ATLS is two days course for those who manage trauma patients. These protocols have been followed by hospitals all over the world to treat trauma patients quickly and efficiently.
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
ATLS is two days course for those who manage trauma patients. These protocols have been followed by hospitals all over the world to treat trauma patients quickly and efficiently.
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
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
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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
2. OBJECTIVES
• Demonstrate concepts of primary and secondary patient
assessment
• Establish management priorities in trauma situations
• Initiate primary and secondary management as
necessary
• Arrange appropriate disposition
3. ATLS
• Trimodal death distribution
o First peak-- instantly (brain, heart, large vessel injury)
o Second peak-- minutes to several hours (GOLDEN PERIOD)
o Third peak-- days to weeks (sepsis, MSOF)
• ATLS focuses on the second peak…..Deaths from:
Intra cranial hemorrhages, TBI (Traumatic Brain Injury)
Basilar skull fractures, orbital fractures
Penetrating neck injuries, spinal cord syndromes
Cardiac tamponade, tension pneumothorax, massive hemothorax, esophageal
injury, diaphragmatic herniation, flail chest, sucking chest wounds, pulmonary
contusion, tracheobronchial injuries, penetrating heart injury, aortic arch injuries
…
Liver laceration, splenic ruptures, pancreatico-duodenal injuries, retroperitoneal
injuries
Bladder rupture, renal contusion, renal laceration, urethral injury…
Pelvic fractures, femur fractures, humerus fractures…
4. Concepts of ATLS
• Treat the greatest threat to life first
• The lack of a definitive diagnosis should never impede
the application of an indicated treatment
• A detailed history is not essential to begin the evaluation
• “ABCDE” approach
5. PRIMARY SURVEY
• Patients are assessed and treatment priorities
established based on their injuries, vital signs, and injury
mechanisms
• ABCDEs of trauma care
o A- Airway maintenance with c-spine protection
o B- Breathing and ventilation
o C- Circulation with hemorrhage control
o D- Disability/Neurologic status
o E- Exposure/Environmental control
6. AIRWAY
• Airway should be assessed for patency
o Is the patient able to communicate verbally?
o Inspect for any foreign bodies
o Examine for stridor, hoarseness, gurgling, pooled
secrecretions or blood
• Assume c-spine injury in patients with multisystem
trauma
o C-spine clearance is done both clinically and
radiographically
o C-collar should remain in place until patient can
cooperate with clinical exam or until c-spine injury is
ruled out.
7. AIRWAY INTERVENTIONS
• Supplemental oxygen
• Suction
• Chin lift/jaw thrust
• Oral/nasal airways
• Definitive airways
o RSI (Rapid Sequence Intubation)for agitated patients with c-spine immobilization
o ETI (Emergency Tracheal Intubation)for comatose patients (GCS<8)
8. BREATHING & VENTILATION
• Airway patency alone does not ensure adequate ventilation
• Injuries that can impair ventilation in short term are tension
pneumothorax, flail chest with pulmonary contusion, massive
hemothorax & open pneumothorax. These injuries should be
evaluated in primary survey.
• Inspect, palpate, and auscultate
o Deviated trachea, crepitus, flail chest, sucking chest wound, absence of breath sounds
• CXR to evaluate lung fields
9. BREATHING INTERVENTIONS
• Ventilate with 100% oxygen (if not intubated)
• Needle decompression if tension pneumothorax
suspected
• Chest tubes for pneumothorax / hemothorax
• Occlusive dressing to sucking chest wound
• If intubated, evaluate ETT position
10. CIRCULATION
• Hemorrhagic shock should be assumed in any
hypotensive trauma patient
• Rapid assessment of hemodynamic status
o Level of consciousness
o Skin color
o Pulses in four extremities
o Blood pressure and pulse pressure
11. Circulation Interventions
• Cardiac monitor
• Apply pressure to sites of external hemorrhage
• Establish IV access
o 2 large bore IVs
o Central lines if indicated
• Crystalloids should be used
• Volume resuscitation
o Have blood ready if needed
o Level One infusers available
o Foley catheter to monitor resuscitation
12. DISABILITY
• Abbreviated neurological exam
o Level of consciousness
o Pupil size and reactivity
o Motor function
o GCS
• Utilized to determine severity of injury
• Guide for urgency of head CT and ICP monitoring
13. GCS
EYE OPENING
(E)
VERABL
RESPONSE (V)
MOTOR
RESPONSE (M)
SPONTANEOUS 4 NORMAL 5 NORMAL 6
VERBAL 3 CONFUSED 4 LOCALIZES TO PAIN 5
PAIN 2 INCOHERENT 3
WORDS
FLEXION TO PAIN 4
NONE 1 INCOMPREHENSIBLE
SOUNDS 2
DECORTICATE 3
NONE 1 DECEREBRATE 2
NONE 1
14. Disability Interventions
• Spinal cord injury
o High dose steroids if within 8 hours
• ICP monitor- Neurosurgical consultation(ICP monitoring
is done with use of Intraventricular catheter, subdural
screw and epidural sensor )
• Elevated ICP
o Head of bed elevated
o Mannitol
o Hyperventilation
o Emergent decompression
15. EXPOSURE
• Complete disrobing of patient
• Logroll to inspect back
• Rectal temperature
• Warm blankets/external warming device to prevent
hypothermia
16. SECONDARY SURVEY
• The secondary survey does not begin until the primary
survey (ABCDEs) is completed, resuscitative efforts are
underway, and the normalization of vital functions has
been demonstrated.
