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Artemy Kalinin
Artemy Kalinin

The Second Edition Of The MISRA C Guidelines.pdf

In 2004, a second edition "Guidelines for the use of the C language in critical systems", or MISRA-C:2004 was produced, with many substantial changes to the guidelines, including a complete renumbering of the rules.

The second edition of the MISRA C guidelines.pdf

The recommendations and processes described in this report seek to enable a developer firstly to assess a system to determine its integrity level and secondly to adopt a suitable development process in order to achieve the confidence level required in the software. The recommendations can also be used by assessors and procurers of such systems to help them determine whether the methods adopted by the system developers are suitable for the proposed application.

Although some acute medications are indicated and/or recommended for aborting attacks, acutetreatments can be overused, potentially leading to medication overuse headache (MOH), a typeofsecondary headache disorder.4 MOH may occur with acute migraine medications, butis commonwith narcotics and barbiturates; this is another reason why AHS guidelines recommend that opioids and barbiturates generally be avoided for migraine treatment.19,26,32

For pain treatment, the WHO analgesic ladder is advised with the exception of strong opioids. For neuropathic pain, anticonvulsants and tricyclic antidepressants may be considered. For inflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine) are advised. To promote peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used to increase blood flow in case vasodilatory medication has insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, vitamin C is recommended. Adequate perioperative analgesia, limitation of operating time, limited use of tourniquet, and use of regional anaesthetic techniques are recommended for secondary prevention of CRPS-I.

Database and cited reference search revealed 94 relevant studies after selection. These included 25 studies on oral or topical drug interventions, 42 studies on invasive treatments, 15 on paramedical interventions, 4 on primary and 8 on secondary prevention of CRPS. Treatment interventions for children with CRPS, comprising 8 studies were described separately.

The effects of a sub-anaesthetic ketamine infusion (10 mg/hour up to 15-50 mg/hour) was assessed in a retrospective study of 33 patients with CRPS-I or -II [18]. Twelve patients experienced a relapse and had a second course of infusions, three patients had a third course, by which pain disappeared completely in 83% of patients. The average duration of pain reduction (data of 20 patients) was 9.4 months. The side-effects were intoxication, hallucinations, dizziness, nausea, light-headedness and blurred vision.

In the second study (n = 58) a moderate effect on pain was found, but no significant reductions in other sensory abnormalities were found [20]. Dizziness, sleepiness and fatigue occurred significantly more often in patients taking gabapentin than in patients taking placebo.


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