Ninety percent of combat fatalities die before reaching medical treatment. Traditional trauma care like ATLS is not directly applicable to combat settings which involve prolonged evacuations, limited resources, and hostile conditions. Tactical Combat Casualty Care was developed to address the unique prehospital challenges of combat medicine. It focuses on controlling hemorrhage, airway management, and shock treatment at the point of injury through various stages of evacuation. Understanding the operational environment is essential, as standard procedures designed for civilian and hospital settings may not apply to combat prehospital care.
polytrauma lecture prepare by three medical student in Kerbala university / college of medicine department of surgery to presented as seminar
for download as ppt
https://drive.google.com/open?id=1bc3HMEeJyhrOwag-AvTFMmPVKi12O1PU
Disaster and Mass Casualty Incidents (updated 7th July 2020)Chew Keng Sheng
A new updated slide on an overview of disaster management in Malaysia, including the formation of NADMA as the dedicated agency to coordinate disaster management in Malaysia.
polytrauma lecture prepare by three medical student in Kerbala university / college of medicine department of surgery to presented as seminar
for download as ppt
https://drive.google.com/open?id=1bc3HMEeJyhrOwag-AvTFMmPVKi12O1PU
Disaster and Mass Casualty Incidents (updated 7th July 2020)Chew Keng Sheng
A new updated slide on an overview of disaster management in Malaysia, including the formation of NADMA as the dedicated agency to coordinate disaster management in Malaysia.
A mass casualty incident is defined as an event which generates more patients at one time than locally available resources can manage using routine procedures. It requires exceptional emergency arrangements and additional or extraordinary assistance.
Air medical transport : An emergency and critical task which might be very challenging for health care workers specially in developing countries like India
A mass casualty incident is defined as an event which generates more patients at one time than locally available resources can manage using routine procedures. It requires exceptional emergency arrangements and additional or extraordinary assistance.
Air medical transport : An emergency and critical task which might be very challenging for health care workers specially in developing countries like India
The biggest online and social media in the CEE region, between 14th-15th October, with famous international speakers like:
Barabási-Albert László (USA – University Harvard)
Horváth László (USA)
Aigerim Shorman (USA)
Dan Gabriel (USA)
Jonathan Hubbard(USA)
Hannes Wirnsberger(DDB)
Johannes Wesemann(UBER)
Thomas Jul (Denmark – Ericsson, evangelist of "The Networked Society")
Chris Sherwood (Allegro)
Tomasz Musial(SmartAdserver)
Torben Heimann(IMorproveDigital)
Rob Webster(MediaCom)
Maciej Wyszy((SocioMantic)
Juraj Sasko (Szlovákia)
Chris Sherwood (Allegro),
Okányi Attila (Romania),
Jo Coombs (TURN)
John Purkiss(UK)
Lori Beattie(UK)
Kristin Billowitch(Rubicon)
The new edition of Fort Drum's post guide is now available as a PDF! If you're new to the installation or just looking for more information about our post and the surrounding areas this is a great resource for you.
Approach to a trauma patient - Advanced Trauma Life SupportParthasarathi Ghosh
Approach to a trauma patient from a Critical Care Medicine perspective with basics of Advanced Trauma Life Support.
References - ATLS Manual 10th Edition
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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.
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. Ninety percent of combat wound fatalities die on the battlefield before
reaching a medical treatment facility. This fact of war emphasizes the need
for continued improvement in combat prehospital care. Trauma care training
for military medics has been based primarily on the principles taught in the
Advanced Trauma Life Support (ATLS) course. ATLS provides a
standardized approach to the management of trauma that has proven very
successful when used in the setting of a hospital emergency department. The
value of at least some aspects of ATLS in the prehospital setting, however,
has been questioned, even in the civilian sector. Military authors have voiced
additional concerns about the applicability of ATLS in the combat setting.
Mitigating factors such as darkness, hostile fire, resource limitations,
prolonged evacuation times, unique battlefield casualty transportation issues,
command and tactical decisions affecting healthcare, hostile environments,
and provider experience levels pose constraints different from the hospital
emergency department. These differences are profound, and must be carefully
reviewed when trauma management strategies are modified for combat
application.
