tag:blogger.com,1999:blog-6635662200187676302024-03-27T16:52:56.039-07:00General Surgery Clinics ~ A Surgeon's BlogDear visitor, A Hearty Welcome to My Blog:
Now the total visitor count is *Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.comBlogger119125tag:blogger.com,1999:blog-663566220018767630.post-71470196942712212842020-04-27T05:36:00.000-07:002020-04-27T05:36:44.083-07:00Schwannoma<div dir="ltr" style="text-align: left;" trbidi="on">
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</span></b></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #7030a0; font-size: 14.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Schwannoma is a benign peripheral nerve
sheath tumor. </span></b></span></b></div>
<div class="separator">
<br /></div>
<b style="mso-bidi-font-weight: normal;"><span style="color: #7030a0; font-size: 14.0pt;">
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Schwannomas are usually solitary.</span></b></div>
<div class="separator">
<br /></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Cell of origin of Schwannoma -
<span style="color: magenta;">Differentiated Schwann cells.</span></span></b></div>
<div class="separator">
<br /></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Pathologically Schwannomas are unique,
because <span style="mso-spacerun: yes;"> </span>schwannomas do not infiltrate
the parent nerve. </span></b></div>
<div class="separator">
<br /></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"><span style="color: red;">Surgical significance</span> of this unique
feature is that schwannoma<span style="mso-spacerun: yes;"> </span>can<span style="mso-spacerun: yes;"> </span>be<span style="mso-spacerun: yes;"> </span>enucleated<span style="mso-spacerun: yes;"> </span>in toto by preserving<span style="mso-spacerun: yes;"> </span>the adjacent nerve. </span></b></div>
<div class="separator">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXDRzm3JSzyCI34YWzUK5GNkhmXCOD2C6iwiUD5aRR8oea0wo2bZnLrFkBYfZXSdGoUOJtJGBWwwj83208F4lNwaX1VyFDAbr42Q86ZVg4RjJs_AO85Woehdy_ABntX5NpMhnajRWXXXw/s1600/IMG-20200319-WA0111.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="780" data-original-width="1040" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXDRzm3JSzyCI34YWzUK5GNkhmXCOD2C6iwiUD5aRR8oea0wo2bZnLrFkBYfZXSdGoUOJtJGBWwwj83208F4lNwaX1VyFDAbr42Q86ZVg4RjJs_AO85Woehdy_ABntX5NpMhnajRWXXXw/s320/IMG-20200319-WA0111.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;"><b>Longitudinal Incision</b></span></td></tr>
</tbody></table>
<div class="separator">
<br /></div>
</span></b><br />
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #7030a0; font-size: 14.0pt;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQrnBoXw4YVdfe5GdP0xVbsw0Da2P-D3jCkz9irGFxyrHyOzLqHIRDyGVrkuiajfgbf13uC6zZ1kDuxxCHbIJhybdBJ_ljE0wBjkAFmBvCeTOT-FBxFMETagMDnjwf-FRYIGzu1wdksV4/s1600/IMG-20200319-WA0112.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="780" data-original-width="1040" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQrnBoXw4YVdfe5GdP0xVbsw0Da2P-D3jCkz9irGFxyrHyOzLqHIRDyGVrkuiajfgbf13uC6zZ1kDuxxCHbIJhybdBJ_ljE0wBjkAFmBvCeTOT-FBxFMETagMDnjwf-FRYIGzu1wdksV4/s320/IMG-20200319-WA0112.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;"><b>Schawannoma Enucleation</b></span></td></tr>
</tbody></table>
</span></b></div>
<div class="separator">
<br /></div>
<br />
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #7030a0; font-size: 14.0pt;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6s-tXCNuzG2MPnRPeKrehsJI7yHMyQa7v9bkyL9KWdmBTc0AbZ2dH9V_NcrbX23BCPJEeiriRZBJzcJmVmo6d9mzIr4Tb-5C8dfJNH_SScZzlg_Egl7mao8tfvE_511axQPJcrs66PO4/s1600/IMG-20200319-WA0113.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="780" data-original-width="1040" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6s-tXCNuzG2MPnRPeKrehsJI7yHMyQa7v9bkyL9KWdmBTc0AbZ2dH9V_NcrbX23BCPJEeiriRZBJzcJmVmo6d9mzIr4Tb-5C8dfJNH_SScZzlg_Egl7mao8tfvE_511axQPJcrs66PO4/s320/IMG-20200319-WA0113.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;"><b>Thinned Out Nerve Sheath After Enucleation</b></span></td></tr>
</tbody></table>
</span></b></div>
<div class="separator">
<br /></div>
<div class="separator">
<br /></div>
<b style="mso-bidi-font-weight: normal;"><span style="color: #7030a0; font-size: 14.0pt;">
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Histological characteristics of schwannoma
– Areas of cellular component (Antoni A) and areas of hypocellular component
(Antoni B).</span></b></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">**************************************************************</span></b></div>
<div class="separator">
<br /></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Most Important Differential Diagnosis of
schwannoma is Neurofibroma.</span></b></div>
<div class="separator">
<br /></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Neurofibromas are usually multiple.</span></b></div>
<div class="separator">
<br /></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Cell of origin of Neurofibroma- <span style="color: magenta;">Transformed
Schwann cells</span>.</span></b></div>
<div class="separator">
<br /></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Pathologically neurofibroma infiltrates
the parent nerve. </span></b></div>
<div class="separator">
<br /></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"><span style="color: red;">Surgical significance</span> – Neurofibroma is<span style="mso-spacerun: yes;"> </span>resected along with the parent nerve and<span style="mso-spacerun: yes;"> </span>nerve<span style="mso-spacerun: yes;">
</span>grafting is done<span style="mso-spacerun: yes;"> </span>to<span style="mso-spacerun: yes;"> </span>preserve the nerve function</span></b></div>
<div class="separator">
<br /></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">***************************************************************</span></b></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Discussion on Neurofibromatosis</span></b></div>
<div class="separator">
<br /></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Two Types of Neurofibromatosis- Type
1& Type 2</span></b></div>
<div class="separator">
<br /></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Type 1 Neurofibromatosis is associated
with</span></b></div>
<div class="separator" style="margin-left: .5in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="color: #002060; font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Café
au lait patches</span></b></div>
<div class="separator" style="margin-left: .5in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="color: #002060; font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Lisch
nodules</span></b></div>
<div class="separator" style="margin-left: .5in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<span style="color: #002060; font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Optic
glioma</span></b></div>
<div class="separator" style="margin-left: .5in; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<br /></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Type 2 Neurofibromatosis is associated
with </span></b></div>
<div class="separator" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="color: #002060; font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Bilateral
acoustic neuromas</span></b></div>
<div class="separator" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="color: #002060; font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"></span><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Meningioma</span></b></div>
</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #7030a0; font-size: 14.0pt;"><div class="separator" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="color: #002060; font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Mesothelioma</span></b></div>
</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #7030a0; font-size: 14.0pt;">
<div class="separator" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="color: #002060; font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Glioma
multiforme</span></b></div>
<div class="separator" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="color: #002060; font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Carcinoma
of Breast</span></b></div>
<div class="separator" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="color: #002060; font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Carcinoma
Colorectum, </span></b></div>
<div class="separator" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="color: #002060; font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Renal
Cell Carcinoma</span></b></div>
<div class="separator" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="color: #002060; font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Hepato
Cellular Carcinoma</span></b></div>
<div class="separator" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="color: #002060; font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Prostatic
Carcinoma</span></b></div>
<div class="separator" style="margin-left: .5in; mso-list: l1 level1 lfo2; text-indent: -.25in;">
<span style="color: #002060; font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;"><span style="font: 7.0pt "Times New Roman";"></span></span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Cutaneous
malignancy</span></b></div>
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: "Calibri","sans-serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">******************************************************************</span></b> </span></b><br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #7030a0; font-size: 14.0pt;"> <span style="color: magenta;">Image Courtesy- Trivandrum Surgical Club</span></span></b></div>
<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #7030a0; font-size: 14.0pt;"><span style="color: #20124d;">******************************************************************</span></span></b></div>
</div>
Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com21tag:blogger.com,1999:blog-663566220018767630.post-77749826801369669372020-04-24T23:41:00.004-07:002020-04-24T23:47:06.528-07:00Hepatic Adenoma<div dir="ltr" style="text-align: left;" trbidi="on">
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<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #7030a0; font-size: 14.0pt;"> Hepatic Adenoma </span></b></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2icsBc6D1wOzQKwY09GYtlmcp3Ff-OaRAb18u8Tpby2sr4OBrEuGVyLVinzSxqlVOE9IZ8_e0fQZakF8nR6XH2LT56LxaQTwiN0TEbB8uqeFko1mfndxpLxDCwXnb1YRxHdQxmjSsjZY/s1600/20191210_085104.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="900" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2icsBc6D1wOzQKwY09GYtlmcp3Ff-OaRAb18u8Tpby2sr4OBrEuGVyLVinzSxqlVOE9IZ8_e0fQZakF8nR6XH2LT56LxaQTwiN0TEbB8uqeFko1mfndxpLxDCwXnb1YRxHdQxmjSsjZY/s320/20191210_085104.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div class="separator">
<span style="font-size: x-small;"><b><span style="color: #7030a0;">Pedunculated Hepatic Adenoma </span></b></span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;"><b>Liver Bed After Excision</b></span></td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ8qx3HO7xWlkO6WlQ4Bc5p7HWkIBfT6VDxjqGsW-z6H30mHOFnB2WxLV27vZj7YDdEim5GZMsk75oSLN1C3RgoqUDQ2DoXsd7uAlailtBTqoL5BXM9t-GCA72HXOSYXZQ0k_xT-z6nb8/s1600/20191210_091913.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="900" data-original-width="1600" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ8qx3HO7xWlkO6WlQ4Bc5p7HWkIBfT6VDxjqGsW-z6H30mHOFnB2WxLV27vZj7YDdEim5GZMsk75oSLN1C3RgoqUDQ2DoXsd7uAlailtBTqoL5BXM9t-GCA72HXOSYXZQ0k_xT-z6nb8/s320/20191210_091913.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;"><b>Excised Tumor</b></span></td></tr>
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<br />
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<br />
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com15tag:blogger.com,1999:blog-663566220018767630.post-25333014022673916442020-04-23T22:19:00.000-07:002020-04-23T22:21:25.278-07:00Massive Splenomegaly<div dir="ltr" style="text-align: left;" trbidi="on">
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<div class="separator">
<b style="mso-bidi-font-weight: normal;"><span style="color: #7030a0; font-size: 14.0pt;">Massive Splenomegaly</span></b></div>
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<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_Mz6KmW4KX1nuN5sr0tqbHGdMNZk8lE2Oj8l9vmURfCI4vklZmn2tmW5NlUyUjZDAmH62rvGfApu8Ib9tMXYjWptfRywVupNmVdEszbKDT7iY9tdlsnqzvyhWAShyH37evRatedio9sE/s1600/IMG-20200319-WA0076.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="960" data-original-width="1280" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_Mz6KmW4KX1nuN5sr0tqbHGdMNZk8lE2Oj8l9vmURfCI4vklZmn2tmW5NlUyUjZDAmH62rvGfApu8Ib9tMXYjWptfRywVupNmVdEszbKDT7iY9tdlsnqzvyhWAShyH37evRatedio9sE/s320/IMG-20200319-WA0076.jpg" width="320" /></a></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt;"> </span></b>
<br />
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Definition: </span><span style="color: #002060; font-size: 14.0pt;"></span></b>Clinically if the enlarged spleen
reaches the right iliac fossa<span style="mso-spacerun: yes;"> </span>by
crossing the midline or if it weighs more than 1.5 Kg we call it as massive splenomegaly.</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"><br /></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Common Causes Massive Splenomegaly:</span></b></span></b></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"></span></b>1. Myelofibrosis</span></b></div>
<div class="separator" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">2.Chronic Myeloid Leukemia</span></b></div>
<div class="separator" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">3.Malarial Spleen (Tropical splenomegaly)</span></b></div>
<div class="separator" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">4. Gaucher's disease </span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Complications of Massive Splenomegaly:-</span></b></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">1. Rupture of spleen with minor trauma</span></b></div>
<div class="separator" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">2. Splenic Abscess formation.</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"><br /></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">Why spleen enlarges towards the Right Ilica Fossa? </span></b></span></b></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"> Attachment of Phrenico colic ligament prevents the enlargement of spleen in the downward direction in to left iliac fossa.</span></b></span></b></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuxcvO370KinhKnw3gEyoW24TogJBDVP7YSZ1X2sgaKhEk9MY5RNfS83HiYfY8uxcC0ISDknr1iB-JWBIMwdz6zFC28TvvJvVJ608R-f2TFjdMUw-Qdh_Bqx57hPc5s6R8D1jf6sD6_Is/s1600/index.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="215" data-original-width="234" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuxcvO370KinhKnw3gEyoW24TogJBDVP7YSZ1X2sgaKhEk9MY5RNfS83HiYfY8uxcC0ISDknr1iB-JWBIMwdz6zFC28TvvJvVJ608R-f2TFjdMUw-Qdh_Bqx57hPc5s6R8D1jf6sD6_Is/s1600/index.jpg" /></a></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"><br /></span></b></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"> </span></b>What is Harri's Dictum?</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;">The Harris’ dictum of odd numbers 1, 3, 5, 7, 9, 11 summarizes splenic data - Normal spleen
measures 1 inch in thickness, 3 inches in breadth, 5 inches in length, weighs 7
ounces, and is located in relation with 9, 10, and 11 ribs on left.</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-size: 14.0pt;"> </span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com2tag:blogger.com,1999:blog-663566220018767630.post-90179581401039542922017-11-23T04:11:00.001-08:002017-11-23T04:11:37.978-08:00Empyema or Pyothorax<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="color: #073763;"><b><span style="font-size: large;">Empyema <span class="_Tgc"> is a collection of pus in the pleural cavity </span></span></b></span><br />
<br />
<span style="color: #073763;"><b><span style="font-size: large;"><span class="_Tgc">Surgical treatment is Postero Lateral Thoracotomy and drainage of pus.</span></span></b></span><br />
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<b><span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwa23DRYri5PzTt29kX57Z-kUTnum4xj5OU50nYOiwhLOqGIUYbwyfEqHbRWWlvej2aT8EWfm-u_uaWjVD42_pZea1W2TqAH6oYgsNeILRmwePRZmCKzZnXD-jwUwr_-GMXil-M0uiCNw/s1600/IMG-20171101-WA0033.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="960" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwa23DRYri5PzTt29kX57Z-kUTnum4xj5OU50nYOiwhLOqGIUYbwyfEqHbRWWlvej2aT8EWfm-u_uaWjVD42_pZea1W2TqAH6oYgsNeILRmwePRZmCKzZnXD-jwUwr_-GMXil-M0uiCNw/s320/IMG-20171101-WA0033.jpg" width="240" /></a></span></b></div>
<br />
<span style="color: #073763;"><b><span style="font-size: large;"><span class="_Tgc">Thickened pleura is separated from the underlying lung ( Decortication) so that lung re-expands fully. </span></span></b></span></div>
Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com14tag:blogger.com,1999:blog-663566220018767630.post-62551202061302757582017-11-23T04:03:00.002-08:002017-11-23T04:17:01.117-08:00Surgical Treatment of Haemorrhoids<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="color: #073763;"><b><span style="font-size: large;">Stapler Haemorrhoidectomy</span></b></span><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiatbLCfN4K5wR37ksECEccsOjhn-zqsYMJehG_CIBNkfK77sWX1r7eqk26Y_T6ynn9shS8tkBIn-c5-k0nHhPl5C1eHHYQKzr9P8anY3xds41MvIByE8jsJKIJC4V16zA6BEJmF8BSQ_E/s1600/IMG-20171123-WA0010.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="719" data-original-width="1280" height="179" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiatbLCfN4K5wR37ksECEccsOjhn-zqsYMJehG_CIBNkfK77sWX1r7eqk26Y_T6ynn9shS8tkBIn-c5-k0nHhPl5C1eHHYQKzr9P8anY3xds41MvIByE8jsJKIJC4V16zA6BEJmF8BSQ_E/s320/IMG-20171123-WA0010.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;"><span style="color: blue;">Pre Op</span></span></td></tr>
</tbody></table>
<span style="color: #073763;"><b><span style="font-size: large;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8zGDpI2jEqtd2ApUVd_pM146QpCvbQzCF1AlMbKI1WFNb5JIFZGX-dpRtThByXZAgtcZ_uRYJJaK4vhcJIcVzy5wInlSlaytiiaRQH0hQcxSlG8u8lNxcuOua6DUR_sePuTXLJpe2DqM/s1600/IMG-20171123-WA0004.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1280" data-original-width="719" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8zGDpI2jEqtd2ApUVd_pM146QpCvbQzCF1AlMbKI1WFNb5JIFZGX-dpRtThByXZAgtcZ_uRYJJaK4vhcJIcVzy5wInlSlaytiiaRQH0hQcxSlG8u8lNxcuOua6DUR_sePuTXLJpe2DqM/s320/IMG-20171123-WA0004.jpg" width="179" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: small;"><span style="color: blue;"><span style="color: #073763;"><span style="font-size: medium;">Stapler Haemorrhoidectomy</span></span></span></span></td></tr>
</tbody></table>
</span></b></span><br />
<span style="color: #073763;"><b><span style="font-size: large;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEis9QYRrkbKcrpKEPs4EQmxgLriGAloDclKXWQeAjLBvrjmYzQX4qWQrb7UbaMbZ84nhHnsKDm0ExfF0q_nNN1UW5lmQO0EK6OoVz3BpKS_6t2AnNVJkPs43v2qY90hXY8EWGzydiXGZ6Y/s1600/IMG-20171123-WA0011.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1280" data-original-width="719" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEis9QYRrkbKcrpKEPs4EQmxgLriGAloDclKXWQeAjLBvrjmYzQX4qWQrb7UbaMbZ84nhHnsKDm0ExfF0q_nNN1UW5lmQO0EK6OoVz3BpKS_6t2AnNVJkPs43v2qY90hXY8EWGzydiXGZ6Y/s320/IMG-20171123-WA0011.jpg" width="179" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;"><span style="font-size: small;">Post Op</span></span></td></tr>
</tbody></table>
</span></b></span><br />
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<span style="color: #073763;"><b><span style="font-size: large;">Image Courtesy: Trivandrum Surgical Club</span></b></span></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com7tag:blogger.com,1999:blog-663566220018767630.post-78275562291393298732017-11-23T03:52:00.003-08:002017-11-23T04:16:38.749-08:00An Unusal Case of Fistula in Ano<div dir="ltr" style="text-align: left;" trbidi="on">
<h2 style="text-align: justify;">
<span style="color: #20124d;"><span style="font-size: large;"><b>Male in his late 40s presented with a discharging sinus near the right side of scrotum of 18 months of duration.No urinary symptoms. No co-morbidity.</b></span></span></h2>
<h2 style="text-align: justify;">
<span style="color: #20124d;"><span style="font-size: large;"><b>MR Fistulogram- Sinus track extending from the root of scrotum through the subcutaneous plane close to the anal verge. No communication with penis.</b></span></span></h2>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkmpRVEOcuNnAWaOneQeTRz-xvqX5MfKwcZkNJo5LsCSWevMs3xMAAJVUs6t89xMHsaBT9w4E55R-uVnninlcuCm-HX5q5KzzECnw8qkQ0bcpM3XQlTr2N9fE85VcvYRlR4JQUXcCaFwg/s1600/IMG-20171123-WA0018.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1280" data-original-width="719" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkmpRVEOcuNnAWaOneQeTRz-xvqX5MfKwcZkNJo5LsCSWevMs3xMAAJVUs6t89xMHsaBT9w4E55R-uVnninlcuCm-HX5q5KzzECnw8qkQ0bcpM3XQlTr2N9fE85VcvYRlR4JQUXcCaFwg/s320/IMG-20171123-WA0018.jpg" width="179" /></a></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjx4wA0_dAsHmCdC4wTCK4xkBrlCBODzImIdSyGlF7AJVAbJhcIAWtVmEm1LITjUaXhaiOug8ehx3lrzZqBfFlPd0ew3oB0aV3MoQnxJMj0kgpz962TSzQNZVgOkYlQpOWRCvmvjrJP7ns/s1600/IMG-20171123-WA0017.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1280" data-original-width="719" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjx4wA0_dAsHmCdC4wTCK4xkBrlCBODzImIdSyGlF7AJVAbJhcIAWtVmEm1LITjUaXhaiOug8ehx3lrzZqBfFlPd0ew3oB0aV3MoQnxJMj0kgpz962TSzQNZVgOkYlQpOWRCvmvjrJP7ns/s320/IMG-20171123-WA0017.jpg" width="179" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: #20124d;"><span style="font-size: large;"><span style="color: blue;">Probing to assess the extent</span></span></span></td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7Gpk1f2Rliz6QogHaeiAHiMfN2zt0zdZRkvqsd8l5kSBykYJBNWzsho0X8db3jzPf-seyYuH7lUaCrNdR7jF-uHOpHSjLTuhrQVeW2Y9CMCTLkCKJivFEWM7ES5cOfxHccOffzq722ZA/s1600/IMG-20171123-WA0014.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1280" data-original-width="719" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7Gpk1f2Rliz6QogHaeiAHiMfN2zt0zdZRkvqsd8l5kSBykYJBNWzsho0X8db3jzPf-seyYuH7lUaCrNdR7jF-uHOpHSjLTuhrQVeW2Y9CMCTLkCKJivFEWM7ES5cOfxHccOffzq722ZA/s320/IMG-20171123-WA0014.jpg" width="179" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;"><span style="font-size: large;">Fistulectomy</span></span></td></tr>
</tbody></table>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwF5xTS6vaMYniAOzCr0rYGaGXlTf7bvUBVPXGcKrJtd2g67SV_lXEptBH2-HFCzYKRt_5f1pDW7yWpfd7zCvy7MPH-GjlOovH62CtycR_8wbPVKk0xff4s9xDsD07qH43EGUs5DToCOc/s1600/IMG-20171123-WA0015.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1280" data-original-width="719" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwF5xTS6vaMYniAOzCr0rYGaGXlTf7bvUBVPXGcKrJtd2g67SV_lXEptBH2-HFCzYKRt_5f1pDW7yWpfd7zCvy7MPH-GjlOovH62CtycR_8wbPVKk0xff4s9xDsD07qH43EGUs5DToCOc/s320/IMG-20171123-WA0015.jpg" width="179" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: blue;"><span style="font-size: large;">Placement of a Non Cutting Seton (Poly Propelene) to Preserve the Anal Sphincter</span></span></td><td class="tr-caption" style="text-align: center;"></td><td class="tr-caption" style="text-align: center;"></td><td class="tr-caption" style="text-align: center;"></td><td class="tr-caption" style="text-align: center;"></td><td class="tr-caption" style="text-align: center;"></td></tr>
</tbody></table>
<h2 style="text-align: justify;">
<span style="color: #20124d;"><span style="font-size: large;"><b> Courtesy: Tivandrum Surgical Club</b></span></span></h2>
</div>
Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com3tag:blogger.com,1999:blog-663566220018767630.post-64273885685141741872016-01-14T18:18:00.000-08:002016-01-14T18:18:59.634-08:00Circulatory Shock<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u>Definition<o:p></o:p></u></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Circulatory shock is a state of </span></b><b><span style="color: #0070c0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">inadequate tissue perfusion</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> needed for the normal cellular respiration. In other words
shock results from inadequate perfusion of the body cells with oxygenated
blood.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u>Pathophysiology of Shock</u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">When the delivery of oxygen and glucose is low, cellular metabolism
changes from aerobic to anaerobic type. The product of aerobic respiration is carbon
dioxide and that of anaerobic respiration is </span></b><b><span style="color: #0070c0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">lactic acid</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">. Accumulation of lactic acid due to anaerobic respiration results
in </span></b><b><span style="color: #ff0066; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">metabolic
acidosis</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">Whenever there
is metabolic acidosis, body tries to compensate it by hyperventilation
producing </span></b><b><span lang="EN-US" style="color: #0070c0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">respiratory alkalosis</span></b><b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">. Inadequate perfusion results in baroreceptor
stimulation in the cardiovascular system. This causes release of catecholamines and
thereby </span></b><b><span lang="EN-US" style="color: #0070c0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">sympathetic over activity</span></b><b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">. It is the cause of rapid pulse in shock.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">Decreased
renal perfusion leads to decreased glomerular filtration and </span></b><b><span lang="EN-US" style="color: #0070c0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">low urine output</span></b><b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">.Anti Diuretic
Hormone production is also increased due
to baroreceptor stimulation . ADH causes increased sodium and water re absorption
which further </span></b><b><span lang="EN-US" style="color: #0070c0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">reduces urine output</span></b><b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">Activation of
the Renin–angiotensin–aldosterone axis causes peripheral </span></b><b><span lang="EN-US" style="color: #0070c0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">vaso- constriction</span></b><b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">. This is the reason for the clinical
manifestation of </span></b><b><span lang="EN-US" style="color: #0070c0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">cold extremities</span></b><b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"> in shock. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">Ischemia of the
intestine results in destruction of the mucosal barrier leading to </span></b><b><span lang="EN-US" style="color: #0070c0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">bacterial translocation</span></b><b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"> from the
lumen of the intestine to the systemic circulation.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Hypoxia and acidosis in turn activates the inflammatory and complement
cascade in the body resulting in the generation of </span></b><b><span style="color: #ff0066; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">oxygen free radicals</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> and inflammatory
mediators. Due to the action of these mediators vascular endothelial damage
occurs and tissue oedema forms. </span></b><b><span style="color: #0070c0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Tissue oedema</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> in turn causes tissue hypoxia.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Cessation of anaerobic metabolism causes failure of the Na/ K<sup>+</sup>
pumps and cell lysis. As a result intracellular K+ is released into the
bloodstream producing the electrolyte abnormality called </span></b><b><span style="color: #ff0066; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">hyperkalemia</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">When the normal circulation is regained the inflammatory
mediators will be flushed away and can cause endothelial injury to lungs and kidneys.
Ultimately this can result in </span></b><b><span style="color: #c00000; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">multi organ failure</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">. Such an injury is known as </span></b><b><span style="color: #0070c0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Re-perfusion Injury.</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #0070c0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u>Types of Shock</u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: #002060; font-family: "Wingdings 2"; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: "Wingdings 2"; mso-fareast-font-family: "Wingdings 2";">¨<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Hypovolaemic </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: #002060; font-family: "Wingdings 2"; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: "Wingdings 2"; mso-fareast-font-family: "Wingdings 2";">¨<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Cardiogenic </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: #002060; font-family: "Wingdings 2"; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: "Wingdings 2"; mso-fareast-font-family: "Wingdings 2";">¨<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Obstructive</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: #002060; font-family: "Wingdings 2"; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: "Wingdings 2"; mso-fareast-font-family: "Wingdings 2";">¨<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Distributive</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="color: #002060; font-family: "Wingdings 2"; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: "Wingdings 2"; mso-fareast-font-family: "Wingdings 2";">¨<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Endocrine</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u>Hypovolaemic
Shock</u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Caused by a reduced circulating volume and is</span></b><b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"> the most common form of Shock.</span></b><b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Two types of
Hypovolaemic Shock are Haemorrhagic or Non-haemorrhagic. Haemorrhagic shock is
due to the excessive blood loss.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Non-haemorrhagic causes of Hypovolaemic Shock<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify; text-indent: 18.0pt;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Dehydration
– <o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Poor fluid intake, Vomiting,
Diarrhoea <o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Urinary loss
(Polyuria -diabetes)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Evaporation- Heat
exhaustion<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Third-space loss<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #0070c0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Third space</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> compartment is extra cellular space which is not normally
perfused with fluids. E.g. Peritoneal cavity, Pleural space etc.The fluid is re
distributed from ECF and is not available to the intravascular space. Hence
fluid sequestration in Third Space can cause Hypovolemia. Third space loss
occurs in –Peritonitis, Intestinal Obstruction, Pancreatitis and Burns.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u>Cardiogenic
Shock</u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Is
due to primary failure of the heart to pump blood<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Causes of cardiogenic shock –<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">
Myocardial infarction <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">
Cardiac dysrhythmias<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">
Valvular heart disease<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">
Blunt myocardial injury <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">
Cardiomyopathy<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u>Obstructive
Shock</u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Due to mechanical
obstruction of cardiac filling<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Resulting in a fall in
Cardiac Output<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Common causes <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Cardiac
tamponade<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Tension
pneumothorax<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Massive pulmonary embolus<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u>Distributive
shock/ Septic Shock</u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Is due to generalized vasodilatation and low systemic vascular
resistance<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Can occur in<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">
Anaphylaxis-histamine release<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Septic
shock-endotoxins<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> High spinal
cord injury <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u>Endocrine
Shock</u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Is a combination of hypovolaemic, cardiogenic and distributive
shock.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Causes are<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Hypothyroidism – due to
decreased responsiveness to catecholamines<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Hyperthyroidism - due
to highoutput cardiac failure.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Adrenal insufficiency
- due to hypovolaemia <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u>Phases of
Shock</u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #c00000; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Phase of Compensation</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">: Body tries to preserve blood supply to brain, kidney and lungs
by reducing the blood flow to </span></b><b><span style="color: #00b0f0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">skin,
muscles and gastro intestinal tract</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">. Body
can compensate a sudden loss of up to 15% of total blood volume. Blood pressure
is also maintained within the normal limits even up to the loss of 40% of
circulatory blood volume. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #c00000; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Phase of Decomposition</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">: If the total loss is more than 15% of total blood volume, compensatory
measures fails and there will be progressive reduction in the function of </span></b><b><span style="color: #00b0f0; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">lungs, heart and brain</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u>Severity
of Shock </u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Based on
the severity, decompensated shock is further classified in to mild, moderate
and severe.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #c00000; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Mild
Shock</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">: Mild tachycardia, tachypnoea and
mild reduction in urine output. Blood pressure is maintained.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #c00000; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Moderate
Shock</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">: More tachycardia and tachypnoea. Urine
output falls less than 0.5ml/ kg/ hr. Blood pressure falls and patient becomes drowsy.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #c00000; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Severe Shock</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">: Severe tachycardia and laboured breathing with profound
hypotension. Urine output becomes nil and patient becomes unconscious.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u>Monitoring
of a patient in Shock</u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Pulse rate<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Blood Pressure/
Central Venous Pressure Monitoing<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Respiratory Rate<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Level of Consciousness<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Urine Output<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Pulse Oxymetry for
Oxygen Saturation<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Arterial Blood Gas Analysis<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Serum Lactate <o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u>Treatment
of Shock</u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #00b050; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level2 lfo2; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Maintain </span></b><b><span style="color: #c00000; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">A</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">irway Patency<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level2 lfo2; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Ensure proper </span></b><b><span style="color: #c00000; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">B</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">reathing<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level2 lfo2; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Regain </span></b><b><span style="color: #c00000; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">C</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">irculation and control of
the bleeding<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level2 lfo2; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Intravenous Fluids – Crystalloids/
Colloids<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level2 lfo2; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Grouped and Cross
Matched Blood Transfusion<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level2 lfo2; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Ionotropic agents
like Dopamine/ Dobutamine <o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level2 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Nor adrenaline (Vasopressor
for peripheral vaso dilatation)<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Antibiotics in septic
shock<o:p></o:p></span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com18tag:blogger.com,1999:blog-663566220018767630.post-75447896124643103702015-08-28T17:35:00.001-07:002015-08-28T17:53:19.260-07:00Gossypiboma<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="margin-bottom: .0001pt; margin: 0cm;">
<b><span style="background: white; color: blue; font-size: 13.5pt;">What is a Gossypiboma?</span></b></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizUMCkx6WQEo1w21btWykJZI7v3bqF-LsPYG3dupHNCoGRhfCCeyFY7q8atwOhswYCDwcgKNXj3ED4zkfVHYOHUdWjhjAa7vJPGrCZYiNUAZsNn_1Vlkuqtx9F_3BiBy740ckrGCIsNTk/s1600/IMG-20150430-WA0093.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="216" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizUMCkx6WQEo1w21btWykJZI7v3bqF-LsPYG3dupHNCoGRhfCCeyFY7q8atwOhswYCDwcgKNXj3ED4zkfVHYOHUdWjhjAa7vJPGrCZYiNUAZsNn_1Vlkuqtx9F_3BiBy740ckrGCIsNTk/s320/IMG-20150430-WA0093.jpg" width="320" /></a><b style="text-align: left;"><span style="background: white; color: #002060;"> </span></b></div>
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<b style="text-align: center;"><span style="background: white; color: #002060; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 18.3999996185303px;">A missed </span><span style="background: white; color: #002060; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8666667938232px;">or</span><span style="background: white; color: #002060; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 18.3999996185303px;"> </span><span style="background: white; color: #002060; font-family: Calibri, sans-serif; font-size: 11pt; line-height: 16.8666667938232px;">retained </span><span style="background: white; color: #002060; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 18.3999996185303px;">mop in the abdomen during laparotomy can become symptomatic later.</span></b></div>
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<b><span style="background: white; color: #002060;"><o:p></o:p></span></b></div>
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<b><u><span style="background: white;"><span style="color: blue;">Symptoms</span></span></u></b><span style="color: #002060;"><o:p></o:p></span></div>
<div style="margin: 0cm 0cm 0.0001pt;">
<b><span style="background: white; color: #002060;">Abdominal
pain, Unexplained Fever</span></b><span style="color: #002060;"><o:p></o:p></span></div>
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<b><u><span style="background: white;"><span style="color: blue;">Diagnosis</span></span></u></b><span style="color: #002060;"><o:p></o:p></span></div>
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<b><span style="background: white; color: #002060;">USG / CT Scan
Abdomen</span></b><span style="color: #002060;"><o:p></o:p></span></div>
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<b><u><span style="color: blue;">Treatment</span></u></b><span style="color: #002060;"><o:p></o:p></span></div>
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<b><span style="background: white; color: #002060;">Re Laparotomy
and removal.</span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com17tag:blogger.com,1999:blog-663566220018767630.post-38667525758062945072014-09-05T19:43:00.000-07:002014-09-05T19:43:11.131-07:00Surgical Emphysema<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Surgical Emphysema or Subcutaneous <o:p></o:p></span></b><b><span style="color: #002060; font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 21.4666652679443px;">Emphysema-</span></b></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td class="tr-caption" style="font-size: 13px;"><b><span style="color: blue;"><b style="text-align: left;"><span style="color: #002060; font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 21.4666652679443px;"> </span><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 21.4666652679443px;">means </span></b></span></b><b style="text-align: left;"><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 21.4666652679443px;"><span style="color: blue;">presence of air in the subcutaneous plane.</span></span></b></td></tr>
</tbody></table>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTOi8pB_-aJg7OjzEnkU9i2WjaCsXgCQ8kfS_V7uyqYps6fUGmXr8XwfU1SO1ikRLCO0QpGwAndxqAYWE2Z2ZpznyMytiJoUIa1J6Pi3yeutDe29-Qn6fWT1JfYKgAFKnysBPJkCiwJgY/s1600/20140410_000826.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTOi8pB_-aJg7OjzEnkU9i2WjaCsXgCQ8kfS_V7uyqYps6fUGmXr8XwfU1SO1ikRLCO0QpGwAndxqAYWE2Z2ZpznyMytiJoUIa1J6Pi3yeutDe29-Qn6fWT1JfYKgAFKnysBPJkCiwJgY/s1600/20140410_000826.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><b><span style="color: blue;">Right Sided Multiple Rib Fractures with Subcutaneous Emphysema</span></b></td></tr>
</tbody></table>
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<b style="color: #002060; font-family: 'Times New Roman', serif; font-size: 19px; line-height: 21.4666652679443px; text-align: left;">Characteristic clinical finding is crackling feel or </b><b style="font-family: 'Times New Roman', serif; font-size: 19px; line-height: 21.4666652679443px; text-align: left;"><span style="color: purple;">creps</span></b><b style="color: #002060; font-family: 'Times New Roman', serif; font-size: 19px; line-height: 21.4666652679443px; text-align: left;">.</b></div>
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<b style="color: #002060; font-family: 'Times New Roman', serif; font-size: 19px; line-height: 21.4666652679443px; text-align: left;"> </b></div>
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<b style="color: #002060; font-family: 'Times New Roman', serif; font-size: 19px; line-height: 21.4666652679443px; text-align: left;">The blown out appearance is sometimes described as </b></div>
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<b style="color: #002060; font-family: 'Times New Roman', serif; font-size: 19px; line-height: 21.4666652679443px; text-align: left;"><br /></b></div>
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<b style="font-size: 13px; text-align: center;"><span style="color: blue;"></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 21.4666652679443px;"><span style="color: magenta;">Michelin Man</span></span><span style="color: #002060; font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 21.4666652679443px;"> (</span><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 21.4666652679443px;"><span style="color: purple;">Tyre Man</span></span><span style="color: #002060; font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 21.4666652679443px;">) </span><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 21.4666652679443px;"><span style="color: magenta;">appearance.</span></span></b></div>
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<b><span style="color: #002060; font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 21.4666652679443px;"><br /></span></b></div>
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<b style="text-align: left;"><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 21.4666652679443px;"><u><span style="color: blue;">Causes</span></u></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">1. Multiple Rib Fractures- Pleural Tear </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">2. Penetrating Chest Injury (Stab /Gunshot)</span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">3. Rupture of Emphysamatic Bullae
on to the mediastinum.</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">4. Rupture Esophagus</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">5. Tracheal Injury</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">6. Facial Bone Fractures ( as sinuses contain air )</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">7. Infection with Gas forming organisms</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
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<b><u><span lang="EN-US" style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: #990000;">Other Conditions producing </span><span style="color: magenta;">Creps on </span></span></u></b><span style="color: magenta; font-family: Times New Roman, serif;"><span style="font-size: 19px; line-height: 21.4666652679443px;"><b><u>palpation</u></b></span></span></div>
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<b><u><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></u></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">1. Face, Neck, Chest - Surgical
Emphysema</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">2. Bone – Definitive Sign of fracture</span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">3. Joint- Osteo Arthritis </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">4. Tendon – </span><span lang="EN-US" style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: purple;">Teno Synovitis,inflammation of tendon sheath.</span></span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com25tag:blogger.com,1999:blog-663566220018767630.post-6288631824421562672014-09-05T14:53:00.000-07:002014-09-05T19:43:39.670-07:00Carcinoma Colon- Synchronous Lesions <div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Carcinoma Colon- Synchronous Lesions</span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b style="text-align: left;"><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: #cc0000;">Definition</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> : Occurrence of two or more primary tumors identified in the same
