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Density of tissue (1) Gas (a) Lung (b) Gastrointestinal tract (2) Liquid Blood vessels (a) (b) Muscle (c) Solid organs i) Spleen ii) Liver iii) Kidney iv) Other (3) Solid (a) Bone b treatment 001 - b order 60caps brahmi with mastercard. Temporary (1) Compression wave of tissue particles (2) Away from the pathway of the bullet (3) Lasts only a few microseconds (4) Tissue damage produced by stretch 3 treatment stye generic brahmi 60caps with amex. Energy potential = United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 15 Trauma: 4 Trauma Systems and Mechanism of Injury: 1 (1) (2) (3) Continuum of energy increase Can be broken down into artificial but workable groups Energy (a) Low energy objects i) Hand driven a) Knife b) Ice pick c) Ax d) Other ii) Minimal cavitation iii) Damage only by cutting edge (b) Medium energy i) Muzzle velocity> 1500 feet! Entrance wound (1) Hole is crushed inward (2) Round or oval shaped (3) Rim (a) Dark (b) 1-2 mm width (c) Produced by grease and other substance on the bullet (4) Abrasion (a) Produced by spinning of the bullet (b) Largest with greatest contact of skin i) Larger when impact is at an angle (5) Burn Flame from barrel (a) (b) End of weapon 4-6 inches from the skin b. Blast United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 16 Trauma: 4 Trauma Systems and Mechanism of Injury: 1 A. The blast effect is broken down in to three phases depending on the type of force that occurs during that phase 2. Pressure wave of the blast (1) Major effect on gas containing organs (a) Organ systems i) Lungs ii) Intestinal tract Pathology (b) i) Rupture of the organ (c) Air emboli b. Location (1) External (a) Controlled (b) Uncontrolled (2) Internal (a) Trauma (b) Non-trauma i) Common sites ii) Uncommon sites (c) Controlled (d) Uncontrolled b. Severity (1) Amounts of blood loss tolerated by (a) Adults (b) Children (c) Infants. Physiological response to hemorrhage Clotting (1) (2) Localized vasoconstriction f. Stages of hemorrhage (1) Stage 1 Up to 15% intravascular loss (a) (b) Compensated by constriction of vascular bed Blood pressure maintained (c) Normal pulse pressure, respiratory rate, and renal output (d) (e) Pallor of the skin (f) Central venous pressure low to normal (2) Stage 2 (a) 15-25% intravascular loss (b) Cardiac output cannot be maintained by arteriolar constriction (c) Reflex tachycardia Increased respiratory rate (d) United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 3 Trauma: 4 Hemorrhage and Shock: 2 (3) (4) (e) Blood pressure maintained (f) Catecholamines increase peripheral resistance (g) Increased diastolic pressure (h) Narrow pulse pressure (i) Diaphoresis from sympathetic stimulation U) Renal output almost normal Stage 3 (a) 25-35% intravascular loss (b) Classic signs of hypovolemic shock i) Marked tachycardia ii) Marked tachypnea iii) Decreased systolic pressure iv) 5-15 ml per hour urine output v) Alteration in mental status vi) Diaphoresis with cool, pale skin Stage 4 (a) Loss greater than 35% (b) Extreme tachycardia (c) Pronounced tachypnea (d) Significantly decreased systolic blood pressure (e) Confusion and lethargy (f) Skin is diaphoretic, cool, and extremely pale 3. Compensation for decreased perfusion (1) Occurrence of event resulting in decreased perfusion. Positive inotrope and chronotrope Aldosterone La) Defends fluid volume (b) Secreted by cells of adre:~al cortex in response to stress LcL Promotes sodium. Etiologic classifications (1) Hypovolemic (a) Hemorrhage (b) Plasma loss (c) Fluid and electrolyte loss (d) Endocrine (2) Distributive (vasogenic) (a) Increased venous capacitance (b) Low resistance, vasodilation (3) Cardiogenic (a) Myocardial insufficiency (b) Filling or outflow obstruction (obstructive) (4) Spinal neurogenic shock (a) Refers to temporary loss of all types of spinal cord function distal to injury i) Flaccid paralysis distal to injury site ii) Loss of bladder and bowel control iii) Priapism iv) Loss of thermoregulation (b) Does not always involve permanent primary injury (5) Spinal shock (a) Also called spinal vascular shock (b) Temporary loss of the autonomic function of the cord at the level of injury which controls cardiovascular function (c) Presentations includes i) Loss of sympathetic tone ii) Relative hypotension a) Systolic pressure 80 - 100 mmHg iii) Skin is pink, warm and dry a) Due to cutaneous vasodilation iv) Relative bradycardia (d) Occurrence is rare (e) Shock presentation is usually the result of hidden volume loss i) Chest injuries ii) Abdominal injuries iii) Other violent injuries (f) Treatment i) Focus primarily on volume replacement Assessment - hypovolemic shock due to hemorrhage (1) Early or compensated (a) Tachycardia (b) Pale, cool skin (3) United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 8 Trauma: 4 Hemorrhage and Shock: 2 a. Diaphoresis Level of consciousness i) Normal ii) Anxious or apprehensive (e) Blood pressure maintained (f) Narrow pulse pressure i) Pulse pressure is the difference between the systolic and diastolic pressures, i. Airway and ventilatory support Ventilate and suction as necessary (1) (2) Administer high concentration oxygen (3) Reduce increased intrathoracic