3. referencesreferences
• Operational Emergency Medical Skills Course Manual,
LTC (Ret) J. Hagmann, M.D., 2004
• Tactical Combat Casualty Care, Committee on Tactical
Combat Casualty Care, Government Printing Agency,
Feb 2003
• Tactical Combat Casualty Care in Special Operations,
CPT Frank Butler, Jr., MC, USN; LTC John Hagmann,
MC, USA; ENS George Butler, MC, USN, Military
Medicine, Vol. 161, Supp 1, 1996
4. 3 environments for care3 environments for care
• HOSPITALS
• TRADITIONAL PRE-HOSPITAL
CARE
• OPERATIONAL “OUT-OF-
HOSPITAL” MEDICAL SUPPORT
5. HOSPITALSHOSPITALS
• Primarily deals with blunt trauma
• Access to full range of specialist Physicians
• Resource intensive
• Advanced trauma care facilities, Intensive
care units
• ATLS procedures
• Pre-surgical evaluation with access to full
labs, blood banks, etc.
6. TRADITIONAL PRE-TRADITIONAL PRE-
HOSPITAL CAREHOSPITAL CARE
• Primarily deals with blunt trauma
• Rapid response times
• Well equipped and supported, utilizes EMT
trained personnel
• Advanced life support capabilities
• Rapid transport and access to ambulances,
helicopters, etc.
• Short evacuation times (usually less than 1 hour
away from hospital)
• Strict medical control and use of protocols
7. OPERATIONAL “OUT-OPERATIONAL “OUT-
OF-HOSPITAL”OF-HOSPITAL”
MEDICAL SUPPORTMEDICAL SUPPORT
• Most significant difference between this and the above are
evacuation times of greater than 1 hour
• Primarily deals with penetrating trauma
• Independent providers
• Austere environments
• Echeloned care
• May have delayed initial medical access (scene safety
important)
• In most cases limited to what medic can carry in aid-bag
• Often pre-injury stressor is present (e.g. dehydration, sleep
deprivation, stress of mission)
8. Operational field careOperational field care
3 distinct areas3 distinct areas
• Care Under Fire
• Tactical Field Care
• Combat Casualty Evacuation Care
“CASEVAC”
9. Care under fireCare under fire
• SECURITY!!
• Limited to what is carried by medic and soldiers
• Care based on MARCH acronym
• M – Massive Bleeding
• A – Airway
• R – Respirations
• C – Circulation
• H - Head The best treatment for a patient
under fire
is to gain Fire Superiority!!
10. Tactical field careTactical field care
• More secure
• More Resources … still resource limited
• ABC’s and Rapid Trauma Assessment
• IV’s and Fluid Resuscitation
• Dressings, Splints and Meds
• CPR - Resuscitation on the battlefield for victims of blast or
penetrating trauma who have no pulse, no respirations, and no other
signs of life will not be successful and should not be attempted.
11. C-spine precautionsC-spine precautions
• C-spine control: even with the neck supported in a C-collar, you
do not prevent all neck injury
– For penetrating trauma, C-spine control is unnecessary (blunt trauma tears
vertebral ligaments requiring support). Penetrating injury blasts away
ligaments, so if there is penetrating trauma then you already have C-spine
trauma
– Value – no one has shown conclusively that C-spine control can reduce
the number of people who become paralyzed. For example, in Austria, an
EMS system was established in the 1980’s using C-spine control but no
differences were detected in numbers of patients who developed paralysis
before and after introduction (does not mean it isn’t there).
– C-spine control tends to be very resource intensive (manpower and
medical management) that we do not use it except for very specific
injuries where you think that there is a C-spine injury.
12. Standard medical procedures have been
developed for the treatment of patients in the
traditional pre-hospital and hospital environments
where evacuations are usually achieved in less
than 1 hour. These procedures are not always
applicable to your work environment.
UNDERSTAND THE ENVIRONMENT YOU
ARE WORKING IN!!
