Fractures
Usually of femoral neck, a serious injury usually occurring in elderly with osteoporosis
Contusions
Usually in anterior aspect of thigh, during contact sports
Strains
Usually to hamstring during sprinting or over striding
Fractures
Usually of femoral neck, a serious injury usually occurring in elderly with osteoporosis
Contusions
Usually in anterior aspect of thigh, during contact sports
Strains
Usually to hamstring during sprinting or over striding
Definition of Osteoporosis - Prevalence - Risk factors for Osteoporosis - Diagnosis of Osteoporosis - Clinical manifestations- Laboratory investigations - DEXA - T and Z score - Management of Osteoporosis - Prevention
Dr. Donald Corenman, M.D., D.C. (http://neckandback.com), is a Vail spine surgeon specializing in all conditions of the spine and has written countless medical articles on spine related disorders including Scheuermann’s Disease—a disease marked by a curvature of the spine and a sagittal plane deformity. This presentation focuses on Scheuermann’s Disease and provides an in-depth look at the disorder. It discusses the symptoms, classifications and treatment options. It also provides a look at what a normal sagittal plane looks like vs a sagittal plane deformity. A curvature of the spine is also a symptom of scoliosis and kyphosis.
Dr. Corenman is a renowned Vail spine surgeon and also is an expert at degenerative spinal conditions including degenerative disc disease, spinal stenosis, sciatica, and spondylolythesis. He is also a sports medicine specialist and treats athletes with traumatic sports related injuries. He recently launched his own website (http://neckandback.com) to educate patients on spine disorders and to offer second opinions to physicians and colleagues who are seeking additional information on specific spine injuries and treatment options.
Definition of Osteoporosis - Prevalence - Risk factors for Osteoporosis - Diagnosis of Osteoporosis - Clinical manifestations- Laboratory investigations - DEXA - T and Z score - Management of Osteoporosis - Prevention
Dr. Donald Corenman, M.D., D.C. (http://neckandback.com), is a Vail spine surgeon specializing in all conditions of the spine and has written countless medical articles on spine related disorders including Scheuermann’s Disease—a disease marked by a curvature of the spine and a sagittal plane deformity. This presentation focuses on Scheuermann’s Disease and provides an in-depth look at the disorder. It discusses the symptoms, classifications and treatment options. It also provides a look at what a normal sagittal plane looks like vs a sagittal plane deformity. A curvature of the spine is also a symptom of scoliosis and kyphosis.
Dr. Corenman is a renowned Vail spine surgeon and also is an expert at degenerative spinal conditions including degenerative disc disease, spinal stenosis, sciatica, and spondylolythesis. He is also a sports medicine specialist and treats athletes with traumatic sports related injuries. He recently launched his own website (http://neckandback.com) to educate patients on spine disorders and to offer second opinions to physicians and colleagues who are seeking additional information on specific spine injuries and treatment options.
This introductory lecture in thoracic surgery covers the following topics:
Development of the lung.
Developmental Anomalies.
Anatomy of the lungs and the bronchial tree.
Diagnostic procedures in thoracic surgery.
Closed tube thoracostomy.
Aspirated tracheobronchial foreign bodies.
Pulmonary hydatid cysts.
Chest injuries ranks 3rd after head injuries and extremity injuries in a case of multisystem trauma.It is of two types blunt chest trauma and peneterating chest trauma.The main cause of blunt chest trauma is road side accidents due to vehicles. Peneterating chest trauma is more dangerous and is common in war injuries and civilian terroism.In this ppp I have discussed some useful uncommon and important aspects of chest injuries
Amputation is one of the meanest yet one of the greatest operations in surgery,i.e. mean- when resorted to where better may be done, Great – as the only step to give comfort to patient and prolong his lhis. This was said by Sir William Ferguson Great British Surgon of 19th century. In this ppp I have described tt in a simple and lucid way
Achalasia cardia is the cause for dysphagia for liquids to begin with and then it will progress to dysphagia to solids as well.The cause for this problem is inadequate relaxation of lower esophageal sphincter. It is directly opposite to GERD where there will be lax lower esophageal sphincter