patient and at the same time.</span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> The most voluminous synchronous cancer is called "</span><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">index</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">"
cancer.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Synchronous Lesions are caused by </span></b><br />
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> common genetic and
environmental factors.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Overall incidence of synchronous colorectal cancers </span></b><br />
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> varies between
2% to 10%.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"> </span><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: purple;">Hence a complete colonoscopic
work up is indicated in every case</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">.</span></b></div>
Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com7tag:blogger.com,1999:blog-663566220018767630.post-64566456146505515162014-03-15T07:45:00.000-07:002014-03-15T07:48:42.058-07:00Buschke-Lowenstein Tumor<div dir="ltr" style="text-align: left;" trbidi="on">
<b><span style="color: blue; font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 24.533334732055664px;">Buschke-Lowenstein Tumor of Penis</span></b><br />
<b style="color: blue; font-family: Times, 'Times New Roman', serif; font-size: x-large;"><br /></b>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbErIarvJmV9sESp0T8Nwf5OZwMO7Rp_MGj2QCtAUwz4Pvyk3GFXs_vt3HJwrUjyEI9BmcSxim7hdocZ4Ee4ai03wSTj21myb4ilncQlHNyEwr1mIvf4o_VYeE_JO24QUF8lWWPeZwj4I/s1600/20140315_120551.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbErIarvJmV9sESp0T8Nwf5OZwMO7Rp_MGj2QCtAUwz4Pvyk3GFXs_vt3HJwrUjyEI9BmcSxim7hdocZ4Ee4ai03wSTj21myb4ilncQlHNyEwr1mIvf4o_VYeE_JO24QUF8lWWPeZwj4I/s1600/20140315_120551.jpg" height="240" width="320" /></a></div>
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<span style="color: purple;"><b><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"> is </span></b><b><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;">Giant condyloma Acuminata affecting anogenital region<o:p></o:p></span></b></span></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Considered as a variant of </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: magenta;">verrucous carcinoma</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Slow growing , locally invasive, low grade malignancy<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Gross appearance -</span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: #274e13;">cauliflower-like morphology</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Aetiology- human papillomavirus (</span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: #990000;">HPV) types 6 and 11</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Diagnostic procedure- Biopsy <o:p></o:p></span></b></div>
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<b><span style="color: blue;"><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;">Treatment - Surgical excision / CO</span><span style="font-family: 'Times New Roman', serif; line-height: 115%;"><span style="font-size: x-small;">2</span></span></span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: blue;"> laser/ Chemotherapy</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: purple;"><u>Differential Diagnosis</u></span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> 1.Squamous Cell Carcinoma</span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> 2. Genital <o:p></o:p></span></b><b><span style="color: #002060; font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 21.466665267944336px;">warts,</span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com5tag:blogger.com,1999:blog-663566220018767630.post-87660438242993579402014-03-06T10:38:00.001-08:002014-03-06T10:38:30.344-08:00Pantaloon Hernia<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">What is a Pantaloon Hernia?<o:p></o:p></span></b></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0YnOMMfjzBZftJL4mJgjsAEG1os32ghKToVVOqfzUPbEYt2USPfI9a0HJ_aLH3GdgldGNEZmgSD87ycBpjhTElgteYlfOH5lKEgEVek1WXTGBWfVnAfqLx1oDggUHfxxB6A4P1_42NWE/s1600/20140305_114724.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0YnOMMfjzBZftJL4mJgjsAEG1os32ghKToVVOqfzUPbEYt2USPfI9a0HJ_aLH3GdgldGNEZmgSD87ycBpjhTElgteYlfOH5lKEgEVek1WXTGBWfVnAfqLx1oDggUHfxxB6A4P1_42NWE/s1600/20140305_114724.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><b><span style="color: purple;">Pantaloon Hernia- Indirect Sac (Black Arrow) & Direct Sac ( White Arrow) </span></b></td></tr>
</tbody></table>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWZuC5pyKaBdQqQ2G6Mv4wBu8VEKEEB2mHUckpyG6kvBUll2y8XLg8nVhtohQYSNtoWimiUzz_8fRebVBd9u6HDHmflMKpGkJm2Xu6Z-7djPoErL74vymDd228sr_rvex_PrO-E5qcraQ/s1600/20140305_114923.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWZuC5pyKaBdQqQ2G6Mv4wBu8VEKEEB2mHUckpyG6kvBUll2y8XLg8nVhtohQYSNtoWimiUzz_8fRebVBd9u6HDHmflMKpGkJm2Xu6Z-7djPoErL74vymDd228sr_rvex_PrO-E5qcraQ/s1600/20140305_114923.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: purple;"><b>Pantaloon Hernia- </b></span><b style="color: purple;"> Inferior Epigastric Vessels ( White Arrow) </b><b style="color: purple;"> & </b><b style="color: purple;">Spermatic Cord (Black Arrow)</b></td></tr>
</tbody></table>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> If an inguinal hernia contains both direct and indirect sac, it
is called a </span><span style="font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><span style="color: magenta;">Pantaloon Hernia.</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="font-family: Times New Roman, serif;"><span style="font-size: 16pt; line-height: 115%;"><span style="color: #002060;"> </span><span style="color: blue;">An indirect sac is dealt by </span></span><span style="color: blue;"><span style="font-size: 21px; line-height: 24.533334732055664px;">opening</span><span style="font-size: 16pt; line-height: 115%;"> the sac ( Herniotomy) , reducing the contents and transfixing it. </span></span></span></b></div>
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<b><span style="color: #002060; font-family: Times New Roman, serif;"><span style="font-size: 16pt; line-height: 115%;"><br /></span></span></b></div>
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<b><span style="font-family: Times New Roman, serif;"><span style="font-size: 16pt; line-height: 115%;"><span style="color: #002060;"> </span><span style="color: #20124d;">A direct sac is reduced into </span></span></span></b><span style="color: #20124d;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">the peritoneal cavity and the plication of the upper part of the Transversalis Fascia over the sac and Ilio pubic Tract-T</span></b><b><span style="font-family: Times New Roman, serif;"><span style="font-size: 16pt; line-height: 24.533334732055664px;">hickened lower most part of the </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 24.533334732055664px;">Transversalis Fascia is done with the non absorbable suture material like poly propelene.</span></b></span></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 24.533334732055664px;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 24.533334732055664px;"> </span><span style="color: purple; font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 24.533334732055664px;">Then the posterior wall of the Inguinal Canal is reinforced with a </span></b><span style="color: purple;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 24.533334732055664px;">poly propelene</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 24.533334732055664px;"> mesh in the plane of the inguinal ligament and conjoint tendon.</span></b></span></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com7tag:blogger.com,1999:blog-663566220018767630.post-44044691615964409652014-02-12T11:10:00.001-08:002014-02-12T11:27:41.700-08:00Retrograde Jejuno Gastric Intussusception<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Retrograde Jejuno
Gastric Intussusception<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisdcbz90TBG7o8Oii4-xMPrH_oLnyVzHT6JJMeNrxGiKQWVF7WvwJRoyJSzBDnNX_VnwOBQfOHrDJ7x9gQ3ncBK0svFLgBmgpb2x45rGNPPRzfi6jKdxNOi7qRttLh_jk2VrPXl-8wneM/s1600/Image(079).jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisdcbz90TBG7o8Oii4-xMPrH_oLnyVzHT6JJMeNrxGiKQWVF7WvwJRoyJSzBDnNX_VnwOBQfOHrDJ7x9gQ3ncBK0svFLgBmgpb2x45rGNPPRzfi6jKdxNOi7qRttLh_jk2VrPXl-8wneM/s1600/Image(079).jpg" height="240" width="320" /></a></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Retrograde Intussusception
means the telescoping in of a distal segment of gastro intestinal tract in to
proximal part. After gastro jejunostomy patient can develop what is called </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: magenta;">Retrograde
Jejuno Gastric Intussusception.</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"> The clinical features
include -</span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"> Lump in the epigastrium, </span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"> Haemetemesis </span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"> Abdominal pain with vomiting</span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"> </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: blue;">Note the '</span><span style="color: magenta;">coil spring appearance</span><span style="color: blue;">' of the jejunum, which can be made out even in a plain radiograph of the abdomen. </span></span></b></div>
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<b><span style="color: #cc0000;"> </span><span style="color: purple;">Courtesy- An Unknown Friend! </span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com2tag:blogger.com,1999:blog-663566220018767630.post-68359076002000184062014-02-12T06:16:00.002-08:002014-02-12T06:16:21.007-08:00Meckel’s Diverticulum presenting as Intussusception.<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Meckel’s Diverticulum presenting as Intussusception.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Telescoping in of a
proximal segment of intestine to a distal segment is called </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: blue;">Intussusception</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">. The
proximal segment is called intussusceptum and the distal segment is called
intussuscepiens.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">The initiating lesion
leading to Intussusception is called a
</span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: magenta;">pathological lead point</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">. A lead point can be a polyp, submucous
lipoma, stromal tumour or </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: purple;">Meckel’s Diverticulum</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">The commonest site of
Intussusception is </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: magenta;">Ileo caecal region</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">. The clinical features include abdominal pain,
vomiting, distension and passage of </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: blue;">Red currant jelly stools</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">The basis of Red
currant jelly stools is due to the excess mucus production from the
intussuscepted intestine which gets mixed with blood from the congested
intestine.<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="font-family: 'Times New Roman', serif; font-size: 16pt;"><span style="color: #002060;">On examination of abdomen, emptiness of the right iliac
fossa is called </span><span style="color: magenta;"><i>signe-de-dance</i> </span></span><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; mso-ansi-language: EN-US;">(<i>The Sign of Dance</i>). It is due to
the pulled up caecum leading to a palpable sausage shaped mass in the umbilical area.<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; mso-ansi-language: EN-US;">Ultra sonological sign of </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt;">Intussusception is called </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt;"><span style="color: magenta;">Target sign</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt;"> on
end on view and a </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt;"><span style="color: blue;">Pseudo kidney appearance </span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt;">in the longitudinal view. Barium
enema appearance of Intussusception is called </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt;"><span style="color: #cc0000;">Claw sign</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt;">.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt;">Non operative management of
Intussusception can be tried with </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt;"><span style="color: magenta;">Hydrostatic reduction</span><span style="color: #cc0000;">.</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt;"> </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt;"><span style="color: blue;">Per operatively Intussusception
is reduced by milking from the distal or advancing point (apex) and not by
pulling from the proximal part.</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com2tag:blogger.com,1999:blog-663566220018767630.post-18022383155789341272014-02-11T09:21:00.000-08:002014-02-11T09:21:03.081-08:00Omental Patch Repair for Duodenal Ulcer Perforation <div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Omental Patch Repair for Duodenal
Ulcer Perforation</span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">One common complication of duodenal ulcer is perforation. Typically
</span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: blue;">an ulcer which is located in the anterior wall of the duodenum perforates and
one is located in the posterior wall bleeds</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Perforation can lead on to peritonitis. Hence it is a surgical
emergency. The type of facies ( facial appearance) we get in a patient with
terminal stage of peritonitis is called </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: magenta;">Hippocratic facies. </span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">The diagnosis of perforation peritonitis can be made from the clinical examination. There
will be abdominal rigidity on palpation. </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: purple;">Abdominal rigidity is due to the
involuntary contraction of abdominal wall muscles</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">. <o:p></o:p></span></b></div>
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<b><span style="font-family: Times New Roman, serif;"><span style="font-size: 16pt; line-height: 115%;"><span style="color: #002060;">The </span><span style="color: blue;">investigation of choice to diagnose a case of perforation
peritonitis is a plain </span></span><span style="font-size: 21px; line-height: 24.533334732055664px;"><span style="color: blue;">radio-graph</span></span><span style="font-size: 16pt; line-height: 115%;"><span style="color: blue;"> of the abdomen</span><span style="color: #002060;"> in erect posture. The characteristic finding in a plain radio-graph is </span><span style="color: magenta;">free gas under the diaphragm. </span><span style="color: #002060;"><o:p></o:p></span></span></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">The treatment of a perforated duodenal ulcer is closure of the
perforation with a patch of the omentum. This is known as </span><span style="font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: #cc0000;">Omental patch repair.</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">
An abdominal lavage with warm Normal saline or Ringer Lactate is mandatory after
the procedure. <o:p></o:p></span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com1tag:blogger.com,1999:blog-663566220018767630.post-75347912864267627672014-02-11T08:16:00.006-08:002021-06-30T15:14:35.563-07:00Smiley Incision for Repair of Para Umbilical Hernia<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="color: #002060; font-family: Times New Roman, serif;"><span style="font-size: 16pt; line-height: 115%;">Smiley Incision for Open
Repair of </span><span style="font-size: 21px; line-height: 24.5333px;">Para Umbilical</span><span style="font-size: 16pt; line-height: 115%;"> Hernia</span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 16pt; line-height: 115%;"><o:p></o:p></span></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif";"><span style="font-size: medium;"><span style="line-height: 115%;"><span id="goog_82923625"></span><span id="goog_82923626"></span><br /></span></span></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif";"><span style="font-size: medium;"><span style="line-height: 115%;"> </span></span></span></b><b><span style="color: #002060;"><span style="font-size: 16pt;">A </span><span style="font-size: 21px;">Para Umbilical</span><span style="font-size: 16pt;"> Hernia is herniation of
the intra abdominal contents like omentum or intestine through a defect in the
linea alba in the region of the umbilicus.</span></span></b><br />
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<b><span style="color: #002060; font-size: 16pt;"> Aetiological factors include
conditions with increased intra abdominal pressure like chronic cough,
constipation, benign prostatic hypertrophy or an intra abdominal tumour. A weak
anterior abdominal wall due to repeated pregnancy is another cause. </span></b><span style="font-size: 16pt;"><o:p></o:p></span></div>
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<b><span style="color: #002060; font-size: 16pt;"> The complications include
irreducibility, intestinal obstruction and strangulation ( arrest of
blood supply ) of the contents. The patient can also experience
dragging pain due to the pull on to the mesentery. Hence a surgical correction
is indicated.</span></b><span style="font-size: 16pt;"><o:p></o:p></span></div>
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<b><span style="color: #002060; font-size: 16pt;"> One common surgical procedure is the open repair of the para umbilical hernia, done under epidural or spinal
anesthesia. The incision is a curved infra umbilical one called the '</span></b><b><span style="color: #cc0000; font-size: 16pt;">smiley incision</span></b><b><span style="color: #002060; font-size: 16pt;">.' The sac is dissected out and content
is visualized.<span class="apple-converted-space"> </span></span></b><b><span style="color: blue; font-size: 16pt;">Beware of the bowel loop especially the
transverse colon which can be a content of the sac</span></b><b><span style="color: #002060; font-size: 16pt;">.</span></b><span style="font-size: 16pt;"><o:p></o:p></span></div>
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<b><span style="color: #002060; font-size: 16pt;"> If the size of the defect
is less than 2 centimeters a primary repair using Number one polypropylene and reinforcing darning ( </span></b><b><span style="color: purple; font-size: 16pt;">figure of eight sutures</span></b><span class="apple-converted-space"><b><span style="color: #002060; font-size: 16pt;"> </span></b></span><b><span style="color: #002060; font-size: 16pt;">) is done. If the size of the defect is
larger a polypropylene mesh is placed for the repair.</span></b><span style="font-size: 16pt;"><o:p></o:p></span></div>
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<b><span style="color: #002060; font-size: 16pt;"> If the mesh is placed over
the linea alba, it is called '</span></b><b><span style="background: white; color: magenta; font-size: 16pt;">On Lay Mesh Repair</span></b><b><span style="background: white; color: purple; font-size: 16pt;">.'</span></b><span class="apple-converted-space"><b><span style="color: #002060; font-size: 16pt;"> </span></b></span><b><span style="color: #002060; font-size: 16pt;"> If the mesh is placed in the
pre peritoneal plane it is called '</span></b><b><span style="color: magenta; font-size: 16pt;">In Lay Mesh Repair</span></b><b><span style="color: #002060; font-size: 16pt;">.'</span></b><span style="font-size: 16pt;"><o:p></o:p></span></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com2tag:blogger.com,1999:blog-663566220018767630.post-28738159639864060342013-08-31T11:42:00.000-07:002015-10-04T09:16:56.735-07:00Non-Occlusive Mesenteric Ischemia ( NOMI )<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Non-occlusive mesenteric ischemia (NOMI) <o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-IN; mso-bidi-font-style: italic; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Acute mesenteric ischemia</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-bidi-font-style: italic;"><i> </i></span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">is
broadly divided in to 4 Sub divisions.<o:p></o:p></span></b><br />
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<span style="color: purple;"><b><span style="background: white; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Acute mesenteric arterial embolism -50%</span></b><b><span style="background: white; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></span></div>
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<span style="color: purple;"><b><span style="background: white; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Acute mesenteric arterial thrombosis - 25%</span></b><b><span style="background: white; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></span></div>
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<span style="color: purple;"><b><span style="background: white; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Non occlusive mesenteric ischemia (NOMI)-20%</span></b><b><span style="background: white; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></span></div>
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<b><span style="background: white; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><span style="color: purple;">Acute mesenteric venous thrombosis -5%</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
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<b><i><span style="background: white; color: blue; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">“Whatever be the cause of mesenteric ischemia, gangrene
of the bowel is the final common pathway ~ a mortality rate of 50-80%.”</span></i></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">In Non-occlusive mesenteric ischemia mesenteric
arteries are patent, but the flow is low due to vaso spasm.<o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="background: white; color: #990000; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><u>Risk Factors</u></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> >50
years of age</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> Myocardial
infarction </span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> Congestive
heart failure</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> Aortic
insufficiency</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> Renal
or hepatic disease </span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> Cardiac
surgery</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> Drugs- Vasopressors,
Ergotamines, Cocaine, Digitalis<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-US;"> </span></b><b><span lang="EN-US" style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Septic
Shock</span></b><br />
<b><span lang="EN-US" style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"></span></b></div>
