...contamination requiring washout and repair of a hollow viscus? Penetrating injuries with any hemodynamic instability and/or signs of intraperitoneal injury are treated operatively at the outset of management -GSWs most often injure the small bowel followed by the colon and liver Clinical thinking Does the patient have an adequate airway, and ability to protect it? Is the patient breathing? Is oxygenation and ventilation adequate? A GSW in the abdomen may penetrate the diaphragm and cause a significant thoracic injury -Does that patient have adequate blood volume and perfusion? How does the patient respond to resuscitation, does the pt take beta blockers that may mask an appropriate tachycardia? -evaluate the pts ability to follow commands and respond appropriately. Is neurological disability a central phenomenon from shock, or is there a direct spinal cord injury? The patient must always be adequately exposed to evaluate all injuries, don’t over look the axial, back, gluteal cleft, and perineum. Patients with penetrating abdominal injuries are best served by antibiotic therapy prior to operative intervention. Initial therapy should be broad, with coverage of both gram-positive and gram negative organisms. Current practice guidelines advise broad spectrum antibiotics prior to incision and throughout operation -tentanus toxoid upon admission The care of the trauma patient does not end with intraoperative repair of injuries. The hypothermic, coagulopathic laparotomy patient is prone...
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...large incision made into the abdomen. Exploratory laparotomy is used to visualize and examine the structures inside of the abdominal cavity. Exploratory laparotomy is a method of abdominal exploration, a diagnostic tool that allows physicians to examine the abdominal organs. The procedure may be recommended for a patient who has abdominal pain of unknown origin or who has sustained an injury to the abdomen. Injuries may occur as a result of blunt trauma (e.g., road traffic accident) or penetrating trauma (e.g., stab or gunshot wound). Because of the nature of the abdominal organs, there is a high risk of infection if organs rupture or are perforated. In addition, bleeding into the abdominal cavity is considered a medical emergency. Exploratory laparotomy is used to determine the source of pain or the extent of injury and perform repairs if needed. Laparotomy may be performed to determine the cause of a patient's symptoms or to establish the extent of a disease. For example, endometriosis is a disorder in which cells from the inner lining of the uterus grow elsewhere in the body, most commonly on the pelvic and abdominal organs. Endometrial growths, however, are difficult to visualize using standard imaging techniques such as x ray, ultrasound technology, or computed tomography (CT) scanning. Exploratory laparotomy may be used to examine the abdominal and pelvic organs (such as the ovaries, fallopian tubes, bladder, and rectum) for evidence of endometriosis. Any growths found...
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...in TAA at 8:22am, intubated and bagged, without pulses, with CPR in progress. What do you want to do??? Reassess ABC’s first and LOOK at the patient!!! Physical Examination reveals a 1-2 cm circular entrance wound midline just below nipple line with profuse bleeding. What do you want to do??? Management Continued Exclude Correctible Causes of PEA Severe Hypovolemia Cardiac Tamponade Tension Pneumothorax Rupture of the Ventricular Wall What do you want to do??? Emergent Thoracotomy - Indications A qualified surgeon must be present at the time of the patient’s arrival to determine the need and potential for success of an Emergency Department resuscitative thoracotomy. Patients with PENETRATING thoracic injuries who arrive pulseless, but with myocardial electrical activity, may be candidates for immediate...
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...of occupational injuries. The aim of the research is to develop occupational injuries measures to prevent accidents at the plant. You must systematically analyze and summarize their reasons. Analysis of the causes of injury allows them to share the organizational, technical, physiological and sanitary. Organizational: violation of legislation on health and safety , requirements , guidelines , rules and regulations , lack of or poor briefing , failure measures for safety, untimely repair or replacement of faulty and outdated equipment. Specifications: non-compliance of safety or fault of production equipment, tools and protective, equipment design flaws. Psychophysiological: erroneous actions of the employee as a result of fatigue, excessive severity and intensity of work, monotony of work, disease state negligence. Sanitation: excessive levels of noise, vibration, adverse weather conditions, the high content in the air of the working area of hazardous substances, the presence of different radiation above the allowable values, insufficient or inefficient lighting violation of the rules of personal hygiene. Research Methods occupational injuries: The statistical method is based on the analysis of statistical data on injuries that accumulated in the company or in the industry for several years. Data from this analysis are contained in the acts of the form N-1 and the records of companies. The statistical method allows all accidents and causes of injuries grouped by gender...
