Until the paramedics arrive, the parent or caregiver should follow these first aid guidelines: Will this mean that he cannont have the laproscopic surgery? Drainage is maintained for several days to help prevent the abscess from reforming. My mother is 74 and had diverticulitis and therefore now has a colostomy. Decompression —A decrease in pressure from the surrounding water that occurs with decreasing diving depth. Was wandering if the illeus could have caused problems with healing of surgical area.
These invertebrate cardiovascular systems have well-developed muscular pumps with complex regulatory mechanisms that facilitate a dynamic range of responses to changing metabolic and environmental demands, and thus have allowed the exploitation of both aquatic and terrestrial ecosystems. In fact, many parallels can be drawn between the well-developed cardiovascular systems of lower vertebrates to those of decapod crustacea and cephalopod Molluscs.
The classic view of an open circulatory system is based on the image of pseudocoelomic or coelomic fluid bathing the tissues directly; this fluid is circulated throughout the coelom via the actions of the body wall musculature and animal movements. These vessels end abruptly where their contents move into the coelom or other large space where gas, nutrient, and waste exchange take place directly between the cells tissues and hemolymph or lymph—at this point the fluid could be described as extracellular fluid.
Hemolymph then moves through venous sinuses or simply through the coelom and into a pericardial sinus, through cardiac ostia and into the heart for recirculation.
Indeed both of these views are technically correct, yet convey the idea of a primitive, poorly designed and regulated cardiovascular system that is unable to sustain higher metabolic demands Figure 1 a. Looking at the issue from the other side, our standard view of a closed circulatory system is based on a system where a multichambered muscular heart pumps blood through parallel systemic and pulmonary circuits simultaneously Figure 1 c.
Blood is pumped into major elastic arteries the aorta and large arteries , which then flows into medium and small smooth muscle-based vessels and then into arterioles, which supply the capillary circulation.
At the capillary level, gas, nutrient, and waste exchange take place between blood and tissues across an endothelial layer. Venous blood then returns to the heart via, venules, small and medium veins, and finally back into the heart via the vena cava. In the closed circulatory system at no point does the blood leave the confines of the vascular endothelia and as such there is a clear distinction between blood and lymph [ 1 — 3 ].
An exhaustive phylogenetic review of cardiovascular morphologies is not necessary to make this point clear. A few well-described examples from specific taxa can be used to illustrate the complexity of the issue and dramatically point out the shortcomings of the existing definitions. Members of the phyla Annelida contain some of the most complex examples of worm-like invertebrates [ 5 — 7 ]. The segmented annelids have evolved several mechanisms in order to enhance convective transport between internal compartments.
The most primitive of these being the development of a coelom and coelomic circulation followed by the development of intracellular iron-based oxygen binding pigments hemoglobins , and the most advanced being a fairly well-developed blood-vascular system [ 8 , 9 ].
While there are many anatomical variations observed in the cardiovascular system of annelids that appear to have evolved due to activity patterns, feeding behaviors and environment, some of the most complex systems are seen in the class Polychaeta.
The general pattern of circulation in polycheate worms starts with a dorsal vessel that runs just above the digestive tract Figure 3. Blood flows anteriorly where the dorsal vessel anastomes with a ventral vessel either directly or by several parallel connecting vessels. The ventral vessel runs under the digestive tract and carries blood posteriorly. Each segment of the animal receives a pair of parapodial blood vessels that arise from the ventral vessel. The segmental parapodial vessels supply the parapodia, the body wall integument , and the nephridia and give rise to intestinal vessels that supply the gut.
Blood moves from the ventral vessel through the parapodial system and returns to the dorsal vessel through a corresponding segmental pair of dorsal parapodial vessels Figure 3.
When gills are present and integrated with the blood vascular system as opposed to being perfused with coelomic fluid they contain both afferent and efferent vessels Ruppert and Barnes Pressures are generated by peristaltic waves of contractions through the dorsal vessels.
These blood vessels and their associated blood sinuses do not contain an endothelium but are lined by only the basal lamina of overlying cells Figure 3 Brusca and Brusca The molluscan cardiovascular system has evolved extensive vascular networks with efficient centralized pumps e. The functional significance of these complex vessels is seen in the highly active Cephalopod Molluscs, which show the most extensive evolution and specialization of the cardiovascular system Figure 4.