Chest injury is one of the common condition in road traffic accident and other injuries including falling from height, blunt trauma and others, which can include fracture of ribs, or penetrating of objects to the lung the open pneumothorax, so this slide will enable you to know how to deal with this injury because mostly this patient are emergency need remediate help
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
3. 33
DEFINITION
Thoracic trauma is not a single entityThoracic trauma is not a single entity
It refers to as injuries of the thoracicIt refers to as injuries of the thoracic
cage and its internal and associatedcage and its internal and associated
structuresstructures
It is one of the surgical emergenciesIt is one of the surgical emergencies
5. 55
Incidence
Varies both geographically and withVaries both geographically and with
SESSES
In the US, S/America, Africa and AsiaIn the US, S/America, Africa and Asia
incidence of penetrating injuries isincidence of penetrating injuries is ↑↑
due to criminal or military activitiesdue to criminal or military activities
In Europe blunt injuries isIn Europe blunt injuries is ↑↑ mainlymainly
due to RTAdue to RTA
6. 66
Morbidity / mortality
Thoracic trauma is associated with significantThoracic trauma is associated with significant
mortality and morbiditymortality and morbidity
Chest trauma accounts for 25% of all traumaChest trauma accounts for 25% of all trauma
deathsdeaths
2/3 of deaths occur after reaching hospital2/3 of deaths occur after reaching hospital
Serious pathological consequences:Serious pathological consequences: --
HypoxiaHypoxia
HypovolaemiaHypovolaemia
Myocardial failureMyocardial failure
7. 77
Age
Trauma including chest trauma isTrauma including chest trauma is
the leading cause of deaths amongthe leading cause of deaths among
people between 1-44 years of agepeople between 1-44 years of age
8. 88
Sex
Male are more affected thanMale are more affected than
females [M>F]females [M>F]
9. 99
Race
Studies reported no racialStudies reported no racial
predilection to thoracic injuriespredilection to thoracic injuries
12. 1212
Blunt thoracic injuries
Direct trauma to the chest cageDirect trauma to the chest cage
The victim is struck in the chest by a moving objectThe victim is struck in the chest by a moving object
→→fractures of the ribs, contused lungs etcfractures of the ribs, contused lungs etc
Compression thoracic injuriesCompression thoracic injuries
The chest is injured by compressionThe chest is injured by compression →→ diaphragmaticdiaphragmatic
rupture, cardiac & lung contusionrupture, cardiac & lung contusion
Deceleration thoracic injuriesDeceleration thoracic injuries
These are injuries resulting from rapid deceleration of theThese are injuries resulting from rapid deceleration of the
body with continuing moving of the internal thoracicbody with continuing moving of the internal thoracic
organsorgans→→ aortic rupture (tear), cardiac and pulmonaryaortic rupture (tear), cardiac and pulmonary
contusioncontusion
13. 1313
Penetrating thoracic injuries
The degree of tissue damage is proportional toThe degree of tissue damage is proportional to
the Kinetic Energy [K.E.] of the penetratingthe Kinetic Energy [K.E.] of the penetrating
objectobject
K.E. = 1/2mvK.E. = 1/2mv22
, therefore K.E., therefore K.E. αα mvmv22
The velocity of the penetrating object is theThe velocity of the penetrating object is the
major determinant of tissue damage than themajor determinant of tissue damage than the
mass of an objectmass of an object
The high the velocity the more energy generatedThe high the velocity the more energy generated
and therefore more tissue damageand therefore more tissue damage
14. 1414
Penetrating injuries [cont]
The mechanism of injury in penetratingThe mechanism of injury in penetrating
thoracic injuries can categorized as:-thoracic injuries can categorized as:-
Low velocity thoracic injuriesLow velocity thoracic injuries
E.g. stab woundsE.g. stab wounds
Velocity < 1200ft/s injuriesVelocity < 1200ft/s injuries
Medium velocity thoracic injuriesMedium velocity thoracic injuries
E.g. Most handgunsE.g. Most handguns
Velocity 1200-2000ft/sVelocity 1200-2000ft/s
High velocity thoracic injuriesHigh velocity thoracic injuries
E.g. most war weapons eg riflesE.g. most war weapons eg rifles
22. 2222
PATHOPHYSIOLOGY
Thoracic injury results into threeThoracic injury results into three
pathophysiological consequencespathophysiological consequences
These are:-These are:-
HypoxemiaHypoxemia
HypovolaemiaHypovolaemia
Myocardial failureMyocardial failure
23. 2323
Hypoxaemia
Refers toRefers to PaOPaO22 oror O2 contents in arterial bloodO2 contents in arterial blood
Results from any injury that disturbs airway orResults from any injury that disturbs airway or
ventilation including:-ventilation including:-
Airway obstructionAirway obstruction
PneumothoraxPneumothorax
Flail chestFlail chest
Lung contusionLung contusion
