managing ballistic injury in the ngo environment

... clear guidance on managing ballistic injury, especially as more and more military reservists are being deployed and their day to day work may not include managing these types of injury Authors have ... were in the final year of a training program lasting at least 10 years A further extract from the paper quoted earlier is illuminating In 1982 the author was a 37 year old Senior Specialist in ... on the stretcher There was nothing else that could be done to reduce the bleeding further When the suction was plugged in things improved again- this gave us another issue The HLS was outside the...

Ngày tải lên: 29/06/2014, 09:20

... can initiate retinal detachment surrounding the tear by pulling on the surface of the adjacent retina The break in the retina may also allow fluid from the vitreous cavity to percolate into the ... is the result of the rupture of a retinal vessel during the tearing process The proximity of a retinal vessel that bridges the break (from the flap to the surrounding retina) may enhance the ... 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...

Ngày tải lên: 22/03/2014, 09:20

... more severe in HIV-negative subjects Even though we could not assess whether baseline differences in age and chronic lung condition influenced this finding, it suggested that the lung injury was ... Conclusion The incidence of PCP in HIV-negative patients in our unit increased from 1993 to 2006 The course of the disease and the outcome were worse in HIV-negative patients than in HIVpositive ... contributed to the collection, analysis, and interpretation of data and to the drafting of the manuscript OH contributed to the collection of data AD, CG, CM, and PB were involved in drafting the manuscript...

Ngày tải lên: 13/08/2014, 10:20

Ngày tải lên: 13/08/2014, 16:20

... ACKNOWLEDGMENTS The following persons participated in meetings and/or reviewed this report in draft They are listed in the positions they held at the time of their participation Kevin Anderson, Administrator, ... homebound and is not getting the services that would facilitate some independence In theory, a home-like atmosphere can be created in any environment, including the nursing home Furthermore, “appropriateness” ... integrating services in various ways There is no consensus on the definition of “integration.” Some people insist funding as well as delivery must be integrated Others argue that the goal of integration...

Ngày tải lên: 28/03/2014, 17:20

... of erythema and scaling, he or she may incorrectly assume that the erosion is the primary lesion and the redness and scale are secondary, while the correct interpretation would be that the patient ... color 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

... a portion of the underlying dermis Excoriation: Linear, angular erosions that may be covered by crust and are caused by scratching Atrophy: An acquired loss of substance In the skin, this may ... 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...

Ngày tải lên: 06/07/2014, 20:20

... of the lesions An 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 ... a skin lesion must be noted and considered during a physical examination: the distribution of the eruption, the types of primary and secondary lesions, the shape of individual lesions, and the ... examining the skin it is usually 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...

Ngày tải lên: 06/07/2014, 20:20

... A–D The distribution of some common dermatologic diseases and lesions Figure 52-7 Psoriasis This papulosquamous skin disease is characterized by small and large erythematous papules ... 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

... dermatitis In contrast, lesions with a generalized arrangement are common and suggest a systemic etiology Figure 52-9 Erythema multiforme This eruption is characterized by multiple erythematous ... 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 52-10 ...

Ngày tải lên: 06/07/2014, 20:20

... lidocaine with or without epinephrine The skin lesion in question can be excised or saucerized with a scalpel or removed by punch biopsy In the latter technique, a punch is pressed against the ... diagnostic findings This decision may require 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 ... elements Brief heating of the slide accelerates dissolution of keratin When the preparation is viewed under the microscope, the refractile hyphae will be seen more easily when the light intensity is...

Ngày tải lên: 06/07/2014, 20:20

... allergens is applied to 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 ... can be used to aid the evaluation of certain skin disorders For example, a Wood's lamp will cause erythrasma (a superficial, intertriginous infection caused by Corynebacterium minutissimum) to show ... 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

... incidence increases as the third, fourth, or fifth power of age in different sites For the interval between birth and age 39, in 72 men and in 51 women will develop cancer; for the interval between ... time during their lives; women have a 37% lifetime risk Cancer is the second leading cause of death behind heart disease Deaths from heart disease have declined 45% in the United States since 1950 ... 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 has come an increase in survival for...

Ngày tải lên: 07/07/2014, 01:20

... treatment The family history may suggest an underlying familial cancer predisposition and point out the need to begin surveillance or other preventive therapy for unaffected siblings of the patient The ... or the presence of a molecular marker, such as the t(8;14) translocation of Burkitt's lymphoma Increasing evidence links the expression of certain genes with the prognosis and response to therapy ... 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...

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 ... tissue 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 ... sites The most widely used system of staging is the TNM (tumor, node, metastasis) system codified by the International Union Against Cancer and the American Joint Committee on Cancer (AJCC) The...

Ngày tải lên: 07/07/2014, 01:20

... defined as the appearance of any new lesion or an increase of >25% in the sum of the products of the perpendicular diameters of all measurable lesions (or an increase of 20% in the sums of the ... 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 hand, continuing ... 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...

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 ... survival, new guidelines are emerging for less frequent follow-up visits, during which the history and physical examination are the major investigations performed As time passes, the likelihood of ... examined (Chap e13) Some problems emerge as a consequence of the disease and some as a consequence of the treatment An understanding of these disease- and treatment-related problems may help in their...

Ngày tải lên: 07/07/2014, 01:20

... to indicate the severity of the pain The clinical condition is often dynamic, making it necessary to reassess the patient frequently Pain therapy should not be withheld while the cause of pain ... the best understood 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 ... process, including dopamine, serotonin, histamine, opioid, and acetylcholine receptors The serotonin receptor antagonists ondansetron and granisetron are the most effective drugs against highly...

Ngày tải lên: 07/07/2014, 01:20