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  <head>
    <title>044-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Trauma, resuscitation, consciousness, perioperative care">
      <outline text="Orientation and primary survey">
        <outline text="Reversible threats before diagnosis">
          <outline text="Trajectory outweighs one normal observation"/>
        </outline>
        <outline text="Prepare team, warming, blood, airway, imaging"/>
        <outline text="Sequence: haemorrhage, airway, breathing, circulation"/>
        <outline text="Treat each threat when found, reassess after each step"/>
        <outline text="Haemorrhage control matched to site">
          <outline text="Tourniquet proximal, tightened, time documented"/>
        </outline>
      </outline>
      <outline text="Airway and cervical spine">
        <outline text="Look for blood, burns, stridor, expanding haematoma"/>
        <outline text="Jaw thrust, suction, oxygen, suitable adjuncts"/>
        <outline text="Definitive airway when protection or course unsecured"/>
        <outline text="Rapid-sequence intubation can cause arrest">
          <outline text="Hypovolaemia, right-heart obstruction, acidosis"/>
          <outline text="Resuscitate first, failed-airway plan"/>
          <outline text="Confirm with waveform carbon dioxide"/>
        </outline>
        <outline text="Spinal restriction must not delay airway or bleeding"/>
      </outline>
      <outline text="Breathing and chest injury">
        <outline text="Tension pneumothorax treated before imaging"/>
        <outline text="Massive haemothorax: blood loss, lung compression"/>
        <outline text="Flail segment and contusion">
          <outline text="Pain, impaired ventilation, delayed hypoxaemia"/>
          <outline text="Analgesia, physiotherapy, selective support"/>
        </outline>
        <outline text="Tamponade causes obstructive shock"/>
      </outline>
      <outline text="Circulation and haemorrhagic shock">
        <outline text="Haemorrhagic until proved otherwise"/>
        <outline text="Early signs precede hypotension">
          <outline text="Young patients maintain pressure until late"/>
        </outline>
        <outline text="Warmed blood components, not excess crystalloid">
          <outline text="Crystalloid dilutes clotting, cools, acidifies"/>
        </outline>
        <outline text="Early tranexamic acid within evidence window"/>
        <outline text="Damage-control resuscitation">
          <outline text="Permissive hypotension until haemostasis"/>
          <outline text="Inappropriate in severe traumatic brain injury"/>
        </outline>
        <outline text="Lethal triad is self-reinforcing">
          <outline text="Warm, control bleeding, shorten procedures"/>
        </outline>
      </outline>
      <outline text="Disability and altered consciousness">
        <outline text="Consciousness, pupils, limbs, glucose, temperature"/>
        <outline text="Coma scale: record components, not score alone"/>
        <outline text="Many causes: trauma, hypoxia, glucose, toxins"/>
        <outline text="Empirical glucose, naloxone, anticonvulsant">
          <outline text="Must not delay ventilation or imaging"/>
        </outline>
        <outline text="Prevent secondary brain injury">
          <outline text="Avoid hypoxia, hypotension, fever, glucose extremes"/>
        </outline>
        <outline text="Herniation signs demand urgent action">
          <outline text="Hyperosmolar therapy, imaging, neurosurgery"/>
        </outline>
      </outline>
      <outline text="Exposure, secondary survey, imaging">
        <outline text="Expose back, perineum, axillae, scalp, skin"/>
        <outline text="Head-to-toe examination after immediate threats">
          <outline text="Repeat: pain, distraction, shock conceal findings"/>
        </outline>
        <outline text="Focused ultrasound cannot exclude all injury"/>
        <outline text="Tomography only when stable or stabilised"/>
        <outline text="Pregnancy does not justify withholding diagnosis"/>
      </outline>
      <outline text="Specific injury patterns">
        <outline text="Traumatic brain injury types">
          <outline text="Anticoagulation raises risk, may need reversal"/>
        </outline>
        <outline text="Spinal-cord injury by level">
          <outline text="Neurogenic shock: lost sympathetic tone"/>
          <outline text="Relative bradycardia, after haemorrhage excluded"/>
        </outline>
        <outline text="Abdominal injury without early peritonism"/>
        <outline text="Pelvic binder over the greater trochanters"/>
        <outline text="Limb threat: artery, compartment, open, crush">
          <outline text="Neurovascular status before and after"/>
        </outline>
      </outline>
      <outline text="Cardiac arrest and post-resuscitation">
        <outline text="Compressions, defibrillator, minimal interruption"/>
        <outline text="Non-shockable: adrenaline, reversible causes"/>
        <outline text="Airway must not degrade compressions">
          <outline text="Waveform carbon dioxide: tube, quality, return"/>
        </outline>
        <outline text="After return of circulation">
          <outline text="Oxygen without prolonged hyperoxia"/>
          <outline text="Delay prognosis until confounders addressed"/>
        </outline>
      </outline>
      <outline text="Preoperative assessment, medicines, fasting">
        <outline text="Risk modification, not clearance"/>
        <outline text="Define urgency, magnitude, blood loss, destination"/>
        <outline text="Tests only when they change management">
          <outline text="Normal test does not offset poor function"/>
        </outline>
        <outline text="Explicit plans for each medicine">
          <outline text="Balance bleeding against thrombosis"/>
          <outline text="Glucocorticoid cover for adrenal suppression"/>
        </outline>
        <outline text="Fasting reduces aspiration, excess dehydrates"/>
        <outline text="Withhold sodium-glucose cotransporter inhibitors">
          <outline text="Euglycaemic ketoacidosis risk"/>
        </outline>
      </outline>
      <outline text="Postoperative physiology and complications">
        <outline text="Surgery and anaesthesia alter every organ"/>
        <outline text="Monitor airway to surgical site"/>
        <outline text="New deterioration is not expected change"/>
        <outline text="Prevention: analgesia, lung expansion, mobilisation"/>
        <outline text="Differential by timing and phenotype"/>
      </outline>
    </outline>
  </body>
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