Mark Corson

By M. Rocko. Silver Lake College.

You have just performed triage on 20 victims loratadine 10mg with visa, including the walking wounded generic loratadine 10 mg without prescription, in 10 minutes or less buy loratadine 10mg amex. You are no longer the most experienced medical resource at the scene, and you are relieved of Incident Command. The nurse begins the process of assigning areas for yellow, red and black tags where secondary triage and treatment can occur. There is still much to do, but you have performed your duty to identify those victims who need the most urgent care. In a normal situation, your modern medical facilities will already have ambulances and trained personnel with lots of equipment on the scene. In a collapse situation, however, the prognosis for many of your victims is grave. Go over our list of victims and see who you think would survive if modern medical care is not available. As we mentioned earlier, the main goal of a medic in a survival situation is to transfer the injured or ill person to a modern medical facility. As such, you will have to make a decision as to whether your patient can be treated for their medical problem at their present location or not. If they cannot, you must consider how to move your patient to where the bulk of your medical supplies are. This means stopping all bleeding, splinting orthopedic injuries, and verifying that the person is breathing normally. If you cannot assure this, consider having a group member get the supplies needed to support the patient before you move them. The most important thing to remember is that you want to carry out the evacuation with the least trauma to your patient and yourself. Many good commercially-produced stretchers are available, but improvised stretchers can be put together without too much effort. A person with a spinal injury should be rolled onto the stretcher without bending their neck or back if at all possible. Other options include taking two long sticks or poles and inserting coats or shirts through them to handle the weight of the victim. Lengths of Paracord or rope can also be crisscrossed to form an effective stretcher. If you must pull a person to safety, grasp their coat or shirt at the shoulders with both hands, allowing their head to rest on your forearms. You could also place a blanket under the patient, and grasp the end of the blanket near their head and pull. Again, if you are uncertain about the extent of any spinal injuries, do your best to not allow much bending of the body or neck during transport. Fireman’s Carry If your patient can be carried, there are various methods available. The “Fireman’s Carry” is effective and keep’s the victim’s torso relatively level and stable. In a squatting or kneeling position, you would grasp the person’s right wrist with your left hand and place it over your right shoulder. Keeping your back straight, place your right hand between their legs and around the right thigh. Using your leg muscles to lift, rise up; you should end up with their torso over your back and the right thigh resting over your right shoulder. If squatting, keep your back straight and use your legs and back muscles to lift the victim. Bend slightly so that the person’s weight is on your hips and lift them off the ground. If you have the luxury of an assistant, you might consider placing your patient on a chair and carry using the front legs and back of the chair. Another two person carry involves one rescuer wrapping their arms around the victim’s chest from behind while the second rescuer (facing away from the patient) grabs the legs behind each knee. It’s important to remember this simple acronym when pulling or carrying a person: B. Back Straight – muscles and discs can handle more load safely when the back is straight. Close to body – avoid reaching to pick up a load; it causes more strain on muscles and joints. Keep Stable – the more rotation and jerking, the more pressure on the discs and muscles. Be sure to check the Video Resources section at the back of this book to see some of these methods being used in real time. We spend a lot of time in this book talking about medical issues in times of trouble, from storms to a complete societal breakdown. However, times of trouble can be very personal, such as when you find yourself or a loved one battling a debilitating medical condition. In certain instances, it is easy for the patient to “fall through the cracks” of a huge medical establishment. Due to his disease, he has developed kidney failure and partial blindness, and has been on dialysis for the last year.

