Extended Topics
Sutures Physician Demeanor Standards of Cleanliness Patient Confidentiality for the free Records Anesthetics Bleeding Burns Contraception Constipation Digestive Problems Diarrhea Emetics Fever Food Allergies Menstrual Problems Migraines/Headaches Nausea Numbing Pain Relief Pregnancy Rehabilitation Respiratory Problems Skin Irritation Sleeping Problems Sprains & Swelling Stomach problems Sunburn Urinary Vomiting Wounds Physicians Tending Wounds Accomodations Medical Fees Standard Clinic Services Darkosis Bazi Plague Dental Work Physician Instruments Infusions Decoctions Water Based Extracts Alcohol Extractor or Tinctures Salves Frostbite Awareness Fractures Broken Nose (Nasal Fracture) Cesarean Delivery
Sutures
Suture Placement
The tissue must be stabilized to allow suture placement. Depending on the surgeon’s preference, toothed or untoothed forceps or skin hooks may be used to gently grasp the tissue.
Excessive trauma to the tissue being sutured should be avoided to reduce the possibility of tissue strangulation and necrosis. Forceps are necessary for grasping the needle as it exits the tissue after a pass. Prior to removing the needle holder, grasping and stabilizing the needle is important. This maneuver decreases the risk of losing the needle in the dermis or subcutaneous fat, and it is especially important if small needles are used in areas such as the back, where large needle bites are necessary for proper tissue approximation.
The needle should always penetrate the skin at a 90° angle, which minimizes the size of the entry wound and promotes eversion of the skin edges. The depth and angle of the suture depends on the particular suturing technique. In general, the 2 sides of the suture should become mirror images, and the needle should also exit the skin perpendicular to the skin surface.
Once the suture is satisfactorily placed, it must be secured with a knot. The instrument tie is most commonly used in cutaneous surgery. First, the tip of the needle holder is rotated clockwise around the long end of the suture material for 2 complete turns. The tip of the needle holder is used to grasp the short end of the suture. The short end of the suture is pulled through the loops of the long end by crossing the hands, such that the 2 ends of the suture material are situated on opposite sides of the suture line. The needle holder is rotated counterclockwise once around the long end of the suture. The short end is grasped with the needle holder tip, and the short end is pulled through the loop again.
Suture Removal
Sutures should be removed within 1-2 weeks of their placement, depending on the
anatomic location. Prompt removal reduces the risk of suture marks, infection, and
tissue reaction. The average wound usually achieves approximately 8% of its expected
tensile strength 1-2 weeks after surgery. To prevent dehiscence and spread of the
scar, sutures should not be removed too soon.
As a general rule, the greater the tension across a wound, the longer the sutures
should remain in place. As a guide, on the face, sutures should be removed in 5-7
days; on the neck, 7 days; on the scalp, 10 days; on the trunk and upper extremities,
10-14 days; and on the lower extremities, 14-21 days. Sutures in wounds under
greater tension may need to be left in place slightly longer. Buried sutures, which are
placed with absorbable suture material, are left in place because they dissolve.
Proper suture removal technique is important to maintain good results after sutures are
properly selected and executed. Sutures should be gently elevated with forceps, and
one side of the suture should be cut. Then, the suture is gently grasped by the knot
and gently pulled toward the wound or suture line until the suture material is
completely removed. If the suture is pulled away from the suture line, the wound edges
may separate.
Horizontal Mattress Suture
The horizontal mattress suture is placed by entering the skin 5 mm to 1 cm from the
wound edge. The suture is passed deep in the dermis to the opposite side of the
suture line and exits the skin equidistant from the wound edge (in effect, a deep simple
interrupted stitch). The needle reenters the skin on the same side of the suture line 5
mm to 1 cm lateral of the exit point. The stitch is passed deep to the opposite side of
the wound where it exits the skin and the knot is tied
Uses
The horizontal mattress suture is useful for wounds under high tension because it
provides strength and wound eversion. This suture may also be used as a stay stitch
to temporarily approximate wound edges, allowing placement of simple interrupted or
subcuticular stitches. The temporary stitches are removed after the tension is evenly
distributed across the wound.
Horizontal mattress sutures may be left in place for a few days if wound tension
persists after placement of the remaining stitches. In areas of extremely high tension
at risk for dehiscence, horizontal mattress sutures may be left in place even after
removal of the superficial skin sutures. However, they have a high risk of producing
suture marks if left in place for longer than 7 days.
Absorbable Sutures
Absorbable buried sutures are used as part of a layered closure in wounds under
moderate-to-high tension. Buried sutures provide support to the wound and reduce
tension on the wound edges, allowing better epidermal approximation of the wound.
They are also used to eliminate dead space, or they are used as anchor sutures to fix
the overlying tissue to the underlying structures.
Technique
The suture is placed by inserting the needle parallel to the epidermis at the junction of
the dermis and the subcutis. The needle curves upward and exits in the papillary
dermis, again parallel to the epidermis. The needle is inserted parallel to the epidermis
in the papillary dermis on the opposing edge of the wound, curves down through the
reticular dermis, and exits at the base of the wound at the interface between the
dermis and the subcutis and parallel to the epidermis. The knot is tied at the base of
the wound to minimize the possibility of tissue reaction and extrusion of the knot. If the
suture is placed more superficially in the dermis at 2-4 mm from the wound edge,
eversion is increased.
Uses
A buried dermal-subdermal suture maximizes wound eversion. It is placed so that the
suture is more superficial away from the wound edge.
Running Subcuticular Suture
Technique
The running subcuticular suture is a buried form horizontal mattress
suture. It is placed by taking horizontal bites through the papillary dermis on
alternating sides of the wound. No suture marks are visible, and the suture may be left
in place for several weeks
Uses
The running subcuticular suture is valuable in areas in which the tension is minimal,
the dead space has been eliminated, and the best possible cosmetic result is desired.
Because the epidermis is penetrated only at the beginning and end of the suture line,
the subcuticular suture effectively eliminates the risk of crosshatching. The suture
does not provide significant wound strength, although it does precisely approximate
the wound edges. Therefore, the running subcuticular suture is best reserved for
wounds in which the tension has been eliminated with deep sutures, and the wound
edges are of approximately equal thicknesses.
Simple Interrupted Sutures
Technique
The most commonly used and versatile suture in surgery is the simple interrupted
suture. This suture is placed by inserting the needle perpendicular to the epidermis,
traversing the epidermis and the full thickness of the dermis, and exiting perpendicular
to the epidermis on the opposite side of the wound. The 2 sides of the stitch should be
symmetrically placed in terms of depth and width. In general, the suture should have a
flask-shaped configuration, that is, the stitch should be wider at its base (dermal side)
than at its superficial portion (epidermal side). If the stitch encompasses a greater
volume of tissue at the base than at its apex, the resulting compression at the base
forces the tissue upward and promotes eversion of the wound edges. This maneuver
decreases the likelihood of creating a depressed scar as the wound retracts during
healing.