13. Mortality curveMortality curve
Following trauma, the chances of a casualty
surviving are dependant upon numerous variables,
including the speed at which appropriate medical
treatment is administered. During this discussion,
we will look at the factors that can affect the chances
of a casualty surviving as injury symptoms
developing from initial penetrating trauma, through
hemorrhage and/or respiratory compromise, to shock
and infection.
14. Mortality curveMortality curve
penetrating traumapenetrating trauma
100%
80%
70%
60%
50%
6min 1hr 6hr 24hr 72hr
Instantaneous Death
Hemorrhage
Airway obstruction
Breathing complications
Shock
Infections
PPE and
good tactics
Self aid
Buddy aid
EMT-B
ALS level skills
Surgery interventions
And Antibiotics
17. Airway managementAirway management
• Resource Intensive methods v. Less
intensive methods
– Allow patient to sit up and manage own airway
– O2 delivery
– Naso v. Oral
– Surgical Cricothyroidotomy v. Intubation
– Needle Cric
18. shockshock
• Shock is initially a physiological protection
response that occurs in response to injury
• Not a state your body slowly goes into
because of injury
• Stages
– Compensated
– Decompensated
– Irreversible
19. ConclusionConclusion
• Operational Environment is different from
civilian pre-hospital environment.
• Know your mission profile and understand
your resources.
• Right intervention at the Right time.
• Regardless of Echelon assigned to… we
ALL are Echelon I medics!
There are three different environments in which medical care is practiced: in hospitals, in standard civilian pre-hospital environments and in operational field environments. Each of these has its own procedures and standards of care that must be met, although the facilities available to meet these standards vary considerably.
Throughout their careers, military medical personnel may be called upon to treat trauma victims in two types of situations – in combat, and in routine life on or off military installations. For non-combat situations, such as motor vehicle accidents, training accidents on the base, falls at home, and civilian acts of violence, the PHTLS guidelines apply. These guidelines should be followed and the appropriate EMS system activated.
Ninety percent of combat wound fatalities die on the battlefield before reaching a medical treatment facility. (1) This fact of war emphasizes the need for continued improvement in combat prehospital care. Trauma care training for military medics has been based primarily on the principles taught in the Advanced Trauma Life Support (ATLS) course. (2) ATLS provides a standardized approach to the management of trauma that has proven very successful when used in the setting of a hospital emergency department. The value of at least some aspects of ATLS in the prehospital setting, however, has been questioned, even in the civilian sector. (3-23) Military authors have voiced additional concerns about the applicability of ATLS in the combat setting. (24-31) Mitigating factors such as darkness, hostile fire, resource limitations, prolonged evacuation times, unique battlefield casualty transportation issues, command and tactical decisions affecting healthcare, hostile environments, and provider experience levels pose constraints different from the hospital emergency department. These differences are profound, and must be carefully reviewed when trauma management strategies are modified for combat application.
These environments are radically different, and a major failure in the past has been to apply ATLS procedures to out-of-hospital and combat environments.
Management during combat missions can be divided into three distinct phases as described below. (31) This approach recognizes a particularly important principle – performing the correct intervention at the correct time in the continuum of field care. A medically correct intervention performed at the wrong time in combat may lead to further casualties.
Security - This must take priority over any medical care given to prevent further injury to casualties and/or care providers. Once your position is secure, move on to the ABC’s. REMEMBER … The best treatment for a patient under fire is to gain Fire Superiority!!
1. Expect casualty to stay engaged as a combatant if appropriate
2. Return fire as directed or required
3. Try to keep yourself from being shot
4. Try to keep the casualty from sustaining additional wounds
5. Airway management is generally best deferred until the Tactical
Field Care phase
6. Stop any life-threatening external hemorrhage:
- Use a tourniquet for extremity hemorrhage
- For non-extremity wounds, apply pressure and/or a HemCon® dressing
7. Communicate with the patient if possible
- Offer reassurance, encouragement
- Explain first aid actions
"Tactical Field Care" is the care rendered once the casualty and his unit are no longer under effective hostile fire. It also applies to situations in which an injury has occurred on a mission, but hostile fire has not been encountered. Medical equipment is still limited to that carried into the field by mission personnel. Time prior to extraction may range from a few minutes to many hours.
