This document outlines a seminar on chest trauma presented by Morriyam Mengist, a third year student of Emergency and Critical Care Nursing at Kotebe Metropolitan University in Addis Ababa, Ethiopia. The seminar covered definitions of chest trauma, mechanisms of injury, and management of immediate life-threatening chest injuries like tension pneumothorax, cardiac tamponade, and massive hemothorax. A case study was presented and management approaches were discussed. The seminar aimed to help students identify and treat life-threatening chest injuries according to ATLS protocols.
Detailed information on assessing the trauma patients with time dependent principle management and selection between early total care and damage control surgery.
Advanced trauma life support is very essential topics that all health professionals should have better understating off it. Its concept should also need to be extended to the general community as the best outcome of those pt depend on the initial care given starting from the time of the traumatic event.
Detailed information on assessing the trauma patients with time dependent principle management and selection between early total care and damage control surgery.
Advanced trauma life support is very essential topics that all health professionals should have better understating off it. Its concept should also need to be extended to the general community as the best outcome of those pt depend on the initial care given starting from the time of the traumatic event.
Mediastinal injury includes cardiac, thoracic aorta, pulmonary vessels and SVC injury. Pelvic includes pelvic fracture. GI injury includes upper and lower GI injuries. Abdominal vascular includes abdominal aorta, IVC and other named vascular injury.
In a tertiary care institute of northern India, the emergency department receives an average of 6–7 patients with poly trauma every day. Of these patients, some come directly and many are referred from other hospitals from the region. Various problems are faced in the management of patients with poly trauma. This presentation aimed to elicit various complaints, suggestions and possible solutions in the management of patients with poly trauma.
Valve in-valve implantation into a failed mechanical prosthetic aortic valveRamachandra Barik
First successful transcatheter valve-in-valve implantation into a failed mechanical prosthetic aortic valve facilitated by fracturing of the leaflets: a case report
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Mediastinal injury includes cardiac, thoracic aorta, pulmonary vessels and SVC injury. Pelvic includes pelvic fracture. GI injury includes upper and lower GI injuries. Abdominal vascular includes abdominal aorta, IVC and other named vascular injury.
In a tertiary care institute of northern India, the emergency department receives an average of 6–7 patients with poly trauma every day. Of these patients, some come directly and many are referred from other hospitals from the region. Various problems are faced in the management of patients with poly trauma. This presentation aimed to elicit various complaints, suggestions and possible solutions in the management of patients with poly trauma.
Valve in-valve implantation into a failed mechanical prosthetic aortic valveRamachandra Barik
First successful transcatheter valve-in-valve implantation into a failed mechanical prosthetic aortic valve facilitated by fracturing of the leaflets: a case report
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Objective
At the end of the session, the students will be able to:
- Define chest trauma
- Explain mechanisms of injury
-Identify life-threatening chest injuries found during the primary
survey.
-
-Treat these immediately life threatening chest injuries.
6. 10/21/2022 6
Case scenario
A 34 yrs old man sustain MVC while he was riding a bicycle against with
Sino truck at 7:30. He arrived at Aabet Hospital post two hours with
streture. On arrival he is conscious.
P/e – v/s, BP= 80/55 mmhg, PR= 112b/m, RR= 28b/m, sp02=86% at room
air, GCS= 15. RBS= 105mg/dl.
Inspection- there is laceration over the chest wall with flat jagular
vein and with normal and symmetrical chest movement both on inspiration
& expiration.
7. 10/21/2022 7
Palpation- There is no any criptus over the chest wall with normal
tracheal alignment .
On Percussion- there is resonant sound over the chest and tympanic on
the abdomen.
An auscultation- There is normal air entry over the chest wall with
reduced heart sound but no murmur or gallop.
An EKG shows reduced amplitude of the waves.
8. 10/21/2022 8
Based on the case
what will be the possible dx?
what is your approach for those patient?
what will be your specific management?
9. 10/21/2022 9
INTRODUCTION
The chest wall, defined here as the bony and muscular structures
covering the entire thoracic cavity, protects internal thoracic organs (heart
and lungs), mediastinal structures (esophagus and trachea), and major
vasculature (aorta and vena cava).
Damage to the chest wall may coincide with significant injury to certain of
these internal structures and thus, warrants careful evaluation.
10. 10/21/2022 10
Definition
A chest trauma is any form of physical injury to the chest including
the ribs ,heart , great vessel, lungs & esophagus.