Uses
Compared with running sutures, interrupted sutures are easy to place, have greater
tensile strength, and have less potential for causing wound edema and impaired
cutaneous circulation. Interrupted sutures also allow the surgeon to make adjustments
as needed to properly align wound edges as the wound is sutured.
Disadvantages of interrupted sutures include the length of time required for their
placement and the greater risk of crosshatched marks (ie, train tracks) across the
suture line. The risk of crosshatching can be minimized by removing sutures early to
prevent the development of suture tracks.
Running Sutures
Technique
The simple running suture is an uninterrupted series of simple interrupted sutures. The
suture is started by placing a simple interrupted stitch, which is tied but not cut. A
series of simple sutures are placed in succession without tying or cutting the suture
material after each pass. Sutures should be evenly spaced, and tension should be
evenly distributed along the suture line. The line of stitches is completed by tying a
knot after the last pass at the end of the suture line. The knot is tied between the tail
end of the suture material where it exits the wound and the loop of the last suture
placed.
Uses
Running sutures are useful for long wounds in which wound tension has been
minimized with properly placed deep sutures and in which approximation of the wound
edges is good. This type of suture may also be used to secure a split- or full-thickness
skin graft. Theoretically, less scarring occurs with running sutures compared with
interrupted sutures because fewer knots are made with simple running sutures;
however, the number of needle insertions remains the same.
Advantages of the simple running suture include quicker placement and more rapid
reapproximation of wound edges, compared with simple interrupted sutures.
Disadvantages include possible crosshatching, the risk of dehiscence if the suture
material ruptures, difficulty in making fine adjustments along the suture line, and
puckering of the suture line when the stitches are placed in thin skin.
Pulley Sutures
Technique
The pulley suture is a modification of the vertical mattress suture. When pulley sutures
are used, a vertical mattress suture is placed, the knot is left untied, and the suture is
looped through the external loop on the other side of the incision and pulled across.
At this point, the knot is tied. This new loop functions as a pulley, directing tension
away from the other strands
Uses
The pulley suture facilitates greater stretching of the wound edges and is used when
additional wound closure strength is desired
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Physicians Demeanor
Physicians will act as befits their station when on duty as well as off. Behaving In such a way as to inspire confidence in potential patients and garner the communitiy's respect. Physicians have no practice, if the patients have no confidence in their professionalism, judgement or skills.
Intoxicants will be imbibed only when there is coverage and never immediately prior to or during your shift, when going on duty or on call. 6 ahns must elapse between a physician's ingestion of alcohol and his treatment of a patient.
Patients shall be treated with respect at all times, Free women's modesty when possible shall bepreserved using rep sheets to cover all but the site to be examined and treated.
Slaves will be treated with impersonal kindness, no admitted kajira or kajiru will be required to serve, fur or otherwise see to a Master's needs, until dismissed as healed.
Staff slaves will not be expected to perform other than their Medical Center duties while on duty. Nor will they be subjected to touches or caresses that might cause them to become unable to perform their duties.
Standards of Cleanliness
Cleanliness, use of disinfectants and antiseptics are a Current Standard of Practice and will beconsidered an essential part of the patient's treatment. Hands are to be washed and gloved inaccordance with accepted medical practice before the patient is touched. Exceptions may be made when patient is off site, and must be stabilized or treated under primitive conditions.
No instrumentation shall be shared from one patient to another without proper sterilization in theautoclave.
Clean scrubs will be donned between patients, new gloves and hands rewashed.
Patient Confidentiality for the free
All examinations and treatrment, surgery and subsequent follow up in the Clinic shall be donewith the patient's dignity and privacy in mind. Private examination offices, treatment rooms andsurgical suites are available.
Patient's immediate family may be consulted and kept abreast of patient's examination, treatment, surgery and recovery status, within a private consulting chamber.
The case, the patient, the patient's identity, status,condition. course of treatment shall not bediscussed, shared or sent to any other than family without the patient's consent, written consent is preferred, verbal consent in the presence of a witness is adequate.
The case may be discussed with other of the green caste for instructional purposes, as long as the patient's name is withheld.
Records
Detailed and legible patient charts will be kept for each patient by the physician, NO Exceptions ( ie: healing log, with name, date and location )and made available to the patient, or sent to the patient's personal physician at the patient's request. Such logs will be kept by the medical center, filed according to patients name, to provide documentation for billing purposes, medical review and quality control as well as for educational purposes.
Anesthetics
Blue Short Grass - Used as a compress on a wound numbs the area making it
easier for a physician to work on it.
Frobican - Anaesthesia
Tassa - Our own well known knock out drug akin to chloroform
Bleeding
Agrimony - As agrimony has substance that are astringents it has the ability to close
wounds and stop bleeding when used as an external compress.
Black Pepper - A painful but extremely effective way of stopping bleeding in an
emergency.
Burns
Aloe Vera - As natural gel it helps soothe and heal sunburn.
Contraception
Sip Root - A bitter root whose extract is the active ingredient in slave wine. Red Savages make their slaves chew as a means of birth control.
Breeding Wine - reverses the effect of slave wine.
Slave Wine - a bitter drink given mainly to slaves to prevent pregnancy. Used to have to take once a month. Now it can be taken just the once.
Constipation
Alfalfa - Has a laxative effect - take 15-20 drops 4 times a day.
Aloe Vera - 2tbs daily as a juice in the morning acts as a laxative.
Goldenseal - As a tincture of 20 drops dail this helps with constipation (Goldenseal is a double edge sword when given for infections of the bowel it tends to destroy good bacteria as well so do not use for more than 1 moon cycle. Do not use in pregnancy as goldenseal stimulates the uterine muscles)
Digestive problems
Alfalfa - Acts as a Diuretic as a tea
Aloe Vera - 1tbs daily as a juice helps reduce inflammation of the stomach
Chamomile - Reduces internal inflammation of the stomach. Used as a tincture of 15
- 20 drops a day or sipped as a tea.
Fever
Chamomile - Sip as a tea when needed to help reduce the temperature.
White Willow - As a tincture 20 drops daily after eating reduces fever
Food Allergies
Agrimony - As a tincture 20 drops twice daily before eating
Menstrual Problems
Angelica - Taken as tincture 20 drops 2-3 times a day helps with Menstural Cramps
(Do not take if pregnant or have high blood pressure may cause skin irritation)
Chamomile - Take the tea a hand before the menstural cycle to aid with the relief of
menstural cramps. As an oil massaged onto the lower back during mensturation (Do
not use the oil in early stages of pregnancy as it can stimulated mestruation)
Migraines/Headaches
Angelica - As a tea mixed with Chamomile it helps with the nausea and pain associated with Migraines (Do not take Angelica if pregnant or with High blood pressure. May cause skin irritations).
