Tension management approaches and capabilities – definitions and key references.

All Watched Over by Machines

But there is still somewhat of a tension between serving those requirements and making sure the business can make a profit, and also ensuring that the expense of complying is adequately funded but not too expensive.

Although immediate needle thoracostomy decompression with a 14-gauge angiocatheter may be indicated in the field, tube thoracostomy in the midaxillary line should be performed immediately in the ED before a chest radiograph is obtained (Fig. 7-3). Recent studies suggest that preferred location for needle decompression may be the fifth intercostal space in the anterior axillary line due to body habitus.

In cases of tension pneumothorax, the parenchymal tear in the lung acts as a one-way valve, with each inhalation allowing additional air to accumulate in the pleural space. The normally negative intrapleural pressure becomes positive, which depresses the ipsilateral hemidiaphragm and shifts the mediastinal structures into the contralateral chest. Subsequently, the contralateral lung is compressed and the heart rotates about the superior and inferior vena cava; this decreases venous return and ultimately cardiac output, which culminates in cardiovascular collapse.

Tension pneumothorax and simple pneumothorax have similar signs, symptoms, and examination findings, but hypotension qualifies the pneumothorax as a tension pneumothorax.

Definitive treatment is closure of the chest wall defect and tube thoracostomy remote from the wound.

Temporary management of this injury includes covering the wound with an occlusive dressing that is taped on three sides. This acts as a flutter valve, permitting effective ventilation on inspiration while allowing accumulated air to escape from the pleural space on the untapped side, so that a tension pneumothorax is prevented.

Complete occlusion of the chest wall defect without a tube thoracostomy may convert an open pneumothorax to a tension pneumothorax.

From Contact Force to Contact Stress

too individualistic, devoid of the community feeling

Now almost 17 years later, while the political tensions remain, a reversal is underway,

Before I leave the building I pass Gang Lu in the hallway and say hello. He has a letter in his hand and he’s wearing his coat. He doesn’t answer, and I don’t expect him to. At the end of the hallway are the double doors leading to the rest of my life. I push them open and walk through.

“You can decide how long she suffers.”

T h e r e i s a n u n d e n i a b l e t e n s i o n b e t w e e n t h e s e t w o p r o p o s i t i o n s . M a n y c o m p i l a t i o n s c o n s i s t o f n o t h i n g b u t r a w d a t a — i . e . , w h o l l y f a c t u a l i n f o r m a t i o n n o t a c c o m p a n i e d b y a n y o r i g i n a l w r i t t e n e x p r e s s i o n . O n w h a t b a s i s m a y o n e c l a i m a c o p y r i g h t i n s u c h a w o r k ? C o m m o n s e n s e t e l l s u s t h a t 1 0 0 u n c o p y r i g h t a b l e f a c t s d o n o t m a g i c a l l y c h a n g e t h e i r s t a t u s w h e n g a t h e r e d t o g e t h e r i n o n e p l a c e . Y e t c o p y r i g h t l a w s e e m s t o c o n t e m p l a t e t h a t c o m p i l a t i o n s t h a t c o n s i s t e x c l u s i v e l y o f f a c t s a r e p o t e n t i a l l y w i t h i n i t s s c o p e