pressure in tension pneumothorax b. Blast injuries United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 1 Trauma: 4 Soft Tissue Trauma: 3 10. Arterial United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 2 Trauma: 4 Soft Tissue Trauma: 3 4-3. Amputation United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 4 Trauma: 4 Soft Tissue Trauma: 3 8. Universal precautions (1) Gloves (2) Hand washing (3) Protective eyewear (4) Masks (5) Gowns (6) Handling and disposal of sharps b. Cutaneous layer (1) Epidermis (a) Stratum germinativum (Basal Layer) (b) Stratum corneum (2) Dermis (a) Fibroblasts (b) Macrophages (c) Mast cells (d) Lymphocytes (e) Papillary dermis (f) Reticular dermis b. Subcutaneous layer (superficial fascia) (1) Loose connective tissue (2) Fat (a) Insulation (b) Protection from trauma c. Deep fascia United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 6 Trauma: 4 Soft Tissue Trauma: 3 2. Hemostasis of wound healing (1) Injury causes changes in normal skin anatomy (2) Reflex vasoconstriction for up to 10 minutes (3) Clotting process begins b. Inflammatory phase (1) Role of granulocytes (2) Role of lymphocytes (3) Role of macrophages c. Epithelialization phase (1) Wound healing within 12 hours (2) Healing through re-establishment of skin layers d. Neovascularization (1) Role of new vessel formation (2) Neovascularization as soon as 3 days after, lasting a total of 21 days (3) New vessel formation United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 7 Trauma: 4 Soft Tissue Trauma: 3. Collagen synthesis (1) Role of fibroblasts in collagen synthesis (2) Time factors involved with collagen fibers (3) Process of collagen lysis and wound healing (4) Time table for the healing and tensile strength of wound Alteration of wound healing a. Anatomic factors (1) Body region (2) Static skin tension (3) Dynamic skin tension (4) Pigmented skin (5) Oily skin b. High risk wounds (1) Bites (human and animal) (2) Foreign bodies (3) Wounds contaminated with organic matter (4) Injection wounds (5) Wounds with significant devitalized tissue (6) Crush wounds (7) Any wound in immunocompromised patients (8) Any wound in patients with poor peripheral circulation Abnormal scar formation United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 8 Trauma: 4 Soft Tissue Trauma: 3 a.

United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 23 Trauma: 4 Thoracic Trauma: 7 2 medications jaundice purchase 60 caps brahmi with visa. Upper extremity injury (1) Contribute to long-term impairment (2) Rarely life-threatening b symptoms pulmonary embolism best brahmi 60 caps. Lower extremity injury (1) Associated with higher magnitudes of injury (2) More significant blood loss (3) More difficult to manage in polytrauma patient (4) Femur and pelvic injuries may constitute life threats 3. Age associated changes in bones Morphological changes (1) (a) Water content of intervertebral disks decreases (b) Increased risk of disk herniation (c) Loss of 1fz to 3/4 inch in stature is common (d) Bone tissue disorders shorten the trunk (e) Vertebral column gradually assumes an arc shape (f) Costal cartilages ossify making the thorax more rigid Shallow breathing due to rigid thoracic cage (g) (h) Facial contours change (2) Fractures (a) Bones are more prone to fracture since they are more porous and brittle (b) Vertebral and femoral neck fractures are most common (c) Degree of bone disorder (osteoporosis) is related to incidence of fracture Physiology a. Purpose of the muscles (1) Cardiac muscle (a) Contracts rhythmically on its own (b) Generates electrical impulses i) Automaticity ii) Excitability iii) Conductivity (2) Smooth muscle (a) Found in lower airways, blood vessels, intestines (b) Under control of automatic nervous system (c) Can relax or contract to alter the inner lumen diameter Skeletal muscle (3) (a) Under conscious control (b) Major muscle mass of the body, allows mobility b. Muscular support of skeleton (1) Tendons (a) Bands of connective tissue binding muscles to bones (M-T-B) Allows for power of movement across the joints (b) Cartilage (2) (a) Connective tissue covering the epiphysis (b) Act as surface for articulation (c) Allow for smooth movement at joints (3) Ligaments (a) Connective tissue which support joints (b) Attach to bone ends (c) Allow for stable range of motion c. Purpose of the bones (1) Acts as a structural form, protects vital organs United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 7 Trauma: 4 Musculoskeletal Trauma: 9 d. Long term disability United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 8 Trauma: 4 Musculoskeletal Trauma: 9 B. Pelvis (1) Complications (a) Hemorrhage (b) Associated organs (c) Pregnancy complications (d) Associated dislocations Femur g. Oblique United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 9 Trauma: 4 Musculoskeletal Trauma: 9 C. Closed fractures - break in the bone which has not yet penetrated the soft tissue a. Comminuted fractures - a break which involves several breaks in the bone causing bone fragment damage; consider the combined blood loss and potential for other injuries 4. Greenstick fractures - a bone break in which the bone is bent but only broken on the outside of