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...Paramedic Case Studies Name Institution Table of Contents Introduction 3 1.1 Clinical plans are prior to arrival on the scene. 4 1.2 Patient selection Criteria for RSI 5 1.3 Steps in an RSI Procedure 6 Step 1 - Preparation 6 Step 2- Preoxygenation 6 Step 3- Pretreatment 7 Step 4- Rapid sequence Induction and Paralysis 7 Step 5- Protection and Positioning 7 Step 6- Placement of the Endotracheal Tube in the Trachea 8 Step 7- Post-intubation Management 8 1.4 Risks and benefits associated with RSI 9 Case 2 10 2.1 Discussion 10 2.2 Clinic plan and initial management 10 2.3 Notification of Arrival 11 Conclusion 11 Case 3 12 Introduction 12 Incident 1 12 Incident 2 13 Incident 3 13 Incident 4 14 Case 4 15 Conclusion 16 References 17 Introduction The basic concept of retrieval medicine is a combination of transfer and care of a patient from one medical institution, site of trauma, and pre-hospital management to a medical institution to provide higher and better level of care. The transfer and retrieval of severely ill and wounded patients entail high-risk activities (Ellis & Hooper, 2010). This paper looks into various case studies to determine the various control measures that might and should be put in place in various retrieval situations so as to increase patient safety and efficiency in pre-hospital care. This comprises of communication procedures, team resource management...
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...present a possible risk for infection Personal Protective Equipment (PPE) - Latex or vinyl gloves, Eye protection, Mask, Gown * Reduces your personal risk for injury or illness SCENE SAFETY Information provided by dispatch may help in determining potential hazards Potential Hazards - Oncoming traffic, Unstable surfaces, Leaking gasoline, Downed electrical lines, Potential for violence, Fire or smoke, Hazardous materials, Other dangers at crash or rescue scenes, Crime scenes Scene Safety 1. Park in a safe area - allows rapid access to your patient and your equipment (infront of the scene) 2. Speak with law enforcement first - ask to accompany you if the victim is a suspect in a crime 3. Do not enter until a professional rescuer has made the scene safe - Carefully evaluate scene & request specific help to manage the scene threats Professional Rescuer: law enforcement, firefighters, utility workers, hazardous materials crew * Remember that hazards do not need to be dramatic situations but could be as simple as a hole in the ground CONSIDER MOI/NOI MECHANISM OF INJURY - how a traumatic injuries occur With traumatic injury, the body has been exposed to some force or energy that has resulted in a temporary injury, permanent damage or even death - helps determine the possible extent of injuries on trauma patients Evaluate: * Amount of force applied to body *...
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...ectopic pregnancies occur in a fallopian tube; hence the term "tubal" pregnancy. Rarely, the egg may implant elsewhere, such as in the abdomen, ovary, or cervix. Presenting complaint: Miss Mao who is 25 years old, complains of a "sharp and stabbing abdominal pain" accompanied by dizziness and eventual loss of consciousness/syncope. She also has been experiencing bleeding. History of presenting complaint/Illness: * She suddenly experienced a sharp right pain localized to the right iliac area, intensity described as 10/10, with radiation to the tip of the right shoulder. * There was accompanying nausea, dizziness and eventual fainting/loss of consciousness. * Most commonly presents 6–8 weeks after last menstrual period. * Classic triad: Pregnant, bleeding or spotting, pelvic pain. * Rupture causes sudden increase in pain, dizziness, and anemia leading to shock and cardiovascular collapse. * Some degree of intermittent abdominal pain in the past 2 weeks, which had initially been dull, but intensity has become much sharper and episodic. * She described this current episode as the sharpest and most painful. * This is first time syncope is associated with the lower abdominal pain. * Pain is worse with movement, and no alleviating factors are reported. Physical Examination: * Well-developed secondary sexual characteristics. * She was met lying on hospital bed, dressed in hospital examining gown, in pain...