Blood is driven at high pressures by the heart through a cell-lined closed circulatory system complex circulatory system that is able to sustain metabolic rates almost equivalent to some vertebrates [ 13 , 14 ]. To sustain such high oxygen uptake rates, paired branchial hearts have evolved to pump venous blood through the gills, after which the arterial blood flows to the ventricle where it is pumped to the systemic circuit.
Functionally, the cephalopods have evolved a multichambered heart capable of maintaining separation between venous and arterial blood and regulating branchial and systemic circulations.
Additionally, this group of animals has developed the cardio-respiratory regulatory mechanisms needed to integrate cardiovascular and ventilatory performance with metabolic demands [ 15 ]. The anatomical complexity of the cardiovascular system, along with the development of capillary-like exchange vessels, an endothelia-like vascular lining and the appropriate regulatory mechanisms appears to have been selected for in this group by increased activity patterns associated with predatory behavior, swimming, and jet propulsion [ 12 , 13 ].
While the cardiovascular systems of these more active cephalopods are quite robust and seem to exhibit convergent evolution with some vertebrates, in terms of their vascular complexity, there is a great deal of discrepancy in reports as to the nature of the endothelia-like lining of the vessels and the degree to which tissues are perfused.
This leads to the question: It can be hypothesized that the invertebrate vascular lining has evolved for reasons more to do with hemodynamics and maintaining laminar flow, than the array of functions ascribed to the vertebrate vascular endothelia. The evolutionary origin of the invertebrate vascular system and its lining are derived from the coelom, yet few invertebrate taxa exhibit a vascular endothelium [ 20 ].
Laminar flow is required to minimize the energy needed to move blood through these complex vascular systems. However, if there are sudden variations in vessel diameter or irregularities in the vessels walls turbulent flow can result. This will take approximately 90 seconds per patient. The German triage system also uses four, sometimes five colour codes to denote the urgency of treatment. The urgency is denoted as follows:. Critical , Emergency , Urgent , Semi-urgent and Non-urgent.
In Japan , the triage system is mainly used by health professionals. The categories of triage, in corresponding color codes, are:. In Spain , there are 2 models which are the most common found in hospitals around the country:. Some autonomous communities in Spain, like Navarre and the Valencian Community , have created their own systems for the community own hospitals.
This grades casualties from Priority 1 needs immediate treatment to Priority 3 can wait for delayed treatment. There is an additional Priority 4 expectant, likely to die even with treatment but the use of this category requires senior medical authority. In the UK and Europe, the triage process used is sometimes similar to that of the United States see below , but the categories are different: Triage in a multi-scale destruction, disaster, catastrophic, casualty event, such as following a tornado or an explosion in a populated area, first responders follow a similar triage category scale as the US military.
The civilian medical industry uses a similar system for triage. Normally medical personnel aren't immediately available on scene.
First responders are usually the first to arrive on scene. They could be police, fire rescue, paramedics, or community individuals with disaster training CERT certified. They are trained to perform first aid, basic life saving and rescue techniques while performing the greatest good, for the greatest number of people. They will rapidly classify victims and sort them into 4 categories, treating quickly as they go.
This system is intended to rapidly identify and classify victims for arriving transport or advanced care medical personnel such as doctors and nurses. The local National Guard and other military units responding would be using the military system of triage rather than civilian. The triage categories are general and the names may vary by region of the nation:. The casualties are then transported to a higher level of care, either a Forward Surgical Team or Combat Support Hospital and re-triaged by a nurse or doctor.
In a combat situation, the triage system is based solely on resources and ability to save the maximum number of lives within the means of the hospital supplies and personnel. In a "naval combat situation", the triage officer must weigh the tactical situation with supplies on hand and the realistic capacity of the medical personnel.
This process can be ever-changing, dependent upon the situation and must attempt to do the maximum good for the maximum number of casualties. Field assessments are made by two methods: Notions of mass casualty triage as an efficient rationing process of determining priority based upon injury severity are not supported by research, evaluation and testing of current triage practices, which lack scientific and methodological bases.
START and START-like START triage that use color-coded categories to prioritize provide poor assessments of injury severity        and then leave it to providers to subjectively order and allocate resources within flawed categories. Research indicates there are wide ranges and overlaps of survival probabilities of the Immediate and Delayed categories, and other START limitations.
Poor assessments, invalid categories, no objective methodology and tools for prioritizing casualties and allocating resources, and a protocol of worst first triage provide some challenges for emergency and disaster preparedness and response. These are clear obstacles for efficient triage and resource rationing, for maximizing savings of lives, for best practices and National Incident Management System NIMS compatibilities,    and for effective response planning and training.
