- •State medical university of ukraine
- •Emergency medicine
- •Poltava, 2008
- •Igor p. Kajdashev m.D., Ph. D, Professor
- •Ionizing versus nonionizing radiation
- •Ionizing radiation: electromagnetic radiation
- •Ionizing radiation: particulate radiation
- •Irradiation, contamination, and incorporation
- •Vapor exposure
- •Imaging Studies:
- •Imaging Studies
- •Imaging Studies
- •Imaging Studies
- •Imaging Studies:
- •Ventricular fibrillation
- •Imaging Studies:
- •Symptoms
- •Physical examination
- •Chest X-rays, sputum cultures, and other tests
- •Community-acquired pneumonia
- •Hospital-acquired pneumonia
- •Treatment
- •Complications
- •Respiratory and circulatory failure
- •Pleural effusion, empyema, and abscess
- •Aetiology
- •Signs and symptoms
- •Diagnosis
- •Differential Diagnosis
- •First Aid Chest wound
- •Blast injury or tension
- •Clinical treatment
- •Imaging Studies:
- •Subtypes
- •Pathology
- •Classification
- •Renal failure classification
- •Imaging Studies:
- •Chronic renal failure
- •Acute or chronic renal failure
- •Acute complications
- •Hyperparathyroidism
- •Etiology
- •Signs and symptoms
- •Diagnosis
- •Treatment
- •Hypocalciemia Pathophysiology
- •Symptoms
- •Clinical signs
- •Addisonian crisis
- •Addisonian crisis
- •Symptoms
- •It can be asymptomatic, but the following symptoms can be present
- •Signs and symptoms
- •Diagnosis
- •Pheochromocytoma
- •Diagnosis
- •Symptoms
- •Causes Pituitary adenoma
- •Other tumors
- •Diagnosis
- •Hormonal
- •Radiological
- •Surgery
- •Signs and symptoms
- •Diagnosis
- •Treatment
- •Pathophysiology
- •Treatment Prehospital Care
- •Hemocoagulation desorders Hemophilia
- •Treatment
- •Causes There are a variety of causes of dic, all usually causing the release of chemicals into the blood that instigates the coagulation.
- •Treatment
- •Signs and symptoms
- •Diagnosis
- •Itp (verlgof disease0
- •Imaging Studies:
Treatment Prehospital Care
Initial care of patients includes supplemental oxygen, intravenous fluid resuscitation, applying direct pressure to any external hemorrhage, fracture splinting, and rapid transport.
Recent prehospital studies suggest that trauma patients should receive minimal fluid resuscitation. This remains unproven and controversial.
The military antishock treatment (MAST) suit is occasionally used in the prehospital setting for trauma patients with pelvis and lower extremity injuries. It is contraindicated in patients with pulmonary edema or a ruptured diaphragm. It is also contraindicated in pregnant patients.
Hemocoagulation desorders Hemophilia
Genetic deficiencies and a rare autoimmune disorder may lower plasma clotting factor levels of coagulation factors needed for a normal clotting process. When a blood vessel is injured, a temporary scab does form, but the missing coagulation factors prevent fibrin formation which is necessary to maintain the blood clot. Therefore, there is no increase in bleeding time with hemophilia because platelets are intact, allowing the formation of these temporary hemostatic plugs (clots). However, "late" bleeding is affected, because these hemostatic plugs are not able to be maintained.
The bleeding with external injury is normal, but incidence of late re-bleeding and internal bleeding is increased, especially into muscles, joints, or bleeding into closed spaces. Major complications include hemarthrosis, hemorrhage, Gastrointestinal bleeding, and menorrhagia.
Treatment
Though there is no cure for haemophilia, it can be controlled with regular injections of the deficient clotting factor, i.e. factor VIII in haemophilia A or factor IX in haemophilia B. Some haemophiliacs develop antibodies (inhibitors) against the replacement factors given to them, so the amount of the factor has to be increased or non-human replacement products must be given, such as porcine factor VIII Troy.
If a patient becomes refractory to replacement coagulation factor as a result of circulating inhibitors, this may be overcome with recombinant human factor VII (NovoSeven®), which is registered for this indication in many countries.
In western countries, common standards of care fall into one of two categories: prophylaxis or on-demand. Prophylaxis involves the infusion of clotting factor on a regular schedule in order to keep clotting levels sufficiently high to prevent spontaneous bleeding episodes. On-demand treatment involves treating bleeding episodes once they arise.
As a direct result of the contamination of the blood supply in the late 1970s and early/mid 1980s with viruses such as Hepatitis and HIV, new methods were developed in the production of clotting factor products. The initial response was to heat treat (pasteurize) plasma-derived factor concentrate, followed by the development of monoclonal factor concentrates which use a combination of heat treatment and affinity chromatography to inactivate any viral agents in the pooled plasma from which the factor concentrate is derived. The Lindsay Tribunal in Ireland investigated, among other things, the slow adoption of the new methods.
Since 1993 (Dr. Mary Nugent), recombinant factor products (which are typically cultured in Chinese hamster ovary (CHO) tissue culture cells and involve little, if any human plasma products) have become available and are widely used in wealthier western countries. While recombinant clotting factor products offer higher purity and safety, they are, like concentrate, extremely expensive, and not generally available in the developing world. In many cases, factor products of any sort are difficult to obtain in developing countries.
Disseminated intravascular coagulation
Disseminated intravascular coagulation (DIC), also called consumptive coagulopathy, is a pathological process in the body where the blood starts to coagulate throughout the whole body. This depletes the body of its platelets and coagulation factors, and there is a paradoxically increased risk of hemorrhage. It occurs in critically ill patients, especially those with Gram-negative sepsis (particularly meningococcal sepsis) and acute promyelocytic leukemia