Disseminated disease, 459 Disseminated gonococcal disease, 852 Disseminated intravascular coagulopathy (DIC), 420 , 500 , 997 Disseminated Neisseria gonorrhoeae, 645 Disorders of hemostasis acquired defects, 794 clinical indications for discharge/admission, 794 inherited bleeding disorders, 792 –793 management disseminated intravascular coagulopathy (DIC), 794 rare inherited coagulation factor deficiencies, 793 –794 Distal interphalangeal (DIP) joint, 1146 , 1343 Distal radius fractures, 1194 –1196 Distal upper extremity, neurologic examination of, 1186 t Distension, 87 See also Abdominal distention Distention abdominal, 87 –93 bowel, 87 , 91 f gastric, 87 , 89 Distraction fractures, 1210 –1211 Distributive shock, 73 , 75 foreign body related, 378 neuromuscular disorders and, 376 –378 pathophysiology, 376 postoperative, 378 treatment, 381 –382 , 382 f Drowning cardiovascular effects, 680 clinical manifestations, 681 definition, 680 hypoxemia and, 680 indications for discharge/admission, 682 initial assessment, 681 management, 681 –682 , 681 f pulmonary edema, 682 f triage considerations, 681 Dysphonia, 133