Tracheobroncheal injuryTracheobroncheal injury
Diaphragmatic ruptureDiaphragmatic rupture
Each of these injuries limits the physiologic functionEach of these injuries limits the physiologic function
of air exchangeof air exchange
24. 2424
Hypovolaemia
Refers to asRefers to as in blood volumein blood volume
Results from intrathoracicResults from intrathoracic
haemorrhage secondary tohaemorrhage secondary to rib #s,rib #s,
injury to the lung parenchyma orinjury to the lung parenchyma or
intercostal vesselsintercostal vessels
25. 2525
Myocardial failure
Refers to as failure of the heart to pump bloodRefers to as failure of the heart to pump blood
to the general circulationto the general circulation
May be caused by eitherMay be caused by either bluntblunt oror penetratingpenetrating
thoracic injurythoracic injury
Causes of myocardial failure include:-Causes of myocardial failure include:-
Cardiac contusionCardiac contusion
Pericardial effusionPericardial effusion
Rupture of ventricular septum or vulvular muscleRupture of ventricular septum or vulvular muscle
Coronary air embolusCoronary air embolus
27. 2727
History
History of chest traumaHistory of chest trauma
Chest painChest pain
Difficulty in breathingDifficulty in breathing
±Haemoptysis±Haemoptysis
±Cough±Cough
28. 2828
Physical examination
General examinationGeneral examination
DyspnoeaDyspnoea
CyanosisCyanosis
AnemiaAnemia
ShockShock
Level of consciousnessLevel of consciousness
Puffy appearance of surgical emphysemaPuffy appearance of surgical emphysema
Restless and gaspingRestless and gasping
29. 2929
Physical examination [cont]
Local examinationLocal examination
Open Chest woundOpen Chest wound →→assess theassess the
depthdepth
Bruises and lacerations on the chestBruises and lacerations on the chest
wallwall
Thoracic spine tendernessThoracic spine tenderness
30. 3030
Physical examination [cont]
Systemic examinationSystemic examination
Respiratory systemRespiratory system
Cardiovascular systemCardiovascular system
Abdominal examinationAbdominal examination
CNS examinationCNS examination
32. 3232
Laboratory studies
Non- specificNon- specific
Adds little informationAdds little information
Hemoglobin estimationHemoglobin estimation
Blood grouping and cross-matchingBlood grouping and cross-matching
Blood gaseous analysisBlood gaseous analysis
PaCO2PaCO2
PaO2PaO2
34. 3434
Imaging studies [cont]
Abdominal USS [FAST]Abdominal USS [FAST]
To rule out associated abdominalTo rule out associated abdominal
visceral injury and pleural effusionvisceral injury and pleural effusion
CT scan –CT scan – chest, brain, abdomenchest, brain, abdomen
Aortogram –Aortogram – to rule out aortato rule out aorta
rupturerupture
37. 3737
MANAGEMENT
The mgt is divided into 5 phasesThe mgt is divided into 5 phases
according to ATLS (Advanced Traumaaccording to ATLS (Advanced Trauma
Life Support)Life Support)
Phase I: Primary survey phasePhase I: Primary survey phase
Phase II: Resuscitation phasePhase II: Resuscitation phase
Phase III :Secondary survey phasePhase III :Secondary survey phase
Phase IV: Supportive care phasePhase IV: Supportive care phase
Phase V: DefinitivePhase V: Definitive treatment phasetreatment phase
38. 3838
Phase I: Primary survey phase
Aim: to identify life threatening conditionsAim: to identify life threatening conditions
The life threatening conditions include:-The life threatening conditions include:-
A=AirwayA=Airway
B=BreathingB=Breathing
C=CirculationC=Circulation
D=DisabilityD=Disability
E=ExposureE=Exposure
This should go hand in hand with the phase IIThis should go hand in hand with the phase II
39. 3939
Phase II. Resuscitation phase
Aim: to treat the immediately lifeAim: to treat the immediately life
threatening conditionthreatening condition
Airway –secure airway & Immobilize theAirway –secure airway & Immobilize the
cervical spinecervical spine
Breathing – optimize ventilationBreathing – optimize ventilation
Circulation- establish i.v. accessCirculation- establish i.v. access
Disability- assess neurological deficitDisability- assess neurological deficit
Expose the patient to avoid missed injuryExpose the patient to avoid missed injury
40. 4040
Airway
A clear patent and functional airwayA clear patent and functional airway
should be establishedshould be established
This can be achieved by:-This can be achieved by:-
Use of airwaysUse of airways
Proper position of the patientProper position of the patient
Endotracheal intubationEndotracheal intubation
AmbubagsAmbubags
TracheostomyTracheostomy
41. 4141
Breathing / Ventilation
Achieved by:-Achieved by:-
Make sure the patient is breathingMake sure the patient is breathing
properlyproperly
use of oxygen masksuse of oxygen masks
Mechanical ventilatorsMechanical ventilators
42. 4242
Circulation
