The document discusses the evaluation and management of abdominal trauma. It notes that in the past the abdomen was difficult to evaluate after injury but now tools like FAST ultrasound and CT scans allow for more organ-specific assessment. The primary survey focuses on controlling hemorrhage from the abdomen or other sites. Further evaluation involves history, physical exam, FAST, laparoscopy, and CT to accurately diagnose injuries before selecting appropriate treatment like laparotomy or observation.
Abdominal Trauma
Blunt Abdominal Trauma
INDICATIONS FOR LAPAROTOMY
ROLE OF DIAGNOSTIC LAPAROSCOPY
FAST EXAM
HEPATIC AND SPLENIC INJURIES
RETROPERITONEAL HEMORRHAGE
DUODENAL AND PANCREATIC INJURY
DIAPHRAGMATIC RUPTURE
SMALL BOWEL INJURY
INJURY TO COLON AND RECTUM
Penetrating Abdominal Trauma
Stab Wounds: Stratification by loci
Gunshot Wounds
DIAGNOSTIC LAPAROSCOPY
Abdominal Trauma
Blunt Abdominal Trauma
INDICATIONS FOR LAPAROTOMY
ROLE OF DIAGNOSTIC LAPAROSCOPY
FAST EXAM
HEPATIC AND SPLENIC INJURIES
RETROPERITONEAL HEMORRHAGE
DUODENAL AND PANCREATIC INJURY
DIAPHRAGMATIC RUPTURE
SMALL BOWEL INJURY
INJURY TO COLON AND RECTUM
Penetrating Abdominal Trauma
Stab Wounds: Stratification by loci
Gunshot Wounds
DIAGNOSTIC LAPAROSCOPY
2 cases of colorectal trauma - one due to blunt trauma abdomen and one due to penetrating trauma to rectum are discussed in the light of colorectal trauma
Elaborate ppt on blunt trauma abdomen and management of specific organ injuries with abdominal compartment syndrome. Good enough to revise and prepare answers.
Duodeno Pancreatic Injuries - Evaluation and Assessment.pptxDr Debmoy Ghatak
retroperitoneal injuries.
here in this segment we will deal with clinical anatomy of retroperitoneum and see how to assess clinically - radiologically -and surgically explore the duodeno pancreatic injuries.
we will see the probable CT findings and which one are the most specific ones. new tests to be used in pancreatic injuries. what are the prevalent latest guidelines of management and how to surgically explore the injuries.
Abdominal Trauma
Blunt Abdominal Trauma
INDICATIONS FOR LAPAROTOMY
ROLE OF DIAGNOSTIC LAPAROSCOPY
FAST EXAM
HEPATIC AND SPLENIC INJURIES
RETROPERITONEAL HEMORRHAGE
DUODENAL AND PANCREATIC INJURY
DIAPHRAGMATIC RUPTURE
SMALL BOWEL INJURY
INJURY TO COLON AND RECTUM
Penetrating Abdominal Trauma
Stab Wounds: Stratification by loci
Gunshot Wounds
DIAGNOSTIC LAPAROSCOPY
Abdominal Trauma
Blunt Abdominal Trauma
INDICATIONS FOR LAPAROTOMY
ROLE OF DIAGNOSTIC LAPAROSCOPY
FAST EXAM
HEPATIC AND SPLENIC INJURIES
RETROPERITONEAL HEMORRHAGE
DUODENAL AND PANCREATIC INJURY
DIAPHRAGMATIC RUPTURE
SMALL BOWEL INJURY
INJURY TO COLON AND RECTUM
Penetrating Abdominal Trauma
Stab Wounds: Stratification by loci
Gunshot Wounds
DIAGNOSTIC LAPAROSCOPY
2 cases of colorectal trauma - one due to blunt trauma abdomen and one due to penetrating trauma to rectum are discussed in the light of colorectal trauma
Elaborate ppt on blunt trauma abdomen and management of specific organ injuries with abdominal compartment syndrome. Good enough to revise and prepare answers.
Duodeno Pancreatic Injuries - Evaluation and Assessment.pptxDr Debmoy Ghatak
retroperitoneal injuries.
here in this segment we will deal with clinical anatomy of retroperitoneum and see how to assess clinically - radiologically -and surgically explore the duodeno pancreatic injuries.
we will see the probable CT findings and which one are the most specific ones. new tests to be used in pancreatic injuries. what are the prevalent latest guidelines of management and how to surgically explore the injuries.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. } In the past : Abdomen was a “Black Box”:
“It is impossible to know what specific
injuries have occurred at initial evaluation”
} Nowadays : Many tools to evaluate organ
specific injury
} The Causes of Abdominal:
◦ Blunt trauma
◦ Penetrating trauma
◦ Blast/gunshot trauma
6. } Primary Survey : A-B-C-D
} Rapid identification and control of major
haemorrhage
} Think site of bledding :
◦ Thorax
◦ Abdomen
◦ Pelvis
◦ Femur fracture
◦ Retroperitoneum
7. } Immediate explorative of the abdomen:
◦ Major haemorrhage from abdominal source
◦ Signs of peritonitis
◦ Evisceration
◦ Chest radiographic evidence of diaphragmatic
rupture
◦ Abdominal impalement
◦ ALL gunshot wounds to the abdomen
11. } History of Illness
◦ Mechanism of Injury
◦ Injury sustain
◦ Time of injury
} Type of injury
◦ Blunt injury
◦ Penetrating injury
◦ Gunshot/blast injury
◦ Combination/multiple trauma
19. Huang MS, Liu M, Wu JK, Shih HC, Ko TJ, Lee CH. Ultrasonography for the evaluation of
hemoperitoneum during resuscitation: a simple scoring system. J Trauma. 1994;36(2):173-7.
