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Abdominal and Genitourinary Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The key feature of abdominal injury is the inability to apply direct or indirect pressure to control bleeding along with the deleterious effects of bowel injury. The abdominal tourniquet is an experimental device that uses direct pressure to the abdomen to occlude the aorta and control bleeding in the lower abdomen and pelvis.56 Experimental evidence suggests the device can effectively occlude blood flow and can be tolerated by conscious subjects; however, it is not in widespread clinical use. A range of novel haemostatic agents are available for use in the pre-hospital setting or emergency department and this is an area of active research. In the setting of abdominal injury foam coagulant that can be injected into the abdominal cavity has been developed and coagulant powders and dressings which can be packed into penetrating injuries are used in various settings.57 Suspended animation is a concept that aims to reduce metabolic activity in severely injured patients to allow time for surgical repair of abdominal trauma. The techniques involve dramatically reducing the temperature of the patient and replacing blood with an antifreeze solution. Proof of concept animal trials have been successful and human trials are planned.58, 59
Chapter 7
Published in Richard Bryant-Jefferies, Counselling a Survivor of Child Sexual Abuse, 2017
Jennifer just nodded. Hearing that phrase repeated back to her somehow made a strong impression. She could feel a reaction around her solar plexus. It felt very wobbly. She could feel a kind of tickly sensation in her arms and it seemed as though her stomach was being gently squeezed. It didn’t feel at all pleasant. She continued to sit with this sensation. She didn’t feel any urge to speak. It was like being in suspended animation. She didn’t know how much time had passed but she heard Laura say, ‘I’m here for you.’ She felt herself nod slightly but she did not respond in any other way. The sensations in her body were very present, and she felt like they were holding her attention and her focus. She remembered again how it had felt to find herself out of her body. Funnily enough, she had felt quite calm about it, it hadn’t been that in itself that had been disturbing. It had been seeing her mother. As that image came back to her she felt the other calmer sensations fade. She was aware that she was shaking her head slightly from side to side. What she was experiencing was utter disbelief. How could she? How could she? She was aware that water was building up in her eyes and she felt a tear trickle down her left cheek.
Pathophysiology of Lightning Injury
Published in Christopher J. Andrews, Mary Ann Cooper, Mat Darveniza, David Mackerras, Lightning Injuries: Electrical, Medical, and Legal Aspects Editors, 1992
Christopher J. Andrews, Mary Ann Cooper, Mat Darveniza, David Mackerras
Jex-Blake22 provides a fascinating account of the history of views on lightning injury which include views on resuscitation. Many are obviously speculative, but an equivalent of cessation of metabolism does not seem to have been mentioned at that time. The first time that the proposal was made is attributed by Critchley21 to Jellinek.23,24 The effect is described in this initial work as “suspended animation”. The notion that respiration and circulation were intimately involved with survival had long been current (see Jex-Blake), and the necessity to reestablish both was known. Critchley21 was the first to suggest that resuscitation after “several hours” of demonstrated cessation of respiration and circulation was possible, based not on personal experience, but on other reports. The reason for the resuscitability was said to be that the victim was in “suspended animation”. Lynch and Shorthouse3 provide a similar Reference to Jellinek and Critchley, and are perhaps the first to question the phenomenon, saying that a certain German expert, Alvensleben, was skeptical about resuscitation after more than one half hour of suspended animation. Nonetheless, they recognized that reports of long-term suspended animation being reversed do exist, but more often after technical electrical injury than lightning injury.
Twelve tips for running an effective session with standardized patients
Published in Medical Teacher, 2020
Jaideep S. Talwalkar, Kali D. Cyrus, Auguste H. Fortin
Before formative sessions, facilitators should make students aware of the opportunity to call a “time-out” during the encounter and to feel comfortable asking to pause if desired (Barrows 1993). By taking time-outs, students can organize their thoughts or seek guidance from classmates when they are stuck. During this time, facilitators can prompt students to articulate their thoughts in real-time (e.g. “Where are you going with this line of inquiry?”). Facilitators can also use time-out to redirect students to use the time available most efficiently (e.g. interrupting a student after multiple closed-ended questions in a workshop designed to practice patient-centered interviewing). Time-out can also be used to “rewind” interviews to address missed opportunities or practice different wording, allowing students to immediately apply feedback. During time-outs, SPs typically remain in character but in “suspended animation,” revealing no awareness of the conversation happening in front of them. Generally, for formative SP sessions, students should utilize all the time available with the SP. For students who finish early, time-out and rewind strategies can be used to redo parts of the encounter or explore portions that were unaddressed the first time (Barrows 1993). When using time-outs, facilitators should seek balance between the benefits outlined above versus the harms of excessive interruption and not allowing students to struggle through situations that they may be able to solve on their own.
Neuroethics, Consciousness and Death: Where Objective Knowledge Meets Subjective Experience
Published in AJOB Neuroscience, 2022
Alberto Molina-Pérez, Anne Dalle Ave
According to the traditional narrative, before passing away, the Buddha attained the state of cessation of perception and feeling, whereby “all of the normal physiological processes are suspended and the subject exists in a state of suspended animation”, meaning that “the Buddha, at this point, was poised between life and death” (Keown 2010).
Veno-venous extracorporeal membrane oxygenation for the acute respiratory distress syndrome: a bridge too far?
Published in Acta Cardiologica, 2021
Alexander Smith, Cliff Morgan, Stéphane Ledot, James Doyle, Tina Xu, Lynn Shedden, Maurizioassariello Passariello, Brijesh Patel, Anne-Marie Doyle, Susanna Price, Christophe Vandenbriele, Suveer Singh
Prolonged ECMO-use for acute respiratory failure is associated with a lower survival rate, compared with reported survival in short duration ECMO [10]. Many patients can maintain a borderline organ function but lose their reserve during the disease process; therefore, even after successful decannulation from ECMO, morbidity and mortality remain high. Concerns regarding the negative impact of prolonged therapy in the context of minimal chance of full recovery are central to MDT discussions. As ECMO can support failing organs for prolonged periods of time it can blur the trajectory of chronic critical illness, masking profiles of clinical decline, or unmasking irretrievable intrinsic conditions at a later point in the critical illness. Whilst some patients recover quickly, there are those who do not recover but also do not deteriorate, leading to a state of ‘suspended animation’, the ‘bridge to nowhere’ [11]. Yet we pose the hypothetical question; is there reason other than rationing ECMO use, why such a patient should not stay on ECMO indefinitely? Here social justice (i.e. a rationed system) competes with surrogate autonomy (the family wish for everything to be done). The ethical dilemmas associated with putting patients onto ECMO support have been considered more recently [11]. However, there is no specific guidance available in the literature for the palliative withdrawal of ECMO in patients who are alert and neurologically intact. Hence, the need to draw from the principles of palliative care in oncology and more recently from care of the dying in the intensive care unit. Indeed, involvement of the palliative care team in the ICU has been shown to improve symptom control and patient and family satisfaction [12]. The value of informed and shared decision making, with a patient centred approach, in accordance with patients and families wishes, is as relevant to patients on ECMO, for whom recovery has been determined not to be possible, as for those with severe cardiac disease or others in the intensive care environment [13]. The use of now established frameworks for end of life pathways allow time for preparation and acceptance [14], and the concept of ‘dying with dignity’ is crucial in these circumstances [15].