Chest injuries are potential life threatening because of the immediate
disturbance of the cardio respiratory physiology and hemorrhage and later
developments of infection, damaged lungs etc.
11. 10/21/2022 11
Anatomy and physiology
The rib cage, intercostal muscles, and costal cartilage form the basic
structure of the chest wall.
In addition, neurovascular bundles comprised of an intercostal nerve,
artery, and vein run along each rib.
The inner lining of the chest wall is the parietal pleura.
.
12. 10/21/2022 12
Anatomy & physiology con’t….
Visceral pleura covers the major thoracic organs.
Between the two is a potential space with a small amount of lubricating
fluid.
The anterior chest wall also contains the sternum and pectoralis
major and minor muscles, as well as the clavicle at its superior border.
Posteriorly, the scapula provides added protection to the superior thorax
13. 10/21/2022 13
Anatomy & physiology con’t….
The chest wall has two important functions:
To assist in the mechanics of respiration and
To protect the intra thoracic organs.
Adequate ventilation is accomplished by creating negative intra thoracic
pressure during inspiration and positive pressure during expiration.
14. 10/21/2022 14
Anatomy & physiology con’t….
During inspiration, a combination of diaphragmatic excursion and
contraction of the inter costal muscles to raise the ribs which increases
intra thoracic volume and decreases intra thoracic pressure, which then
pulls air passively into the lungs.
In expiration, this process is reversed: all the muscles relax and
intra thoracic pressure passively increases and volume decreases, forcing
air out of the lungs
15. 10/21/2022 15
Anatomy & physiology con’t….
The mediastinum is an anatomic division of the thorax extending from the
diaphragm inferiorly to the thoracic inlet superiorly.
Its borders include the sternum anteriorly, the vertebral column posteriorly,
and the parietal pleura laterally.
Contained within the mediastinum are the heart, aorta, trachea, and
esophagus.
Injuries to any of these structures are potentially life-threatening. One
lung is located lateral to each side of the mediastinum.
18. 10/21/2022 18
Mechanisms of injury
1) Blunt chest trauma
Most common cause of serious chest injuries
- RTA, falls, direct blows, crushing injuries.
2) Penetrating trauma.
Immediate result can be severe bleeding or
impaired breathing.
•Injuries to the heart, lungs, and great vessels
•can quickly lead to shock and cardiac arrest.
10/21/2022 18
19. 10/21/2022 19
Immediate life threatening injuries
Injuries that can cause death in a matter of minutes and, therefore,
must be identified and treated during the primary evaluation and
resuscitation.
Chest injuries can be divided into
•Immediate life threatening injuries
•Potentially life threatening injuries
20. 10/21/2022 20
Immediate life threatening injuries includes
Airway obstruction/ laryngeo tracheal injury.
Open pneumothorax.
Managed at primary survey
Tension pneumothorax (it is our focus )
Massive hemothorax.
Cardiac tamponade.
Flail chest.
con’t….
22. 10/21/2022 22
PATHOPHYSIOLOGY
Blunt & / penetrating chest injured
injury to the tissues themselves effect of hampered ventilation
oxygen supply
to meet the
increased
metabolic
demands after
trauma cannot
be met
supply-demand mismatch
Hypotension, hypoxia and acidosis, exacerbating all other injuries.
23. 10/21/2022 23
General management of trauma
As in any patient with trauma, the evaluation and treatment of chest
trauma patient is based on ATLS protocol. These include:
1. Primary Survey and resuscitation (ABC of life)
2. Secondary survey/ sample/
3. Definitive management
24. 10/21/2022 24
con’t….
The Primary Assessment constitutes the basis of trauma care and
adheres to the following sequence: ABCDE
A- Asses and manage the airway, apply C-collar
Ensure airway is adequate
Open air way using jaw thrust
Insert the adjuncts/OPA, NPA/ if necessary
Suction the air way if there is any secretion
Intubate the patient if necessary
25. 10/21/2022 25
B- asses and manage breathing.
Asses RR, SP02,lung sounds, chest symmetry, cyanosis color etc.
OR you can use L= Look chest raise
L=Listen for air escape
F= Feel the air
Adequate supplemental oxygen using either non invasive
method or put on mechanical ventilation depend on the cause and severity
of the illness.
26. 10/21/2022 26
con’t….
During Assessing the trauma patient’s breathing aims at identifying
thoracic injuries that will cause rapid respiratory failure.
