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Copy of Bassnectar explains Dubstep

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윤덕 장

on 10 October 2012

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Transcript of Copy of Bassnectar explains Dubstep

Assessment for Abdominal TRAUMA Have you ever overlloked (in under 5 minutes) SURVEY
HISTORY Mechanism
of
injury DO IT ASSESSMENT one method is... then,
How we can do this rapidly and accurately? and it
goes....algorithm With blunt trauma, specifically those resulting from a vehicular crash, clinicians should ask about ... and then there's 12 4+S
created by sudden deceleration can cause lacerations of both solid and hollow organs at their points of attachment to the peritoneum.
They may also create tears at vascular pedicles
or cause stretch injuries to the intima and media of arteries, resulting in infarction of thesusceptible organ. What have to do next.. The next way of assessment is.. Must care about with... According to a systematic review of 12 studies involving 10,757 patients, the physical examination findings associated most closely with a clinically significant intraabdominal injury following BAT include the following.. Seat belt sign
(likelihood ratio (LR) range 5.6 to 9.9)
Rebound tenderness
(uncommon but substantially increases risk when present; LR 6.5, 95% CI 1.8-24)
Hypotension
(defined as SBP <90 mmHg; LR 5.2, 95% CI 3.5-7.5)
Abdominal distension
(LR 3.8, 95% CI 1.9-7.6)
Abdominal guarding
(LR 3.7, 95% CI 2.3-5.9)
Concomitant femur fracture
(LR 2.9, 95% CI 2.1-4.1) 1. inspection
- Exposure
- Extenal wound from restraint device
- MUST be cautiously logrolled to check posterior Abd. and that's it would be drum n bass: pecial Consideration Abd.
Pain
Tenderness
Distention Mechanism
Information Lower chest

-Pelvic injury machine-like grid to the drums Inability
to tolerate a delayed diagnosis Unprotected inj.
(i.e.motorcycle
- crashes) MVC
with fatalities
or
substantial inj. High speed distracting inj.
(e.g.long bone Fx) if we KNOW HOW to do assess, Let us know MANAGEMENT F.A.S.T Focused Assessment Sonography in Trauma An international consensus conference concluded that prudent evaluation should involve two FAST examinations performed at least 6 hours apart supplemented with serial physical examinations to avoid missing an injury. 1. hepatorenal recess
2. splenorenal recess
3. douglas pouch
4. pericardium evaluation EMT 2nd conference
to the SAT/27th/ OCT THIS SUFFERER? NO external wound even occured severe TRAUMA.. BUT if the Pt. progress
unstable vital sign..? if you are in the field... 2 kinds of patient cases 9.4. M/ 54 age TA patient Rapidly Accuratly Why is the mechanism of injury important? Informations provided by prehospital personnel or witness can be very helpful in..
predicting injury patterns . BLUNT TRAUMA
RESTRAINT USE
PENETRATING BLUNT TRAUMA A direct blow direct contact with the lower rim of the steering wheel or a door intruding into the passenger space as the result of a motor vehicle crash compression and crushing injuries
to abdominal viscera! The organs most frequently injury
include... spleen(40~50%)
liver (35~45%)
small bowel(5~10%) Truncal and cevical injuries from restraint devices RESTRAINT DEVICE INJURY Lap Seat Belt compression
Hyperflexion tear or avulsion of mesentry
Rupture of small bowel or colon
Thrombosis ofiliacartery or abdominal aorta
chance fracture of lumbar vetebrae
pancreatic or duodenal injury shouder harness sliding under the seat belt(submarining)
compressiong intimal tear or thrombosis in innominate, carotid,subclavian or vetebral arteries
fracture or dislocation of cevical spine
intimal tear or thrombosis insubclavian artery
rib fractures
pulmonary contusion
rupture of upper abdominal viscera Air bag contact
contact/deceleration
flexion
hyperextension(unretrained) corneal abrasion
abrasion of face neck, and chest
cardiac rupture
cevical or thoracic spine fracture often results from a motor vehicle collision (MVC) BLUNT TRAUMA Shearing forces  Fatality at the scene
 Vehicle type and velocity
 Whether the vehicle rolled over
 Patient's location within the vehicle
 Extent of intrusion into the passenger compartment
 Extent of damage to the vehicle
 Steering wheel deformity
 Whether seat belts were used and, if so, what type
 Whether front or side air bags were deployed but mechanism alone cannot reliably predict the need for emergent laparotomy and must be coupled with other information such as prehospital vital signs, physical exam findings, diagnostic tests, and underlying medical conditions the following historical features: 9.18. M/61 3m fall down patient (cc) image by nuonsolarteam on Flickr The next way of assessment is...? (likelihood ratio (LR) range 5.6 to 9.9) 2. Ausculation
-May be difficult because in a noisy situation
-check absence or presence of bowel sound
-some findings are most useful when they
are nomal initially and change over time Physical Examination 3.Percussion percussion causes slight movement of the
peritoneum and may elicit signs of peritoneal irritation. 4.Palpation may also elicit and distingush superficial and deep
tenderness Pelvic fracture
Multiple system injury
Closed head injury
Blunt aortic disruption
Transfers Other studies for E.M.T? In FAST, This examination is a bedside screening tool to aid clinicians in identifying free intraperitoneal or intrathoracic fluid WHO needs evaluation? Decreased level
of
consciousness
/altered sensorium pain-masking drug
or
medications include the following.. # C.C. : Lt. shouder & Lt. hip pain 금일 onset time: 17:30 pm
in-door time: 18:40 pm # Non - specific PHx(HT-, DM-,Tbc -; op Hx.-, adm Hx-) Mechanism survey #vehicle type: 1.5 truck ( driver)
#accident type: roll over
#speed : about 70km/h
#restraint device (+)
#modified wheel
#air bag was not deployed Physical Examination alert mentality, (GCS grade : 15point)

V/s BP-110/70, HR-76, RR-20 Spo2:98% # Modified Lt. clavicl & DT, Lt.shouder pain
# Both chest wall DT(+) & decreased lung sound
# Lt. leg straight rising test(+)
# Lt. ilium site DT
# Lt.hand dosal sit 2cm laceration&injured muscl level
# Lumbar area DT(+) & abrasion. # the unstable patient with blunt abdominal trauma (BAT) must coincide with physical examination and diagnostic testing aimed at determining the presence or absence of hemoperitoneum and organ injury. must look for intraabdominal injury in patients with an altered sensorium or extraabdominal injuries Notify the blood bank directly (ie, by telephone or in person) of the need for transfusion careful attention to potential spinal cord injuries and guard against injury during positioning  Prompt consultation with a trauma center SUMMARY AND RECOMMENDATIONS (cc) image by nuonsolarteam on Flickr (cc) image by nuonsolarteam on Flickr dignostic imaging lab Progress 18:40
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