Although buy loratadine 10mg online, Bromley et al have found that echogenic intracardiac foci could be diagnosed in 18% of fetuses with trisomy 21 and that the risk for trisomy 21 is four times higher in fetuses with this soft marker 10 mg loratadine sale, other researchers showed that in low risk population (maternal age loratadine 10 mg without prescription,35, biochemical screening showing low risk) it is not associated with chromosomal abnor- malities, and in that case amniocentesis is not advised. The echogenic bowel usually disappears by the end of second trimester or third tri- mester of pregnancy. In some cases strong asso- ciation between trisomy 21 and echogenic bowel is found, and sometimes (in 1/3 to 1/2 of cases) it is the only abnormality that can be detected antenataly. Some authors like Brom- ley and Thomas reviewed their data and reported that echogenic bowel could be an ultra- sonographic marker for trisomy 21 and trisomy 13. According to their findings, for iso- lated echogenic bowel with no other soft markers the risk for trisomy 21 is 4,2 times that of the background risk. Therefore, it is recommended that if echogenic bowel is diagnosed in low risk population careful examination should be performed, in order to exclude other structural malformations. Mild hydronephrosis was defined by Benaceraf et al as a dilatation of renal pelvis $4 mm at 16 to 20 weeks of ges- tation, $5 mm at 20 to 30 weeks, and $7 mm at 30 to 40 weeks of gestation. The severity of renal pelvis dilatation does not affect the risk for aneuploidy, but as the severity of renal pelvis dilatation increases, the incidence of required neonatal treatment increases. Mild hydronephrosis in most of the cases (74% in one study) resolve spontaneously. In the case of mild hydronephrosis in low risk population there is not enough evidence to advice chromosome analysis. When measured in the second trimester of preg- nancy femur is short, and humerus even shorter. Although short femur is associated with increased likelihood of trisomy 21, some studies showed that it can not be used as an independent risk factor to screen trisomy 21. Accord- ing to her studies, Benaceraff concluded that short humerus might be a better marker for trisomy 21. Hydrocephaly can be the consequence of an obstruction of the cerebrospinal fluid flow or a hyper production of fluid. Diagnosis relies on the measurement of the atrial width which is normally 7,6 6 0,6 independently from gestational age. The cut-off value is 10 mm, measurements below 10 mm are con- sidered to be normal, those between 11 and 14 mm are defined as borderline or mild ventriculomegaly, and measurements above 15 mm refer to frank ventriculomegaly. It is caused by increase of cerebrospinal fluid, hypoplasia, dysplasia or atrophy of the brain tissue, craniosynostosis, etc. Isolated mild ventriculomegaly may resolve in utero in about 29% of cases, remains stable in 57%, progresses in 14%. It has been reported that overall outcome of isolated mild ventriculomegaly in early childhood appears to be good with approximately 90% of cases being normal. Unfortunately, reported outcomes are at short terms and unclear and fur- ther studies and long terms follow-ups are needed. On the other hand, mild or borderline ventriculomegaly is commonly associated with agenesis of corpus callosum, spina bifida and fetal infections. It is very important to exclude fetal infection and to offer the parents genetic counseling and testing. Moreover, abnormal ductus venosus flow is associated with significant neonatal morbidity and perinatal mortality. Early detection of an increased resistance of ductus venosus has been associated with a higher risk of chromosomal anomalies and congenital heart de- fects. Its effectiveness is greater for autosomal trisomies, especially in terms of its high specificity and positive predictive value. High incidence of cardiac defects in chromoso- mally abnormal fetuses has been documented. Recent data are suggesting that its use in combination with nuchal trans- lucency increases the specificity. Donald School Atlas of Clinical Application of Ultrasound in Obstetrics and Gynecology. The importance is that although 75%-80% occurs at term3, 4 it is one of the main causes of Prematurity accounting for the 30-40% of preterm before 32 weeks1 (table 1), and is one of the first causes of Perinatal Mortality. When that occurs before labor, it is because its resistance is diminished (except in some cases in which it is caused by direct aggression as amniocentesis, amnioscopy, or other traumatic circumstances). Their weakness sometimes is caused by an asymptomatic and sub clinical infection, as was published by Romero5, and in other cases by congenital weakness (Elhers-Danlos Syndrome), or acquired by Vitamin C deficit, or by smoking. Our experience1 confirms these data as described in table 2, and it is also confirmed in developing countries by Stewart at al7. Other important consequences of prematurity and infection are the intraventricular hemorrhage, the necrotizing enterocoli- tis, and also in the fetus, and linked to the oligohydramnios, the limb position defects, the facial anomalies, and especially the risk of pulmonary hypoplasia that occurs only in cases with «severe oligohydramnios» (no amniotic liquid pocket. Latency time, Latency time in weeks 3,4 6 1,8 1,2 6 0,7 0,4 6 0,2 and % of chorioamnionitis Chorioamnionitis % 22,8 30,0 13,4 with conservative management by groups of weeks of gestation. A sterile swab of fluid should be obtained from the posterior fornix of the vagina and placed on a clean glass slide, and on a piece of nitrazine paper. In both cases the rate of false positive is about 10%, and the accuracy between 93-96%. At any gestational age a patient with evident intrauterine infection (clinical Chorio- amnionitis), fetal distress or abruptio placentae, is best cared with by expeditious delivery. A general exploration (including temperature, pulse and arterial pressure) and cervical cultures, vaginal/rectal specific cultures for Streptococcus agalactiae, and vaginal Gram need to be performed in all cases.