the bend; children are most likely to have these 5. Transverse fracture - a broken bone that occurs at right angles to the long part of the bone involved 8. Dislocations - a bone moved from its normal position at a joint and may have associated fractures 9. Sprains - an injury to the tendons, muscles or ligaments around a joint, marked by pain, swelling, and dislocation of the skin over the joint 10. Strains - damage, usually muscular, that results from excessive physical effort 11. Stress fracture - a bone break, especially one or more of the foot bones, caused by repeated, long-term, or abnormal stress Pathological fractures Vascular injuries Dislocations and subluxations 1. Hip (1) Posterior United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 10 Trauma: 4 Musculoskeletal Trauma: 9 h. Examples Typical blood loss in an uncomplicated fracture during the first two hours 1. Patients with life/ limb-threatening injuries or conditions, including life/ limb-threatening musculoskeletal trauma 2. Patients with other life/ limb-threatening injuries and only simple musculoskeletal trauma 3. Patients with life/ limb-threatening musculoskeletal trauma and no other life/ limbthreatening injuries 4. Never allow a horrible looking, but noncritical musculoskeletal injury to distract you C. Crepitation United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 12 Trauma: 4 Musculoskeletal Trauma: 9 F. It makes most sense to move a long bone injury into a "splintable" straight position b. Wood United States Department of Transportation National Highway Traffic Safety Administration Paramedic: National Standard Curriculum 13 Trauma: 4 Musculoskeletal Trauma: 9 3. Typically dislocated joints should be immobilized in the position of injury and transported for reduction b. An attempt to reposition any dislocated joint into anatomical position should be made if distal circulation is impaired and if transportation is long or prolonged d. Check circulation and nerve function before and after any manipulation of any injured bone or joint. Discontinue an attempt at repositioning if (1) Pain is increased significantly by manipulation, and/ or (2) Resistance to movement is encountered 2.

Pad between affected digits and bandage affected tissues loosely with a soft treatment 4 syphilis discount brahmi 60caps without prescription, sterile dressing medications bad for liver buy discount brahmi 60 caps on-line. A frame around the frostbitten area can be constructed to prevent blankets from pressing directly on the injured area. Patients who clearly have only superficial frostbite can be treated as outpatients if they have no other medical problems such as hypothermia that require admission. All other patients with frostbite should be admitted to a hospital unit that has experience in caring for patients with frostbite. Inappropriate amputations are commonly performed by doctors inexperienced in caring for frostbite patients. Normally, a line of demarcation separates living tissue from mummified tissue that will not survive. However, the line of demarcation on the surface hides live tissue that usually extends well past the line of demarcation. Trench foot and immersion foot are identical injuries that are caused by prolonged exposure to cold wet conditions that do not cause actual freezing of tissue. Trench foot is caused by exposure to cold wet conditions on land and immersion foot is caused by exposure to cold water. These injuries are often associated with immobility and usually require days to develop fully. Early injury may develop in a few hours, however, especially with repeated exposures. Pernio is caused by exposure to cold with less moisture than the amount necessary to cause trench foot or immersion injury. An unusual form of pernio, equestrian pernio, may affect the lateral thighs of riders. Prevention of nonfreezing cold injury is best accomplished by the use of appropriate handwear and footwear, keeping feet and hands dry and avoiding constriction. Athletes who are susceptible to pernio may need to pay special attention to keeping hands and feet warm and dry. There is no pain or swelling unless attempts are made to rewarm the affected part. The second stage (prehyperemic) begins immediately after removal from cold exposure and usually lasts a few hours, although occasionally it can persist for several days. The extremities turn a mottled pale blue, but pigmented skin can obscure the color change. Long-range sequela may include chronic severe pain and decreased circulation with increased risk for further cold injury. Unlike frostbite, rewarming should not be rapid as the goal is to relieve discomfort rather than to thaw frozen tissue. If it is clear that the injury does not involve freezing, standard treatment is slow rewarming in air. Under no circumstances should nonfreezing cold injuries be exposed to snow or ice. Environmental conditions however, especially over the course of several days and in the face of endurance competitions, can alter mechanisms of heat dissipation during thermal stress and contribute to dehydration, electrolyte imbalance, and exertional heat-related illnesses. The primary consequence of dehydration and minor exertional heat illness is impaired