critical care for ballistic trauma in austere environments

... VII  Critical Care 38 Critical Care for Ballistic Trauma in Austere Environments 585 Christian B Swift and Geoffrey S.F Ling 39 Transfer and Evacuation 597 Robert D Tipping and ... driver for this new 3rd edition of Ballistic Trauma One of the most worrying problems is the changing nature of surgical training In 1982, when this author deployed to war, surgical training was ... discarded training programme Three years of general professional training, followed by six years of higher training had resulted in exposure to the generality of surgery It included postings to nine separate...

Ngày tải lên: 29/06/2014, 09:20

... pre-existing retinal holes, the increase in retinal detachment following cataract extraction is substantial.104 Prevalence and Incidence The incidence of phakic nontraumatic retinal detachment in the ... retina and X-linked juvenile retinoschisis) are well known in the development of retinal dialyses There are no other known risk factors for developing a retinal dialysis other than involvement in ... fluorescein dye is injected intravenously into the vascular circulation and observed as it transits the retina and choroid Pneumatic retinopexy The injection of air or expanding gases into the eye in...

Ngày tải lên: 22/03/2014, 09:20

... (Table 2) Yearly incidence of intensive care unit admissions for P jiroveci pneumonia in HIV-negative and HIV-positive patients The yearly incidence of ICU admissions for PCP in HIV-negative and ... associated with an increased mortality during PCP compared with HIV-positive status [3,5,6,17-19], maintained this grim prognostic value for the critical forms of the disease This difference in mortality ... often failed in HIV-negative patients and should be cautiously monitored in this population Key messages • • The incidence of Pneumocystis pneumonia requiring critical care increased in patients...

Ngày tải lên: 13/08/2014, 10:20

Ngày tải lên: 13/08/2014, 16:20

... disabilities, including the administration of injections and the monitoring of adverse drug interactions, be considered long-term care or ongoing medical care? Hospitals still provide long-term care for ... remain in, traditional long-term care settings, including their own homes Services and housing are both essential to the development of long-term care policy and systems CARE SETTINGS Long-term care ... family members living in nursing homes Still others engage in long-distance caregiving, arranging for the care of a parent or other relative who lives far away The importance of an informal support...

Ngày tải lên: 28/03/2014, 17:20

... differential diagnosis (Table 52-4) For instance, the finding of scaling papules (present in patients with psoriasis or atopic dermatitis) places the patient in a different diagnostic category ... of skin or systemic disease For instance, the sometimes minor differences in color and shape that distinguish a melanoma (Fig 52-1) from a benign nevomelanocytic ... different from the surrounding skin This differs from a macule only in size Papule: A small, solid lesion,

Ngày tải lên: 06/07/2014, 20:20

... with intact epidermis (i.e., loss of dermal or subcutaneous tissue) or as sites of shiny, delicate, wrinkled lesions (i.e., epidermal atrophy) Scar: A change in the skin secondary to trauma or inflammation ... Poikiloderma: Skin that displays variegated pigmentation, atrophy, and telangiectases Polycyclic: A configuration of skin lesions formed from coalescing rings or incomplete rings Pruritus: A ... in lichen planus Milia: Small, firm, white papules filled with keratin Morbilliform: Generalized, small erythematous macules and/or papules that resemble lesions seen in measles Nummular: Coin-shaped...

Ngày tải lên: 06/07/2014, 20:20

... ideal skin examination includes evaluation of the skin, hair, and nails as well as the mucous membranes of the mouth, eyes, nose, nasopharynx, and anogenital region In the initial examination ... are seen in this patient with cutaneous small vessel vasculitis (Courtesy of Robert Swerlick, MD; with permission.)[newpage] APPROACH TO THE PATIENT: SKIN DISORDER In examining the skin it is ... advisable to assess the patient before taking an extensive history This way, the entire cutaneous surface is sure to be evaluated, and objective findings can be integrated with relevant historic...

Ngày tải lên: 06/07/2014, 20:20

... lesions Figure 52-7 Psoriasis This papulosquamous skin disease is characterized by small and large erythematous papules and plaques with overlying adherent silvery scale Figure 52-8 ...

Ngày tải lên: 06/07/2014, 20:20

... 52-10) or primary irritant dermatitis In contrast, lesions with a generalized arrangement are common and suggest a systemic etiology Figure 52-9 Erythema multiforme This eruption is characterized ... morphology It usually represents a hypersensitivity reaction to drugs (e.g., sulfonylamides) or infections (e.g., HSV) (Courtesy of the Yale Resident's Slide Collection; with permission.) Figure...

Ngày tải lên: 06/07/2014, 20:20

... Many skin diseases can be diagnosed on gross clinical appearance, but sometimes relatively simple diagnostic procedures can yield valuable information In most instances, they can be performed ... with a minimum of equipment Skin Biopsy A skin biopsy is a straightforward minor surgical procedure; however, it is important to biopsy a lesion that is most likely to yield diagnostic findings ... expertise in skin diseases and knowledge of superficial anatomic structures in selected areas of the body In this procedure, a small area of skin is anesthetized with 1% lidocaine with or without epinephrine...

