asamvav111

Thank you for everything! Wish you all the best in your future ventures. God bless.

nox

hugs

figure-skating

robot

"I have a growing investment portfolio, some real estate, and a stable life that affords me anything a middle class man would want." Marry me please and keep getting more rich! Jokes apart, I do understand your problem. May be you could see a shrink. But, unless you learn to find happiness in your own self, you will never find lasting happiness and peace. Every external object or person you try to find happiness in, is perishable and liable to change. So, you must learn to be happy on your own, without depending on an outside source. It takes a long time to achieve this. So, do not despair if it takes a little longer. We are here for you.

^Okay best wishes to both of you! Now tell me one thing, when is the next GFD chapter going to be posted? Love as always. God bless.

A Degree doesn't a Writer make. Rest is said eloquently by others.

hidden

Happy Birthday, Myr! God bless. Hope you have a grand birthday. Thank you for all that you do. Hugs and Chocolates.

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russian

Oh reminds me of Pope Innocent (???!!!!) VIII!

JoAnn111!

...but there are no mummies there! What a disappointment! Celethiel Sama must twist this and write a story! Similar element in the Harry Potter HBP is that lake full of inferi.

wingman

kiss

thief

"but necrophilia is NEVER ok." I literally shuddered hearing your voice at this point inside my head,( yea... you have a voice inside my head) but we can never thank you enough for all the time and dedication you put in GA and your stories.

Some values: Pulse: Normal 60-100 beats/min Mild to moderate bleed >100 beats/min Severe bleed initially >100 then <60 beats min ultimately none May be non recordable even if the pt. is alive, ecg is checked then Pt. in shock has "rapid, thready pulse" BP: Normal Systolic 90-120 Diastolic 60-90 written usually like this 120/80 mm hg Will fall with moderate to severe blood loss. Tends to stay normal till much later. Respiratory Rate: Normal 12-18 breaths/min Pt. having difficulty breathing will have higher rate but the depth of respiration will be less Temperature: Normal 37.8 oC or 98.6 oF Fever>38.3 oC or 101 oF >104 oF starts frying your brain. Pulse-oxymetry: measures oxygen saturation in blood. Normal >94% We don't want it get below 90% In severe cardiorespiratory compromise the values can get below 80% All values are for adults. Children have different values. Very old people have different values. Different cases have different values. But, this is just a basic literary guideline. For more, research your individual traumas separately. You can always ask us questions. And lastly for anyone else: Please don't take these as medical advice. If you have a query regarding health, see your doctor.

Cia gave the most insightful infos. I will just add few more imp ones. 1) Assessment goes from head to toe and from surface to deep. 2) Injuries we look for are Contusion, Abrasion, Laceration, Penetrating & Perforating injury, Incised wound, Fractures of Bones & Dislocation of Joints, Soft tissue injury, Any visible bleed, Internal injury and blood loss, Burn/Scald, Electrical and Chemical injury, Injury from sexual offences, Non-accidental and Hidden injuries etc. 3) The assessment begins with a simple ABCDE protocol, this is called Primary Survey: A - Airway maintenance and Stability of the Cervical Spine B - Breathing maintenance C - Circulation and Cardic status D - Assessment of Neurological Deficit E - Exposure and Maintenance of Environmental Temperature A is done by clearing the mouth, check for injury inside mouth and inserting an airway tube that will prevent the fall back of tongue if the patient is unconscious. Cervical Spine is stabilized by use of a collar. B is done by checking if there is any trauma particularly to the chest and if the pt. can breath on his own. Pulse-oxymeter helps in this. If not then Tracheostomy may be performed (because the larynx can swell up causing Laryngeal oedema and shut the airway from inside; this by passes it and creates a path directly to the trachea) and Positive Pressure Artificial Ventilation(multiple types) is used in most cases. Chest injury will have to be repaired in an emergency surgery. C is done by checking for blood loss, monitoring pulse and bp continuously, getting an ecg. Circulation is maintained by putting in fluid (Normal Saline, Hartmann's Solution etc) till blood grouping and cross matching reports arrive then we give appropriate blood and blood product. But the heart can give out due to volume overload so that has to be assessed as well. A penetrating cardiac injury will go directly to OT for an emergency open heart surgery. D is done to check for signs of concussion and spinal injury. We use something called Glasgow Coma Scale. Eye signs are imp here. Only obvious neurological damage is assessed, subtle one's will have to wait. E is done by completely stripping the patient and meticulously looking for injuries. Often the limbs have fractures etc and swells up. So we cut away the clothing. Pt. is checked front and back and thoroughly. Then body temp is maintained by cooling/warming blankets, antipyretics (anti fever - most commonly paracetamol) etc. This part is most imp to save a person's life. 4) Next is the Secondary Survey. Now we are at our leisure and know the pt. is not gonna die in next half hour. So we take a detailed history and perform complete physical examination including a detailed neurological work up. I won't bore you with details here. This usually means we try to learn as much as about the accident and about the pt. before, during and after the accident from a bystander. Usually the pt. is knocked out cold with pain meds and is sleeping by the end of this. We send for a bunch of tests, formulate a treatment plan and talk to the family. Any patient with neurological damage, we can't give any prognosis for next 72 hours. Regular bleeders should start showing improvement after the surgery in 24 hours. Complicated cases depend on respective injuries and how fast they received treatment. Major internal injuries are mostly on God's hands whether we accept it or not. But it all depends. I often read in novels how the doctor tells the patient's near and dear ones that the pt. is gonna be well in this many hours. In practice you will never see it. The best they can give you is courage and understanding. 5) Non-accidental and hidden injuries are basically those that are not possible by just an accident. Often the perpetrator is the abuse victim's family member or partner. They try to pass these off as accidental injuries and the victim often corroborates that story in fear of retribution or simply Stockholm Complex common in long term victims. Search internet for the list of such injuries. Hidden injuries are those that are made by a perpetrator, most commonly a family member, in order to kill the victim discretely. This will be commonly miss by the physician unless a high degree of suspicion prevails. Often than not in this cases the history is multi versioned and frequently changed. The physical signs revealed by the examination do not correlate to the extent of injury seen. Again the list is in the internet. Self inflicted injuries also fall under this group, but they have telltale signs. Much is said about them in popular culture. I won't elaborate them here.