onclick="sort_by('incoming_links_points')" /><br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_google.gif" width="16" height="16" onclick="sort_by('google_pr_points')" /><br><br>RSS<br><br>Site Score<br><br>Badge<br><br>1st<br><br>Golf Blog and Golf Forum<br><br>1,173<br><br>21,552<br><br>80,480<br><br>2<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>100<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>2nd<br><br>ARMCHAIR GOLF BLOG<br><br>901<br><br>n/a<br><br>n/a<br><br>1<br><br>5<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>98.3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>3rd<br><br>The Sand Trap<br><br>n/a<br><br>21,319<br><br>115,164<br><br>19<br><br>5<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>98.24<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>4th<br><br>Golfblogger.com: Daily Golf Blog, Golf News, Michigan Golf<br><br>n/a<br><br>285,823<br><br>1,187,197<br><br>9<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>98.11<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>5th<br><br>Irish Golf Desk<br><br>133<br><br>1,472,304<br><br>1,507,359<br><br>3,230<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>97.78<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>6th<br><br>SirShanksAlot.com - Everything Golf<br><br>187<br><br>352,589<br><br>1,888,873<br><br>8<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>97.44<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>7th<br><br>Golf Instruction &amp; Help<br><br>n/a<br><br>n/a<br><br>n/a<br><br>13,500,000<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>97.44<br><br><img style="float:left;margin:10px;border:none;" src="http://visit-hungary.com/site/upload/2009/12/Golf.jpg" width="305" /><br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>8th<br><br>The Hackers Paradise<br><br>n/a<br><br>26,285<br><br>83,326<br><br>14<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>96.98<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>9th<br><br>Golf Girls Diary<br><br>n/a<br><br>n/a<br><br>2,440,967<br><br>2<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>96.96<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>10th<br><br>GolfDash Blog<br><br>43<br><br>731,664<br><br>1,556,586<br><br>3<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>96.59<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>11th<br><br>Golf Vacation Insider - Tip of the Day<br><br>n/a<br><br>58,845<br><br>503,863<br><br>5<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>96.33<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>12th<br><br>Mike Pedersen Golf Blog<br><br>367<br><br>1,117,753<br><br>2,659,277<br><br>2<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>96.28<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>13th<br><br>Playing the Top 100 Golf Courses in the World<br><br>n/a<br><br>n/a<br><br>1,798,164<br><br>1<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>96.16<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>14th<br><br>Golf Tip Reviews<br><br>266<br><br>384,452<br><br>3,351,452<br><br>1<br><br>5<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>96.12<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>15th<br><br>Press Tent Blog: Golf news from inside the ropes<br><br>n/a<br><br>n/a<br><br>n/a<br><br>1<br><br>6<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>96.1<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>16th<br><br>Myrtle Beach Golf<br><br>n/a<br><br>178,537<br><br>1,143,121<br><br>15<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>95.95<br><br><img <a href="http://www.reunionarena.org/tag/budget/">golf training</a> src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>17th<br><br>Golfblogger.com- Golf News &amp; Golf Blog<br><br>n/a<br><br>4,201,603<br><br>2,852,590<br><br>4<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>95.85<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>18th<br><br>Weeks Speaks<br><br>n/a<br><br>n/a<br><br>n/a<br><br>1<br><br>5<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>95.82<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>19th<br><br>Intothegrain.com - Golf tips, news, reviews and opinions<br><br>210<br><br>295,010<br><br>3,105,254<br><br>8<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>95.79<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>20th<br><br>KPJ Golf Fitness Confidential<br><br>3<br><br>n/a<br><br>n/a<br><br>4,020<br><br>2<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>95.77<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>21st<br><br>PutterZone.com —Best Putter <a href="http://www.calmicro.com/tag/golf-simulator/">golf training aids</a> Reviews<br><br>n/a<br><br>308,411<br><br>2,022,163<br><br>6<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>95.61<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>22nd<br><br>Golf Babes<br><br>n/a<br><br>n/a<br><br>2,310,943<br><br>1<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>95.45<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>23rd<br><br>Golf-Patents,com: The Golf Industrys Source for IP News<br><br>n/a<br><br>2,029,716<br><br>2,271,579<br><br>4<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>95.33<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>24th<br><br>Hitting the Links!