exercise performance. This chapter addresses the prehospital emergency diagnosis and treatment of several potentially life-threatening conditions seen in the sporting environment, including the following: 1. Establish if the athlete has collapsed without any preceding or associated trauma. A lack of trauma prior to collapse suggests a medical etiology such as dehydration, heat illness, cardiac dysrhythmias, or hypoglycemia 3. Did the athlete appear to have difficulty with coordination, or were they confused prior to collapse If the patient has collapsed but is conscious, note if they are able to speak or seem confused or disoriented: 1. Obtain a focused history, asking if the patient recalls what happened and what symptoms preceded the event: 1. Was the patient feeling lightheaded, dizzy, short of breath, or experiencing any pain prior to collapse Does the patient have a headache, nausea, chills, tingling sensations, or muscle cramps

Yet until medical students finally spend hours with patients in the hospital while on clinical rotations medications routes cheap 60 caps brahmi with amex, they really have no idea what this experience is like treatment anemia buy 60 caps brahmi free shipping. Most love talking with patients, forming relationships with them, and examining them for signs of disease. Others, however, find that interacting with sick people is less appealing than they had imagined. They do not like performing physical examinations, for example, or dealing with gushes of body fluids or the smell of infected wounds. No matter what your colleagues might say, wanting a specialty with more (or less) patient contact has no bearing on how good a physician you will be. There is a place for everyone in medicine-even for those who decide to work behind the scenes. Radiologists and pathologists, who have basically no contact with patients, are equally as righteous doctors as internists, who interact with and examine patients in every single encounter. Every specialist or subspecialist has an important role in patient care; some just have more face time with patients than others. You should decide how much patient contact you want in your career and rule out specialties that may not meet your needs. If long-term relationships and continuity of care are important, consider areas like internal medicine and family practice. If you like getting down and dirty, think about careers in emergency medicine, obstetrics-gynecology, and surgery. In some specialties, like urology and orthopedic surgery, doctors only have to perform focused physicals (instead of examining everything). In fields like emergency medicine and anesthesiology, contact with the patient is typically short and to the point. Emergency medicine physicians, for instance, are always dealing with many angry patients with nonemergent complaints who have been kept waiting for hours on end. Pediatricians have to interact with demanding, concerned parents in addition to sick infants and children. Oncologists (medical, surgical, and radiation) have patients with mortal diseases that typically lead to poor outcomes despite aggressive treatment. Obstetricians manage a highly litigious group of patients who could slap them with a malpractice suit for any minor defect in their baby. Although these examples seem like stereotypes, the maxim that all doctors are not equal also holds true for their patients. Think about the areas of medicine in which you are the happiest and forget about how others (family, friends, and colleagues) might view your chosen specialty. Always remember that every type of doctor has an important role in the big picture of medicine, and the idea that one specialty garners more respect and prestige than another is really just a matter of personal opinion. Because all medical students have excelled academically their entire lives, those who subscribe to these beliefs find it hard at this point to stop being the best. For them, a career in family practice or psychiatry may not carry as much social status as being a worldrenowned neurosurgeon or earning a position in ophthalmology, an ultracompetitive specialty. After working long hours in the hospital or clinic, physicians end up taking calls in the middle of the night to deliver a baby, remove an appendix, or admit a patient. Compared to previous generations of physicians, the millennium medical student seeks a much better balance between life and work. They desire less night call, fewer hours spent in the hospital, and more control over their work schedules. Many are even willing to give up income and professional aspirations to have better personal lives and more free time. The current focus is now shifting to specialties with more controllable lifestyles and higher incomes relative to the length of training. What accounts for the higher priority of quality-of-life issues in a medical career

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References:

• http://www.globalhealth.org/wp-content/uploads/GlobalHealthBriefingBook_FINAL_web.pdf
• https://www.cartercenter.org/resources/pdfs/health/ephti/library/lecture_notes/nursing_students/LN_human_anat_final.pdf
• https://www.alabamapublichealth.gov/covid19/assets/cov-sah-youth-camps.pdf