• The secondary survey is a head to toe evaluation of the
trauma patient that is complete history, physical
examination including reassessment of all vital signs.
• Each region of the body is completely examined as the
potential to miss an injury is high.
• Complete neurologic examination including repeat GCS
and blood investigations, radiographs, ultrasounds
(Fast)and CT scans are obtained.
17. SECONDARY SURVEY
• The AMPLE history is a useful mnemonic for this
purpose:
Allergies
Medications currently used
Past illnesses/Pregnancy
Last meal
Events/Environment related to the injury
• During the secondary survey, physical examination
follows the sequence of head, maxillofacial structures,
cervical spine and neck, chest, abdomen,
perineum/rectum/vagina, musculoskeletal system, and
neurologic system.
18. HEAD
• The entire scalp and head should be examined for
lacerations, contusions and evidence of fractures. Because
edema around the eyes can later preclude an in-depth
examination, the eyes should be reevaluated for Visual acuity,
Pupillary size, Hemorrhage of the conjunctiva and/or fundi,
Penetrating injury, Contact lenses (remove before edema
occurs), Dislocation of the lens, Ocular entrapment
• A quick visual-acuity examination of both eyes can be
performed by asking the patient to read printed material such
as a hand held Snellen chart, or words on an IV container or
dressing package. Ocular mobility should be evaluated to
exclude entrapment of extraocular muscles due to orbital
fractures.
19. MAXILLO FACIAL STRUCTURES
• Examination of the face should include palpation of all
bony structures, assessment of occlusion, intraoral
examination and assessment of soft tissues.
• Maxillofacial trauma that is not associated with airway
obstruction or major bleeding should be treated only
after the patient is stabilized completely and life-
threatening injuries have been managed.
20. CERVICAL SPINE & NECK
• Patients with maxillofacial or head trauma should be
presumed to have an unstable cervical spine injury
(e.g., fracture and/or ligament injury), and the neck
should be immobilized until all aspects of the
cervical spine have been adequately studied and an
injury has been excluded.
• The absence of neurologic deficit does not exclude injury
to the cervical spine, and such injury should be
presumed until a complete cervical spine radiographic
series and CT
21. CHEST
• A complete evaluation of the chest wall requires palpation of
the entire chest cage, including the clavicles, ribs, and
sternum. Sternal pressure can be painful if the sternum is
fractured or costochondral separation
• Significant chest injury can manifest with pain, dyspnea, and
hypoxia. Evaluation includes auscultation of the chest and a
chest x-rays exist.
• Auscultation is conducted high on the anterior chest wall for
pneumothorax and at the posterior bases for hemothorax.
• Distant heart sounds and decreased pulse pressure can
indicate cardiac tamponade. In addition, cardiac tamponade
and tension pneumothorax are suggested by the presence of
distended neck veins
22. ABDOMEN
• Abdominal injuries must be identified and treated
aggressively. The specific diagnosis is not as important
as recognizing that an injury exists that requires surgical
intervention.
• Spleen is the most common organ injured in blunt
trauma and liver being the second are often associated
with other abdominal injuries.
• Patients with unexplained hypotension, neurologic injury,
impaired sensorium secondary to alcohol and/or other
drugs and equivocal abdominal findings should be
considered candidates for peritoneal lavage, abdominal
ultrasonography or if hemodynamic findings are normal,
CT of the abdomen.
