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The MAC address in Figure 2-11 is 004005-607D49, although in print, we represent the MAC as 00 40 05 60 7D 49 The first six digits, in this example 00 40 05, represent the number of the manufacturer of the NIC Once the IEEE issues to a manufacturer those six hex digits often referred to as the organizationally unique identifier (OUI) no other manufacturer may use them The last six digits, in this example 60 7D 49, are the manufacturer s unique serial number for that NIC; this portion of the MAC is often referred to as the device ID Would you like to see the MAC address for your NIC If you have a Windows system, type IPCONFIG /ALL from a command prompt to display the MAC address (Figure 2-12) Note that IPCONFIG calls the MAC address the physical address, which is an important distinction, as you ll see a bit later in the chapter Okay, so every NIC in the world has a unique MAC address, but how is it used Ah, that s where the fun begins! Recall that computer data is binary, which means it s made up of streams of ones and zeroes NICs send and receive this binary data as pulses of electricity, light, or radio waves The NICs that use electricity to send and receive data are the most common, so let s consider that type of NIC The specific process by which



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Arrhythmias are often caused by hypoxia or electrolyte imbalance, and these conditions should be sought and treated If ventricular arrhythmias persist, administer lidocaine or amiodarone at usual antiarrhythmic doses Caution: Avoid class Ia agents (quinidine, procainamide, disopyramide), which may aggravate arrhythmias caused by tricyclic antidepressants, calcium channel blockers, or -blockers Wide QRS complex tachycardia in the setting of tricyclic antidepressant overdose (or quinidine and other class Ia drugs) should be treated with





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Administer lorazepam, 2 3 mg, or diazepam, 5 10 mg, intravenously over 1 2 minutes, or if intravenous access is not immediately available midazolam, 5 10 mg intramuscularly If convulsions continue, administer phenobarbital, 15 20 mg/kg slowly intravenously over no less than 30 minutes; or phenytoin, 15 mg/kg intravenously over no less than 30 minutes (maximum infusion rate, 50 mg/min) For druginduced seizures, phenobarbital is preferred over phenytoin The drugs may be used together if necessary Maintenance doses may be required if drug toxicity is expected to last more than 18 24 hours Seizures due to a few drugs and toxins may require antidotes or other specific therapies (as listed in Table 38 2)

ing rhabdomyolysis, renal failure, and coagulopathy (see 37)

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Treat hyperthermia aggressively by removing all clothing, spraying the patient with tepid water, and fanning the patient If this is not rapidly effective, as shown by a normal rectal temperature within 30 60 minutes, or if there is significant muscle rigidity or hyperactivity, induce neuromuscular paralysis with a nondepolarizing neuromuscular blocker (eg, vecuronium) Once paralyzed, the patient must be intubated and mechanically ventilated In patients with seizures, absence of visible muscular convulsive movements may give the false impression that brain seizure activity has ceased; however, this must be confirmed by electroencephalography Dantrolene (2 5 mg/kg intravenously) may be effective for hyperthermia associated with muscle rigidity that does not respond to neuromuscular blockade (ie, malignant hyperthermia) Bromocriptine, 25 75 mg orally daily, has been recommended for neuroleptic malignant syndrome Cyproheptadine, 4 mg orally every hour for three or four doses, has been used to treat serotonin syndrome

Hyperthermia may be associated with poisoning by amphetamines (especially Ecstasy), atropine and other anticholinergic drugs, cocaine, salicylates, strychnine, tricyclic antidepressants, and various other medications Overdoses of serotonin reuptake inhibitors (eg, fluoxetine, paroxetine, sertraline) or use in a patient taking an MAO inhibitor may cause agitation, hyperactivity, and hyperthermia ( serotonin syndrome ) Haloperidol and other antipsychotic agents can cause rigidity and hyperthermia (neuroleptic malignant syndrome [NMS]) (See section on schizophrenia and other psychotic disorders in 25) Malignant hyperthermia is a rare disorder associated with general anesthetic agents Hyperthermia is a rapidly life-threatening complication Severe hyperthermia (temperature > 40 41 C) may rapidly cause brain damage and multiorgan failure, includ-

The negative power here means that the power is really flowing from Bus 3 to Bus 2 (e) None of the components in the power system are even close to being overloaded

Give an antidote (if available) when there is reasonable certainty of a specific diagnosis (Table 38 3) Antidotes them-

Figure 2-12

Toxin or Drug Methylenedioxymethamphetamine (MDMA; Ecstasy ) Isoniazid Lithium Organophosphates Strychnine Comments Seizures may be due to hyponatremia

Toxic Agent Acetaminophen Anticholinergics (eg, atropine) Anticholinesterases (eg, organophosphate pesticides) Specific Antidote N-Acetylcysteine Physostigmine Atropine and pralidoxime (2-PAM) Flumazenil (rarely used; see warning in text) Oxygen, hyperbaric oxygen Sodium nitrite, sodium thiosulfate; hydroxocobalamin (Cyanokit) Digoxin-specific Fab antibodies Specific chelating agents Pyridoxine (vitamin B6) Ethanol (ethyl alcohol) or fomepizole (4-methylpyrazole) Naloxone, nalmefene Specific antivenin

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