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...factors, clinical manifestations, and management of thoracic and abdominal aneurysms, venous insufficiency, venous stasis ulcers, PAD, acute arterial ischemia. (be sure to know the difference in venous and arterial disease!) PAD (thickening of the artery walls, which results in the progressive narrowing of the arteries of the upper and lower extremities) -risk factors: tobacco use (most important), hyperlipidemia, elevated high sensitivity C-reactive protein, diabetes (occurs much earlier), uncontrolled hypertension, increases with age, African Americans, 2 times higher in Mexican/Hispanic American women then white women -PAD is a marker for advanced systemic artherosclerosis** -atherosclerosis is the leading cause** -these patients are more likely to suffer from CAD and cerebral artery disease -artherosclerosis= migration and replication of smooth muscle cell, deposition of connective tissue, lymphocyte and macrophage infiltration, and accumulation of lipids -clinical symptoms occur when the vessel is 60 to 70 percent occluded Thoracic and Abdominal aortic aneurysms -aneuryisms happen more in men than women, increases with age - most occur as abdominal aortic aneurisms -thoracic= often asymptomatic, chest pain extending into interscapular area (most common symptom), hoarseness, dysphagia -abdominal= often asymptomatic, abdominal pain, back pain, pulsatile mass pre-umbilical and slightly to the left -abdominals a. are caused by artherosclerosis (male gender, over 65, high...
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...wall of a high pressure artery. The areas within the aorta that an aneurysm is known to occur is the aortic root, aortic arch and the ascending and descending aorta. An aneurysm can occur in anyone of these sections and can grow large enough to rupture which causes severe bleeding inside the chest cavity (Thoracic Aortic Aneurysm, 2012). Anytime you have a blood vessel with a weakened area that begins to bulge, it has the possibility of rupturing. A majority of aneurysms occur in the aorta, the largest artery in the body which carries oxygen-rich blood away from the heart to all parts of the body. The aorta comes out from the left ventricle of the heart and travels through the chest (thoracic) down into the abdomen where it is termed abdominal aorta (Thoracic Aortic Aneurysm, 2012). The Thoracic Aortic Aneurysm (TAA) accounts for one in four aortic aneurysms. With the aneurysm being in the aorta there is a greater risk of death due to massive internal bleeding. “Sixty percent of thoracic aortic...
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...GI and Diabetes Exam Study Guide Tube Feeding – (enteral nutrition) refers to the administration of a nutritional balanced liquefied food or formula through a tube inserted into the stomach, duodenum, jejunum. It is used to provide nutrients via the GI tract either alone or as a supplement to oral or parenteral nutrition. - Nasogastric (NG) Tube – is most commonly used for short-term feeding problems. Other means of feeding are; esophagostomy, gastrostomy or jejunostomy. Transpyloric tube placement or placement into the jejunum is used when physiologic condition warrant feeding the pt below the pyloric sphincter. Special Indications – anorexia, orofacial fractures, head and neck cancer, neurologic or psychiatric conditions that prevent oral intake, extensive burns and those who are receiving chemotherapy or radiation therapy. Procedure for tube feeding 1. Patient position – 30-45 degrees position. Head remain elevated for 30-60 mins 2. Patency of tube – Tube should be irrigated with water before and after each feeing to ensure patency. 3. Tube Position – Placement of tube is checked before each feeing or every 8 hours with continuous feeings. Checking methods; aspiration and pH. 4. Formula 5. Administration of feeding – feeing are given either by gravity drip method or by feeding pump. 6. General Nursing Considerations – daily weight, accurate I’s and O’s. Blood glucose check. Complication Related To tube and feeding - Vomiting and or Aspiration -...