Lavender - Drink twice daily as a tea if the patient can keep anything down, if not use the oil in a burner in a darkened room.
Nausea
Angelica - Sip a mild tea when feeling nausea (do not use when pregnant or high
blood pressure and may cause skin irritation)
Peppermint - As a tea take 1 cup twice a day to help reduce nausea and sickness. Sucking on a twig also helps nausea.
Numbing
Blue Short Grass - As a compress on an area, it numbs the near surrounding area.
Pain Relief
Kanda - This is a strong drug used here on Gor its properties akin to the opiates of Earth. The leaves are to be chewed for pain but should never be swallowed. It can be poisonous and fatal. (Use with caution)
Valerian - 30 drops in water reduces muscle tension, pain and has a calming effect.
Pregnancy
Peppermint - As a tea take 1 cup twice a day to help reduce nausea and sickness.
Sage - Take as a tincture 20 drops per day it stimulates fertility
- Helps reduce excessive milk in lactating women (avoid during pregnancy though)
Ramberry Leaves - As a tea can be given in the last two months in pregnancy to aid in labour. And can be sipped during labour. Do not take before the last two months.
Rehabilitation
Alfalfa - Helps recovery from any debilitating illness taken as a tea
- Helps to stimulate the appetite - 15 drops taken before each meal
Lavender - Use the oil in a burner in the patients room, it relaxes and is a mood elevator and reduces anxiety.
Respiratory Problems
Angelica - Acts as an expectorant for chest infections tak as an infusion adding 1tbs
of dried herbs to 2 goblets of boiling water (do not use in pregnant women, or high
blood pressure. May cause skin irritation)
Cayenne - Given as small does of compacted dried herbs helps with bronchial
disorders 1-2 tablets with each meal.
Liptus - Helps with respatory problems. Parts Used : Leaves and the oil distilled from them.
Preparations & Doasage : An infusion may be made with 1-2 tsp of the leaves to a cup of boiling water. Let infuse for 10-15 minutes. The dose of tincture is 1ml. 3 times a day.
Exernal Use : Put 5 drops of the oil in a hot bath or 6 drops in boiling water, put towel over head and inhale the vapors.
Skin Irritation
Agrimony - As a compress used to treat things like Eczema
Cayenne - Used as a cream it reduces skin irritations (Do not use on broken skin)
Goldenseal - Used as a salve or compress it aids in skin irritation
Sleeping Problems
Bergamot - Used as an oil in a burner promotes restfull sleep
Valerian - Take 25 drops of tincture before bed.
Sprains and Swelling
Amaranth - When crushed and made into a compress it helps reduce swelling
Lavender - Used as a compress or slave helps aleviate sore and aching bones and muscles
Peppermint - Use drops of mixed oils on the sore muscles.
Valerian - 30 drops in water reduces muscle tension, pain and has a calming effect.
Willow - 20 drops a day after a meal willow acts as an anti-inflammatory agent.
Stomach Problems
Alfalfa - Helps to stimulate the appetite - 15 drops taken before each meal
Angelica - Relieves symptoms of an upset stomach take a tincture of 20 drops 2- 3
times daily (do not use when pregnant or high blood pressure and may cause skin
irritation)
Goldenseal - Has an antibacterial action in the bowl and gut. As a tincture take 20 drops daily. (Goldenseal is a double edged sword along with killing of bad bacteria it also kills of good therefore only use for the maximum of one moon. Do not use in pregnancy as it stimulates the uterine muscles)
Peppermint - Drink as a tea twice a day, as it has an antispasmodic agent for bowels.
Sunburn
Aloe Vera - As a natural remedy for sunburn apply the gel directly to the affected
area.
Chamomile - Gently apply chamomile oil to the affected area (Do not use oil in the
early stages of pregnancy as it may stimulate mensturation)
Urinary
Alfalfa - Relieves symptoms of cystitis as a tincture of 15-20 drops twice daily
Angelica - Relieves symptoms of cystitis take as a tincture 20 drops 2-3 times daily
(do not use when pregnant or high blood pressure and may cause skin irritation)
Chamomile - To aid with cystitis drink copiousamounts of tea, sit in a chamomile
bath and place compresses over the lower abdomen.
Vomiting
Amaranth - Sip tea slow to help with the reduction of vomiting
Peppermint - As a tea take 1 cup twice a day to help reduce nausea and sickness.
Wounds
Agrimony - As agrimony has substance that are astringents it has the ability to close
wounds and stop bleeding when used as an external compress.
- Used as a healing cream it helps speed wound healing.
Healing Salve - As we all know the magical cure for anything here on Gor (use always)
Sage - Used as a compress sage provides a readily available antiseptic agent to promote the healing of wounds.
Physicians
"the first day the Physician, a quiet man in the green garments of his caste, examined me, thoroughly. The instruments he used, the tests he performed, the samples he required were not unlike those of Earth. ...I could see neither cords nor battery cases. Yet the room was filled with a soft, gentle white light, which the physician could regulate by rotating the base of the bulb. Further, certain pieces of his instrumentation were clearly far from primitive. For example, there was a small machine with gauges and dials. In this he would place slides, containing drops of blood and urine, flecks of tissue, a strand of hair. With a stylus he would note readings on the machine, and, on the small screen at the top of the machine, I saw, vastly enlarged, what reminded me of an image witnessed under a microscope. -Captive of Gor, p 92-93
A physician entered the booth with his kit slung over the shoulder of his green robes. When the physician had finished the cleansing, chemical sterilization and dressing of the wounds [dagger stab wounds] he left. The scribe paid the physician a tarsk bit." -Beasts of Gor p104
Be that as it may, the Priest Kings have limited man severely on this planet in many respects, notably in weaponry, communication, and transportation. On the other hand, the brilliance which men might have turned to destructive channels was then diverted, almost of necessity, to other fields, most notably medicine. -Assassin of Gor pg 30
I looked about the room, turning my head painfully, and saw that the room was some sort of operating chamber, filled with instrumentation, with racks of delicate tongs and knives. In one corner there was a large drumlike machine with a pressurized door which might have been a sterilizer. -Priest Kings of Gor pg. 253
"Who has done this?" I asked.
"I," said Parp. "The operation is not as difficult as you might expect and I have performed it many times."
"He is a member of the Caste of Physicians," said Kusk, "and his manual dexterity is superior even to that of Priest Kings." -Priest Kings of Gor pg. 254
The Physicians are one of the five High Castes which make up the Gorean government. This is the caste of those who concern themselves with the healing arts. Surgeons, apothecaries, medical researchers and health practitioners are all members of this caste. Universally recognized as non-combatants during time of war.
