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By: J. Rasul, M.B.A., M.D.

Vice Chair, Saint Louis University School of Medicine

Injuries (1) Cervical spine (a) Similar to lateral impact in vehicle (2) Torso (a) Compression i) Lateral chest Lateral abdomen ii) (b) Deceleration i) Aorta ii) Pedicled organs 3 medications containing sulfa buy naltrexone overnight. Head Helmet (1) (a) 300% increase brain injury without helmet Spine (b) i) Small protection ii) No increase b treatment quadratus lumborum buy naltrexone online pills. Legs pushed by bumper (c) Torso moves after the legs (2) Torso (a) Pelvis (b) Crushed by front of vehicle (c) Lateral or posterior angulation Deceleration (sheer injuries) a) Aorta b) Pedicled organs Compound tibial fibula fractures United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 13 Trauma: 4 Trauma Systems and Mechanism of Injury: 1 b symptoms pneumonia buy 50mg naltrexone amex. Continued motion of the torso (1) Ankles symptoms 20 weeks pregnant buy cheap naltrexone 50 mg on line, knees, femur (2) Acetabulum, pelvis (3) Spine (a) Break the "S" (b) Arch i) Convexity stretched & opened ii) Concavity compressed (4) Torso (a) Deceleration (shear) i) Liver ii) Kidney iii) Spleen iv) Aorta Head first a. Compression Skull fracture (1) (2) Brain (a) Contusion (b) Laceration (3) Spine United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 14 Trauma: 4 Trauma Systems and Mechanism of Injury: 1 b. Density of tissue (1) Gas (a) Lung (b) Gastrointestinal tract (2) Liquid Blood vessels (a) (b) Muscle (c) Solid organs i) Spleen ii) Liver iii) Kidney iv) Other (3) Solid (a) Bone b. Temporary (1) Compression wave of tissue particles (2) Away from the pathway of the bullet (3) Lasts only a few microseconds (4) Tissue damage produced by stretch 3. Energy potential = United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 15 Trauma: 4 Trauma Systems and Mechanism of Injury: 1 (1) (2) (3) Continuum of energy increase Can be broken down into artificial but workable groups Energy (a) Low energy objects i) Hand driven a) Knife b) Ice pick c) Ax d) Other ii) Minimal cavitation iii) Damage only by cutting edge (b) Medium energy i) Muzzle velocity> 1500 feet! Entrance wound (1) Hole is crushed inward (2) Round or oval shaped (3) Rim (a) Dark (b) 1-2 mm width (c) Produced by grease and other substance on the bullet (4) Abrasion (a) Produced by spinning of the bullet (b) Largest with greatest contact of skin i) Larger when impact is at an angle (5) Burn Flame from barrel (a) (b) End of weapon 4-6 inches from the skin b. Blast United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 16 Trauma: 4 Trauma Systems and Mechanism of Injury: 1 A. The blast effect is broken down in to three phases depending on the type of force that occurs during that phase 2. Pressure wave of the blast (1) Major effect on gas containing organs (a) Organ systems i) Lungs ii) Intestinal tract Pathology (b) i) Rupture of the organ (c) Air emboli b. Location (1) External (a) Controlled (b) Uncontrolled (2) Internal (a) Trauma (b) Non-trauma i) Common sites ii) Uncommon sites (c) Controlled (d) Uncontrolled b. Severity (1) Amounts of blood loss tolerated by (a) Adults (b) Children (c) Infants. Physiological response to hemorrhage Clotting (1) (2) Localized vasoconstriction f. Stages of hemorrhage (1) Stage 1 Up to 15% intravascular loss (a) (b) Compensated by constriction of vascular bed Blood pressure maintained (c) Normal pulse pressure, respiratory rate, and renal output (d) (e) Pallor of the skin (f) Central venous pressure low to normal (2) Stage 2 (a) 15-25% intravascular loss (b) Cardiac output cannot be maintained by arteriolar constriction (c) Reflex tachycardia Increased respiratory rate (d) United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 3 Trauma: 4 Hemorrhage and Shock: 2 (3) (4) (e) Blood pressure maintained (f) Catecholamines increase