These include
• tension pneumothorax,
•open pneumothorax,
•massive haemothorax
•flail chest.
27. 10/21/2022 27
C= asses and manage circulation
Asses temperature, PR, BP, UOP, capillary refill time
mental status change for organ perfusion /brain/
Open IV line & send sample
Maintain adequate circulation status by administering
fluids depend up on patient status.
During assessing of circulation, cardiac tamponade must be rule out as it
is life threatening injury which affect circulation
28. 10/21/2022 28
D= asses neurology/ disability/
Asses consciousness using time, place and person.
Asses mental status change using
- AVPU
- GCS
RBS
Anti pain
30. 10/21/2022 30
ADJUVANTS TO PRIMARY SURVEY
1) Imaging: X-ray of the chest / pelvis / cervical and thoraco lumbar spine
should always be performed, and make sure that the films are checked
thoroughly by an experienced enough person. For the cervical spine the
minimum requirement is a lateral film that shows all seven cervical
vertebrae and T1.
31. 10/21/2022 31
con’t….
2) Take blood for
a. Cross match of urgent blood products;
b. Electrolytes, basic haematology, clotting screen, arterial blood gases,
serum amylase or lactate: when resources are limited these should not be
done routinely but ask what the clinical usefulness of each result will be in
this patient;
c. Blood cultures (or pus for gram stain and culture) if the patient is septic.
32. 10/21/2022 32
con’t….
3) Urine catheter, but always check for possible urethral injury first.
4) Severely injured patients at risk of rapid exsanguination might need
emergency damage control surgery as part of resuscitation.
33. 10/21/2022 33
Check list for trauma patient mgt
Did I complete primary survey (ABCDE)?
Have I completed resuscitation?
-O₂?
-IV fluids?
- Blood
Did I complete secondary assessment?
-History (Reports)?
-Complete physical examination?
-Chart review (Vital signs, Fluid balance, Drugs)
- Results?
34. 10/21/2022 34
Con’t…
Is my patient…
STABLE?
UNSTABLE?
Am I unsure?
Is the problem…
Diagnostic
Therapeutic
Both
Do I need to intervene…
Diagnostic?
Therapeutic?
Ask for help
35. 10/21/2022 35
Laryngeo tracheal injury/Airway obstruction/
Airway obstruction can be a primary problem or the result of other injury.
The most common causes of airway obstruction are the tongue, avulsed
teeth, dentures, secretions, and blood.
It includes damage to the trachea & bronchi, which can result from:
-trauma to the neck or chest,
-inhalation & aspiration.
- maxillofacial injuries
- oropharyngeal injuries
36. 10/21/2022 36
S & S
Anxiety, hoarseness, stridor,
Hypoventilation, apnea,
Use of accessory muscles,
Altered mental status, and cyanosis.
37. 10/21/2022 37
RX
Establish a patent airway with c.collar
Jaw thrust
Remove foreign bodies
Suction for secretion
Insert an airway
ETT
Tracheostomy
O2
38. 10/21/2022 38
Open Pneumothorax(sucking chest wound)
An injury in which an open wound in the chest wall has exposed
pleural space to atmosphere.
The open wound allows air mov`t through the defect during
spontaneous respiration, causing ineffective alveolar ventilation.
The atmospheric & intra thoracic pressure is equal which leads to in
effective ventilation , results in hypoxia and hypercarbia.
39. 10/21/2022 39
S & S
difficulty breathing/severe dyspnea
Respiratory distress
Frothy blood at wound site
Hypovolemia , cyanosis
Diminished breath sounds
41. 10/21/2022 41
Mgt
Assess & manage ABCDEs
Three sided Cover with occlusive dressing
Transport with unaffected side slightly elevated
Insertion of a thoracostomy tube
Definitive closure of wound is necessary.
42. 10/21/2022 42
Tension pneumo thorax
One way valve air leak occurs either from the lung or chest wall.(air
forced in to the thoracic cavity without any means of escaping ,completely
collapsing the affected lung )
Caused by ppv & mis guided
central venous access.
45. 10/21/2022 45
Mgt
Assess & manage ABCDEs
Rapidly inserting a needle into the 2nd ICS
in the MCL of affected hemi
thorax.
Definitive treatment requires insertion
of chest tube into 5th ICS (nipple
level), anterior to mid-axillary line.
46. 10/21/2022 46
Cardiac Tamponade
Compression of the heart as the result of
accumulation of fluid within the pericardial
space.
