Advance Directive Form: Fill & Download for Free

I was an RN care manager, supervising the care of a woman in her mid sixties. She'd had lifelong health problems, including cerebral palsy, IIRC. Other diagnoses had contributed to this lady getting progressively weaker and less able to communicate or participate in basic care.When the patient was alert and able to make her wishes known, she had insisted on being a Full Code. This meant that, if her heart stopped, we were to begin CPR and call the paramedics. I approached her several times to review her code status, and she never wavered. She wanted CPR. Trouble was, she also checked the box on her advance directive form indicating “comfort care only.” This meant that we couldn't do any life-prolonging measures, no IV fluids or medication, no antibiotics.TALK ABOUT A CATCH-22.This patient had a daughter. This daughter must've had her own issues, her own damage that I could only guess at. She was involved in her Mom's care but only by phone; I think she lived out of state. I talked to her about the advance directive, and she said, “Mom knows what she wants.”Fast forward a couple of weeks, and the patient is declining: Not eating, refusing to work with therapy, showing signs of confusion. Both patient, daughter, and attending doctor refuse to have the patient sent to the hospital. They also refuse to change her code status.On a beautiful spring morning, the patient lies in bed, her breathing getting shallower, her skin going paler. Another nurse and I stand by, monitoring her vital signs, dreading what is about to happen. She stops breathing, and we go into Full Code mode: Chest compressions, ambu-bag, call 911. This is before the days when every airport and Walmart has an automatic emergency defibrillator.CPR isn't like they show on TV. Chest bones crack, then break, then become mush under your hands. Stomach contents fill the patient's mouth, then seep out around the ambu-bag mask. The patient's abdomen swells as it fills with the air that's supposed to be going into her lungs. And you CANNOT STOP until a doctor calls it or another first responder takes over or you're too exhausted to continue.That patient's last 20 minutes on this planet were horrific, needlessly so. And the same scenario plays out dozens of times a day all over this country because health care providers aren't educating people about what really happens during a full code.

That wasn’t dust, it was cloud.When moisture laden air (like you find near a port) is compressed and then suddenly decompressed, humidity condenses out into fog or cloud (which are the same thing).When I was a kid, I spent many an hour producing cloud in a small acrylic pressure chamber I’d gotten as part of a science kit. Dribble a little water in the bottom, drop in a smouldering match (the smoke provided particles to help nucleate condensation), seal the lid, pump it up, pop the seal, and presto—cloud in a bottle.That’s exactly what happened in Beirut. As the shockwave flew outward, it compressed the air in front of it. As it passed, the air behind it dropped momentarily to a lower pressure and temperature than it had had before the blast, causing a sheet of cloud to form. Then the heat of the blast melted through the new cloud as fast as it was produced.This exact thing happens around most large detonations, but one may never before have been captured from as many angles under such conducive conditions as in this massive blast through air laden both with sea moisture, salt, and pollution.The rapidly dancing white sheets seen flying toward the camera in some of the videos are something few ever see and live to report: sheet cloud forming behind a shockwave advancing directly toward the observer.In this image below, you can see the whole shock cloud—a hemispheric shell forming behind the shockwave. The shockwave is nearly invisible in the air, but visible on the surface of the seawater, through which sound travels four times faster.Inside the cloud rises the tell-tale orange smoke plume of ammonium nitrate decomposition.The rectangular window through the shell of cloud is a pressure shadow. The massive rectangular silo building acted as a shield, blocking passage of the shock wave and leaving a gap where no compression is occurring and so no cloud forming behind it.If you like science, you might enjoy my free award-winning scifi sampler

Thanks for asking me this question. The full of PCLT form is Paper Line clear Ticket. This form utilised in special circumstances in Indian Railways. A train can enter in a block section when line clear obtained from advance station. This line clear obtained through a special instrument named “Block Instrument”. Here is a picture of block instrument.When if for any reason the block instrument failed but communication available between two stations, then the PCLT used. Line clear obtained from advance station through telephone and station master issue this form to Loco Pilot to enter into block section with his train. In this condition the starter signal will be at On position. There are two PCLT for two directions. For down direction form no is T/D 1425. It's endorse with serial no ,train no, with time and date. This form authorised Loco Pilot to pass Signal at On condition. Here is a picture of PCLT for down direction.For up direction the form no T/C 1425. System is same as above. Here is picture of PCLT of T/C 1425.Images source Google.Thanks for reading my answer.