nobody seems to care much about these guys, yet your arm would swell up without them — there’s just enough net fluid leak from capillaries to cause problems in the absence of another set of pipes to return that transudate to the circulatory system
let’s have a little respect for lymphatics
colored SEM, 27x
credit: Susumu Nishinaga
We now know that 24 hours without sleep, or a week of sleeping four or five hours a night induces an impairment equivalent to a blood alcohol level of .1 percent. We would never say, ‘This person is a great worker! He’s drunk all the time!’ yet we continue to celebrate people who sacrifice sleep for work. — Insights from the doctor who coaches athletes on sleep. Pair with the science of what actually happens while you sleep and how it affects your every waking hour. More on sleep here. (via medicalschool)
One star. [x]
It’s a congenital malformation in which the heart is abnormally located either partially or totally outside of the thorax. The ectopic heart can be found along a spectrum of anatomical locations, including the neck, chest, or abdomen. In most cases, the heart protrudes outside the chest through a split sternum
4% of Canadian Paramedics make it to retirement.... FOUR PERCENT! -
This figure is far too small!
For my readers: What are the retirement rates like in your country? If higher, what do you think has contributed to the number?
We see seat belt signs at our trauma center with some regularity. There are plenty of papers out there that detail the injuries that occur and the need for a low threshold for surgically exploring these patients. I have not been able to find specific management guidelines, and want to share some tidbits I have learned over the years. Yes, this is based on anecdotal experience, but it’s the best we have right now.
Tips for trauma professionals:
- Common injuries involve the terminal ileum, proximal jejunum, and sigmoid colon. My observation is that location in the car is associated with the injury location, probably because of the location of the seat belt buckle. In the US, drivers buckle on the right, and I’ve seen more terminal ileum and buckethandle injuries in this group. Front seat passengers buckle on the left, and I tend to see proximal jejunum and sigmoid injuries more often in them.
- Seat belt sign on physical exam requires abdominal CT for evaluation, regardless of age. The high incidence of significant injury mandates this test.
- Seat belt sign plus any anomaly on CT requires evaluation in the OR. The only exception would be a patient with minimal fluid only in the pelvis with an unremarkable abdominal exam. But I would watch them like a hawk.
- In patients who cannot be examined clinically (e.g. severe TBI), a rising WBC count or lactate beginning on day 2 after adequate resuscitation should prompt a trip to the OR. This is an indirect method for detecting injured bowel or mesentery.
- Laparoscopy may be used in patients with equivocal findings. Excessive blood, bile tinged fluid, succus, or lots of fibrin deposits on the bowel should prompt conversion to laparotomy. Tip: place all ports distant to the seat belt mark. The soft tissues are frequently disrupted, and gas may leak into this pocket prohibiting good insufflation of the peritoneal cavity.
- If in doubt, open the abdomen. It’s bad form to put in the scope, see something odd, and walk away. Remember, any abnormal finding after trauma is related to trauma until proven otherwise. It’s almost never pre-existing disease.
The cervical spinal cord
By removing the rear arches of the neck (cervical) vertebra and the fibrous covering (dura) over the spinal cord one sees the cervical spinal cord and its nerves. The blood vessels nourishing the cord and vertebral column and the origin of the cord from the brain are clearly shown.
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