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<b><span lang="EN-US" style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
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<b><u><span style="background: white; color: #990000; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Pathophysiology </span></u></b><b><u><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></u></b></div>
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<b><u><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></u></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Tissue hypoxia can result in </span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Bowel wall spasm - vomiting or diarrhoea. </span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Mucosal sloughing -bleeding</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Transmural infarction, Oedema, Congestion</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Necrosis and perforation –Abdominal Distension</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">(8-12 hours from the onset of symptoms) </span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
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<b><i><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">“At this stage, little abdominal tenderness is
present, producing the classic intense visceral pain that is disproportionate to
physical examination findings”</span></i></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
</div>
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<b><u><span style="background: white; color: #990000; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></u></b></div>
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<b><u><span style="background: white; color: #990000; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Clinical
Presentation</span></u></b><b><u><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></u></b></div>
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<b><u><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal">
<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> As the bowel becomes gangrenous, rectal
bleeding and signs of sepsis (eg, tachycardia, tachypnea, hypotension, fever,
altered mental status)</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Often,
these elderly patients are already in an intensive care unit (ICU) with </span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> Acute respiratory failure </span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> Hypotension from cardiogenic /septic shock</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> On vasopressive drugs or digitalis<o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">When infarction occurs, the clinical condition of the ICU patient
deteriorates with no apparent reason. </span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Patients may report increased pain associated with vomiting. </span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">They may become hypotensive and tachycardic, with loose
bloody stool.</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><u><br /></u></span></b>
<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><u>Investigations</u></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0cm;">
<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Plain radiograph- may show stripes of Air- </span></b><b><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: magenta;">Pneumatosis
intestinalis </span></span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">in late stages</span></b></div>
</div>
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<br /></div>
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<br /></div>
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<b><span lang="EN-US" style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-US;">CT Scan Abdomen& CT
Angiography-Investigation if Choice<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span lang="EN-US" style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
</div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">NOMI is characterized by alternating dilation
and narrowing of the intestinal branches ( “string of sausages” sign), due to spasm
of the mesenteric vessels.</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">
<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">MR Angiogram has a sensitivity of 100% and a
specificity of 91%. It is particularly effective for evaluating Mesenteric Vein
Thrombosis.<o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><u><span lang="EN-US" style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-US;">Treatment</span></u></b><b><u><span lang="EN-US" style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-US;"> </span></u></b><b><u><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></u></b></div>
</div>
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<b><u><span lang="EN-US" style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></u></b></div>
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<!--[if !supportLists]--><span style="color: #002060; font-family: "Arial","sans-serif"; font-size: 16.0pt; line-height: 115%; mso-fareast-font-family: Arial;">•<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">I/v Fluids</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span style="color: #002060; font-family: "Arial","sans-serif"; font-size: 16.0pt; line-height: 115%; mso-fareast-font-family: Arial;">•<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><b><span lang="EN-US" style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">Oxygen
Inhalation </span><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%; mso-ansi-language: EN-IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"> </span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> maintain a saturation 96-99%</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span style="color: #002060; font-family: "Arial","sans-serif"; font-size: 16.0pt; line-height: 115%; mso-fareast-font-family: Arial;">•<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Vasodilators –</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> Papaverine -infused
through the angiography catheter</span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> Dose 30-60 mg/h and
adjust the dose for clinical response. </span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> Continue this for
at least 24 hours. </span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"> If the catheter
slips into the aorta, significant hypotension can occur. </span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></b></div>
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<!--[if !supportLists]--><span style="color: #002060; font-family: "Arial","sans-serif"; font-size: 16.0pt; line-height: 115%; mso-fareast-font-family: Arial;">•<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Broad-spectrum antibiotics and pain medications</span></b><br />
<span style="color: #002060; font-family: Arial, sans-serif; font-size: 16pt; line-height: 115%; text-indent: -18pt;"><span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><br />
<div style="text-align: left;">
<span style="color: #002060; font-family: Arial, sans-serif; font-size: 16pt; line-height: 115%; text-indent: -18pt;"><span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"><br /></span></span><span style="color: #002060; font-family: Arial, sans-serif; font-size: 16pt; line-height: 115%; text-indent: -18pt;"><span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><b style="color: #002060; font-size: 7pt; text-indent: -18pt;"><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;">Resection of gangrenous bowel and Anastomosis.</span></b></div>
</div>
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<b><u><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: magenta;">Driven Home Messages</span><span style="color: #002060;"><o:p></o:p></span></span></u></b></div>
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<b><u><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><br /></span></u></b></div>
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<span style="color: purple;"><b><span lang="EN-US" style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;">High degree of
Suspicion is required for the diagnosis of NOMI</span></b><b><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><o:p></o:p></span></b></span></div>
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<b><span lang="EN-US" style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<span style="color: purple;"><b><span lang="EN-US" style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;">CT Angiogram is the
Investigation of choice</span></b><b><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><o:p></o:p></span></b></span></div>
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<b><span lang="EN-US" style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
<br />
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<b><span lang="EN-US" style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: purple;">Early Diagnosis and
Resuscitation can decrease the morbidity and mortality.</span></span></b><b><span style="background: white; color: #002060; font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 115%;"><o:p></o:p></span></b><br />
<b><span lang="EN-US" style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b>
<b><span lang="EN-US" style="background-color: white; background-position: initial initial; background-repeat: initial initial; font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b>
<b><span lang="EN-US" style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: blue; font-family: 'Times New Roman', serif; font-size: 16pt; line-height: 115%;">Image Courtsey-Dr Balagopal Sir</span></b></div>
</div>
</div>
Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com4tag:blogger.com,1999:blog-663566220018767630.post-28988333761131914602013-08-23T09:10:00.002-07:002013-08-23T09:10:30.956-07:00<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Primary Assessment in Trauma ( For the Interns)<o:p></o:p></span></u></b></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7ZAMLFJIbPld6bbdbDp0zG-3zQ_mPfbDUImu9GW2m1JZgb2mQCtj3ALHdZGGuxWDeQ9xNDE0x6IsJj0lkoTw-_y0pYEUGLHtsFLV5fOqh877N60KtdUJ7UhCEKRWmRD5DuPXFDqEw0xA/s1600/Picture+y.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7ZAMLFJIbPld6bbdbDp0zG-3zQ_mPfbDUImu9GW2m1JZgb2mQCtj3ALHdZGGuxWDeQ9xNDE0x6IsJj0lkoTw-_y0pYEUGLHtsFLV5fOqh877N60KtdUJ7UhCEKRWmRD5DuPXFDqEw0xA/s1600/Picture+y.jpg" height="320" width="181" /></a></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
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<span style="color: blue;"><b><span lang="EN-US" style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;">The protocol for assessment and the
management of trauma victims is called ATLS</span></b><b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"> (</span></b><b><span lang="EN-US" style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;">Advanced Trauma Life Support)</span></b><b><span lang="EN-US" style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"> </span></b></span><b><span lang="EN-US" style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: blue;">The founder of ATLS is Dr James K.
Styner .</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
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<b><u><span lang="EN-US" style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">The Story Behind ATLS !</span></span></u></b><b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></u></b></div>
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<b><u><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">In 1976, Dr. James K. Styner, met with an accident. His wife was
killed instantly and three of his four children sustained critical injuries. The
care his children received from the
nearest hospital was totally inadequate due to the lack of proper training of
the staff !<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Hence he started a training programme to the health care workers
in 1976 called ATLS (Advanced Trauma Life Support) and now it is the accepted protocol
for trauma management in the world over.<o:p></o:p></span></b></div>
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<b><u><span lang="EN-US" style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: magenta;">General
Principles of ATLS</span></span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><u><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></u></b></div>
<ol start="1" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="color: #002060; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">Rapid Evaluation of Patient-Time wasted costs
lives!</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></b></li>
<li class="MsoNormal" style="color: #002060; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><b><u><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">A definitive diagnosis is Not necessary to start
Rx.</span></u></b><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></u></b></li>
<li class="MsoNormal" style="color: #002060; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">Treatment should be started in the Golden Hour !</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></b></li>
<li class="MsoNormal" style="color: #002060; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">Fixing up the Priorities!</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></b></li>
<li class="MsoNormal" style="color: #002060; mso-list: l1 level1 lfo1; tab-stops: list 36.0pt; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">Should be governed by ‘First do no harm’
principle. </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></b></li>
</ol>
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<b><u><span lang="EN-US" style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">Golden Hour </span><span style="color: #002060;"><o:p></o:p></span></span></u></b></div>
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<b><u><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">It is the First Hour following the injury and Not after reaching
the Hospital! If treatment is started during this period the complication rates
are less and the survival rates are more.<o:p></o:p></span></b></div>
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<b><u><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></u></b></div>
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<b><u><span lang="EN-US" style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">Fixing up of Priorities</span><span style="color: #002060;"><o:p></o:p></span></span></u></b></div>
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<b><u><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">The things which will kill the patient first are always checked
and treated first. <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Things which will kill the patient later are managed
later. <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Thus, airway problems are managed first. Secondly treat
breathing problems, <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Later treat circulatory problems. Finally offer the definitive treatment.<o:p></o:p></span></b></div>
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<br /></div>
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<b><u><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: magenta;">Guidelines of Approach to a Trauma Victim</span><span style="color: #002060;"><o:p></o:p></span></span></u></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">First Check for Responsiveness …Shake or Tap or Shout, "Are
you OK?<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">If No Response, Look for Respiration and
Pulse.<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Carefully place the person on his back without twisting the head
and neck .<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Remove crash helmet with manual in-line stabilization of the
cervical spine <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Look for chest/abdominal movement . Listen for breath sounds and
abnormal noises <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Feel at mouth and nose for expired air.<o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Then feel for the pulse. Radial/Brachial/Carotid-Do not palpate
both the carotids simultaneously!<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Remember -complete airway obstruction is silent.</span></b> <b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">If the person can
utter his name properly, that means his airway is intact.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">If there is no respiration/pulse start CPR as follows:-<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Clear the airway – Only Jaw Thrust( No head tilt or chin lift
)with manual in-line stabilization of the cervical spine.</span></b> <b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Pull the tongue out
so that it stays in the mouth and not obstructing the throat. An ‘Oropharyngeal
Airway’ if available can be used to keep the tongue forward.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: Times New Roman, serif; font-size: small;"><span style="line-height: 115%;">In Standard CPR, a cycle includes 30 chest </span></span><span style="color: #002060; font-family: Times New Roman, serif;"><span style="line-height: 18px;">compressions</span></span><span style="color: #002060; font-family: Times New Roman, serif; font-size: small;"><span style="line-height: 115%;"> followed
by two rescue breathing. 5 cycles can be given within 2 minutes. Re assess the
patient after every 5 cycles.<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: Times New Roman, serif; font-size: small;"><span style="line-height: 115%;">Hands-only CPR can be given by those who are reluctant to give
mouth-to-mouth breathing. Blood circulation can be restored with chest </span></span><span style="color: #002060; font-family: Times New Roman, serif;"><span style="line-height: 18px;">compress ions</span></span><span style="color: #002060; font-family: Times New Roman, serif; font-size: small;"><span style="line-height: 115%;">.<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">For rescue breathing, one should use the strength of your cheeks
to deliver gentle puffs of air (instead of deep breaths from your lungs).<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">In a hospital set up one can use a face mask or an Ambu Bag for
giving artificial respiration.</span></b> <b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">If a Defibrillator is available, deliver one shock if instructed
by the device, then begin CPR.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Remember giving CPR doubles a person's chances of survival.</span></b>
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">The
difference between your doing something and doing nothing could be someone's
life!<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Never be panic or lose the presence of mind if something goes
wrong unexpectedly. Take control of the situation as team leader. Do not
hesitate to get help when needed. The most important first aid is ‘Common
sense.’</span></b> <b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">Do not pull out an impacted object like a knife or push the protruded
intestines back in to the abdomen ,at the site of event.</span></b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<o:p> </o:p><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">The person who provides the first aid should look after his
safety first.</span></b><b><span style="color: #e5e5ff; font-family: "Garamond","serif"; font-size: 40.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: +mj-cs; mso-fareast-font-family: +mj-ea; text-shadow: auto;"> </span></b><b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">Consider all patients as Biohazards and
take maximum precautions possible for your safety.</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Start an intravenous infusion. Control bleeding if any. Remember
5 Ps to control bleeding-Positioning(a limb above the level of head), Pressure,
Packing ,Procedural (wound suturing) and Patience ( the most important!).<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: Times New Roman, serif; font-size: small;"><span style="line-height: 115%;">Any major trauma victim will be </span></span><span style="color: #002060; font-family: Times New Roman, serif;"><span style="line-height: 18px;">benefited</span></span><span style="color: #002060; font-family: Times New Roman, serif; font-size: small;"><span style="line-height: 115%;"> by giving oxygen
inhalation. Re assure the victim and give maximum comfort as possible. Remember
the famous quote by Hippocrates -Cure sometimes, treat often, comfort always!<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: Times New Roman, serif; font-size: small;"><span style="line-height: 115%;"><br /></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: Times New Roman, serif; font-size: small;"><span style="line-height: 115%;">Do not forget that a doctor is also a human being. He also makes
mistakes. The best way to </span></span><span style="color: #002060; font-family: Times New Roman, serif;"><span style="line-height: 18px;">minimize</span></span><span style="color: #002060; font-family: Times New Roman, serif; font-size: small;"><span style="line-height: 115%;"> mistakes is to follow this golden principle
‘Check, Re check and Check again!’<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: Times New Roman, serif; font-size: small;"><span style="line-height: 115%;"><br /></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: Times New Roman, serif; font-size: small;"><span style="line-height: 115%;">People judge you by your physical appearance, your ability to
communicate, your knowledge and skills in the subject and your attitude and </span></span><span style="color: #002060; font-family: Times New Roman, serif;"><span style="line-height: 18px;">behavior</span></span><span style="color: #002060; font-family: Times New Roman, serif; font-size: small;"><span style="line-height: 115%;"> towards the patients and the relatives. So keep a watch on these four
aspects. (Dress neatly, be polite and empathetic as well as keep updated in
your knowledge and skills.)<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: Times New Roman, serif; font-size: small;"><span style="line-height: 115%;"><br /></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Empathy means understanding what others are feeling because you
have experienced it yourself or can put yourself in their shoes. </span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Sympathy means acknowledging another
person's emotional hardships and providing comfort and assurance.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Follow the principles of Medical Ethics ( Dharma). If you
safeguard ethics (dharma), it will protect you in return. But if you destroy
ethics (dharma), it will destroy you.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">There is no substitute for experience. Surgical techniques are
learned through supervised practice. Learn the art of performing following
surgical procedure. Grab the first opportunity. Don’t wait for the next <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><u><span style="color: purple;">Practicals:-</span></u></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><u><span style="color: purple;"><br /></span></u></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;">