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...First Aid/CPR/AED PARTICIPANT’S MANUAL American Red Cross First Aid/CPR/AED PARTICIPANT’S MANUAL This participant’s manual is part of the American Red Cross First Aid/CPR/AED program. By itself, it does not constitute complete and comprehensive training. Visit redcross.org to learn more about this program. The emergency care procedures outlined in this book reflect the standard of knowledge and accepted emergency practices in the United States at the time this book was published. It is the reader’s responsibility to stay informed of changes in emergency care procedures. PLEASE READ THE FOLLOWING TERMS AND CONDITIONS BEFORE AGREEING TO ACCESS AND DOWNLOAD THE AMERICAN RED CROSS MATERIALS. BY DOWNLOADING THE MATERIALS, YOU HEREBY AGREE TO BE BOUND BY THE TERMS AND CONDITIONS. The downloadable electronic materials, including all content, graphics, images and logos, are copyrighted by and the exclusive property of The American National Red Cross (“Red Cross”). Unless otherwise indicated in writing by the Red Cross, the Red Cross grants you (“recipient”) the limited right to download, print, photocopy and use the electronic materials, subject to the following restrictions: ■ The recipient is prohibited from selling electronic versions of the materials. ■ The recipient is prohibited from revising, altering, adapting or modifying the materials. ■ The recipient is prohibited from creating any derivative works incorporating, in part or in whole, the content of the materials...
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...Acquisitions Editor: Crystal Taylor Product Managers: Kelley A. Squazzo & Catherine A. Noonan Designer: Doug Smock Compositor: SPi Technologies First Edition © 2011 Lippincott Williams & Wilkins, a Wolters Kluwer business. 351 West Camden Street Baltimore, MD 21201 Printed in China All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the abovementioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market street, Philadelphia, PA 19103 USA, via email at permissions@lww.com, or via website at lww.com (products and services). Library of Congress Cataloging-in-Publication Data Lambert, Harold Wayne, 1972– Lippincott’s illustrated Q&A review of anatomy and embryology / H. Wayne Lambert, Lawrence E. Wineski ; with special contributions from Jeffery P. Hogg, Pat Abramson, Bruce Palmer. — 1st ed. p. ; cm. Includes index. ISBN 978-1-60547-315-4 1. Human anatomy—Examinations, questions, etc. I. Wineski, Lawrence E. II. Title. [DNLM: 1. Anatomy—Examination Questions...
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...VELEZ COLLEGE F. Ramos St., Cebu City College of Nursing A CASE ANALYSIS REPORT ON PATIENT N.M.C., 47 YEARS OLD, FEMALE, DIAGNOSED WITH UTERINE LEIOMYOMA (s/p TOTAL ABDOMINAL HYSTERECTOMY and BILATERAL SALPINGO OOPHORECTOMY), BILATERAL OVARIAN NEWGROWTHS, METABOLIC SYNDROME, AND HYPERTENSION Submitted By: Villavelez, Carmina Anne Z. BSN III-C Submitted to: Mrs. Miraluna Echavez, RN, MN March 2013 UTERINE LEIOMYOMA/ UTERINE FIBROIDS Uterine fibroids are noncancerous growths of the uterus that often appear during your childbearing years. Also called fibromyomas, leiomyomas or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer. As many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound. In general, uterine fibroids seldom require treatment. Medical therapy and surgical procedures can shrink or remove fibroids if you have discomfort or troublesome symptoms. Rarely, fibroids can require emergency treatment if they cause sudden, sharp pelvic pain or profuse menstrual bleeding. Symptoms In women who have symptoms, the most common symptoms of uterine fibroids include: * Heavy menstrual bleeding * Prolonged menstrual periods — seven days or more of menstrual bleeding * Pelvic pressure or pain *...