Tarnsman of Gor
"A notable exception to the generalization that woman of a Caste normally do not engage in Caste work is the Caste of Physicians, whose women are commonly trained, as are the boys, in the practice of medicine. Even the Physicians however, normally do not admit their women to full practice until they have borne two children. The purpose of this is to retain a high level of intelligence in the caste. Professional women, it is well understood, tend not to reproduce themselves, a situation which, over time, would be likely to produce a diminution in the quality of the caste. Concern for the future of the caste is thus evidenced in this limitation by the physicians on the rights of their women to participate without delay in the caste craft. The welfare of the caste, typically, takes priority in the Gorean mind over the ambitions of specific individuals. The welfare of a larger number of individuals, as the Goreans reason, correctly or incorrectly, is more important than the welfare of a smaller number of individuals. I do not argue this. I only report it. The woman of the Physicians, at the age of fifteen, in many cities, wears two bracelets on her left wrist. When she has one child one bracelet is removed; when she has a second child the second bracelet is removed. She may then, if she desires, enter into the full practice of her craft."
Fighting Slave of Gor pg. 210
"Thurnock" I said, "give this Physician a double tarn of gold."
Marauders of Gor pg. 19
"There is at least one area, however," said my father, "In which the Priest Kings do take a most active interest in this world, and that is the area of technology. They limit, selectively, the technology available to us, the Men Below the Mountains. For example, incredibly enough, weapon technology is controlled to the point where the most powerful devices of war are the crossbow and lance. Further, there is no mechanized transportation or communication equipment or detection devices such as the radar and sonar equipment so much in evidence in the military establishments of your world." "On the other hand," he said, "you will learn that in lighting, shelter, agricultural techniques, and medicine, for example, the Mortals, or the Men Below the Mountains, are relatively advanced."
From Tarnsman of Gor pg. 32
Tending Wounds
A physician entered the booth with his kit slung over the shoulder of his green robes. When the physician had finished the cleansing, chemical sterilization and dressing of the wounds [dagger stab wounds] he left. The scribe paid the physician a tarsk bit." -Beasts of Gor p104
I found Flaminius, the Physician, in his quarters, and he obligingly, though drunk, treated the arm which Ho-Tu had slashed with the hook knife. The wound was not at all serious. The games of Kajurilia can be dangerous, remarked Flaminius, swiftly wrapping a white cloth about the wound, securing it with four small metal snap clips." Assassin of Gor pg. 264
Using the dagger as an awl, punching through the flesh, and the long lacing from the lance head, while Hassan held together the edges of the ripped furrows, I crudely sewed together the rent bloodied meat before me." Tribesmen of Gor pg. 263
"He touched the bloodied cut on my belly, where the branch had struck me. Then, with his hand, he lifted my head, turning it, looking at the cut on my cheek. We are not pleased, he said. I said nothing. Bring salve, he said. An ointment was brought, and he smeared it across the two cuts. It was odorless. To my surprise it seemed to be absorbed almost immediately. You must be careful, he said. Again I said nothing. You might have marked yourself, he said, or might have been blinded. He returned the ointment to another man. They are superficial, he told me, and will heal without trace." - Captive of Gor pg. 29 - 30
"The hunting arrow, incidentally, has a long, tapering point, and this point is firmly fastened to the shaft. This makes it easier to withdraw the arrow from its target. The war arrow, on the other hand, uses an arrowhead whose base is either angled backwards, forming barbs, or cut straight across, the result in both cases being to make the arrow difficult to extract from a wound. The head of the war arrow, too, is fastened less securely to the shaft than is that of the hunting arrow. The point thus by intent, if the shaft is pulled out, is likely to linger in the wound. Sometimes it is possible to thrust the arrow through the body, break off the point and then withdraw the shaft backwards. At other times, if the point becomes dislodged in the body, it is common to seek it with a bone or greenwood probe, and then, when one has found it, attempt to work it free with a knife. There are cases where men have survived this. Much depends, of course, on the location of the point." -Savages of Gor pg. 40
Accomodations
Slave Wards - 2 tarsk bit per day (to be paid by the owner)
Private Rooms - 50 tarsks per day
Private Rooms with slave rooms - 1 silver per day
Private Suits - 2 Silver tarsks per day
Maternity Rooms - 1Silver and 50 tarsks per day
Medical Fees
Examination - 5 tarsk bit
Minor Wounds - 10 tarsk bit
Ob/Gyn -15 Tarsk per visit (if not registered with the clinic)
Ob/Gyn if registered with one of our physicians - I gold from 1st consultation to delivery
Delivery -2 Silver tarsks
Cesarian Section - 3 Silver
Emergency Operations minor - 1 Silver
Emergency Operations med - 2 Silver tarsks
Emergency Operations Complicated - 5 Silver
Standard Clinic Services
Anti Natal
Broken bones
Childbirth
Cesarean Section
Examinatation (Emergency)
Examinatation (Pregnancy)
Examination (Routine)
Examination (Home visit)
Examination (Stablilization Serums)
Emergency House Calls
Gynecological Procedures
Sprains/Fractures
Surgery all levels
Sutures/Stitches
Wounds
Darkosis
Dar-kosis is a virulent, wasting disease and is similar in many ways to leprosy. "Dar-kosis" means "Holy Disease" and it is also known as the "Sacred Affliction" though its name is rarely mentioned. Those inflicted with the disease are commonly known as Afflicted Ones. It is highly contagious and the afflicted must wear yellow robes as a mark of their illness. Many victims also periodically clack a wooden device to warn people to stay away. Because of this, victims have much freedom of movement though if they approach a city, they risk being stoned. "Those who contract the disease are regarded by law as dead." (Assassin of Gor, p.266) This has important legal ramifications. A Free Companionship would be ended. Any will would take effect. The Afflicted lose everything. "The Afflicted are dead. The Afflicted are nameless." (Tarnsman of Gor, p.151)
The Initiate Caste feels that Dar-kosis is an instrument of the Priest-Kings to punish those who displease them. The afflicted are thus holy to the Priest Kings and it is heresy to shed their blood. Interestingly though, stoning them is not considered heresy. Initiates have constructed Dar-Kosis pits where the Afflicted may voluntarily imprison themselves. They will be provided with food and drink by men on tarns, who will drop it into the pits. Once in a Pit, an Afflicted is not permitted to leave. Because it is considered a holy disease, the Initiates will not permit the Physician's Caste to research a cure. There is little love lost between the Physicians and Initiates.
A few years before the events of Assassin of Gor, a group of Physicians in Ar tried to seek a cure. Flaminius, first in his Caste, led the research program. The Physicians had developed a strain of urts resistant to Dar-kosis. They then created a serum, cultured from the urt blood. When this was injected into other animals, they could not be infected by the disease. But at that time, someone betrayed them to the Initiates. The Initiates asked them to stop the research but they refused. The Initiates petitioned Marlenus but he refused to do anything. Soon after, a group of armed men stormed the Cylinder of Physicians. They damaged the Cylinder, burnt the research floors, killed some of the Physicians and ruined most of the research. That would stop their research for several years. Flaminius was burned over half his body and became somewhat of a drunk. After the events of Assassin of Gor, Flaminius chooses to return to his research for a Dar-Kosis cure.