23. FAST
• FOCUSED ASSESSMENT SONOGRAPHY in TRAUMA.
• It is a bedside ultrasound highly preferred in trauma
patients.
• The four classic areas examined for free fluid are
Perihepatic space (Morison’s pouch), Perisplenic space,
Pericardium and Pelvis.
• The newer version- eFAST (Extended FAST) which
includes examination of both lungs (b/l anterior thoracic
sonography). This allows for the detection of
pneumothorax.
24. PERINEUM/ RECTUM/ VAGINA
• The perineum should be examined for contusions,
hematomas, lacerations, and urethral bleeding.
• Pregnancy tests should be performed on all females of
childbearing age.
25. MUSCULOSKELETAL SYSTEM
• The extremities should be inspected for contusions and
deformities. Palpation of the bones and examination for
tenderness and abnormal movement aids in the identification
of occult fractures.
• Pelvic fractures can be suspected by the identification of
ecchymosis over the iliac wings, pubis, labia or scrotum.
Assessment of peripheral pulses can identify vascular injuries.
• Ligament ruptures produce joint instability. Muscle-tendon unit
injuries interfere with active motion of the affected structures.
Impaired sensation and/or loss of voluntary muscle
contraction strength can be caused by nerve injury or
ischemia, including that due to compartment syndrome.
26. NEUROLOGIC EXAM
• A comprehensive neurologic examination includes not
only motor and sensory evaluation of the extremities, but
reevaluation of the patient’s level of consciousness and
pupillary size and response.
• Patients should be monitored frequently for deterioration
in level of consciousness and changes in the neurologic
examination, as these findings can reflect worsening of
the intracranial injury.
• If a patient with a head injury deteriorates neurologically,
oxygenation and perfusion of the brain and adequacy of
ventilation (i.e., the ABCDEs) must be reassessed.
Intracranial surgical intervention or measures for
reducing intracranial pressure may be necessary.
27. SUMMARY
• Trauma Survey includes
Primary survey : ABCDE’s
Secondary survey: AMPLE history with head to toe evaluation
• ECG’s, ABG’s, FAST, blood investigations, X-ray’s and CT
scans are also important in excluding the injuries.
• Reevaluation: Trauma patients must be reevaluated
constantly to ensure that new findings are not overlooked and
to discover deterioration in previously noted findings.
• Continuous monitoring of vital signs and urinary output is
essential.
• The relief of severe pain is an important part of
• the treatment of trauma patients.
Rapid sequence intubation (RSI) is an airway management technique that produces inducing immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent) and is the fastest and most effective means of controlling the emergency airway
the cessation of spontaneous ventilation involves considerable risk if the provider does not intubate or ventilate the patient in a timely manner
RSI is particularly useful in the patient with an intact gag reflex, a “full” stomach, and a life threatening injury or illness requiring immediate airway control
Contraindications of foley catheter (signs of possible urethral injury): 1. Blood at urethral meatus 2. Perineal eccymosis 3. Blood in the scrotum 4. High riding or non palpable prostate 5. Pelvic Fractures
If suspicious of urethral injury---retrograde urethrogram prior to insertion
Decorticate: flexor- arms like ‘C’. Problems with C spine tract or cerebral hemispheres
Decerebrate: extensor- arms like ‘S’. Problems with mid brain and pons
Intraventricular catheter is the most accurate monitoring method.
Subdural screw method id used if the monitoring needs to be done right away.
Epidural sensoris less invasive than other but cannot remove excess CSF.
Diagnostic peritoneal lavage was earlier used to determine which patients needed exploratory laparotomy. But DPL is difficult to perform in pregnant patients and is overly sensitive.
CT abdomen has better specificity than DPL for intra abdominal injury but can be difficult to perform if the patient is hemodynamically unstable and is expensive.
Musculoskeletal examination is not complete without examination of the patient’s back as significant injuries may be missed.
Any evidence of loss of sensation, paralysis, or weakness suggests major injury to the spinal column or peripheral nervous system. Neurologic deficits should be documented when identified.
For adult patients, maintenance of urinary output at 0.5 mL/kg/h is desirable. In pediatric patients who are older than 1 year, an output of 1 mL/kg/h is typically adequate. ABG analyses and cardiac monitoring devices should be used. Pulse oximetry on critically injured patients and end-tidal carbon dioxide monitoring on intubated patients should be initiated.