<br><br>n/a<br><br>n/a<br><br>n/a<br><br>1<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>95.29<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>25th<br><br>Golf Breaking News<br><br>n/a<br><br>n/a<br><br>n/a<br><br>3<br><br>1<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>94.92<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>26th<br><br>Golf for Beginners Blog and Podcast<br><br>n/a<br><br>n/a<br><br>3,801,304<br><br>124,000<br><br>5<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>94.8<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>27th<br><br>Front9Back9 Golf Blog<br><br>n/a<br><br>3,478,818<br><br>4,927,110<br><br>2<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>94.51<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>28th<br><br>Ottawa Golf Blog<br><br>n/a<br><br>2,607,760<br><br>4,429,363<br><br>1<br><br>5<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>94.34<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>29th<br><br>Buzzin Golf<br><br>n/a<br><br>2,284,671<br><br>9,575,298<br><br>1<br><br>5<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>94.1<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>30th<br><br>LinksLifeGolf<br><br>n/a<br><br>1,992,341<br><br>5,308,396<br><br>2<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>94.02<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>31st<br><br>Sandbox8.com: Golf Views<br><br>n/a<br><br>2,982,219<br><br>10,077,348<br><br>9<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>94.01<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>32nd<br><br>GolfBrainz<br><br>n/a<br><br>n/a<br><br>3,183,261<br><br>3,550<br><br>2<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>93.64<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>33rd<br><br>Grouchy Golf Blog<br><br>n/a<br><br>2,570,152<br><br>7,379,016<br><br>3<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>93.1<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>34th<br><br>The Golf Course Guru<br><br>n/a<br><br>1,470,368<br><br>6,277,015<br><br>2<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>92.96<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>35th<br><br>The Year in Golf: Australian Golfers Around the World<br><br>n/a<br><br>n/a<br><br>11,872,858<br><br>15,200<br><br>2<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>92.57<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>36th<br><br>Golfgal<br><br>n/a<br><br>2,605,505<br><br>10,887,854<br><br>1<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>92.44<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>37th<br><br>Sports Coach Golf Simulators<br><br>n/a<br><br>n/a<br><br>10,186,056<br><br>121,000<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>92.23<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>38th<br><br>Now On The Tee<br><br>n/a<br><br>n/a<br><br>10,185,671<br><br>6<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>92.15<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>39th<br><br>Pro Golf Swing Videos<br><br>n/a<br><br>420,435<br><br>12,021,290<br><br>1,040<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>92.1<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>40th<br><br>Ted &amp; Buck Golf!<br><br>n/a<br><br>n/a<br><br>9,475,601<br><br>n/a<br><br>n/a<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>91.36<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>41st<br><br>Richardgolf.com Golf Course Instruction Blog<br><br>n/a<br><br>1,270,991<br><br>12,890,164<br><br>4<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>91.28<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>42nd<br><br>Nathan Uebergang: Ubers Official Blog Website<br><br>n/a<br><br>n/a<br><br>12,753,962<br><br>2,900<br><br>1<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>91.2<br><br><object width="400" height="241"><param name="movie" value="http://www.youtube.com/v/iYu1YIrFiuY&hl=en_US&fs=1&"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/iYu1YIrFiuY&hl=en_US&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="400" height="241"></embed></object><br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>43rd<br><br>Real Women Golf<br><br>n/a<br><br>n/a<br><br>20,423,677<br><br>102,000<br><br>4<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>91.08<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>44th<br><br>Golf blog, reviews, commentary and humor<br><br>n/a<br><br>1,229,982<br><br>15,480,640<br><br>1<br><br>2<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>90.93<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>45th<br><br>Golf All Around<br><br>n/a<br><br>n/a<br><br>14,111,767<br><br>755,000<br><br>n/a<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>90.78<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>46th<br><br>Golf Swing On Plane<br><br>n/a<br><br>n/a<br><br>15,818,900<br><br>2,640<br><br>n/a<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>90.63<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>47th<br><br>Golf For Golfers<br><br>n/a<br><br>n/a<br><br>18,082,227<br><br>24,900<br><br>1<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>90.63<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>48th<br><br>Golf Stinks<br><br>n/a<br><br>n/a<br><br>20,753,683<br><br>6<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>90.53<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>49th<br><br>Kettlebell Golf Workout<br><br>n/a<br><br>n/a<br><br>11,869,844<br><br>1<br><br>n/a<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>90.39<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" /><br><br>50th<br><br>Golf Blog, News and Forums<br><br>n/a<br><br>3,730,917<br><br>21,915,434<br><br>4<br><br>3<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/icon_rss.gif" border="0" alt="rss" width="17" height="17" /><br><br>90.17<br><br><img src="http://www.blogmetrics.org/components/com_rating/images/badge-icon.gif" class="badgeType" alt="100" />[[/html]] - Comments: 0