Bazi Plague
Bazi plague, also known as the pox, is a deadly, rapidly-spreading disease with no known cure. Its symptoms include pustules all over the body and a yellowing of the whites of the eyes. The pox is transmitted by lice. Some people are immune to it and for some it is only a temporary problem. Others die swiftly. Slaves that get the pox are usually killed. Bazi was struck by a plague some years ago and its port was closed by the Merchant's Caste for two years. The plague burnt itself out in about eighteen months. By the events of Explorers of Gor, Bazi has still not recovered from the economic tragedy of this closure. In Schendi, they still had Physicians checking incoming ships for signs of disease. Gieron and sajel are drugs that in combination can reproduce the physical effects of this disease without causing any real injury. Gieron is an allergen that causes a yellowing of the whites of the eyes. Sajel is a simple pustulant.
Dental Work
Dental work on Gor is rarely done or needed. Due to its rarity, dentistry is probably not a subcaste. There would be insufficient work to support such a specialist. Cavities are rare because of the simple diet of Goreans and their absence of emotional stress, guilt, and worry. The mouths of slave girls are often checked by a buyer or slaver to see if she has fillings or not. That is normally a sign that the girl is from Earth due to the rarity of dental work on Gor.
Infusions
A tea made by pouring boiling water over an herb and allowing it to steep, covered, with no additional heat source. Infusions generally have a short shelf life. Prepare as needed.
Decoctions
A thick herbal tea or soup made by boiling the herb in water, then simmer it, covered until you have a thick brew with very little water, or until you reach a consistency of your requirement.
Water Based Extracts
Make a strong decoction of the herb. That is, boil it in water, then simmer it, covered, until you have a thick brew with very little water. Cool, and strain the boiled herb into the brew. Add an equal amount of vegetable glycerine to the thick decoction and mix well. Pour into a sterile dark glass bottle, stopper tightly and store in a cool place. Treated with care this fluid extract will last a year or more.
Vegetable glycerin, an edible humectant that moisturizes the skin, is an essential fattyacid generally derived from coconut or palm. It is used as a preservative and stabilizing agent. Never add glycerine to hot liquids as it is temperature sensitive and will coagulate. Always mix with cold or warm liquids.
Fluid extracts are used both to concentrate and preserve the active ingredients of an herb. Fluid extracts are considered by many herbalists to be the preferred way to preserve water soluble active ingredients. When properly made one fluid ounce of fluid extract equals one ounce of fresh herb.
Alcohol Extractor or Tinctures
Water is a good medium to extract gums, mucilage, saponins and tannins, but not so good for oils and resins. Alcohol is ideal for extracting fats, resins, waxes and most alkaloids. It is an excellent preservative and is quickly assimilated. The substance used to extract the herbs is known as the menstrum. The herbs you are tincturing are known as the mark. Tincturing will extract and preserve both the water-soluble and alcohol-soluble properties of an herb.
Prepare the herbs by chopping or grinding them. Tincture several herbs together if you are creating a formula. Put them in a sterile jar with a tight lid, and cover them with . paga Alcohol must be at least 50 proof to have good preservative qualities.
Shake daily. Strain after a month, first with a strainer and then through a clean undyedcloth, squeezing tightly. Pressing the herbs through a sieve while still in the cloth can be helpful. Bottle in sterile amber glass bottles. Label and date. Store away from heat and light. Take tinctures by putting 1 dropperful in a hot drink.
Tinctures may also be made using vegetable glycerin rather than alcohol. This is best when making tinctures for those that are alcohol intolerant as well as for children, pregnant and nursing mothers. Glycerin is both a solvent and preservative that has an effectiveness somewhere between water and alcohol. It is naturally sweet, pleasant tasting and helps to extract mucilage, vitamins, minerals and tannins from plant material. It is good for herbs high in tannins but doesn't extract resins well. It is slightly antiseptic, demulcent and healing when diluted. Glycerites are usually prepared using 1 part water to 2 parts glycerin. Glycerites have a shorter shelf life than tinctures prepared with alcohol, about 1 to 3 years. Tinctures made in alcohol will last for many years.
Salve
A salve is made with herb, an oil, beeswax, and a preservative. The best kind of oil to use is olive or sesame. Do not use the drying oils, such as soybean and linseed. A good preservative to use is Gum Benzoin, either the powder or your own tincture madewith our high grade Sumatran Gum Benzoin Powder, . Choose glass, or earthenware to mix or store your herbal preparations. The containers you use to store the mixtures should be airtight and sterile.
Begin by heating the oil to boiling (in a glass pan). Add the herbs of your choice and simmer, covered, for about 3 hours. If part of your herbal recipe includes bark or roots, place these in the oil first and simmer them for the first 1½ hours before adding flowers or leaves. If using fresh herbs, always leave the lid off the container for the first 30 mintues in order to allow the water to evaporate from the herbs.
After the mixture is ready, strain and add beeswax. You will need about 1½ ounces of beeswax for each pint of oil used. Next, add a half teaspoon of the tincture of benzoin for each pint of oil. Mix well. To test for consistency, put a small amount of the salve in the fridge. Add more beeswax to thicken. When the desired consistency is reached, pour into labeled jars. Salves last for years.
Frostbite Awareness and Treatment (Hypothermia)
Frostbite is frozen body tissue, localized damage is caused to skin and other tissues due to extreme cold. Frostbite generally happens to the body parts furthest from the heart i.e. (toes, feet, legs, noses, and ears). The initial stages of frostbite are generally referred to as frostnip.
There are three sub categories of frostbite you will also need to be familiar with to help assess the patient. The most common being frostbite, which may appear as white or pale yellow patches, with a strong burning sensation when tissue is re-warmed. Frostnip will result in temporary loss of sensation in the affected area for up to one year. Red swelling in the area followed by blue spots, often visible in the morning or right after travel. If untreated, the spots will grow into black areas which is also known as frostbite. Frostnip can be reversed if treated in a timely manner.
The next category is known as chilblains which are ulcers that affect the extremities, this occurs when a predisposed individual is exposed to cold and humidity. The cold exposure damages the capillary beds in the skin, which in turn can cause redness, itching, blisters, and inflammation. Chilblains can be prevented by keeping the feet and hands warm in cold weather.
The last category is hypothermia which is a condition in which an organisms temperature drops below that required for normal metabolism which is 35 degrees
and body functions. When the body is exposed to cold its internal mechanisms may be unable to replenish the heat that is being lost to the organism’s surroundings. Hypothermia can be prevented by wearing wool fabrics to provide insulation it breaths and it will dry quickly from the bodies sweat.
