16 Matching Annotations
  1. Aug 2020
  2. Jul 2020
  3. Apr 2020
    1. 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.
    1. 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.

      needle thoracostomy (5th intercostal ant axil) tube thoracostomy CXR

    2. 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.
    3. Tension pneumothorax and simple pneumothorax have similar signs, symptoms, and examination findings, but hypotension qualifies the pneumothorax as a tension pneumothorax.
    4. Definitive treatment is closure of the chest wall defect and tube thoracostomy remote from the wound.
    5. 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.
    6. Complete occlusion of the chest wall defect without a tube thoracostomy may convert an open pneumothorax to a tension pneumothorax.
  4. Oct 2019
    1. From Contact Force to Contact Stress

      "De la fuerza de contacto a la tensión de contacto". Explica la relación de las fuerzas de impacto con tensiones.

  5. Feb 2019
    1. too individualistic, devoid of the community feeling

      This begins to take aim at the tension between individualism and collectivism, a "me vs. we" scenario with great implications in social society, as well as in the intellectual realm.

  6. Oct 2016
    1. Now almost 17 years later, while the political tensions remain, a reversal is underway,

      Why after so long has nothing changed? Why don't people figure something out sooner

  7. Sep 2015
    1. 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.

      This was a very interesting paragraph. No one realizes what is going to happen next. As the reader you do not even realize that she had this decision to leave and he is making the decision to kill people and himself. This made me go back and remember that she said something to him and that the rest of her life is really changed once she leaves those doors.

    2. “You can decide how long she suffers.”

      I felt so sad for the dog. I didn't want her to suffer more. It is such a hard experience to go through when you want your animal to be with you forever.

  8. Feb 2014
    1. 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