Ngày tải lên: 06/07/2014, 20:20

... certain skin disorders For example, a Wood's lamp will cause erythrasma (a superficial, intertriginous infection caused by Corynebacterium minutissimum) to show a characteristic coral pink color, ... the patient's back under occlusive dressings and allowed to remain in contact with the skin for 48 h The dressings are removed, and the area is examined for evidence of delayed hypersensitivity ... caused by necrotizing vasculitis (Fig 52-4) will not Diascopy is performed by pressing a microscope slide or magnifying lens against a lesion and noting the amount of blanching that occurs Granulomas...

Ngày tải lên: 06/07/2014, 20:20

... age 39, in 72 men and in 51 women will develop cancer; for the interval between ages 40 and 59, in 12 men and in 11 women will develop cancer; and for the interval between ages 60 and 79, in men ... deaths by site for men and women are shown in Table 77-1 Cancer incidence has been declining by about 2% each year since 1992 Table 77-1 Distribution of Cancer Incidence and Deaths for 2007 Male ... period of increases, cancer deaths began to decline in 1997 (Fig 77-2) The five leading causes of cancer deaths are shown for various populations in Table 77-2 Along with the decrease in incidence...

Ngày tải lên: 07/07/2014, 01:20

... pollution, indoor smoke from household fuels, and contaminated injections Figure 77-3 Patient Management Important information is obtained from every portion of the routine history and physical examination ... on invasive tissue biopsy and should never be made without obtaining tissue; no noninvasive diagnostic test is sufficient to define a disease process as cancer Although in rare clinical settings ... common in less developed countries Stomach cancer incidence is similar in more and less developed countries but is much more common in Asia than North America or Africa The most common cancers in...

Ngày tải lên: 07/07/2014, 01:20

... examination, radiographs, isotopic scans, CT scans, and other imaging procedures; pathologic staging takes into account information obtained during a surgical procedure, which might include intraoperative ... lower growth fractions Information obtained from studying the tumor itself will increasingly be used to influence treatment decisions Host genes involved in drug metabolism can influence the safety ... adjacent to the tumor, and inspection and biopsy of organs commonly involved in disease spread Pathologic staging includes histologic examination of all tissues removed during the surgical procedure...

Ngày tải lên: 07/07/2014, 01:20

... http://www.cancer.gov/cancertopics/pdq Information can be obtained through a facsimile machine using CancerFax by dialing 301-402-5874 Patient information is also provided by the National Cancer Institute in at least three formats: ... patient's hand, continuing regular examinations, and taking time to talk 2 The National Cancer Institute maintains a database called PDQ (Physician Data Query) that is accessible on the Internet under ... only palliative care Resist these forces In addition to the medicines administered to alleviate symptoms (see below), it is important to remember the comfort that is provided by holding the patient's...

Ngày tải lên: 07/07/2014, 01:20

... gonadotropin Gestational trophoblastic Pregnancy disease, gonadal germ cell tumor Calcitonin Medullary cancer of the thyroid Catecholamines Pheochromocytoma Oncofetal Antigens Alphafetoprotein Hepatocellular ... Hepatocellular carcinoma, gonadal germ Cirrhosis, cell tumor Carcinoembryonic antigen Adenocarcinomas hepatitis Pancreatitis, of the colon, pancreas, hepatitis, lung, breast, ovary inflammatory bowel ... Lymphoma, Ewing's sarcoma Hepatitis, hemolytic many others Tumor-Associated Proteins anemia, Prostate-specific Prostate cancer Prostatitis, antigen prostatic hypertrophy Monoclonal Myeloma Infection,...

Ngày tải lên: 07/07/2014, 01:20

... doing The appearance of unexpected toxicity may be an indication that a supplemental therapy is being taken.3 Information about unsound methods may be obtained from the National Council Against ... disease-free by the original treatment, the patient is followed regularly for disease recurrence The optimal guidelines for follow-up care are not known For many years, a routine practice has been ... and physical examination are the major investigations performed As time passes, the likelihood of recurrence of the primary cancer diminishes For many types of cancer, survival for years without...

Ngày tải lên: 07/07/2014, 01:20

... prochlorperazine For highly emetogenic agents such as cisplatin, mechlorethamine, dacarbazine, and streptozocin, combinations of agents work best and administration should begin 6–24 h before treatment ... responsible for coordinating the secretory and muscle contraction activity that leads to emesis Diverse receptor types participate in the process, including dopamine, serotonin, histamine, opioid, ... form Stimuli that activate signals in the chemoreceptor trigger zone in the medulla, the cerebral cortex, and peripherally in the intestinal tract lead to stimulation of the vomiting center in...

Ngày tải lên: 07/07/2014, 01:20