B. Philippi, H Siahaan : FAST Evaluation in RSCM 2012
20. } Advantages :
◦ Fast-bedside
◦ Sensitive to hemoperitoneum (82-97%)
◦ Non invasive
◦ No radiation/contrast
} Disadvantages
◦ Operator dependent
◦ Not as good for solid parenchymal damage,
retroperitoneum, or diaphragmatic defects.
◦ Limited by obesity, substantial bowel gas, and free air.
◦ Can’t distinguish blood from ascites.
21. } Advantages :
◦ Fast
◦ Sensitive and objective
} Disadvantages :
◦ Specialized training
◦ Invasive – Need streril equipments
◦ Not injury specific
◦ Miss retroperitoneal and diaphragm injury
} Not recommended if prior to laparotomy
22.
23.
24. } Advantages
◦ Very specific and sensitive
◦ Good for evaluating back
and retroperitoneal injuries
◦ Allow staging of blunt organ injury
} Disadvantages
◦ Require time and patient transport
◦ Patient must in stable condition
25. } Rationale
◦ Exploratory laparotomy in trauma patient with
suspected intra-abdominal injury can be NEGATIF
LAPAROTOMY with increasing morbidity and
mortality
◦ Diagnostic Laparoscopy can perform to decrease
negatif laparotomy
(10-20% no significant organ injury)
26. } Improved diagnostic accuracy compared to
◦ FAST: poor specificity
◦ DPL: poor specificity, invasive, not informative for
retroperitoneal injuries
◦ CT: hollow viscus injuries difficult to identify
} Reduction of non therapeutic laparotomy
rates
} Reduction of short and long-term morbidity –
↓ ICU stay, ↓ overall LOS
Risk future adhesive bowel obstruction
27.
28.
29. } Indication :
◦ Highly suspected intra-abdominal injury after negatif
initial examination
◦ Abdominal stab wound through fascia/peritoneum
◦ Gunshot wound suspected through abdomen
◦ Diagnosis diafragm injury
◦ Transdiafragm pericardial window in heart injury
} Contraindication (absolut or relative)
◦ Unstable Hemodinamic
◦ Peritonitis
◦ Significant Intra-abdominal injury
◦ Posterior stab wound with suspected colon injury
◦ Limited skill to perform laparoscopy
30. } Contraindication (absolut or relative)
◦ Unstable Hemodinamic
◦ Peritonitis
◦ Significant Intra-abdominal injury
◦ Posterior stab wound with suspected colon injury
◦ Limited skill to perform laparoscopy
31.
32.
33.
34. PF
normal
PF
tak
jelas/tak
dapat
dipercaya/
tidak
di
follow
up
Peritonitis
Pemeriksaan
Serial
Hemodinamik
Stabil
Hemodinamik
Tidak
Stabil
Trauma
Tumpul
Abdomen
FAST
Positif
Negatif
Trauma
abdomen
tidak
jelas
Trauma
abdomen
jelas
FAST
Negatif Positif
Laparotomi
Evaluasi
ulang:-‐
organ
lain-‐
penyebab
lain
Penanganan
Selektif
Laparotomi
35. cedera
organ
(+)
cedera
organ
(+)
cedera
organ
jelas
cedera
organ
(+)
tembus
(-‐)
tembus
(+)
cedera
diafragma
Repair
Laparotomi
cedera
organ
(-‐)
cedera
organ
tidak
jelas
Tembak
Trauma
Tembus
Abdomen
Indikasi
Laparotomi:
Syok,
Peritonitis
,
Eviserasi,
Tertancap,
Udara
bebas,
Darah
di
oriMisium/selang,
Tidak Ya
Tusuk
Abdomen
Depan
Flank/
belakang
Torako-‐
abdominal
Laparoskopi
CT
Scan
+
Kontras
Eksplorasi
lokal
luka
Laparoskopi
Observasi
cedera
organ
(-‐)
tembus
(+)
Laparoskopi
Tutup
luka
Observasi
/
Rawat
jalan
36. } Abdominal trauma is a complex situation
needing prompt and thorough approach
} Primary survey : controlled abdominal
bledding
} Specific examination à accurate treament
} FAST is useful for initial assestment of blunt
abdominal trauma
} Laparoscopic surgery : good visualization in
specific injury