The mortality curve is based on documented studies, done by the Uniformed Services University of Health Sciences, from Desert Storm all the way back to documented casualties of the Revolutionary war.
Ø About 20% of the injuries have an Instantaneous Death Rate (IDR) no matter what care they receive. These would include casualties with major system trauma (heart or CNS). The IDR has changed very little during the last 200 years. The use of modern Personal Protective Equipment (PPE) has reduced the rate from 25% to 20%. There are documented cases of casualties with non-survivable injuries surviving for up to six minutes. Therefore, after six minutes, about 80% will be alive.
Ø By the end of the first hour, another 10% will die from exsanguinating hemorrhage (carotid or femoral arteries) or from obstruction of the airway (choking, facial tissue and/or swelling occluding the airway). If a casualty can make it through the first hour, highly probable they will make it to the third hour. Therefore, after sixty minutes, about 70% will be alive.
Ø By six hours, another 10% will succumb from breathing complications (even those with large sucking chest wounds can survive up to six hours). By this time, there will be some showing the first signs of shock caused by subtler bleeding. Although at this stage, they are unlikely to die from shock alone. Lose about half for every subsequent six-hour delay in evacuation/care. Therefore, after six hours, about 60% will be alive.
Ø Between six and twenty-four hours, deaths occur from shock early on, but after this condition, they remain relatively stable. Therefore, after six hours, curve is relatively unchanged, about 60% will still be alive.
Ø By seventy-two hours, deaths occur mostly from infections. Therefore, after seventy-two hours, about 50% will still be alive.
MITIGATING FACTORS
0-6 minutes – Not much. Prevent injuries; PPE and good tactics.
6-60 minutes – Basic Care. Self aid / Buddy aid / EMT-B. Stop exsanguinating hemorrhage by direct pressure or tourniquet, open occluded airway.
1-6 hours – ALS level skills. Decompress chest, chest tubes, oxygen, IV access / resuscitation, airway management.
6 hours or more – Surgery interventions required to show any marked improvements in survival rates.
Tourniquet v. Dressing… or Alternate means… Quikclot, Hemcon, Fibrin bandage
Airway – High Acuity airway methods v. simple methods
Shock- Actual instant body response v. A state that the body eventually goes into from trauma
Fluid Replacement – Hypovolemic resuscitation v. 2 lg bore IV’s
The most common form of shock, seen in the operational environment, is induced by hypovolemia where not enough blood is available to take oxygen to the cells: for example due to blood loss through an open wound or internal hemorrhage.
Shock causes release of epinephrine (adrenaline), resulting in changes in these symptoms, because they are all mediated by epinephrine. In some trauma patients suffering from shock, epinephrine levels have been seen to increase from “normal” levels of 100, up to 14,000.
However, increased epinephrine release and the above symptoms can also be seen in people who are not suffering from shock (e.g. if scared). How do you tell the difference between someone who is scared and releasing epinephrine and someone in traumatic shock? You measure their lactic acid levels.
From observations made on casualties in World War I, it was initially believed that shock was a momentary pause in the act of death. Shock was thought to occur until lactic acid reached a critical level and once that level was reached, death resulted. Therefore, is a patient could get back blood flow, hypoxia was corrected and the patient recovered.
During World War II, it took on average 24 hours to get a patient to hospital care, and it was noticed that of patients with nearly identical injuries, some whose lactic acid levels went back to normal still died. This lead to the idea of the existence of a condition of irreversible shock where death resulted because too much damage occurred due to the previous levels of lactic acid: i.e. that shock is a disease state (33).
However, since the late 1960’s, shock has not been considered to be a disease state. Although lactic acid accumulation is dangerous (as lactic acid is a poison), the symptoms associated with shock are considered not to be so important. This change came about after various studies were undertaken to assess the effects of shock. An example is given below.