peripheral resistance (g) Increased diastolic pressure (h) Narrow pulse pressure (i) Diaphoresis from sympathetic stimulation U) Renal output almost normal Stage 3 (a) 25-35% intravascular loss (b) Classic signs of hypovolemic shock i) Marked tachycardia ii) Marked tachypnea iii) Decreased systolic pressure iv) 5-15 ml per hour urine output v) Alteration in mental status vi) Diaphoresis with cool, pale skin Stage 4 (a) Loss greater than 35% (b) Extreme tachycardia (c) Pronounced tachypnea (d) Significantly decreased systolic blood pressure (e) Confusion and lethargy (f) Skin is diaphoretic, cool, and extremely pale 3. Compensation for decreased perfusion (1) Occurrence of event resulting in decreased perfusion. Positive inotrope and chronotrope Aldosterone La) Defends fluid volume (b) Secreted by cells of adre:~al cortex in response to stress LcL Promotes sodium. Etiologic classifications (1) Hypovolemic (a) Hemorrhage (b) Plasma loss (c) Fluid and electrolyte loss (d) Endocrine (2) Distributive (vasogenic) (a) Increased venous capacitance (b) Low resistance, vasodilation (3) Cardiogenic (a) Myocardial insufficiency (b) Filling or outflow obstruction (obstructive) (4) Spinal neurogenic shock (a) Refers to temporary loss of all types of spinal cord function distal to injury i) Flaccid paralysis distal to injury site ii) Loss of bladder and bowel control iii) Priapism iv) Loss of thermoregulation (b) Does not always involve permanent primary injury (5) Spinal shock (a) Also called spinal vascular shock (b) Temporary loss of the autonomic function of the cord at the level of injury which controls cardiovascular function (c) Presentations includes i) Loss of sympathetic tone ii) Relative hypotension a) Systolic pressure 80 - 100 mmHg iii) Skin is pink, warm and dry a) Due to cutaneous vasodilation iv) Relative bradycardia (d) Occurrence is rare (e) Shock presentation is usually the result of hidden volume loss i) Chest injuries ii) Abdominal injuries iii) Other violent injuries (f) Treatment i) Focus primarily on volume replacement Assessment - hypovolemic shock due to hemorrhage (1) Early or compensated (a) Tachycardia (b) Pale, cool skin (3) United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 8 Trauma: 4 Hemorrhage and Shock: 2 a. Diaphoresis Level of consciousness i) Normal ii) Anxious or apprehensive (e) Blood pressure maintained (f) Narrow pulse pressure i) Pulse pressure is the difference between the systolic and diastolic pressures, i. Airway and ventilatory support Ventilate and suction as necessary (1) (2) Administer high concentration oxygen (3) Reduce increased intrathoracic pressure in tension pneumothorax b. Blast injuries United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 1 Trauma: 4 Soft Tissue Trauma: 3 10. Arterial United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 2 Trauma: 4 Soft Tissue Trauma: 3 4-3. Amputation United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 4 Trauma: 4 Soft Tissue Trauma: 3 8. Universal precautions (1) Gloves (2) Hand washing (3) Protective eyewear (4) Masks (5) Gowns (6) Handling and disposal of sharps b. Cutaneous layer (1) Epidermis (a) Stratum germinativum (Basal Layer) (b) Stratum corneum (2) Dermis (a) Fibroblasts (b) Macrophages (c) Mast cells (d) Lymphocytes (e) Papillary dermis (f) Reticular dermis b. Subcutaneous layer (superficial fascia) (1) Loose connective tissue (2) Fat (a) Insulation (b) Protection from trauma c. Deep fascia United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 6 Trauma: 4 Soft Tissue Trauma: 3 2. Hemostasis of wound healing (1) Injury causes changes in normal skin anatomy (2) Reflex vasoconstriction for up to 10 minutes (3) Clotting process begins b. Inflammatory phase (1) Role of granulocytes (2) Role of lymphocytes (3) Role of macrophages c. Epithelialization phase (1) Wound healing within 12 hours (2) Healing through re-establishment of skin layers d.