At thirty two degrees blood vessels close to the skin start to constrict. The same response may also happen with the exposure to severe high winds. The constriction helps to preserve core body temperature. In extreme cold, when the body is exposed to cold for long periods of time this protective strategy can reduce blood flow in some areas of the body to dangerously low levels. This lack of blood leads to the eventual freezing and death of skin tissue in the affected areas. There are three stages of frostbite, each of these have varying degrees of pain.
Stage1
First degree frostbite causes skin to appear yellow or white there may be slight burning sensations. This stage is mild and can be reversed by the gradual warming of the affected area.
Stage2
Second degree frostbite develops after continued exposure, this stage is characterized by the disappearance of pain and the reddening and swelling of the skin. Treatment in this stage may result in blisters and it may also peel the skin.
Stage 3
Third degree results in waxy and hard skin. It is at this stage that the skin dies and edema may occur as a result of the lack of blood. If third degree frostbite is not treated immediately then the damage and the frostbite becomes permanent, nerve damage will occur due to oxygen deprivation and neurological damage as well. Frostbitten areas will turn discolored, purplish at first, and soon turn black. After a while nerve damage becomes so great that feeling is lost in the frostbitten areas. Blisters will also occur, if feeling is lost in the damaged area(s), immediately check for cuts and breaks in the skin as it is vital. Infected open skin can lead to gangrene and amputation may be needed.
Treatment of frostbite centers on re-warming depending on what degree of frostbite; thawing of the affected tissue. Excessive movement of frostbitten tissue can cause ice crystals that have formed in the tissue to do further damage. Splinting and or wrapping frostbitten extremities is therefore recommended to prevent such movement. For this reason, rubbing, massaging, shaking, or otherwise applying physical force to frostbitten tissues in an attempt to re-warm the patient can be harmful. Warming can be achieved by the use of two methods.
Method 1
Passive re-warming involves using body heat or room temperature to aid the patients body in re-warming itself. This includes wrapping in blankets and moving to a warmer environment (if possible).
Method2
Active re-warming is the direct addition of heat to a patient usually in the addition to the treatment included in passive re-warming. Active re-warming requires more equipment and therefore may be difficult to perform in the pre clinic environment. When performed active re-warming seeks to warm the injured tissue as quickly as possible without burning them . This is desirable as the faster the tissue is thawed, the less tissue damage occurs. Active re-warming is usually achieved by immersing the injured tissue in a water bath that is held between one hundred four degrees and one hundred eight degrees. Warming of peripheral tissues can increase blood flow to these areas back to the bodies core. This may produce a degree in the bodies core and temperature and increase the risk of cardiac dysrhythmias.
Debridement and or amputation of necrotic tissue is usually delayed, with exceptions being made for signs of infection and gangrene. Remember frostbite is blood poisoning which can be fatal, however it can be kept stable but will not heal until after you have left the ice. Also good blood circulation is essential.
Thanks to Amara Berhanu for her research on this.
Fractures
What is a fracture?
A fracture is a partial or complete break in the bone. When a fracture occurs, it is classified as either open or closed:
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open fracture (Also called compound fracture.) - the bone exits and is visible through the skin, or a deep wound that exposes the bone through the skin.
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closed fracture (Also called simple fracture.) - the bone is broken, but the skin is intact.
Fractures have a variety of names. Below is a listing of the common types that may occur:
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greenstick - incomplete fracture. The broken bone is not completely separated.
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transverse - the break is in a straight line across the bone.
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spiral - the break spirals around the bone; common in a twisting injury.
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oblique - diagonal break across the bone.
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compression - the bone is crushed, causing the broken bone to be wider or flatter in appearance
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comminuted - the break is in three or more pieces and fragments are present at the fracture site.
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segmental - the same bone is fractured in two places, so there is a "floating" segment of bone.
What causes a fracture?
Fractures occur when there is more force applied to the bone than the bone can absorb. Bones are weakest when they are twisted. Breaks in bones can occur from falls, trauma, or as a result of a direct blow or kick to the body.
What are the symptoms of a fracture?
The following are the most common symptoms of a fracture. However, each individual may experience symptoms differently. Symptoms may include:
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pain in the injured area
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swelling in the injured area
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obvious deformity in the injured area
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difficulty using or moving the injured area in a normal manner
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warmth, bruising, or redness in the injured area
How is a fracture diagnosed?
In addition to a complete medical history (including asking how the injury occurred) and physical examination, diagnostic procedures for a fracture may include the following:
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x-ray
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appearance
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feeling the area
Treatment for a fracture:
Specific treatment for a fracture will be determined by the physician based on:
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age, overall health, and medical history
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the extent of the condition
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tolerance for specific medications, procedures, or therapies
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expectations for the course of the condition
The goal of treatment is to control the pain, promote healing, prevent complications, and restore normal use of the fractured area.
An open fracture (one in which the bone exits and is visible through the skin, or a deep wound that exposes the bone through the skin) is considered an emergency.
Treatment may include:
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splint/cast (immobilizes the injured area to promote bone alignment and healing to protect the injured area from motion or use)
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medication (to control pain)
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tractionTraction is the application of a force to stretch certain parts of the body in a specific direction. Traction consists of pulleys, strings, weights, and a metal frame attached over or on the bed. The purpose of traction is to stretch the muscles and tendons around the broken bone to allow the bone ends to align and heal.
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surgerySurgery may be required to put certain types of broken bones back into place. Occasionally, internal fixation (metal rods or pins located inside the bone) or external fixation devices (metal rods or pins located outside of the body) are used to hold the bone fragments in place to allow alignment and healing.
Spars and Fractures
Fractures are breaks in the bone that are often caused by a blow or a fall. A fracture may be classified as a simple fracture (a thin fracture that may not run through the entire bone), or a compound fracture, in which the broken bone protrudes through the skin. Most fractures occur in the arms and legs. Symptoms may include tenderness over the bone, swelling of the affected area, deformity of the limb, and increased pain upon movement.
What are stress fractures?
Stress fractures are weak spots or small cracks in the bone caused by continuous overuse.
A stress fracture may not cause swelling. However, each individual may experience symptoms differently. Symptoms may include:
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pain in the front of the foot, often after long or intense bouts of exercise
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pain that disappears after practice sparring, then returns when sparring is continued
How is a stress fracture diagnosed?
Diagnosis of a stress fracture usually is confirmed with a complete medical history and a physical examination.
Treatment for a stress fracture:
Specific treatment for a stress fracture will be determined by the physician based on:
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age, overall health, and medical history
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extent of the injury
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tolerance for specific medications, procedures, and therapies
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expectation for the course of the injury
Treatment may include:
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rest
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shock-absorbing devices to use during sparring
Ceasarean
Cesarean Delivery
(Cesarean Section, C-section, Cesarean Birth)
Procedure Overview
What is a cesarean delivery?
