Then reduce A-P rotation through movement causing changes in pelvic volume and/or architecture. A split scoop type stretcher is ideal for lifting and transporting patients (Figure 16. Do not spring the pelvis – it adds little relevant clinical informa- Lee C, Porter K. Crush, burn and blast injury though representing a small • Understand the practical aspects of the management of proportion of overall injuries present their own challenges (see extremity trauma in the prehospital environment individual chapters for detail). Attention should be paid to the • Understand the indications for and principles of prehospital likely mechanism of injury as this may identify otherwise occult amputation. Aetiology Injury assessment Extremity trauma is common; alone and in combination with Ideally all extremity injuries would be identified and classified in the multisystem injury it represents a significant proportion of a prehospital arena; however, this is often impractical. Extremity trauma represents primary survey injuries, multisystem trauma and environmental challenges in terms of assessment, management, packaging and conditions may lead (appropriately) to the delayed identification transport: many of these challenges can be overcome through a of injuries. Extremity trauma may be both life and limb Injuries should be identified as open (compound) or closed – any threatening (Boxes 17. A rapid assessment prior to rapid sequence induction may identify nerve • Pelvic fractures injuries, which would otherwise be missed. Nerve blocks though purported to be useful are often impractical in the prehospital setting. Reducing periosteal stretch through early reduction of fractures further reduces patient pain. In the case of traumatic amputation and if circumstances allow, the amputated part should be transported with the patient. Reducing, splinting and packaging Long bone fractures and some joints are suitable for reduction prehospitally. Larger joints (shoulder and hip) are often best left for in-hospital reduction – the exception to this rule may be where packaging and transport are compromised by limb position (Figure 17. When an adequate level of analgesia with or without sedation has been achieved the limb should be brought into anatomical alignment: techniques for individual bones and joints vary and are beyond the scope of this chapter.
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As the gravid uterus enters the upper abdomen in the third Introduction trimester the lower ribs become splayed and relatively fixed, Caring for pregnant women can be daunting even for the most reducing the contribution of the intercostal muscles during forced experienced prehospital practitioner. There is also elevation of the diaphragm in late preg- ing of pregnancy related changes in anatomy and physiology and nancy due to pressure from the compressed abdominal contents a stepwise approach to care should enable prehospital teams to and as such it is recommended that thoracostomies are performed optimize outcomes for mothers and their babies. Anatomical and physiological changes Circulation in pregnancy The placental perfusion requirement increases with advancing ges- Airway tation and is reflected by a gradual increase in cardiac stroke Several anatomic changes occur during pregnancy that can impact volume and heart rate by 10–20 bpm. There is a pro- The engorgement and friability of the respiratory tract, mucosal gressive reduction in blood pressure in the first trimester, followed oedema and capillary engorgement of nasal and oropharyngeal by a steady increase in the third trimester to pre-pregnancy val- mucosa and laryngeal tissues increase the possibility of iatro- ues. Pregnancy-induced the pregnant patient at risk of postural hypotension during rapid weight gain and an increase in breast size may obstruct laryn- postural changes. During the late second and third trimester the gravid uterus Unmounted blade insertion or a short-handled ‘stubby’ laryngo- compresses the inferior vena cava in the supine position (aorto- scope handle are useful alternatives. The bowels and omentum are displaced which can Supine Lateral make the diagnosis of appendicitis or disseminated infection, more Vena difficult. In advanced pregnancy assessment should be performed in the left lateral position to eliminateaortocavalcompression. Themanagementofcatastrophic obstetric haemorrhage involves immediate transfer to hospital with circulation management en route. In the shocked pregnant patient the uterus should be considered as a fifth source of concealed Figure 28. An assessment of the fundus and fetus forms the final part of the primary survey in the pregnant patient. Make a In the event of blood loss the maternal circulation is maintained brief assessment of the fundal height, noting any significant uterine by diverting blood away from the uterus with only minimal change tenderness. A fundal height below the umbilicus suggests that if the to the patient vital signs. The pregnant patient may tolerate a loss fetus is delivered it is unlikely to survive.
Sancho, 41 years: Karma yoga: a means to attain enlightenment • Epilepsy (Ramaratnam & Sridharan 2000) through everyday social activities • Headache (Latha & Kaliappan 1992) 3. Study identification The report should include the full name of the patient, medical record number, and date of birth. They are thought to be psychoactive, although their clinical effects require clarification.
Campa, 56 years: The rate of correction should not be more than 1mEq/L/hour, and not more than half the water deficit should be given within 24 hours. A potentially dangerous scenario is where a diabetic ends up in an Emergency Department with hypoglycaemia but is mistaken for a fighting drunk. Preparations containing valepotriates 45 are effective in the treatment of daytime mental and motor agitation and lack 46 of concentration; they have a calming effect when taken prior to stress situa- 47 tions.
Ines, 54 years: She has a long leg brace but she didn’t want to wear it so In physical examination, there was tingling sense on right hand. Chung1 arthritis was induced in adult male Sprague-Dawley (250–300 g) 1Seoul National University Hospital, Rehabilitation Medicine, via intraarticular injection of complete Freund’s adjuvant into the Seoul, Republic of Korea tibiotarsal joint. Chapter 6 • Assessment/Palpation Section: Skills 165 example, adding dorsiflexion during the straight leg Box 6.
Mojok, 45 years: This destroys the cytosketelon, causing the membrane to form blebs, irregular bulges in the plasma membrane of a cell caused by localised decoupling of the cytoskeleton from the plasma membrane, ultimately leading to degradation and usually death of the cell. Churchill Livingstone, London Simons D, Mense S 1997 Understanding and measurement of muscle tone as related to clinical Ward R (ed) 1997 Foundations of osteopathic medicine. Specific disorders are charac- This was the time of the energy crisis, and newly terized by well-defined signs, symptoms, and constructed or remodeled buildings were being laboratory findings.
Ernesto, 65 years: Nystagmus associated with pe- ripheral disorders is generally horizontal or rotatory and does not change direc- tions, but is more pronounced when the patient looks in the direction of the fast component (away from the involved side). J Neurol Neurosurg transient ischaemic attack in high-risk patients Psychiatry 2006; 77(7):826–9. Tips from the field • Routine use of a bougie for endotracheal intubation will mitigate C-spine manipulation • Exclude other causes of shock before attributing hypotension to neurogenic shock • Pregnant women secured to a long back board should be elevated on theirright side by tilting the board 15–20 degrees and placing pillows or blankets beneath Figure 14.
Thorek, 59 years: The bend pattern is an important movement skill and If, during the squat, the load is between the legs brings with it much controversy. Cell damage causes neurotransmitter loss, the most consistent damage being to cholinergic neurones connecting sub-cortical nuclei to cerebral cortex. Some guidelines for prescribing drugs in the elderly Take a careful drug history and check for use of over-the-counter drugs Be familiar with the effects of age on the pharmacology of drugs Strive to make a diagnosis before instituting therapy Use smaller starting doses Adjust the dose according to response Review the drug treatment plan regularly and keeping it simple Be alert to the possibility of iatrogenic illness Beware interactions between disease states and drugs.
Ilja, 51 years: Decline in memory, judgement and general slowing of thought processing can pose potential risks to the patient e. The group had seven voluntary committee members, and in its first weeks of existence it began a furious media blitz, getting stories on as many programmes and in as many newspapers as possible. Localised lesions of the hemispheres, such as infarcts, haemorrhages or tumours result in focal neurological deficits, and for coma to occur, the damage has to be extensive.