<b style="text-indent: -18pt;"><span style="color: #002060;"><span style="font-family: Times New Roman, serif;"><span style="line-height: 18px;"> </span></span><span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><b style="text-indent: -18pt;"><span style="color: #002060; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 18px;">1.</span></b><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">How to establish an intravenous access</span></b><br /><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">How to do endo tracheal intubation</span></b><br /><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">How to insert a inter costal drainage tube</span></b><br /><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">How to give a splint immobilization for fractures</span></b><br /><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">How to do wound suturing</span></b><br /><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">How to do dressing in various parts of the body</span></b><br /><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">How to do needle pericardio centesis</span></b><br /><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">How to do tracheostomy</span></b><br /><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">9.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">How to do needle cricothyroidotomy</span></b><br /><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">10.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">How to needle
drainage of tension pneumo thorax</span></b><!--[if !supportLists]--></div>
</div>
Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com6tag:blogger.com,1999:blog-663566220018767630.post-19317383125821722572013-08-20T17:20:00.000-07:002013-08-20T17:26:38.347-07:00Internal Hernia<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Internal Hernia<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<div class="separator" style="clear: both; text-align: center;">
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><br /></span></b></div>
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<div class="MsoNormal">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt;"><span style="color: blue;">Internal hernia is the protrusion of
abdominal viscous through a rent in the peritoneum
or mesentery. </span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><br /></span></b></div>
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<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt;"><span style="color: purple;">Types of internal hernia are:- </span><span style="color: #002060;"><o:p></o:p></span></span></u></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><br /></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Para duodenal hernia ( Most common)<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Trans mesenteric hernia<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Trans omental hernia<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Foramen of Winslow<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Pericaecal hernia<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Sigmoid mesocolon hernia<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Supravesical hernia<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Pelvic hernia<o:p></o:p></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt;"><span style="color: blue;">Internal herniation of small bowel
can result in Intestinal Obstruction.<o:p></o:p></span></span></b></div>
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<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt;"><span style="color: purple;">Clinical Features:</span><span style="color: #002060;"><o:p></o:p></span></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Abdominal pain</span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Abdominal distension<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Absolute constipation<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Vomiting<o:p></o:p></span></b></div>
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<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt;"><span style="color: purple;">Investigations:</span><span style="color: #002060;"><o:p></o:p></span></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Plain radiograph of Abdomen<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Ultra sound Abdomen<o:p></o:p></span></b></div>
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<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt;"><span style="color: purple;">Surgical Treatment:</span><span style="color: #002060;"><o:p></o:p></span></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Emergency Laparotomy <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Reduction of the hernia if the loops
of intestines are viable<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Resection anastamosis if the involved
segment of intestine is not viable.<o:p></o:p></span></b></div>
<br />
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Obliteration of the defect in the
mesentery/omentum /peritoneal aperture.<o:p></o:p></span></b></div>
</div>
</div>
Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com98tag:blogger.com,1999:blog-663566220018767630.post-7213484809967066652013-08-04T17:26:00.002-07:002013-08-20T10:04:04.773-07:00First Aid - Basic Principles <div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 20.0pt; line-height: 115%;"> </span><span style="color: #002060; font-family: 'Times New Roman', serif; line-height: 115%;"><span style="font-size: large;"> </span></span></b><b><span style="color: #002060; font-family: 'Times New Roman', serif; line-height: 115%;"><u><span style="font-size: large;">First
Aid</span></u></span></b></div>
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<b style="text-align: justify;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> </span></b><br />
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<b style="text-align: justify;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-28uK1QCTLo4VUh2zzTzpHFmWHREiCHnRbRZxgs255rpflWJQNUskU-af_Lxj3UzGTfvfOAEnkRagOWQOpV4n5wu_stWXw_Fv6TbBaqeuw3L-O6165HgQzJzxpSDu5D7vkvE6AzmvYB4/s1600/DSC03518.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-28uK1QCTLo4VUh2zzTzpHFmWHREiCHnRbRZxgs255rpflWJQNUskU-af_Lxj3UzGTfvfOAEnkRagOWQOpV4n5wu_stWXw_Fv6TbBaqeuw3L-O6165HgQzJzxpSDu5D7vkvE6AzmvYB4/s1600/DSC03518.JPG" height="182" width="320" /></a></span></b></div>
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<b><span style="color: #002060; font-family: 'Times New Roman', serif; font-size: 14pt;"><u>First Aid </u></span></b><b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Definition:<o:p></o:p></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Initial care given to an injured or
sick person </span></b><b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">to sustain life or to
minimize deformity, </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">before professional medical care is available is
called First Aid.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><br /></span></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Basic Facts:</span></u></b></div>
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<span style="color: #002060; font-family: Symbol; font-size: 14pt; text-indent: -18pt;"><span style="font-family: 'Times New Roman'; font-size: 7pt;"><br /></span></span></div>
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<span style="color: #002060; font-family: Symbol; font-size: 14pt; text-indent: -18pt;"><span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">First Aid can be performed by anybody-non expert or
a trained person.</span></b></div>
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<span lang="EN-US" style="color: #002060; font-family: Symbol; font-size: 14pt; text-indent: -18pt;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span></div>
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<b style="text-indent: -18pt;"><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"> The person
who provides the first aid should look after his safety first.</span></b></div>
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<span style="color: #002060; font-family: Times New Roman, serif;"><span style="font-size: 19px;"><b><br /></b></span></span><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Whatever be the cause of injury or illness, the
basic principles of First Aid are the same.</span></b></div>
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<span style="color: #002060; font-family: Times New Roman, serif;"><span style="font-size: 19px;"><b><br /></b></span></span><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">A definitive diagnosis is not needed for the
initiation of the First aid.</span></b></div>
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<b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><br /></span></b></div>
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<span style="color: #002060; font-family: Symbol; font-size: 14pt; text-indent: -18pt;"><span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><b style="text-indent: -18pt;"><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Never be Panic when you face an unexpected
situation.</span></b></div>
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<span style="color: #002060; font-family: Times New Roman, serif;"><span style="font-size: 19px;"><b><br /></b></span></span><b style="text-indent: -18pt;"><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">The most
important First Aid is Common Sense!</span></b><!--[if !supportLists]--></div>
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<b style="text-indent: -18pt;"><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;"><br /></span></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Aims of First Aid:<o:p></o:p></span></u></b></div>
<b style="color: #002060; text-align: justify;"><u><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">To preserve life</span></u></b><b style="color: #002060; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">: the important aim of First Aid is to save a
life.</span></b><br />
<span style="color: #002060; font-family: Times New Roman, serif;"><span style="font-size: 19px;"><b><br /></b></span></span><b style="color: #002060; text-align: justify;"><u><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">To Minimize Deformity</span></u></b><b style="color: #002060; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">: Second aim of First Aid is
to </span></b><b style="color: #002060; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">prevent further injury. </span></b><br />
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<b style="color: #002060; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">Like- keeping
the patient away from harmful environment, applying bandage to stop a
bleed and the ideal position of evacuation from the scene of event etc.</span></b></div>
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<span style="color: #002060; font-family: Times New Roman, serif;"><span style="font-size: 19px;"><b><br /></b></span></span></div>
<b style="color: #002060; text-align: justify;"><u><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">To Promote Recovery</span></u></b><b style="color: #002060; text-align: justify;"><u><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN;">:</span></u></b><b style="text-align: justify;"><span style="font-family: 'Times New Roman', serif; font-size: 14pt;"><span style="color: #002060;"> If
the First aid is given within the first hour following Injury or Trauma
the chance of recovery is more. Hence this hour is called </span><u style="color: #002060;">Golden Hour</u><span style="color: #002060;">!
( Remember the </span><span style="color: #cc0000;">Golden hour</span><span style="color: #002060;"> is </span><u style="color: #002060;">the first hour following injury</u><span style="color: #002060;"> and
not the time of arrival at a hospital!)</span></span></b><br />
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<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt;"><span style="color: magenta;">Remember, the difference between your
doing something and doing nothing could be someone's life. </span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt;"> <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt;"><u>Cardiopulmonary Resuscitation</u></span></b><b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN; mso-font-kerning: 18.0pt;"> </span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN; mso-font-kerning: 18.0pt;"> </span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN; mso-font-kerning: 18.0pt;">Normal Heart Rate is 72/minute<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-IN; mso-font-kerning: 18.0pt;">Normal Respiratory Rate is 16-20/minute<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Cardiopulmonary resuscitation (CPR) is a lifesaving procedure
useful in emergencies like heart attack, drowning, or trauma in which a
person’s breathing or heartbeat has
stopped. <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: Times New Roman, serif; font-size: medium;"><span style="line-height: 115%;">Anybody can begin CPR with chest </span></span><span style="color: #002060; font-family: Times New Roman, serif;"><span style="font-size: 19px; line-height: 21px;">compressions</span></span><span style="color: #002060; font-family: Times New Roman, serif; font-size: medium;"><span style="line-height: 115%;">. This is called Hands-Only CPR.<o:p></o:p></span></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Most people who experience cardiac arrest at home, work or in a
public location die because they don't receive immediate CPR from someone on
the scene. <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Remember, the difference between your doing something and doing
nothing could be someone's life.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">The American Heart Association recommends deep presses on the
chest of an adult cardiac arrest victim until help arrives, works just as well
as standard CPR .<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Remember CPR can double a person's chances of survival!<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Hands-only CPR is simpler and easier to remember. <o:p></o:p></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;"><u>How to Give Hands-Only CPR?</u></span></span></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Give chest compressions at the centre of the chest at a rate of
about 100 per minute</span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">. Continue till the arrival of the medical team. <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: #002060;">If you're well trained and confident in your ability, start </span><u><span style="color: #002060;">CPR
with 30 chest compressions with two Rescue breaths.( </span><span style="color: #cc0000;">Standard CPR</span><span style="color: #002060;">)<o:p></o:p></span></u></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u><br /></u></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">The above advice applies to adults, children and infants needing
CPR.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">CPR can keep oxygenated blood flowing to the brain</span></span></u></b><b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;"> and other vital
organs until more definitive medical treatment can restore a normal heart
rhythm. </span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">When the heart stops, the lack of oxygenated blood can cause
brain damage in only a few minutes. A person may die within eight to 10
minutes.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Before starting CPR, check: <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Is the person conscious or unconscious?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the person appears unconscious, tap or shake his or her
shoulder and ask loudly, "Are you OK?"<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the person doesn't respond begin CPR first but do not forget
to call for the help.<o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">ABC of Standard CPR</span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">Airway:</span></span></u></b><b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;"> </span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Clear the airway <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Clean the airway to remove any dirt or secretions.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Slightly tilt the head and lift the chin and pull the tongue out
so that it stays in the mouth and not obstructing the throat.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">An ‘Oropharyngeal Airway’
if available can be used to keep the tongue forward.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b> </div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">If the person can utter his name properly, that means his airway
is intact</span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">1. Put your palm on the person's forehead and gently tilt the
head back. Then with the other hand, gently lift the chin forward to open the
airway. Beware of possible cervical spine injury while tilting the head!<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">2.Check for normal breathing, taking no more than five or 10
seconds. Look for chest movement, listen for normal breath sounds, and feel for
the person's breath on your cheek and ear. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the person isn't breathing normally begin mouth-to-mouth
breathing. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If you believe the person is unconscious from a heart attack
skip mouth-to-mouth rescue breathing and continue chest compressions.<o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">Breathing</span></span></u></b><b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">:</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Breathe for the person <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Rescue breathing can be mouth-to-mouth breathing or
mouth-to-nose breathing if the mouth is seriously injured or can't be opened. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Step 1</span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">. Pinch the nostrils shut for mouth-to-mouth breathing and cover
the person's mouth with yours, making a seal. One can place a hand kerchief
over the victim’s mouth. (Better way of giving artificial respiration is by
using a Face mask and an Ambu bag.)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Step 2</span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">.Prepare to give two rescue breaths. Give the first rescue
breath- lasting one second- and watch to see if the chest rises. If it does
rise, give the second breath. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the chest doesn't rise, repeat the Jaw thrust, chin-lift manoeuvre
and then give the second breath. <u>Use the strength of your cheeks to deliver
gentle puffs of air (instead of deep breaths from your lungs)</u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u><br /></u></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Step 3.</span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Resume chest compressions at a rate of about 100 compressions a
minute to restore circulation. <u>30 chest compressions followed by two rescue
breaths is considered as one cycle CPR</u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u><br /></u></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Step 4.</span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Continue CPR until there are signs of breathing movement or
emergency medical personnel take over.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">Circulation</span></span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">: Restore blood circulation with chest compressions <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">1.Put the person on his or her back on a firm surface.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">2.Kneel next to the person's neck and shoulders.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">3.Place the heel of one hand over the centre of the person's
chest, between the nipples. Place your other hand on top of the first hand.
Keep your elbows straight and position your shoulders directly above your
hands.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">4.Use your upper body weight (not just your arms) as you push
straight down on (compress) the chest at least 2 inches (approximately 5
centimetres). Push hard <u>at a rate of about 100 compressions a minute</u>.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">5. Continue chest compressions and rescue breathing until there
are signs of chest movement or until emergency medical personnel take over.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: purple;">This action should be taken only for adults who unexpectedly
collapse, stop breathing and are unresponsive. Most likely that the person is
having cardiac arrest.<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0cm; text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;">Hands only CPR -100 Chest compressions/minute<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0cm; text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;">Standard CPR-30 chest compressions followed by two rescue
breaths</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Choking- First Aid<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Choking occurs when a foreign object becomes lodged in the
throat or windpipe, blocking the flow of air. In adults, a piece of food often
is the culprit. Young children often swallow small objects. As choking cuts off
oxygen to the brain, administer first aid as quickly as possible.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Choking is common during feasts or <u>Bada Khana</u> in which
people take alcohol and meat together! <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">The universal sign for choking is hands held in front of throat.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Also look for these indications: Inability to talk, difficulty
breathing or noisy breathing, inability to cough forcefully, skin, lips and
nails turning blue or dusky, loss of consciousness etc<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">In case of choking Remember "<u>Five-and-Five"
approach</u> to delivering first aid:<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0cm; text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;">"<u>Five-and-Five" approach</u> <o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0cm; text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;">First, deliver five back blows between the person's shoulder
blades over the back of chest with your hand.<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0cm; text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;">Then give 5 abdominal thrusts. Perform five abdominal thrusts
(also known as the <u>Heimlich manoeuvre</u>).<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0cm; text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;">Alternate between 5 blows over the back of chest and 5 thrusts
until the blockage is dislodged.<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0cm; text-align: justify;">
<br /></div>
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">How to perform abdominal thrusts (Heimlich manoeuvre)?<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Stand behind the person. Wrap your arms around the waist. Bend
the person forward slightly. Make a fist with one hand. Position it slightly
above the person's navel. Grasp the fist with the other hand. Press hard into
the abdomen with a quick, upward thrust - as if trying to lift the person up.
Perform a total of 5 abdominal thrusts, if needed. If the blockage still isn't
dislodged, repeat the five-and-five cycle.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the person becomes unconscious, perform standard CPR with
chest compressions and rescue breaths. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: purple;">How to perform Heimlich manoeuvre on yourself? <o:p></o:p></span></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">First, if you're alone and choking call for help if possible.