News & Society :: Pittsburgh PA DUI Information - 12 Aug 2016 11:54

Tags:

[[html]]If you have been arrested for a DUI in Pittsburgh, PA, you are most likely going to need a proven attorney to defend your rights. Receiving a DUI Pennsylvania can also be referred to as drunk driving, driving while impaired (DWI) or the new driving after imbibing (DAI). DUI laws in PA are can be severe and your only hope can be a criminal defense attorney that specializes in DUI cases.<br><br>There are two types of cases that come after receiving a DUI. The first case takes place through the criminal court, they can assign multiple penalties including fines, jail, loss of driving privileges, mandatory alcohol programs, and more. The second case involves the Pennsylvania Department of Transportation, this is the one that can suspend driving privileges.<br><br>If you happen to be pulled over on suspicion of drunk driving, you have the right to refuse the breath, blood or urine test, however doing so will automatically result in a one year loss of driving privileges. This is because under Pennsylvania law, if you <a href="http://www.peaceinthecaucasus.org/guidelines-choosing-great-lawyer/">find criminal defense lawyer</a> hold an operator's (driver's) license and are in physical control of a motor vehicle, you are deemed to <a href="http://www.tamayolawfirm.com/tag/maryland-dwi-lawyer/">criminal defense attorney salary</a> have given implied consent to chemical tests.<br><br>If caught, the PA DUI laws specify that your punishment will be related to how much alcohol is in your system. The lowest level is enacted when you're caught with a blood alcohol level (BAC) of .08 to .099. The intermediate level is .1 to .159. Anything over .16 is punished at the most severe level.<br><br>Additionally, the PA DUI laws provide for <a href="http://www.airportnet.org/what-you-should-do-after-a-dwi-arrest/">criminal defense cases</a> different punishments based on whether this is your first drunk driving arrest. Each subsequent arrest brings with it more severe penalties. The DUI arrests are calculated within the last 10 years. On a first time DUI, you do not have the right to a jury trial.<br><br><img style="float:left;margin:10px;border:none;" src="http://www.jimdicks.com/images/Criminal-Defense-13.jpg" width="336" /><br><br><object width="400" height="241"><param name="movie" value="http://www.youtube.com/v/yJl7W-erRZ4&hl=en_US&fs=1&"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/yJl7W-erRZ4&hl=en_US&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="400" height="241"></embed></object><br><br>Last, when you get arrested for a DUI you can very likely face jail time, a license suspension, probation, community service, alcohol classes, and many fines and fees. Have a great lawyer on your side will drastically reduce these penalties and will allow you to get the best deal possible. Sometimes they can even get you out of the DUI all together and that is by far your best option.<br><br>&#13;[[/html]] - Comments: 0