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Things changed again after President Uribe launched his Democratic Security Policy medicine allergy order genuine naltrexone, which reduced the emphasis on searching for a negotiated peace with the guerrillas in favor of more active resistance to the insurgency (see Internal Armed Conflict and Peace Negotiations medications causing tinnitus order naltrexone with a visa, ch medicine 377 order naltrexone now. Representatives of all political persuasions in Colombia could thus find reasons from time to time to condemn clerical involvement in politics symptoms als purchase naltrexone overnight delivery. Likewise, the clergy has suffered its share of outrages and assassinations inflicted by both guerrillas and paramilitaries, including the murder of two bishops by the guerrillas. Divorce is an issue that reflects as well as anything the ambiguities and also long-term decline in the power of the church and of traditional religious values (see also Family, this ch. Divorce became legal in Colombia in 1976, but with a glaring exception: Roman Catholic Church weddings could be dissolved only by ecclesiastical annulment. However, the pressure to obtain such annulments grew steadily, as did social acceptance of de facto separations and of foreign divorces that technically had no validity in Colombia. At least in the cities, the act of shedding or changing spouses no longer drew much attention. Finally, the 1991 Constituent Assembly declared that all marriages are subject to the civil law and can therefore be legally terminated. Although the assembly did not remove the mention of God from the constitution and vigorously rejected a move to legalize abortion, it underscored the increasing secularization of Colombian society, not just by its handling of divorce but also by omitting any reference to Roman Catholicism as the national religion. The constitution now guarantees strict legal equality of all religious denominations. A few years later, the Constitutional Court would put an end to the traditional yearly ceremony consecrating the republic to the Sacred Heart of Jesus. In May 2006, the same court, meeting beneath the crucifix that adorns the wall of its chamber, declared that abortion cannot be prohibited in extreme cases, such as following incest or rape. Despite protests by the clergy and traditionalists, with threats to excommunicate 123 Colombia: A Country Study any doctor who carried out such an operation, the decision was not subject to appeal, and the first legal abortions in Colombian history soon took place. Formal religious toleration and the first Protestant (Presbyterian) missionary activity date back to the mid-1800s, but roughly 100 years later Protestants still comprised less than 1 percent of the total population. Even such small numbers often suffered severe repression during the years of La Violencia; their experience attracted attention and sympathy to the Protestant groups and actually seems to have won them new members. However, their main growth has occurred since the 1960s, associated with the rapid social and cultural changes taking place in the country that among so much else weakened habitual allegiance to Roman Catholicism. During this process of expansion, the role of North American and European Protestant missionaries became steadily less important, as Colombians took over the leadership of congregations and other religious bodies; indeed, some of the current evangelical and Pentecostal denominations are of purely Colombian origin. The growth of Protestantism in Colombia is still less than in many other Latin American countries, but Protestants now make up about 10 percent of the population. The denominations with longstanding roots in Colombia, such as Presbyterians and Methodists, have not been the main beneficiaries of growth. Instead, as in Latin America generally, the most explosive expansion has been that of the churches commonly called Pentecostal-even if the Pentecostal movement was slower to take hold in the Colombian case-with others classified simply as evangelical having moderate growth. The older, established denominations have their greatest strength within the middle sectors of society, whereas the Pentecostal churches, whose style of worship has something in common with the emotional and magical aspects of Latin American popular Roman Catholicism, have had notable success in attracting upwardly mobile members of the working and lower-middle classes. Protestant churches of one sort or another are to be found in all parts of the country, including some traditional Amerindian communities formerly regarded as a special preserve of the Roman Catholic religious orders. The Protestants have built schools, just as the Roman Catholic Church has done, and some denominations are deeply involved in 124 the Society and Its Environment social services, for nonmembers as well as their own congregations. In 1989 a broad range of Protestant churches joined forces to create the Evangelical Confederation of Colombia, which does not include every denomination but does to a large extent speak for the Protestant churches generally. More unusual was the creation of explicitly evangelical political parties to take part in elections for the 1991 Constituent Assembly: the Christian Union and the Christian National Party. Presenting a joint ticket, they elected two of the 70 members of the assembly, and one of their delegates was named to head a key committee.

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Syndromes

  • Abdominal pain
  • Any food prepared using unclean cooking utensils, cutting boards, or other tools
  • Cortisone creams may help reduce the inflammation.
  • Do you have allergies?
  • Involuntary movements
  • Use night splints to stretch the injured fascia and allow it to heal.
  • The type of tumor (glioma or other type)
  • Feeling hopeless or helpless
  • Fluid buildup around the lungs (pleural effusion)