Caused by a large or uncontrolled
pericardial effusion, i.e. The build up of fluid
inside the pericardium
47. 10/21/2022 47
Patho-physiology
The outer layer of the heart is made of fibrous tissue which does not easily
stretch, so once fluid begins to enter the pericardial space because of the
etiological factors.
The pressure inside the pericardium starts to increase.
The fluid pressure is applied over the ventricles of the heart. It leads to
decrease in the preload and of the ventricles.
Leading to decreased stroke volume, hypotension and hypovolemic shock
48. 10/21/2022 48
S/ S
Beck’s triad
Elevated central venous pressure (2-6 mm of Hg/ 2-8 cm of H2O)
Pulses paradoxus (paradoxical pulse, is an abnormally large decrease
insystolic blood pressure and pulse wave amplitude )
Dyspnea, Cyanosis, Hypovolemic shock
ECG amplitude is decreased.
49. 10/21/2022 49
Diagnostic evaluation
C/M
Physical examination
ECG- Changes in the ST & QRS complex
Echocardiogram-to identify the accumulation of fluid.
Chest x-ray
CT/MRI
Monitoring CVP
50. 10/21/2022 50
Mgt
Asses and manage ABCDs
For penetrating trauma, Prepare for emergency thoracotomy to control
bleeding.
Assist in pericardiocentesis.
Monitor CVP
Obtain urinary output hourly to evaluate tissue perfusion.
Continuous ECG monitoring to identify dysrhythmias
In heart surgery patients post op, the nurses monitor the amount of chest
tube drainage.
53. 10/21/2022 53
Massive Hemothorax
Blood in the pleural space as the result of penetrating or blunt chest
trauma.
This excess blood can interfere with normal breathing by limiting the
expansion of the lungs.
Due to rapid accumulation of blood more
than 1.5L(1/3rd)of total blood volume.
55. 10/21/2022 55
Patho physiology
Its cause is usually traumatic, from a blunt or penetrating injury to
the thorax.
Resulting in a rupture of the pleural cavity of the lungs and also rupture of
the blood vessels surrounding the lungs .
This rupture allows blood to spill into the pleural space.
Each side of the thorax can hold 30 to 40% of a person's blood volume.
56. 10/21/2022 56
Interfere with the normal movement of the lungs, resulting in dyspnea,
poor ventilation, and abnormal oxygenation, tachypnea
•Cyanosis
•Decreased or absent breath sounds on affected side
•Tracheal deviation to unaffected side
•Unequal chest rise
•Tachycardia
58. 10/21/2022 58
Mgt
Rapid crystalloid infusion and blood
A single chest tube (#38 fr) is inserted at the nipple level, anterior to
mid axillary line/ hemopneumo thorax/
If 1.5L is evacuated, it is highly likely that pt will require an early
thoracotomy.
59. 10/21/2022 59
FLAIL CHEST AND PULMONARY CONTUSION
Loss of stability of chest walls as a result of multiple rib fractures or
combined rib and sternum fractures.
When two or more adjacent ribs #ed at two
or more points.
Allowing freely moving segment of chest
wall to move in paradoxical motion.
Underlying pulmonary contusion is considered
to be the major cause of respiratory insufficiency
with flail chest
60. 10/21/2022 60
Patho physiology
Because of vehicle collisions and falling. Their will a multiple rib fractures
or combined rib and sternum fractures.
When this occurs, one portion of the chest has lost its bony connection to
the rest of the rib cage.
During respiration, the detached part of the chest will be pulled in and
blown out (paradoxial movements)
Normal mechanism of breathing is impaired
61. 10/21/2022 61
It leads to the following signs and symptoms like,
•Dyspnea.
•Cyanosis.
•Fractured ribs are likely to eventually puncture the pleural sac and lung,
possibly causing a pneumothorax.
•Respiratory failure.
•Severe pain during respiration.
64. 10/21/2022 64
Summary
Chest injuries are potential life threatening because of the immediate
disturbance of the cardio respiratory physiology and hemorrhage and later
developments of infection .
These patients can usually be treated or their conditions temporarily
relieved by relatively simple measures such as intubation, ventilation , tube
thoracostomy, fluid resuscitation and needle pericardiocentesis.
The ability to recognize this important injuries and the skill to perform the
necessary procedures can be life saving.
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Reference
Best Emergency book manual
upto date 21.6
Critical care Emergency Medicine
Tintinalis Emergency Medicine
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