Then perform abdominal thrusts to dislodge the item. Place a fist slightly
above your navel. Grasp your fist with the other hand and bend over a hard
surface like a half wall or chair. Press your fist inward and upward. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Injury / Wounds –First Aid<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">1.Stop the bleeding. Apply firm pressure with a clean cloth or
bandage.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">2.Clean the wound ideally with Normal Saline or clean water<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">3.Apply an antiseptic cream. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">4.Cover the wound with bandages to keep the wound clean and keep
harmful bacteria out.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: purple;">Use Pressure Points to Stop Severe Bleeding<o:p></o:p></span></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If bleeding does not stop by the application of direct pressure
over the wound, apply firm pressure over the pressure points. Pressure point is
an area where an artery can be pressed against an underlying bone so as to stop
the flow of blood.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Brachial Pressure Point-Middle of the Cubital fossa inner to
Biceps tendon. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: Times New Roman, serif; font-size: medium;"><span style="line-height: 115%;">Femoral Pressure Point-At the </span></span><span style="color: #002060; font-family: Times New Roman, serif;"><span style="font-size: 19px; line-height: 21px;">center</span></span><span style="color: #002060; font-family: Times New Roman, serif; font-size: medium;"><span style="line-height: 115%;"> of the groin ( Mid Inguinal
Point) <o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;">Routine use of tourniquet is not recommended except in near total
amputation of a limb with uncontrollable haemorrhage. Make sure that
tourniquet is applied as close to the major injury.</span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Puncture wound<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">A puncture wound doesn't usually cause excessive bleeding. Often
the wound seems to close almost instantly. But this doesn't mean treatment
isn't necessary. A puncture wound, such as from stepping on a nail, can be
dangerous because of the risk of infection. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Gunshot Wound<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">1.Call for emergency medical assistance. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">2.</span></b> <b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Make sure you are safe.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">3.</span></b><span style="font-size: 32pt; line-height: 115%;"> </span><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Also make sure that everyone's firearm is pointed away from any
other person(s), cleared of ammunition, safe and secured.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">4.</span></b><b><span style="font-size: 40pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Do not move the victim unless you must do so to keep him safe or
to access care<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">5.</span></b><b><span style="font-size: 30pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Act quickly. Time is your enemy in treating the victim. Victims
who reach medical facilities during the "Golden Hour" have a much
better likelihood of surviving.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">6.</span></b><span style="font-size: 27pt; line-height: 115%;"> </span><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Always look for an exit wound. Check the victim as thoroughly as
possible for other wounds that you may be unaware of. Pay special attention to
the armpit, buttocks or other difficult-to-see areas. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">7. Avoid
completely undressing the victim before emergency help arrives as this may
advance shock or</span></b><b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"> Hypothermia</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Blast Injury<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Injury occurs from being struck by material thrown by the blast
and<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">from being thrown by the blast.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Injuries to hollow organs, including the lungs, caused by the
shock wave from the blast leading to life-threatening breathing emergencies.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u>First aid for a blast injury affecting breathing</u><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If person is injured because of a blast you should suspect a
head or spinal injury therefore, prevent any movement.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Make sure the casualty is rested in a semi-sitting position if
there is no suspected head or spinal injury. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Monitor breathing and if ineffective, give assisted breathing.
If breathing stops, give Artificial Respiration.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Precautions:<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Wear all protective
clothing (hats, gloves, goggles, etc</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">.)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Make use of Shelters<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Varicose Vein Bleed<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Apply pressure bandage and keep the limb elevated to stop
bleeding from <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">the varicose veins.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Head Injury- First Aid</span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">The features of Head Injury in an adult are: - External
Bleeding, Internal Bleeding from Ear or Nose, Cerebro Spinal Fluid leakage from
the nose or ears, Severe headache, Change in level of consciousness,
Black-and-blue discoloration below the eyes or behind the ears, Cessation of
breathing, Confusion, Loss of balance, Weakness or an inability to use an arm
or leg, Unequal pupil size, Slurred speech, Seizures, Vomiting etc.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">The features of Head Injury in children are: - Any of the signs
or symptoms for adults, Persistent crying, Refusal to eat, Bulging in the soft
spot on the front of the head (infants).<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Keep the person still. Keep the head slightly lower down than
the chest so that if at all the person vomits the vomitus should not obstruct
the airway.</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Avoid moving the person's neck. If the person is wearing a
helmet, don't remove it. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Stop any bleeding. Apply firm pressure to the wound with sterile
gauze or a clean cloth. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Watch for changes in breathing and alertness. If the person
shows no signs of circulation begin CPR.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Things to Remember<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">External Bleeding-Apply Pressure Bandage to stop external
bleeding.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Internal Bleeding or CSF Leak-Do not try to stop it with
packing.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Head to be Tilted to one side-so that the vomitus may not
obstruct the air way</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">. </span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Do not pull out an impacted foreign body-it can do more
harm.</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Spinal
Injury- First Aid</span></u></b></div>
<div class="MsoNormal" style="page-break-after: avoid; text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b> <b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-language: EN-IN; mso-no-proof: yes;"><!--[endif]--></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Assume a person has a spinal injury if:1)There's evidence of a
head injury with an ongoing change in the person's level of consciousness, 2)The
person complains of severe pain in his or her neck or back,3)The person is not
moving his neck, 4)An injury has exerted substantial force on the back or head,
5)The person complains of weakness, numbness or paralysis or lacks control of
his or her limbs, bladder or bowels, 6)The neck or back is twisted or
positioned oddly</span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If injury to spine is suspected, keep the person still. Place
heavy towels on both sides of the neck or hold the head and neck to prevent
movement.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Provide as much first aid as possible without moving the
person's head or neck. If the person shows no signs of circulation begin CPR,
but do not tilt the head back to open the airway. Use your fingers to gently grasp
the jaw and lift it forward. If the person has no pulse, begin chest
compressions.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the person is wearing a helmet, remove it carefully to with
the help of another person stabilizing the head and neck together. You need at
least one other person to move him. With one of you at the head and another
along the side of the injured person, work together to keep the person's head,
neck and back aligned while rolling the person onto one side.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Log roll the victim with the help of another person on a Hard
Stretcher or Spine Board. Otherwise permanent paralysis or respiratory arrest
can occur.<o:p></o:p></span></b></div>
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<br /></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Syncope/ Shock - First Aid<o:p></o:p></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Lie down the patient on a flat surface. Lift both feet together
so that the blood supply of the brain is increased. <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don’t be panic.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Make the patient lie down on a flat surface. <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Lift both feet together so that the blood supply of the brain is
increased.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Make sure about the good aeration of the room <o:p></o:p></span></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Epistaxis/ Nose Bleed- First Aid<o:p></o:p></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Nosebleeds are common. It can be due to a local cause like a hit
on nose or as a part of head injury.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the nose bleed is a part of head injury the person may show
other features of head injury like loss of consciousness,</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> vomiting or seizures.
In the absence of these, one should think of a local cause.</span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Epistaxis due to a local cause:-Sit upright and lean forward.
Pinch the nose. Using thumb and index finger. Breathe through your mouth.
Continue to pinch for five to 10 minutes. Pinching exerts pressure to the
bleeding point on the nasal septum and often stops the flow of blood. <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">To prevent re-bleeding, don't pick or blow your nose and don't
bend down for several hours after the bleeding episode. During this time
remember to keep your head higher than the level of your heart.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Nasal pack with sterile gauze or an inflatable latex balloon to
put pressure on the blood vessel and stop the bleeding.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Ask if the person is taking any drugs like anti coagulants, such
as aspirin or warfarin or anti hypertensives.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Check the blood pressure. High blood pressure is one cause of
epistaxis in adult.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">The commonest cause of nose bleed in a child is Nose Picking or
keeping the finger inside the nose quite often.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Do not try to stop a nose bleed if it is as a part of Head Injury
(Internal Bleeding)<o:p></o:p></span></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Face Injury- First Aid<o:p></o:p></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">In serious face injury obstruction of the air way is a major
complication. Hence maintenance of air way is an important aspect in the first
aid. Oro pharyngeal air way can be kept for a patent airway. Even in the absence of this one can ensure a
patent airway by keeping the tongue forward.<o:p></o:p></span></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Neck Injury- First Aid<o:p></o:p></span></u></b></div>
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<span style="font-family: Verdana, sans-serif; font-size: 9pt; line-height: 115%;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%;"> </span></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">A strong suspicion is needed to rule out cervical spine injury.
Immobilization is the key principle.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">A penetrating injury in the neck can become fatal without
obvious bleeding.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;">Tying a bandage around the neck should not be done as it may do
more harm. <o:p></o:p></span></span></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Chest Injury- First Aid<o:p></o:p></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Chest Injury can be of two types-Penetrating/ Non Penetrating.
Penetrating injury can be as a result of Gun Shot Wound or stab injury.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Bleeding from a non penetrating injury can be dealt with
pressure bandage.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">But if a penetrating wound in the chest is suspected (person
will complain of chest pain and breathing difficulty), that wound should be
dressed using a broad pad. Air tight plaster must be applied over that. This is
to prevent entry of atmospheric air in to the chest cavity. This can result in
Tension Pneumothorax.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">The most comfortable posture for a person with chest injury is
sitting posture.</span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Hence ideal position of carrying a person with chest injury will
be sitting position.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">In case of Gun Shot Wounds, search for an exit wound at the
back.<o:p></o:p></span></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Abdominal Injury- First Aid<o:p></o:p></span></u></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Apply dry, sterile dressing to all open wounds.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Never pull out an impacted knife or metal piece. Stabilize
penetrating object.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-fareast-language: EN-IN; mso-no-proof: yes;"> </span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Never attempt to put the intestines back at the site of event!<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Place a clean saline soaked cloth over it and transport the
patient to the nearest hospital.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Never give water or food for the patient. Feeding of such
patient can worsen the condition. <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Ideal position of carrying a person with Abdominal Injury will
be supporting his back of chest and folding the knee, so that the abdominal
area gets relaxed.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Making the person lie can cause more discomfort for the patient.</span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Look for an exit wound at the back in case of Gun Shot Wounds.<o:p></o:p></span></b></div>
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<br /></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Fracture ( Broken Bone) - First Aid<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Signs of Fracture</span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">: Even gentle pressure or movement causes pain. The limb or
joint appears deformed. The bone has pierced the skin. In fracture femur, the
leg and foot turns outward abnormally.<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">First Aid<o:p></o:p></span></u></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don't move the person except if necessary to avoid further
injury. Take these actions immediately while waiting for medical help: <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Stop any bleeding. Apply pressure to the wound with a sterile
bandage, a clean cloth or a clean piece of clothing. <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Immobilize the injured area. <u>Don't try to realign the bone or
push a bone that's sticking out back in</u>. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If you've been trained in how to splint and professional help
isn't readily available, <u>apply a splint to the area above and below the
fracture sites</u>.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Padding the splints can help reduce discomfort</span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">. Apply ice packs to
limit swelling and help relieve pain until emergency personnel arrive. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don't apply ice directly to the skin</span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> — wrap the ice in a
towel, piece of cloth or some other material.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Treat for shock. If the person feels faint or is breathing in
short, rapid breaths lay the person down with the head slightly lower than the
trunk and, if possible, elevate the legs.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="page-break-after: avoid; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%;"> </span> </div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Burns-First Aid<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Put off the fire and shift the victim to safe place.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Hold the burned area under cool (not cold) running water for 10
or 15 minutes or until the pain subsides. Or immerse the burn in cool water or
cool it with cold compresses. Don't put ice directly over the burn.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Cover the burn with a sterile gauze bandage. Don't use fluffy
cotton, or other material that may get lint in the wound. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Putting ice directly on a burn can cause a person's body to
become too cold and cause further damage to the wound. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don't apply egg whites, butter or ointments to the burn. This could
cause infection.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don't break blisters. Broken blisters are more vulnerable to
infection.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don't remove burned clothing. However, do make sure the victim
is no longer in contact with the hot object.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don't immerse large severe burns in cold water. Doing so could
cause a drop in body temperature (hypothermia) and deterioration of blood
pressure and circulation (shock).<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If there is no breathing or other sign of circulation, begin
CPR.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Elevate the burned body part or parts. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Cover the area of the burn. Use a cool, moist, sterile bandage;
clean, moist cloth; or moist cloth towels.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Make the patient drink water as much as possible.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Chemical Burns- First Aid<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">1. Remove the chemical by first brushing any remaining dry
chemical and then rinsing the chemical off the skin surface with cool, gently
running water for 10 to 20 minutes or more'</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">2. Remove clothing or jewellery that has been contaminated by
the chemical.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">3. Wrap the burned area loosely with a dry, sterile dressing (if
available) or a clean cloth.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">4. Rewash the burned area for several more minutes if the person
experiences increased burning after the initial washing.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Chemical Splash in the Eye<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Flush the eye with water. Use clean, lukewarm tap water for at
least 20 minutes, and use whichever of these approaches is quickest: <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Get into the shower Hold the affected eye or eyes open.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don't rub the eye — this may cause further damage. Don't put
anything except water or saline rinse in the eye, and don't use any eye drops. If
available wear sun glasses to protect from the sunlight.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 1.0pt 4.0pt 1.0pt 4.0pt;">
<div class="MsoNormal" style="border: none; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 1.0pt 4.0pt 1.0pt 4.0pt; padding: 0cm; text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;">Take the chemical container or the name of the chemical with you
to the emergency department.</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
</div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Electric Shock- First Aid<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: Times New Roman, serif; font-size: medium;"><span style="line-height: 115%;">The danger from an electrical shock depends on the type of
current, how high the voltage is, how the current </span></span><span style="color: #002060; font-family: Times New Roman, serif;"><span style="font-size: 19px; line-height: 21px;">traveled</span></span><span style="color: #002060; font-family: Times New Roman, serif; font-size: medium;"><span style="line-height: 115%;"> through the body,
the person's overall health and how quickly the person is treated. <o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Call your local emergency number immediately if any of these
signs or symptoms occurs: <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Cardiac arrest, Heart rhythm problems (arrhythmias),
Breathlessness, Muscle pain and contractions, Burns, Seizures. Numbness (Neurologic
deficit), Unconsciousness.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">While waiting for medical help, follow these steps: <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Look first. Don't touch. The person may still be in contact with
the electrical source. Touching the person may pass the current through you.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Turn off the source of electricity, if possible. If not, move
the source away from you and the person, using a dry, non conducting object
made of cardboard, plastic or wood.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Check for signs of circulation (breathing, coughing or
movement). If absent, begin cardiopulmonary resuscitation (CPR) immediately.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Lay the person down and, if possible, position the head slightly
lower than the trunk with the legs elevated.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: #cc0000;">Caution</span></span></u></b><b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: #cc0000;">! </span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">Don't touch the person with your bare hands if he or she is
still in contact with the electrical current.<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;"><br /></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">Don't get near high-voltage wires until the power is turned off.
Stay at least 20 feet away — farther if wires are jumping and sparking.</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Heat Stroke- First Aid<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Heatstroke often results from exercise or heavy work in hot
environments combined with inadequate fluid intake. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Young children, older adults, people who are obese and people
born with an impaired ability to sweat are at high risk of heatstroke. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">What makes heatstroke severe and potentially life-threatening is
that the body's normal mechanisms for dealing with heat stress, such as
sweating and temperature control, become inadequate. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">The main sign of heatstroke is a markedly elevated body
temperature — generally greater than 104 F (40 C) — with changes in mental
status ranging from personality changes to confusion and coma. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Other signs and symptoms are:- dry and hot Skin, Tachycardia, Rapid
and shallow breathing, Elevated or lowered blood pressure, Cessation of
sweating, Irritability, confusion or unconsciousness, Feeling dizzy or
lightheaded, Headache, Nausea, Fainting, which may be the first sign in older
adults.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: purple;"><u>First aid measures for heatstroke: </u></span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: purple;"><u><br /></u></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Move the person out of the sun and into a shady or
air-conditioned space. Cool the person by covering with damp sheets or by
spraying with cool water. Direct air onto the person with a fan or newspaper.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Have the person drink cool water or other non alcoholic beverage
without caffeine.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">To prevent Heat stroke drink enough </span></b><b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">water and eat more salt during summer
exercises.</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Hypothermia- First Aid<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">When exposed to cold temperatures, hypothermia, can result. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Wet or inadequate clothing, falling into cold water and even not
covering your head during cold weather can increase your chances of
hypothermia. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Signs and symptoms of hypothermia include: Shivering, Slurred
speech, Abnormally slow breathing, Cold, Pale skin, Loss of coordination ,Fatigue,
lethargy or apathy, Confusion or memory loss, Bright red, cold skin (infants).<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><u><span style="color: purple;">First Aid measures of Hypothermia: </span></u><span style="color: #002060;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><u><span style="color: purple;"><br /></span></u></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Move the person out of the cold. If going indoors isn't
possible, protect the person from the wind, cover the head, and insulate the
individual from the cold ground.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Remove wet clothing. Replace wet things with a warm, dry
covering.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don't apply direct heat. Don't use hot water, a heating pad or a
heating lamp to warm the person.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Instead, apply warm
compresses to the centre of the body — head, neck, chest and groin. Don't
attempt to warm the arms and legs. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Heat applied to the arms and legs forces cold blood back toward
the heart, lungs and brain, causing the core body temperature to drop. This can
be fatal.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don't give the person alcohol. Offer warm non alcoholic drinks,
unless the person is vomiting.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don't massage or rub the person. Handle people with hypothermia
gently because their skin may be frostbitten, and rubbing frostbitten tissue
can cause severe damage.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Snake Bite</span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: purple;">Do’s</span><span style="color: #002060;"><o:p></o:p></span></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Make sure the victim and others are a safe distance away from
the snake and try to memorize its appearance. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Keep the victim calm. Give him enough courage and confidence. Take
control of the situation without becoming panic. Reassure him about the
recovery.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Immobilize the bitten arm or leg and prevent any movement of the
victim as far as possible to block the poison from spreading throughout the
body.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Never let the victim run. Only allow him to walk if absolutely unavoidable.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Remove the wrist watch, ring, bangles and jewellery that may
become constrictive if the limb becomes oedematous.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Cleanse the wound and cover it with a clean, dry dressing.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">In case of neurological bites (All elapid's and hydrophilic:
Cobras, King Cobras, Kraits, Coral snakes and Sea Snakes), pressure
immobilization (Sutherland method - with Long crepe or other stretchy bandage
(5 - 10 cm wide, several rolls) and splint to be applied immediately to the
bitten limb, starting at the digits and working up to the groin or arm pit.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Take the victim to hospital as soon as possible.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Note the time of the bite and the progression of any visible symptoms.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Give the doctor a brief and correct description of the bite and
symptoms.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: purple;">Don’ts</span><span style="color: #002060;"><o:p></o:p></span></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Do NOT waste time with trying to get any elaborate first aid.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Never try to suck out the venom. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don't cut the wound further to let out blood or to remove the
venom. Never tamper with the site of the bit, as bite marks may give a
clue about the type of snake.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don't give the victim coffee or alcohol.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Do not tie a tourniquet or use ice.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Don't try to capture the snake, but try to remember its colour
and shape so you can describe it, which will help in the treatment.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Never go to traditional healers or try home remedies.<u> Anti
snake venom serum is the only proven cure for venomous snakebites.<o:p></o:p></u></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><u><br /></u></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">All the above actions often cause more damage than good.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: purple;">Pressure immobilization (Sutherland method) </span><span style="color: #002060;"><o:p></o:p></span></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">The pressure-immobilisation first aid technique was developed in
the 1970's by Professor Struan Sutherland. Its purpose is to retard the
movement of venom from the bite site into the circulation, thus "buying
time" for the patient to reach medical care.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Research with snake venom has shown that very little venom
reaches the blood stream if firm pressure is applied over the bitten area and
the limb is immobilised. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Pressure-immobilisation was initially developed to treat
snakebite, but it is also applicable to bites and stings by some other venomous
creatures. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;">How to give Pressure-immobilisation?</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;"><br /></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Step1.</span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Apply a broad pressure bandage or elastocrepe bandage from
below upwards and over the bite site as soon as possible. Do not remove
trousers, as this will help the venom to enter into the bloodstream.</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">The bandage should be as tight as you would apply to a sprained
ankle. The patient should avoid any unnecessary movements.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Step2.</span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Extend the bandages as high as possible (ideally up to the groin
or in the case of arm, up to the armpit).<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Step3. </span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Apply a splint to, immobilize the adjacent joints.</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Step4.</span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Bind the splint firmly to the limb as possible. Walking should
be restricted.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">In cases of bites on the hand and forearm : apply elastocrepe
bandage up to the axilla, use a splint to the elbow and use a cuff and collar sling. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;">How to Prevent Snakebite?</span></span></u></b><b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;"> </span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">(</span><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">Prevention is always better than cure!</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> )</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">To reduce your risk of snakebite, avoid touching any snake.