Cesarean delivery (also called a cesarean section or C-section) is the surgical delivery of a baby by an incision through the mother's abdomen and uterus. This procedure is performed when it is determined to be a safer method than a vaginal delivery for the mother, baby, or both.
In a cesarean delivery, an incision is made in the skin and into the uterus at the lower part of the mother’s abdomen. The incision in the skin may be vertical (longitudinal) or transverse (horizontal), and the incision in the uterus may be vertical or transverse.
A transverse incision extends across the pubic hairline, whereas, a vertical incision extends from the navel to the pubic hairline. A transverse uterine incision is used most often, because it heals well and there is less bleeding. Transverse uterine incisions also increase the chance for vaginal birth in a future pregnancy. However, the type of incision is determined by conditions of the mother and the fetus.
Reasons for the Procedure
If a woman is unable to deliver vaginally, the fetus is delivered surgically by performing a cesarean delivery. Some cesarean deliveries are planned and scheduled accordingly, while others may be performed as a result of complications that occur during labor.
There are several conditions which may make a cesarean delivery more likely. These include, but are not limited to, the following:
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abnormal fetal heart rate - The fetal heart rate during labor is a good indicator of how well the fetus is handling the contractions of labor. The heart rate is usually monitored electronically during labor, with the normal range varying between 120 to 160 beats per minute. If the fetal heart rate indicates a problem, immediate action can be taken, such as giving the mother oxygen, increasing fluids, and changing the mother's position. A cesarean delivery may be necessary.
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abnormal position of the fetus during birth - The normal position for the fetus during birth is head-down, facing the mother's back. However, sometimes a fetus is not in the right position, making delivery more difficult through the birth canal.
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labor that fails to progress or does not progress normally
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baby is too large to be delivered vaginally
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placental complications (e.g., placenta previa, in which the placenta blocks the cervix and presents the risk of becoming detached prematurely from the fetus)
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certain maternal medical conditions (e.g., diabetes, high blood pressure)
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twins or other multiples
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previous cesarean delivery
Risks of the Procedure
As with any surgical procedure, complications may occur. Some possible complications of a cesarean delivery may include, but are not limited to, the following:
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bleeding
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abnormal separation of the placenta, especially in women with previous cesarean delivery
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injury to the bladder or bowel
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infection in the uterus
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wound infection
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difficulty urinating and/or urinary tract infection
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delayed return of bowel function
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blood clots
A woman may or may not be able to have a vaginal birth with a future pregnancy, called a vaginal birth after cesarean (VBAC). Depending on the type of uterine incision used for the cesarean birth, the scar may not be strong enough to hold together during labor contractions.
Before the Procedure
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The physician will explain the procedure and offer the opportunity to ask any questions about the procedure.
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The patient will be asked when she last had anything to eat or drink. If the cesarean delivery is a planned procedure and requires general, spinal, or epidural anesthesia, the patient will be asked to fast for eight ahns before the procedure, generally after midnight.
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The patient may be given medication to decrease the acid in her stomach and to help dry the secretions in her mouth and breathing passages.
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The area around the surgical site may be shaved.
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Plan to have someone stay with the patient after a cesarean delivery. She may have pain in the first few days and will need help with the baby.
During the Procedure
A cesarean delivery may be performed in an operating room or a designated delivery room. Procedures may vary depending on one's condition and physician’s practices.
In most cases, the patient will be awake for a cesarean delivery. Only in rare situations will a mother require general anesthesia (asleep) for this type of birth. Most cesarean deliveries today are performed with a local anesthesia. With this type of anesthesia, the patient will have no feeling from her waist down, and she will be awake and able to hear and see her baby as soon as he/she is born.
Generally, a cesarean delivery follows this process:
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She will be asked to undress completely and put on a sterile gown.
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She will be positioned on an operating or examination table.
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A urinary catheter may be inserted if it was not inserted before coming to the operating room.
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An intravenous (IV) line may be started in her arm or hand.
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For safety reasons, straps will be placed over her legs to secure her position on the table.
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Hair around the surgical site may be clipped or shaved and the skin will be cleansed with an antiseptic solution.
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Her abdomen will be draped with sterile material. A drape will also be placed above her chest to screen the surgical site.
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Her heart rate will continuously be monitored as well as her blood pressure, breathing, and blood oxygen level during the procedure.
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Once the anesthesia has taken effect, an abdominal incision will be made above the pubic bone, either transverse or vertical.
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Deeper incisions will be made through the tissues and muscle until the uterine wall is reached. A final incision will be made in the uterus. This incision is either transverse or vertical.
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The amniotic sac will be opened, and the baby will be delivered through the opening. She may feel some pressure and/or a pulling sensation.
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The umbilical cord will be cut.
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Medication to help the uterus contract and expel the placenta will be given in her IV.
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The placenta will be removed.
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The uterus will be examined for any tears or remaining pieces of placenta.
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Sutures will be used to close the incision in the uterine muscle and the uterus will be repositioned in the pelvic cavity.
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The muscle and tissue layers will be closed with sutures and the skin incision will be closed with sutures.
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A sterile bandage/dressing will be applied.
After the Procedure
In the clinic:
She will be taken to the recovery room or allowed to rest in the same room for observation. Her blood pressure, breathing, pulse, bleeding, and the firmness of her uterus will be monitored.
Usually, her baby can be brought to her while she is recovering after surgery. In some cases, babies born by cesarean will first need to be monitored in the nursery for a short time. Breastfeeding can begin in the recovery area, just as with a vaginal delivery.
After about one to two ahns in recovery, she will either be moved to a room for the rest of her stay or remain in the same room after adjustments to the bed.
As her anesthesia wears off, she may receive pain medication as needed by an attendant by administering it through her intravenous line.
In addition to the soreness of her abdomen, she may also have gas pains as the intestinal tract begins working again after surgery. She will be encouraged to get out of bed. Moving around and walking are helpful in relieving gas pains. She may also feel some uterine contractions called after-pains for a few days. The uterus continues to contract and get smaller over several hands.
Her urinary catheter will be removed usually by the next day after surgery.
Depending on her situation, she may be given liquids to drink a few ahns after surgery. Her diet may be gradually advanced to more solid foods as tolerated.
She may be given antibiotics in her IV while in the clinic and a prescription to continue the antibiotics at home.
At home:
She will need to wear a sanitary pad for bleeding. It is normal to have vaginal bleeding for several days after birth, followed by a discharge that changes from dark red/brown to a lighter color over several weeks.
She should not have intercourse until the time recommended by her physician, usually 5 hands. She may also have other restrictions on her activity, including no strenuous activity, riding, or heavy lifting.
Pain relievers such as valerian may be recommended.
Arrangements will be made for a follow-up visit with her physician, usually two to three hands after the procedure.
