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  <head>
    <title>044-02 Resuscitation physiology, occult injury, and perioperative risk control</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Resuscitation, occult injury, perioperative risk">
      <outline text="Resuscitation as hypothesis testing">
        <outline text="Identify threat, intervene, check response"/>
        <outline text="Normal first pressure or scan does not end it">
          <outline text="Compensation hides injury, bleeding evolves"/>
        </outline>
        <outline text="Mechanism predicts concealed injury"/>
        <outline text="Definitive control alongside diagnosis"/>
        <outline text="Record hypothesis, response, remaining uncertainty">
          <outline text="Short repeated cycles give speed and accuracy"/>
        </outline>
      </outline>
      <outline text="Haemorrhage control and transfusion">
        <outline text="External haemorrhage before airway"/>
        <outline text="Pelvic binder at the greater trochanters">
          <outline text="Reduces pelvic volume and motion"/>
        </outline>
        <outline text="Blood components beat large crystalloid volumes"/>
        <outline text="Citrate binds calcium">
          <outline text="Lowers contractility and coagulation"/>
        </outline>
        <outline text="Tranexamic acid early, within validated window"/>
        <outline text="Massive transfusion needs repeated tests">
          <outline text="Ratio first, then targeted replacement"/>
          <outline text="Rising pressure does not prove haemostasis"/>
        </outline>
      </outline>
      <outline text="Airway prediction, induction, confirmation">
        <outline text="Shock, obesity, pregnancy shorten safe apnoea"/>
        <outline text="Induction removes sympathetic tone">
          <outline text="Positive pressure reduces venous return"/>
          <outline text="Arrest in hypovolaemia, tamponade, right failure"/>
        </outline>
        <outline text="Waveform carbon dioxide most reliable">
          <outline text="Falling trace: disconnection, displacement, arrest"/>
        </outline>
        <outline text="Preparation: roles, two suction systems, devices">
          <outline text="Check hypotension, endobronchial tube after"/>
        </outline>
      </outline>
      <outline text="Obstructive and haemorrhagic shock">
        <outline text="Tension pneumothorax restricts venous return">
          <outline text="Treat without imaging"/>
          <outline text="Needle fails: length, kinking, clot, position"/>
          <outline text="Finger thoracostomy or tube more definitive"/>
        </outline>
        <outline text="Tamponade may lack distended veins"/>
        <outline text="Haemorrhagic shock lowers oxygen delivery">
          <outline text="Tachycardia and vasoconstriction hold pressure"/>
        </outline>
        <outline text="Permissive hypotension in selected torso trauma">
          <outline text="Unsuitable in severe brain injury, differs in pregnancy"/>
        </outline>
      </outline>
      <outline text="Occult injury and imaging">
        <outline text="Secondary survey finds concealed injury"/>
        <outline text="Abdominal bleeding may be painless">
          <outline text="Seat-belt mark, lower ribs, falling haemoglobin"/>
        </outline>
        <outline text="Negative focused scan misses injuries">
          <outline text="Retroperitoneal, hollow viscus, diaphragm"/>
        </outline>
        <outline text="Tomography is a destination, not treatment room"/>
        <outline text="Pregnancy: maternal perfusion resuscitates fetus"/>
        <outline text="Tertiary survey after consciousness returns"/>
        <outline text="Pulse does not reassure about compartments"/>
      </outline>
      <outline text="Brain injury and altered consciousness">
        <outline text="Hypoxaemia and hypotension worsen outcome"/>
        <outline text="Document findings before sedation and paralysis"/>
        <outline text="Herniation: pupil, motor fall, bradycardic hypertension">
          <outline text="Osmotherapy and hyperventilation buy time"/>
          <outline text="Do not remove the mass"/>
        </outline>
        <outline text="Support and test reversible causes together"/>
        <outline text="Naloxone titrated to ventilation"/>
        <outline text="Persistent unresponsiveness after convulsion"/>
      </outline>
      <outline text="Cardiac arrest and post-arrest care">
        <outline text="Compressions maximise coronary, cerebral flow"/>
        <outline text="Sudden carbon dioxide rise suggests return"/>
        <outline text="Prevent a second wave of organ injury">
          <outline text="Avoid hypoxaemia and prolonged hyperoxia"/>
        </outline>
        <outline text="Confounders obscure neurological assessment">
          <outline text="Early poor motor response is insufficient"/>
        </outline>
        <outline text="Handover: timings, rhythm, presumed cause"/>
      </outline>
      <outline text="Preoperative risk and functional capacity">
        <outline text="Risk modification, not ritual clearance"/>
        <outline text="Match surgical stress to organ reserve"/>
        <outline text="Routine tests create incidental findings"/>
        <outline text="Functional capacity has many limits">
          <outline text="Stair failure may be knee pain"/>
        </outline>
        <outline text="Frailty predicts delirium and slow recovery"/>
        <outline text="Discuss function and rehabilitation burden"/>
      </outline>
      <outline text="Perioperative medicines">
        <outline text="Stopping anticoagulation trades clot for bleeding">
          <outline text="Bridging itself causes bleeding"/>
        </outline>
        <outline text="Antiplatelets depend on stents and urgency"/>
        <outline text="Withhold cotransporter inhibitors early">
          <outline text="Fasting and stress cause ketoacidosis"/>
        </outline>
        <outline text="Do not omit antiseizure or Parkinson medicines"/>
      </outline>
      <outline text="Postoperative deterioration and handover">
        <outline text="Never dismissed as just surgery"/>
        <outline text="Timing and phenotype narrow the cause">
          <outline text="Hypotension: bleeding, vasodilation, heart"/>
          <outline text="Hypoxaemia: atelectasis, aspiration, embolism"/>
          <outline text="Delirium may be first sign of sepsis"/>
        </outline>
        <outline text="Handover: findings, airway, drains, plans"/>
        <outline text="Recovery measured by eating, walking, self-care"/>
      </outline>
    </outline>
  </body>
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