Instead, back away slowly. Most snakes avoid people if possible and bite only
when threatened or surprised.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">• Take care when clearing vegetation, or dry leaves in your
garden.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: Times New Roman, serif; font-size: medium;"><span style="line-height: 115%;">• Supervise kids in the outdoors, especially in a green </span></span><span style="color: #002060; font-family: Times New Roman, serif;"><span style="font-size: 19px; line-height: 21px;">neighborhood</span></span><span style="color: #002060; font-family: Times New Roman, serif; font-size: medium;"><span style="line-height: 115%;">.<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: Times New Roman, serif; font-size: medium;"><span style="line-height: 115%;"><br /></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">• Use torch /flashlight at night and keep wearing shoes.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">• Check shoes before wearing them.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">• Watch your step while walking and see the area before you sit!<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">• Keep your backyard free of junk and make sure your solid waste
is managed properly. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">• If you see a snake, do nothing. Let it go. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">• Do not try to pick it up or kill it. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">• If a snake has entered your premises, call professional snake
rescuers.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Carbon Monoxide Poisoning- First Aid<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">1.Get the Person to Fresh Air<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">2.Move the person away from carbon monoxide area.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">3.If the person is unconscious, check for injuries before
moving.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">4.Turn off carbon monoxide source if you can do so safely.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">5. Begin CPR, if the person is not breathing normally.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">6. Call for Help<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">7. Continue CPR until the person begins breathing or emergency
help arrives.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">8. Give Oxygen if facilities are available<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Insect Bite<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Signs and symptoms of an insect bite result from the injection
of venom or other substances into body.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">The venom causes pain and sometimes triggers an allergic
reaction. Nausea, swelling of lips, breathlessness, abdominal pain, hypotension
(shock).<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Bites from bees, wasps are typically the most troublesome. Bites
from mosquitoes, ticks, biting flies, ants, scorpions and some spiders also can
cause reactions. Scorpion and ant bites can be very severe. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Move the victim to a safe area to avoid more stings. <u>Remove
the stinger, especially if it's stuck on the skin. </u>This will prevent the
release of more venom. <u>Wash the area with soap and water. Apply a cold pack
or cloth filled with ice to reduce pain and swelling</u>. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Severe allergic reactions are manifested as Difficulty breathing,
swelling of the lips or throat, Faintness, Dizziness, Confusion, Tachycardia, Nausea,
cramps and vomiting.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Loosen tight clothing and cover the person with a blanket. Don't
give anything to drink.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Turn the person on his or her side to prevent choking if there's
vomiting or bleeding from the mouth.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Begin CPR if there are no signs of circulation, such as
breathing, coughing or movement.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Dog Bite /Animal Bite- First Aid</span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">For minor wounds. If the bite barely breaks the skin and there's
no danger of rabies, treat it as a minor wound. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Wash the wound thoroughly with soap and water. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Apply an antiseptic cream to prevent infection and cover the
bite with a clean bandage.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">For deep wounds. If the animal bite creates a deep puncture of
the skin or the skin is badly torn and bleeding, apply pressure with a clean,
dry cloth to stop the bleeding.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Domestic pets cause most animal bites. Dogs are more likely to
bite than cats. Cat bites, however, are more likely to cause infection because
they are usually puncture wounds and can't be thoroughly cleaned.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Bites from nonimmunized
domestic animals and wild animals carry the risk of rabies. Rabies is more
common in bats and foxes than in cats and dogs. Rabbits, squirrels and other
rodents rarely carry rabies. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Children or adults exposed to bats, or who are sleeping and
discover bats present, seek medical advice, even if they don't think they've
been bitten. This is because bat bite marks are hard to see.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Human Bites- First Aid<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Human bites can be as dangerous as or even more dangerous than
animal bites because of the types of bacteria and viruses contained in the
human mouth. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If someone cuts his knuckles on another person's teeth, as might
happen in a fight, this is also considered a human bite. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If you sustain a human bite that breaks the skin: <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">1. Wash the wound thoroughly with soap and water.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">2. Stop the bleeding by applying pressure with a clean, dry
cloth.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">3. Apply an antibiotic cream to prevent infection.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">4. Apply a clean bandage. Cover the affected area with a non stick
bandage.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">5. Tetanus toxoid injection and antibiotic prophylaxis are indicated.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Such wounds can have a broken piece of tooth inside. Hence it is
advised to take an X ray of the affected part.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Stroke- First Aid<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">A stroke occurs when there's bleeding into brain or when normal
blood flow to brain is blocked.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> A stroke is a true
emergency. The sooner treatment is given; the more likely it is that damage can
be minimized. Every moment counts. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">In the event of a possible stroke, use </span><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">FAST</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> to remember warning
signs. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">F</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">ace. Does the face droop on one side trying to smile?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">A</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">rms. Is one arm lower when trying to raise both arms?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">S</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">peech. Can a simple sentence be repeated? Is speech slurred or
strange?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: magenta;">T</span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">ime. During a stroke every minute counts. If you observe any of
these signs, call your local emergency number immediately.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Other signs and symptoms of a stroke include: <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Weakness or numbness on one side of your body including either
leg, </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Dimness, blurring or loss of vision, particularly in one eye, </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Severe headache with no apparent
cause, </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Unexplained dizziness, unsteadiness or a sudden fall, especially
if accompanied by any of the other signs or symptoms.</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">First Aid to Stroke is to keep the air way patent and to prevent
further harm because of the paralysis.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Risk factors for stroke include having high blood pressure,
having had a previous stroke, smoking, having diabetes and having heart
disease. The risk of stroke increases with age.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Poisoning- First Aid<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Many conditions mimic the signs and symptoms of poisoning,
including seizures, alcohol intoxication, strokes and insulin reactions. </span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Look
for Empty medication bottles or scattered pills at the scene.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Signs and symptoms of poisoning <o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Burns or redness around the mouth and lips, from drinking
certain poisons<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Breathe that smells like chemicals, such as kerosene or paint
thinner<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Burns, stains and odours on the person, on clothing.Vomiting, breathlessness,
sleepiness, confusion or other unexpected signs<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Drowsy or unconscious, Uncontrollably restless or agitated,Having
seizures<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">What to do while waiting for help?<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the person has been exposed to poisonous fumes, such as
carbon monoxide, get him or her into fresh air immediately.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the person swallowed the poison, remove anything remaining in
the mouth.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the suspected poison is a household cleaner or other
chemical, read the label and follow instructions for accidental poisoning.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the poison spilled on the person's clothing, skin or eyes,
remove the clothing. Flush the skin or eyes with cool or lukewarm water, such
as by using a shower for 20 minutes or until help arrives.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Make sure the person is breathing. If not, start CPR and Rescue
breathing.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Take the poison container (or any pill bottles) with you to the
hospital.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">What NOT to do</span></u></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> Don't give ipecac syrup or do anything to induce vomiting.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Amputated Limb/ Finger<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> </span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Calm the injured person. Keep the bleeding under control with
pressure bandage. Elevate the injured arm.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the injured person is unaware of the amputation, cover the
amputation site with a cloth to protect the person from psychological trauma.
They will be more equipped to learn of the amputation in a more stable
environment.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the finger is near by, collect it, but do not compromise the
care of the victim to find the finger. <o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;">Remember, the person will survive without the finger if they
receive prompt appropriate care. The finger will do nothing for them if they
bleed to death!</span><span style="color: #002060;"><o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Wrap the finger in a clean, slightly damp but not dripping wet
paper towel.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">If the victim is stable, rinse the finger if it is dirty, then
place it in a plastic sealable bag.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Place the bag into another one filled with ice or cold water.
Never place the finger directly on cold water or ice as this could cause
frostbite in the finger and damage the tissue so that it can't be reattached.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">Once the medical personnel arrive, give them the finger so it
can be transported to the hospital and possibly reattached.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><u><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">Mass
Casualty Management- Triage<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">Triage is
allocation of priority to a group of injured persons so as to get maximum
benefit to maximum number of persons with the available resources.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"> </span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">As per triage,
when a mass casualty occurs we group the patients in to four categories as follows
and a color coded disc is worn over the patient’s collar for the early
identification during transport.<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">Priority
1-Life saving emergency-Red Disc<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">Priority
2-Limb saving emergency-Yellow Disc<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">Priority
3-Minor Wounds-Green Disc</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<b><span lang="EN-US" style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;">Priority
4-Severely Injured-No scope of recovery-Blue Disc</span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;"><u>Practical Exercises</u></span></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;"><br /></span></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">1.How to check for Pulse- Radial/ Brachial /Carotid and Femoral<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">2.How to check for Respiration<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">3.How to give CPR<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">4.How to check for Spine Injury<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">6.How to make a modified stretcher<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">7.How to give a splinting<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">8.How to give Bandage<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">9.Evacuation Methods<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal">
<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">10.Practice to give courage to the victim.<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="color: blue; font-family: Times New Roman, serif;"><span style="font-size: 19px; line-height: 21px;"><b><u>MCQs</u></b></span></span><b><span style="font-family: 'Times New Roman', serif; font-size: 14pt; line-height: 115%;"><span style="color: blue;"><u> </u> </span></span><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;"> <u>25
Marks</u></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">1. Who can give First Aid ?<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">A)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A Doctor C) A
Health Worker<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">B)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A Qualified person in First Aid D) Anybody </span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">2. What is the normal Respiratory Rate per minute for an Adult?<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">A)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">72 C)
16-20<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">B)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">110 D)
98 </span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">3. Standard CPR is <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt;">A) One Chest Compression, One Rescue Breathing<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt;">B) Two Chest Compressions, Two Rescue Breathing<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt;">C) Ten Chest Compressions, Two Rescue Breathing<br />
D) Thirty Chest Compressions, Two Rescue Breathing<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">4. What is the </span></b> <b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">ABC of CPR?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Act, Beware, Care<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Age, Basic, Care<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Airway, Breathing, Circulation<br />
D) Anybody, Basic, Care<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">5. What is the </span></b> <b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">first aid for Choking?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Back Blows and Abdominal Thrusts<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Make the person lay down<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Make the person sit <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) Apply Bandage<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">6. What is the </span></b> <b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">ideal position for evacuation of a chest injury patient?</span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Lying<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Walking<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Standing <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) Sitting<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">7 . What is the </span></b> <b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">ideal position for evacuation of a head injury patient?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Lying<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Leg down <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Head tilted to one side<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) Sitting<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">8. A spine injury patient should be shifted by<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Pulling the patient<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Bending the spine <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Lying in a Hard platform<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) Sitting<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">9. What is the </span></b> <b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">first aid for Syncope?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Leg lifting<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Head rising<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Bandaging<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) Injections<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">10. Which is Not correct for a chest injury patient?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Sitting position<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Air Tight Bandaging<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Broad Pads for Dressing<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) Small Pieces of cotton for Dressing<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">11. Which is the correct first aid for Abdominal injury?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Push the intestines back<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Allowing the patient to drink<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Apply splints<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) Lying with knee bend position<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">12. Which is the correct first aid for Fracture?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Apply Ice Directly<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Realign the bone<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Apply splints<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) Glucose Drip<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">13. Which is the correct first aid for Gun Shot Injury?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Apply pressure dressing<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Remove the bullet from the wound<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Shout at the patient<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) Give Blood Transfusion<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> </span></b><b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"> </span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">14. Which is correct for Blast Injury?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Amputation of a part of Limb<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Breathing Difficulty<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Splinter Injury<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) All of the Above<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">15. Which is the correct First Aid for Burns?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Break the Blisters<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Apply Ice Directly<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Apply Egg white<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) Ask the patient to drink plenty of water<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">16. Which is the correct First Aid for Snake Bite?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Suck out the venom<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Kill the snake first<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Make the patient Run<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) Give Courage and do Pressure immobilisation<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">17. Which is the correct First Aid for Carbon Monoxide Poisoning?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Give Fresh Air<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Apply Ice<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Apply Splint<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) Pressure Bandage<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">18. Which is the correct First Aid for Dog Bite?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Kill the Dog<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Give injections<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Give Blood Transfusion <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) Wash the wound with Soap and water<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">19.What are the signs of Fracture<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) Pain<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) Deformity<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) Abnormal mobilty <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) All<o:p></o:p></span></b></div>
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<br /></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">20.What is the normal pulse rate per minute?<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">A) 16<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">B) 72<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">C) 120 <o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">D) 80<o:p></o:p></span></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Write True or False<o:p></o:p></span></u></b></div>
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<b><u><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></u></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">21.Nose bleed in a head injury patient should be stopped- True /
False<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">22.Impacted foreign body like splinters, metal piece or bullet
should be removed immediately as a first aid- True / False<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">23.Support a fractured limb gives relief to the patient- True /
False<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">24.HIV spreads through contaminated blood- True /
False<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">25.Smoking and alcohol are injurious to health- True / False<o:p></o:p></span></b></div>
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<b><span style="color: #002060; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">Answers.</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">1. D</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">2. C</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">3. D</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">4. C</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">5. A</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">6. D</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">7. C</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">8. C</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">9. A</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">10. D</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">11. D</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">12. C</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">13. A</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">14. D</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">15. D</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">16. D</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">17. A</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">18. D</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">19. D</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">20. B</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">21. </span></span></b><b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">False</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">22. </span></span></b><b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">False</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">23. True</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">24.</span></span></b><b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 18px;"><span style="color: purple;">True</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 18px;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;">25.</span></span></b><b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 18px;"><span style="color: purple;">True</span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 18px;"><span style="color: purple;"><br /></span></span></b></div>