Weird Laws in the USA - 05 Aug 2016 13:48

Tags:

[[html]]In the earlier times, the laws and regulations in the country or a region were made by the kings or heads of the region. Most of the time, the wish of an autocratic ruler turned into a law in his kingdom. Hence, people were forced to obey these laws; however strange they may seem. Would you believe me if I tell you that It is illegal to die in the Houses of Parliament? Now, can anything beat this? Yes, you may not be aware but, there are several strange laws in America that will either stun you or make you roll down with laughter!<br><br>Crazy Laws in America<br><br>The following is a compilation of weird American laws practiced in different states.&#13;<br><br>All lollipops are banned in Washington.&#13;<br><br>In Texas, the entire Encyclopedia Britannica is banned simply because it contains the formula for making beer at home.&#13;<br><br>One cannot kill a squirrel with a gun in a courtroom in Canton, Mississippi.&#13;<br><br>Now, here is one of the world's strangest laws. In Iowa, a man with a mustache cannot kiss a woman in public!&#13;<br><br>In South Dakota, it is illegal to lie down or fall asleep in a cheese factory.&#13;<br><br>In Pennsylvania, it is not legal to catch a fish with any body part, including your hands, except for your mouth!&#13;<br><br>In the state of Oklahoma, it is mandatory for dogs to have a permit signed by the mayor in order <a href="http://philadelphialaw.pen.io">lawyer accident car</a> to assemble in group of three or more on any private property.&#13;<br><br>It is legal to throw a snake at someone, but, it is illegal to shake a snake at someone in the state of Ohio.&#13;<br><br>In West Virginia, it is illegal to put an ice cream cone in one's back pocket on Sundays.&#13;<br><br>In North Carolina, if a man and a woman who aren't married go to a hotel and register themselves as married then, according to the state law, they are legally married.&#13;<br><br>In New York State, jumping off a building is punishable by death!&#13;<br><br>It is against the law to tie a giraffe to a telephone pole or a street lamp in Atlanta.&#13;<br><br>In Nebraska, a parent can be arrested if his child is unable to hold back a burp during a church service.&#13;<br><br>In Massachusetts, snoring is prohibited unless all bedroom windows are closed and locked!&#13;<br><br><img style="float:left;margin:10px;border:none;" src="http://s3-media2.fl.yelpcdn.com/bphoto/K9CqXnGWxFOAAY_7Nq25Cg/o.jpg" width="292" /><br><br>In Texas, one can not put graffiti on someone else's cow.&#13;<br><br>It is illegal to stand near or in a building without any reason for being there in Minnesota.&#13;<br><br>In Indiana, it was a law for all black cats to wear bells on Friday, the 13th.&#13;<br><br>In Hartford, Connecticut, you are not allowed to cross the street walking on your <a href="http://philadelphialawyer.strikingly.com">car accident lawsuit</a> hands!&#13;<br><br>Now this is one of the weird funny laws, in Maine, it is illegal to step out of a plane in flight!&#13;<br><br>In the state of Indiana, it is illegal to make a monkey smoke a cigarette.&#13;<br><br>In Miami, it is illegal to imitate an animal.&#13;<br><br><object width="400" height="241"><param name="movie" value="http://www.youtube.com/v/oJiCE9Y5lIU&hl=en_US&fs=1&"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/oJiCE9Y5lIU&hl=en_US&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="400" height="241"></embed></object><br><br>It is a punishable offense to push a live moose out of a moving airplane in Alaska.&#13;<br><br>In Ohio, women are prohibited from wearing patent leather shoes anywhere in public.&#13;<br><br>In Florida, men (!!!) may not be seen in public in any kind of strapless gown!&#13;<br><br>It is forbidden for a driver to be blindfolded while operating a vehicle in Alabama.&#13;<br><br>You will find many such strange laws in other parts of the world. Some of the aforementioned laws might be possibly outdated now. However, they still leave us amazed and confounded![[/html]] - Comments: 0


Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License