Inefficient triage also provides challenges in containing health care costs and waste. There have been no cost-benefit analyses of the costs and mitigation of triage inefficiencies embedded in the healthcare system. Such analyses are often required for healthcare grants funded by taxpayers, and represent normal engineering and management science practice. These inefficiencies relate to the following cost areas:.
Because treatment is intentionally delayed or withheld from patients, advanced triage has ethical implications. Bioethical concerns have historically played an important role in triage decisions, such as the allocation of iron lungs during the polio epidemics of the s and of dialysis machines during the s. Similar issues may occur for paramedics in the field in the earliest stages of mass casualty incidents when large numbers of potentially serious or critical patients may be combined with extremely limited staffing and treatment resources.
Research continues into alternative care, and various centers propose medical decision-support models for such situations. From Wikipedia, the free encyclopedia. This article is about the concept of triage as it occurs in medical emergencies and disasters.
For other uses, see Triage disambiguation. Simple triage and rapid treatment. Concept, history, and types".
Annals of Emergency Medicine. National Research Council of Canada. Journal of Japanese Association for Acute Medicine. Australian Journal of Emergency Management: Archived from the original PDF on Archived from the original on Tolley's handbook of disaster and emergency management.
Retrieved 24 May Kraus; Ru Ding; Edbert B. Hsu; Guohua Li; Judy B. Disaster Medicine and Public Health Preparedness: European Journal of Trauma and Emergency Surgery. Archived from the original PDF on December 5, How well are we prepared?
Australasian College for Emergency Medicine. Hoyt; Wilson, William J. An Outcomes Assessment After a Disaster. The Answer is Clear! In a form of spina bifida called meningocele, the protective membranes around the spinal cord meninges push out through the opening in the vertebrae, forming a sac filled with fluid.
But this sac doesn't include the spinal cord, so nerve damage is less likely, though later complications are possible. Also known as open spina bifida, myelomeningocele is the most severe form. The spinal canal is open along several vertebrae in the lower or middle back.
The membranes and spinal nerves push through this opening at birth, forming a sac on the baby's back, typically exposing tissues and nerves. This makes the baby prone to life-threatening infections. Signs and symptoms of spina bifida vary by type and severity. Symptoms can also differ for each person. Typically, meningocele and myelomeningocele are diagnosed before or right after birth, when medical care is available.
These children should be followed by a specialized team of doctors throughout their lives and families should be educated on the different complications to watch for. Children with spina bifida occulta typically don't have any symptoms or complications, so usually only routine pediatric care is needed. Doctors aren't certain what causes spina bifida. As with many other problems, it appears to result from a combination of genetic and environmental risk factors, such as a family history of neural tube defects and folate deficiency.
Spina bifida is more common among whites and Hispanics, and females are affected more often than males. Although doctors and researchers don't know for sure why spina bifida occurs, they have identified some risk factors:. If you have known risk factors for spina bifida, talk with your doctor to determine if you need a larger dose or prescription dose of folic acid, even before a pregnancy begins.
If you take medications, tell your doctor. Some medications can be adjusted to diminish the potential risk of spina bifida, if plans are made ahead of time. Spina bifida may cause minimal symptoms or only minor physical disabilities. If the spina bifida is severe, sometimes it leads to more significant physical disabilities. Severity is affected by:. This list of possible complications may seem overwhelming, but not all children with spina bifida get all these complications.
And these conditions can be treated. Folic acid, taken in supplement form starting at least one month before conception and continuing through the first trimester of pregnancy, greatly reduces the risk of spina bifida and other neural tube defects.
It's critical to have enough folic acid in your system by the early weeks of pregnancy to prevent spina bifida. Because many women don't discover that they're pregnant until this time, experts recommend that all women of childbearing age take a daily supplement of micrograms mcg of folic acid. Several foods, including enriched bread, pasta, rice and some breakfast cereals, are fortified with mcg of folic acid per serving.
Folic acid may be listed on food packages as folate, which is the natural form of folic acid found in foods. If you're actively trying to conceive, most pregnancy experts believe supplementation of at least mcg of folic acid a day is the best approach for women planning pregnancy.
Your body doesn't absorb folate as easily as it absorbs synthetic folic acid, and most people don't get the recommended amount of folate through diet alone, so vitamin supplements are necessary to prevent spina bifida. And, it's possible that folic acid will also help reduce the risk of other birth defects, including cleft lip, cleft palate and some congenital heart defects.