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<b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;"><span style="color: purple;"><br /></span></span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com1tag:blogger.com,1999:blog-663566220018767630.post-60170469542340947332013-07-11T16:03:00.002-07:002013-07-11T16:03:35.572-07:00Sigmoid Volvulus<div dir="ltr" style="text-align: left;" trbidi="on">
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXlK6ZHAXraIaBdPHVJmw1JzJrrp7SlzUwh27BrU8acTUvPNctoPPDuXwoLCnwaHCZ69OB9blACghkA66ySDxzDUDvXMwZ3-gcuSw4Py5mOsAisBfM1G7rJ2sZST728my4jzdAq2gafr4/s1600/20130701_014243.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" nya="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXlK6ZHAXraIaBdPHVJmw1JzJrrp7SlzUwh27BrU8acTUvPNctoPPDuXwoLCnwaHCZ69OB9blACghkA66ySDxzDUDvXMwZ3-gcuSw4Py5mOsAisBfM1G7rJ2sZST728my4jzdAq2gafr4/s320/20130701_014243.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Sigmoid Vovulus</td></tr>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Sigmoid Volvulus<o:p></o:p></span></b></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #ff0066; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Volvulus</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"> is the twisting up of a loop of intestine on its mesenteric axis.<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">It can lead to partial or complete intestinal obstruction.<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">The volvulus is most common in the Sigmoid colon due to the long mesentery and comparatively loaded colon.<o:p></o:p></span></b></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Radiological Appearance of Volvulus is called Omega Sign/ Inverted U Appearance or </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #ff0066; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Pneumatic Tyre Appearance</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><o:p></o:p></span></b></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><u><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Treatment <o:p></o:p></span></u></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Resuscitation <o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Non operative decompression using a Rectal Tube<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Laparotomy, </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #ff0066; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Detorsion , Resection and primary anastamosis</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">.<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><u><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">What is </span></u></b><b style="mso-bidi-font-weight: normal;"><u><span lang="EN-US" style="color: #7030a0; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Volvulus Belt Countries?</span></u></b><b style="mso-bidi-font-weight: normal;"><u><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>Volvulus Belt Countries are <span style="mso-spacerun: yes;"> </span>South America, Africa , The Middle East, India and Russia, where the incidence of colonic volvulus is high.</span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com0tag:blogger.com,1999:blog-663566220018767630.post-9847680244466549542013-07-11T07:12:00.000-07:002013-08-20T07:11:10.115-07:00Amyand's Hernia<div dir="ltr" style="text-align: left;" trbidi="on">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifEw6OnfL1Rz-4WHDiUzoNUNJEnuy3PpPHuvW5_Wp4eYfy6yvAciyy5U8xDMBbgFckxP-JCTteK6rqwjH57QhB5UKnq_KfsejUPj4pYFjdsvrmjgtYbnsSxBOC-yPyhWEOnspXkE5p3X8/s1600/20130701_092009.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEifEw6OnfL1Rz-4WHDiUzoNUNJEnuy3PpPHuvW5_Wp4eYfy6yvAciyy5U8xDMBbgFckxP-JCTteK6rqwjH57QhB5UKnq_KfsejUPj4pYFjdsvrmjgtYbnsSxBOC-yPyhWEOnspXkE5p3X8/s320/20130701_092009.jpg" height="240" nya="true" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Amyand's Hernia</td></tr>
</tbody></table>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5WuGhkF8ov48UiEhssUmOOWPoMhyphenhyphenlLKrgkqhH4V5YnnAnc-xQOO65s04CFb1mJ8U1gqN_-qs-uUJsKI7v7VV4dGVD-1ZEdq31QOB7TPaeA8lCafTBJ7JAeAolkuDeQRtuHpt0Feu1Kv8/s1600/20130701_092451.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5WuGhkF8ov48UiEhssUmOOWPoMhyphenhyphenlLKrgkqhH4V5YnnAnc-xQOO65s04CFb1mJ8U1gqN_-qs-uUJsKI7v7VV4dGVD-1ZEdq31QOB7TPaeA8lCafTBJ7JAeAolkuDeQRtuHpt0Feu1Kv8/s1600/20130701_092451.jpg" height="240" width="320" /></a></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGinyzYfJoi7yT6YIZojQ5CtUuunYNecccIqJ2CJSUHFlzgVt69NIbBjLsoKQNsDOqe5ZUO9QNqj0lQzADq602Ey50OYsehxD2D7mh-EmvtHPl4Sly6W6zfLBCWmoeQYUA7BEXt0diKoI/s1600/20130701_091902.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGinyzYfJoi7yT6YIZojQ5CtUuunYNecccIqJ2CJSUHFlzgVt69NIbBjLsoKQNsDOqe5ZUO9QNqj0lQzADq602Ey50OYsehxD2D7mh-EmvtHPl4Sly6W6zfLBCWmoeQYUA7BEXt0diKoI/s320/20130701_091902.jpg" height="240" nya="true" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Amyand's Hernia</td></tr>
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<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">What is an Amyand's hernia?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Amyand's hernia is an inguinal hernia with Vermiform Appendix as the content.<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">First documented successful appendectomy was done by Claudius Amyand, Sergeant-surgeon to King George II of England, in 1735.</span></b></div>
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<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">What is an Inflamed Hernia?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">When the hernia sac contains an inflamed organ like Vermiform Appendix, Salpynx or Meckel’s Diverticulum it is called Inflamed Hernia.<o:p></o:p></span></b></div>
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<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">What is an Ogilvie Hernia?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">A direct hernia occurring through the defect in the conjoint tendon is called Ogilvie hernia. <o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">What is a Sliding Hernia/ Hernia-en-Glissade?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">A hernia in which the viscous (Caecum /Left colon or Urinary Bladder) forms the posterior wall of the hernia sac.<o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">What is a Richter’s Hernia?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">A hernia in which the content is the circumference of the intestine.<o:p></o:p></span></b></div>
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<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">What is a Littre’s Hernia?<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">A hernia in which the content is Meckel’s diverticulam<o:p></o:p></span></b></div>
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<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">What is a Maydl’s<span style="mso-spacerun: yes;"> </span>Hernia?<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">A hernia in which the content is W shaped loop of the intestine. Hence it is also called Hernia-en-W<o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">What is a Giant Hernia?<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">A hernia which hangs down below the mid thigh of the patient on standing position is called a Giant Hernia.<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">What is Nyhus Classification of Hernia?<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Type 1</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"> : Indirect inguinal hernia, internal ring normal</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Type 2 </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">: Indirect inguinal hernia, internal ring dilated,</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>posterior inguinal wall intact;</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>inferior deep epigastric vessels not displaced</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Type3</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"> : Posterior wall defect</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>3a* <span style="mso-bidi-font-weight: bold;">Direct inguinal hernia</span></span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>3b* Indirect inguinal hernia, internal ring dilated,<span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>medially encroaching on transversalis fascia</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>3c* Femoral hernia</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span lang="EN-US" style="mso-bidi-font-weight: bold;">Type4</span><span lang="EN-US"> : Recurrent hernia<o:p></o:p></span></span></b></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5WuGhkF8ov48UiEhssUmOOWPoMhyphenhyphenlLKrgkqhH4V5YnnAnc-xQOO65s04CFb1mJ8U1gqN_-qs-uUJsKI7v7VV4dGVD-1ZEdq31QOB7TPaeA8lCafTBJ7JAeAolkuDeQRtuHpt0Feu1Kv8/s1600/20130701_092451.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5WuGhkF8ov48UiEhssUmOOWPoMhyphenhyphenlLKrgkqhH4V5YnnAnc-xQOO65s04CFb1mJ8U1gqN_-qs-uUJsKI7v7VV4dGVD-1ZEdq31QOB7TPaeA8lCafTBJ7JAeAolkuDeQRtuHpt0Feu1Kv8/s1600/20130701_092451.jpg" height="240" width="320" /></a></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com1tag:blogger.com,1999:blog-663566220018767630.post-73713713645645291632013-07-04T17:39:00.000-07:002013-08-20T07:12:17.250-07:00Torsion Testis<div dir="ltr" style="text-align: left;" trbidi="on">
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Torsion Testis
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><br /></span></b></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBkgn1Jx_hjfK8n6giarj263ww1MyLwWfX8h76RZiM5arbKsjUKQ1ybCJjXMywzGP1ADdSjAcJGMN0_B7FuJNPkMEbt5_NzN2dD85Hsf-zvmSdfazVIgAk82XUc8c5RWE7ZEzuS5D9Ph0/s1600/20130630_195244.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBkgn1Jx_hjfK8n6giarj263ww1MyLwWfX8h76RZiM5arbKsjUKQ1ybCJjXMywzGP1ADdSjAcJGMN0_B7FuJNPkMEbt5_NzN2dD85Hsf-zvmSdfazVIgAk82XUc8c5RWE7ZEzuS5D9Ph0/s320/20130630_195244.jpg" height="240" oya="true" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><strong><span style="color: blue;">Torsion Testis - Left</span></strong></td></tr>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMdz4VU-aBQdRW_BC9eb2ojibAViNL5aQmn5QDJkCPeF-I6MTSwUG5E2qdKtQDs_GAgDfsdBzjRxrj4ra_1saLfAmbMyCBGeZluJIq9vK1lIQJIaPd7rfACWquxjy2v2ku0xMDCKF343Y/s1600/20130630_201021.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMdz4VU-aBQdRW_BC9eb2ojibAViNL5aQmn5QDJkCPeF-I6MTSwUG5E2qdKtQDs_GAgDfsdBzjRxrj4ra_1saLfAmbMyCBGeZluJIq9vK1lIQJIaPd7rfACWquxjy2v2ku0xMDCKF343Y/s1600/20130630_201021.jpg" height="240" width="320" /></a></span></b></div>
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"> <b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"></span></b></span></b><br />
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: magenta;"><u>Testicular torsion</u></span> is a Surgical Emergency</span></b></span></b></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">
</span></b>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><u><span style="color: purple;">Common Age Group</span></u>: 10-25 Years<o:p></o:p></span></b></span></b></div>
<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><u><span style="color: purple;">Clinical Features:</span></u> <o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Sudden onset of pain in the testis, groin or Lower Abdomen<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Associated nausea or vomiting may be present<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">The affected testis lies in a horizontal position or pulled up position.<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: purple;"><u>Differential Diagnosis<o:p></o:p></u></span></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Acute Epididymo Orchitis<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Strangulated Inguinal Hernia<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Testicular Trauma<o:p></o:p></span></b></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">In Acute Epididymo Orchitis, elevation of the testis or scrotal support results in the relief of <span style="mso-spacerun: yes;"> </span>pain.<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">In Torsion testis elevation of the testis results in aggravation of<span style="mso-spacerun: yes;"> </span>pain.<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: purple;"><u>Specific Investigation<o:p></o:p></u></span></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Doppler Ultrasound<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: purple;"><u>Treatment<o:p></o:p></u></span></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Scrotal Exploration. Untwist the torsion of the spermatic cord. Look for the viability of the testis. If the testis is viable, fix the tunica albugenia to the scrotal wall. If the testis is gangrenous a low orchidectomy is performed. Opposite side testis is also fixed as a precaution during the same operation.<o:p></o:p></span></b></div>
</span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com0tag:blogger.com,1999:blog-663566220018767630.post-30965471965600259282013-07-04T05:19:00.000-07:002013-07-04T05:19:25.714-07:00Penetrating wound Abdomen-Splenic Injury<div dir="ltr" style="text-align: left;" trbidi="on">
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Penetrating wound Abdomen- Splenic Injury</span></span></b></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7h2QvBK6_F-LM4fKN8BcL51JjJnliS9I7RXLSvzG3ockRwlt9ExFB9tGTcWzTT9bVGOcFDGPJk92Jw-mOjwZKTPrkvy-IPmrp1o-RTdrY2McjwbnAzLZ9sqDAyUnFbfv99PRwUJpqcFM/s1600/20130630_214238.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7h2QvBK6_F-LM4fKN8BcL51JjJnliS9I7RXLSvzG3ockRwlt9ExFB9tGTcWzTT9bVGOcFDGPJk92Jw-mOjwZKTPrkvy-IPmrp1o-RTdrY2McjwbnAzLZ9sqDAyUnFbfv99PRwUJpqcFM/s320/20130630_214238.jpg" height="240" width="320" xya="true" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><strong><span style="color: #20124d;">Penetrating Stab Injury Abdomen</span></strong></td></tr>
</tbody></table>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #7030a0; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Management of Splenic Injury<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: blue;">Primary Survey and Resuscitation</span></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>A- Airway maintenance with control of Cervical Spine</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>B- Breathing</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>C-Circulation-Intravenous Fluids</span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>D- Dysfunction of CNS Assessment</span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span>E- Exposure in the Controlled Environment<o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: blue;">Secondary Survey</span></span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"> :- </span></b><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Detailed Head to Foot Examination</span></b><b><span lang="EN-US" style="color: white; font-family: 'Times New Roman','serif'; font-size: 32pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: +mn-ea; mso-fareast-language: EN-IN; text-shadow: auto;"> </span></b><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Head to find out other associated Injuries:-</span></b></div>
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<div class="MsoNormal" style="margin: 0cm 0cm 10pt 36pt; mso-list: l0 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7pt 'Times New Roman';"> </span></span></span><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Face</span></b><b><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt 36pt; mso-list: l0 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7pt 'Times New Roman';"> </span></span></span><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Chest</span></b><b><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt 36pt; mso-list: l0 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7pt 'Times New Roman';"> </span></span></span><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Abdomen</span></b><b><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt 36pt; mso-list: l0 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7pt 'Times New Roman';"> </span></span></span><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Pelvis and Perineum</span></b><b><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt 36pt; mso-list: l0 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7pt 'Times New Roman';"> </span></span></span><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Extremities</span></b><b><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt 36pt; mso-list: l0 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7pt 'Times New Roman';"> </span></span></span><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">General</span></b><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"> </span></b><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">examination of vital signs</span></b><b><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt 36pt; mso-list: l0 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7pt 'Times New Roman';"> </span></span></span><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Local</span></b><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"> </span></b><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Inspect anterior abdomen, lower thorax, perineum</span></b><b><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin: 0cm 0cm 10pt 36pt; mso-list: l0 level1 lfo2; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">q<span style="font: 7pt 'Times New Roman';"> </span></span></span><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Log roll to inspect posterior abdomen</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">. </span></b><b><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: blue;">Definitive care</span> - </span></b><b><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Investigations and Treatment<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><o:p> </o:p></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><o:p> </o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: purple;">Signs of Abdominal Trauma</span></span></b></div>
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<div class="MsoNormal" style="margin: 0cm 0cm 10pt 36pt; mso-list: l2 level1 lfo3; tab-stops: list 36.0pt; text-indent: -18pt;">
<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7pt 'Times New Roman';"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Tachycardia</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7pt 'Times New Roman';"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Hypotension</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7pt 'Times New Roman';"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Pallor</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7pt 'Times New Roman';"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Restriction of Abdominal Movements</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7pt 'Times New Roman';"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Grey Turners Sign/ Cullen’s Sign</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7pt 'Times New Roman';"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Rigidity</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7pt 'Times New Roman';"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Ballance’s Sign</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7pt 'Times New Roman';"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Absence of Bowel Sounds</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: purple;">What is </span><span style="color: magenta;">Ballance’s Sign?<o:p></o:p></span></span></b></div>
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<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7pt 'Times New Roman';"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Shifting Dullness on the Right of Abdomen</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7pt 'Times New Roman';"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Dull note on Percussion on the Left of Abdomen</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7pt 'Times New Roman';"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Due to Early Coagulation of Blood in the Left of Abdomen in Splenic Trauma</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: purple;">What is the difference between Guarding and Rigidity ?</span></span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7pt 'Times New Roman';"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Guarding is the voluntary contraction of the abdominal wall muscles</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<span style="color: #002060; font-family: Wingdings; font-size: 14pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7pt 'Times New Roman';"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Rigidity is the involuntary contraction of the abdominal wall muscles</span></b><b style="mso-bidi-font-weight: normal;"><span style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: purple;">What are the treatment options available for Splenic Injury?<o:p></o:p></span></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: #20124d;">Non Operative Management</span> ( <span style="color: magenta;">Preferred</span>)<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Splenorraphy<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Partial Splenectomy<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Splenic Auto Transplantation<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Splenectomy<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">What is the rationale of opting for <span style="color: magenta;">Non Operative Management</span>?<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">1.<span style="font: 7pt 'Times New Roman';"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">To avoid complications with splenectomy like iatrogenic injury to the pancreas.<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">2.<span style="font: 7pt 'Times New Roman';"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">To avoid immunosuppressive effects of Splenectomy-like OPSI ( Overwhelming Post Splenectomy Infection)<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;"><span style="font: 7pt 'Times New Roman';"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><o:p> </o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">What are the indications of <span style="color: magenta;">Angio Embolization</span> in Splenic Injury?<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">1.<span style="font: 7pt 'Times New Roman';"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Extravasation of the contrast during CECT Abdomen<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">2.<span style="font: 7pt 'Times New Roman';"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Delayed splenic rupture/ Secondary splenic injury due the Pseudo Aneurysm Bleed.<o:p></o:p></span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com0tag:blogger.com,1999:blog-663566220018767630.post-72496496173059160842013-06-23T07:44:00.001-07:002013-06-23T07:44:25.844-07:00Mesenteric Cyst<div dir="ltr" style="text-align: left;" trbidi="on">
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Mesenteric Cyst
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnEwP1JexryLlGS_9c-ldM40f8agylSOZ0Dw3f1XzOefOolAXnXDhbykVAwDyENpBtKvCgDQaqP5xiTiYnHbRk7qLsXG_aB5aP4gJU3Gm41en-JnHm1Iv6zS47a3Shr3xjFF2WCnDrD7A/s1600/20130619_103830.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnEwP1JexryLlGS_9c-ldM40f8agylSOZ0Dw3f1XzOefOolAXnXDhbykVAwDyENpBtKvCgDQaqP5xiTiYnHbRk7qLsXG_aB5aP4gJU3Gm41en-JnHm1Iv6zS47a3Shr3xjFF2WCnDrD7A/s320/20130619_103830.jpg" width="320" wya="true" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="color: #20124d;"><strong>Mesenteric Cyst</strong></span></td></tr>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><o:p></o:p></span></b> <b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Mesenteric Cysts are cysts arising from the mesentery. </span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><u><span style="color: purple;">Types of Mesenteric cysts:-</span></u></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">1.<span style="font: 7pt 'Times New Roman';"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Chylo lymphatic cyst ( Commonest )<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">2.<span style="font: 7pt 'Times New Roman';"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Enterogenous cyst<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">3.<span style="font: 7pt 'Times New Roman';"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Urogenital Remnant<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"><span style="mso-list: Ignore;">4.<span style="font: 7pt 'Times New Roman';"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Teratomatous Dermoid Cyst (Least common)<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: purple;"><u>Commonest age group</u></span>- Second decades of Life<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: blue;">What is the characteristic clinical feature of a Mesenteric Cyst?<o:p></o:p></span></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Painless cystic intra abdominal swelling in the umbilical region which moves freely in a plane perpendicular to the line of attachment of root of mesentery.<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: purple;"><u>Differential Diagnosis<o:p></o:p></u></span></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Omental cyst/ Ovarian cyst<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: purple;"><u>Complications<o:p></o:p></u></span></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Torsion</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Rupture<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Infection<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Hemorrhage into the cyst<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: blue;">What is the difference in <span style="color: magenta;">Blood supply</span> of a Chylo lymphatic cyst and an Enterogenous cyst?<o:p></o:p></span></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">Blood supply of a Chylo lymphatic cyst is independent of the adjacent intestine.Hence simple excision is possible.</span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;">But Enterogenous cyst derives its blood supply in common with the adjacent potion of the intestine.<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #002060; font-family: 'Times New Roman','serif'; font-size: 14pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="color: magenta;">Hence surgical removal of an enterogenous cyst entails the resection of the related segment of the intestine.<o:p></o:p></span></span></b></div>
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Dr Rajendran MChttp://www.blogger.com/profile/04244419300291741530noreply@blogger.com2