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...*MEDCOM Pam 40-7-21 SUMMARY OF CHANGE MEDCOM Pamphlet 40-7-21 Algorithm-Directed Troop Medical Care This major revision-. Updates references (paragraph 3). . Expands the MTF commander’s responsibilities (paragraph 6). . Provides additional background information (paragraph 7). . Provides a new paragraph on the use of ADTMC (paragraph 8). . Revises guidance relevant to the assignment of screeners (paragraph 9). . Simplifies training requirements (paragraph 10). . Refines supervisory requirements (paragraph 11). . Significantly revises the screeners’ performance evaluation requirements (paragraph 13). . Allows the use of other approved algorithmic systems besides the ADTMC (paragraph 18). . Deletes the use of MEDCOM Form 425-R (Internal/External Audit Form for ADTMC). . Provides changes to the narratives that accompany the following algorithms: SORE THROAT, A-1 EAR PAIN/DISCOMFORT/DRAINAGE, A-2 SINUS PROBLEMS/PAIN, A-4 RINGING IN THE EARS (TINNITUS), A-8 EXTREMITY PAIN NOT ASSOCIATED WITH A JOINT, B-3 NAUSEA/VOMITING/DIARRHEA, C-1 RECTAL PAIN/ITCHING/BLEEDING, C-3 CONSTIPATION, C-4 CHEST PAIN, D-2 DIZZINESS/FAINTNESS/BLACKOUT, F- 1 NUMBNESS/TINGLING, F-3 PARALYSIS/WEAKNESS, F-4 FATIGUE, G-1 MEDCOM Pam 40-7-21 FEVER/CHILLS, G-2 ACNE, J-2 SHAVING PROBLEM--PSEUDOFOLLICULITIS BARBAE (PFB) (INGROWN HAIRS), J-3 DANDRUFF (SCALING OF THE SCALP), J-4 HAIR LOSS, J-5 ATHLETE’S FOOT (TINEA PEDIS), J-6 JOCK ITCH (TINEA CRURIS), J-7 SCALING, DEPIGMENTED...
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...*MEDCOM Pam 40-7-21 SUMMARY OF CHANGE MEDCOM Pamphlet 40-7-21 Algorithm-Directed Troop Medical Care This major revision-. Updates references (paragraph 3). . Expands the MTF commander’s responsibilities (paragraph 6). . Provides additional background information (paragraph 7). . Provides a new paragraph on the use of ADTMC (paragraph 8). . Revises guidance relevant to the assignment of screeners (paragraph 9). . Simplifies training requirements (paragraph 10). . Refines supervisory requirements (paragraph 11). . Significantly revises the screeners’ performance evaluation requirements (paragraph 13). . Allows the use of other approved algorithmic systems besides the ADTMC (paragraph 18). . Deletes the use of MEDCOM Form 425-R (Internal/External Audit Form for ADTMC). . Provides changes to the narratives that accompany the following algorithms: SORE THROAT, A-1 EAR PAIN/DISCOMFORT/DRAINAGE, A-2 SINUS PROBLEMS/PAIN, A-4 RINGING IN THE EARS (TINNITUS), A-8 EXTREMITY PAIN NOT ASSOCIATED WITH A JOINT, B-3 NAUSEA/VOMITING/DIARRHEA, C-1 RECTAL PAIN/ITCHING/BLEEDING, C-3 CONSTIPATION, C-4 CHEST PAIN, D-2 DIZZINESS/FAINTNESS/BLACKOUT, F- 1 NUMBNESS/TINGLING, F-3 PARALYSIS/WEAKNESS, F-4 FATIGUE, G-1 MEDCOM Pam 40-7-21 FEVER/CHILLS, G-2 ACNE, J-2 SHAVING PROBLEM--PSEUDOFOLLICULITIS BARBAE (PFB) (INGROWN HAIRS), J-3 DANDRUFF (SCALING OF THE SCALP), J-4 HAIR LOSS, J-5 ATHLETE’S FOOT (TINEA PEDIS), J-6 JOCK ITCH (TINEA CRURIS), J-7 SCALING, DEPIGMENTED SPOTS ON THE CHEST, BACK, AND UPPER...
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