Patients with thoracic trauma may bePatients with thoracic trauma may be
associated with massive blood loss leadingassociated with massive blood loss leading
to hemorrhagic shockto hemorrhagic shock
A functional i.v. fluid should be establishedA functional i.v. fluid should be established
to restore blood volume and preventto restore blood volume and prevent
irreversible shockirreversible shock
During the shock state use crystalloid fluidDuring the shock state use crystalloid fluid
BT should be given in case of hemorrhagicBT should be given in case of hemorrhagic
shockshock
43. 4343
Dysfunction of CNS
Neurologic evaluation should beNeurologic evaluation should be
assessed as follows:-assessed as follows:-
Levels of consciousness using GCSLevels of consciousness using GCS
Pupil size and response to lightPupil size and response to light
Motor activity and tactile sensationMotor activity and tactile sensation
Oculocephalic [doll’s eye]Oculocephalic [doll’s eye]
44. 4444
Exposure of the patient
TheThe patient should be fullypatient should be fully
exposed/ undressed to avoidexposed/ undressed to avoid
missed injuriesmissed injuries
45. 4545
Phase III :Secondary survey phase
Not started until phase I &II areNot started until phase I &II are
completecomplete
This include:-This include:-
HistoryHistory
Physical examinationPhysical examination
InvestigationsInvestigations
46. 4646
History
Take history from relatives, friends,Take history from relatives, friends,
ambulance staff, police etcambulance staff, police etc
Mechanism of injuryMechanism of injury
When was the injuryWhen was the injury
Mechanism of impactMechanism of impact
Type of weaponType of weapon
47. 4747
History [cont]
AMPLE historyAMPLE history
A= history of allergiesA= history of allergies
M= medicationsM= medications
P= pre-morbid illnessP= pre-morbid illness
L= last mealL= last meal
E= events surrounding injuryE= events surrounding injury
48. 4848
History [cont]
Associated injuriesAssociated injuries
HeadHead
Abdominal injuriesAbdominal injuries
Major long bone fracturesMajor long bone fractures
SpinesSpines
Pelvic fracturesPelvic fractures
49. 4949
History [cont]
Other symptomsOther symptoms
Loss of consciousnessLoss of consciousness
Bleeding from the ENTBleeding from the ENT
50. 5050
Physical examination
General examinationGeneral examination
Local examinationLocal examination
Systemic examinationSystemic examination
52. 5252
Local examination
Look for:-Look for:-
Open chest wound- assess the depthOpen chest wound- assess the depth
Bruises and lacerations on the chestBruises and lacerations on the chest
wallwall
Thoracic spines tendernessThoracic spines tenderness
55. 5555
Respiration examination [cont]
PalpationPalpation
Feel for:-Feel for:-
Tracheal / Mediastinal shiftTracheal / Mediastinal shift
Tenderness over the chest wallTenderness over the chest wall
Creptus of rib fracturesCreptus of rib fractures → do→ do
compression test to rule out rib #scompression test to rule out rib #s
SternumSternum
Crackly feeling of surgical emphysemaCrackly feeling of surgical emphysema
57. 5757
Respiration examination [cont]
AuscultationAuscultation
Note the following:-Note the following:-
Clicking sounds from rib #Clicking sounds from rib #
Course creptations of surgical emphysemaCourse creptations of surgical emphysema
or absence of breath sounds on the affected sideor absence of breath sounds on the affected side
indicating fluid or air in the pleural cavity or collapsedindicating fluid or air in the pleural cavity or collapsed
lunglung
High pitched breath sounds suggesting tensionHigh pitched breath sounds suggesting tension
pneumothoraxpneumothorax
Presence of breath sounds suggesting rupturedPresence of breath sounds suggesting ruptured
diaphragmdiaphragm
59. 5959
Abdominal examination
Look for:-Look for:-
Evidence of haematomaEvidence of haematoma
Distended abdomenDistended abdomen
Tenderness over the epigastrium /LtTenderness over the epigastrium /Lt
hypochondriumhypochondrium
62. 6262
Phase V: Definitive treatment phase
Depends on the type of injuryDepends on the type of injury
Open chest woundOpen chest wound
Treatment: surgical toilet, closure of theTreatment: surgical toilet, closure of the
woundwound
Simple rib#Simple rib#
Treatment: bed rest, analgesics,Treatment: bed rest, analgesics,
antibiotics, physiotherapy as soon as painantibiotics, physiotherapy as soon as pain
71. 7171
Chest trauma- Summary
CommonCommon
SeriousSerious
Primary goal is to provide oxygen to vital organsPrimary goal is to provide oxygen to vital organs
RememberRemember
AAirwayirway BBreathingreathing
CCirculationirculation
DDysfunction of CNSysfunction of CNS
EExposure to avoid missed injuryxposure to avoid missed injury
Be alert to change in clinical conditionBe alert to change in clinical condition