Notify her to contact her physician if she has any of the following:
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heavy bleeding
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foul-smelling drainage from her vagina
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fever and/or chills
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severe abdominal pain
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increased pain, redness, swelling, or bleeding or other drainage from the incision site
Her physician may give additional or alternate instructions after the procedure, depending on her particular situation.
Broken Nose/Nasal Fracture
One of the most common injuries during the fair especially during the spars, is Nose injuries. This scroll is filled with information on the injuries and how to treat them. Please use them as a reference if needed.
Broken Nose (Nasal Fracture)
A nasal fracture is a break in the bone over the ridge of the nose. It usually results from a blunt injury and is one of the most common facial fracture. Symptoms of a broken nose include pain, blood coming from the nose, bruising around the eyes, misshapen appearance, swelling, and difficulty breathing through the nose. Serious nose injuries can cause problems and require immediate attention. However, for minor nose injuries, the physician may prefer to see the victim after the swelling subsides to evaluate the extent of injury.
How does one get a broken nose?
A nose break can happen during play, spars, accidents, and falls. However, it may be hard to tell if the nose is broken. Swelling can make the nose look crooked even if it is not broken. When the swelling goes down after a few days, it is easier to tell if the nose is really crooked and possibly broken.
What are the symptoms?
Symptoms of a broken nose include:
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Nose pain.
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Swelling of the nose.
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A crooked or bent appearance.
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Bruising around the nose or eyes.
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A runny nose or a nosebleed.
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A grating sound or feeling when the nose is touched or rubbed.
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Blocked nasal passages.
Possible complications of a broken nose include:
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Infection of the nose, sinuses, or facial bones.
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Permanent breathing difficulty.
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Persistent drainage from one or both nostrils. This may be caused by cerebral spinal fluid draining from the brain into the nose and can occur after a head injury or after surgery on the nose or ears.
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Change in the appearance of the nose or the tip of the nose.
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Crooked (deviated) nasal septum. The nasal septum is the structure that divides the nose into two parts.
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A hole in the nasal septum or causing the bridge of the nose to collapse.
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A large amount of blood in the nasal septum (nasal septal hematoma).
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A change in or loss of sense of smell.
How is it treated?
Immediately after the fracture, apply ice and keep the head elevated to help reduce swelling. The patient may need pain medication. Have the patient lean forward and breathe through their mouth in order to stop as much blood as possible from draining into their throat.
Immediate treatment is needed for some injuries that occur with a broken nose, such as:
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A large amount of blood in the nasal septum (nasal septal hematoma).
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A nosebleed that cannot be stopped.
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Severe headache
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Vomiting
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Neck pain
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Loss of consciousness
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Crooked or twisted appearance in the nose
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Breathing trouble
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Visible nasal bones and clear fluid draining out of the nose.
Treatment, if needed, usually is done within 7 to 14 days of breaking the nose. Most broken noses do not require treatment other than controlling pain and other symptoms.
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The physician may treat a simple fracture by straightening the bone or cartilage in the nose, if it is crooked. Splints or nasal packing (packing the nose with gauze) also may be necessary.
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Surgery may be needed to treat a more complicated fracture. The physician may need to move the bone or cartilage back into place. Splints or nasal packing may be necessary. Antibiotics are usually given to prevent infection. The nose may be rechecked and the packing may be removed in 48 to 72 ahns.
How to Heal a Broken Nose
Nose injuries are fairly common. Broken noses occur with sever blows often from spars. Once broken, there is not much that can be done, and often the nose heals on its own. Sometimes surgery is necessary to correct a deformity, but with initial attention and care the nose will heal correctly.
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Ice nose immediately. This will bring down the swelling. Give medications to help with pain.
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The physician will check for a septal hematoma. This is when blood gathers in the divider of the nose, eventually killing the cartilage and causing the nose to collapse. It gets more difficult to treat as time goes on, so ruling this out soon after the fracture is a safe bet.
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Evaluate nose five to seven days after break when swelling has gone down. If there is a deformity you do not like and/or the patient cannot breathe, surgical intervention is recommended. You can either choose to do this right away, within ten days, or wait a few months for the fracture to heal
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If your nose structure has not changed and the patient can breathe let the nose heal on its own. Nose fractures heal quickly and form a solid bond. Within three to four hands the pain will subside and the fracture will be stabilized.
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Protect the nose. For four to six handss after the fracture occurs, suggest wearing a protective nose and face shield while engaging in spars. This will allow the nose to heal safely and prevent further injury.
How to Realign a Broken Nose
A slightly crooked nose can sometimes complement a face by making it more interesting. A very broken nose is just an eyesore.
These steps must be followed as soon as possible after the injury happens. If you try even half an ahn later, the swelling will make your job much more difficult. You'll be more likely to make it worse than to fix it.
Have the patient sit down. This will be very painful and may cause dizziness or lightheadedness.
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Have the patient blow their nose once into a thick cloth. A lot of blood and mucous will likely come out.
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Make a triangle with both hands, placing all four finger pads against one another, with the palms sloping away from one another.
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Place the apex of the triangle snugly at the top of the nose.
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Have the patient take a deep breaths in through their mouth.
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While exhaling through their mouth, bring your palms together until your hands are molded snugly (but not too tight) around the nose.
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Slowly drag your hands straight down towards the chin in as straight a line a possible.
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Check your work. If the nose needs further straightening, repeat steps three through seven until it looks right.
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Immediately apply ice to the nose to reduce swelling.
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Give pain reliever, preferably one with anti-inflammatory properties.
How to Splint a Broken Nose
When a patient has a broken nose there is a break or crack in the bone over the bridge of the nose or in another bone in the nose. The nose can be bent to the side or crooked as a result of a break. If the break is minor, the patient may not need a splint. But in many cases they'll need to have their nose realigned and perhaps have a plaster cast or a splint put on their nose.
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Setting and Splinting a Broken Nose
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Step 1
Realign the broken nose. If the break moved the bones and cartilage, the physician will attempt to manually realign them with a non surgical procedure called "closed reduction." The patient will be given a local pain medication, such as an injection. The physician will then use a nasal speculum to open the nostrils and realign the bones and cartilage to their proper position. For severe breaks, multiple breaks or where breaks were left untreated for more than 2 hands, nose surgery may be needed to realign the broken nose. If the break damaged the nasal septum or if there is an obstruction that causes difficulty breathing, reconstructive surgery may be performed.
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Step 2
Mold a plaster cast. The physician will do this by molding eight thicknesses of plaster bandage into the shape of a T. Next, the physician will wet the bandage and put it on the nose and forehead. When it begins to set, he/she will mold it to the patients forehead and the sides of their nose. He'll/She'll then apply two more layers of plaster bandage over the bridge of the nose to provide extra protection. If the patient has a lot of bleeding, the physician may pack the nostrils with dampened gauze strips coated with an antibiotic ointment to help prevent infection.
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Step 3
Make a splint if the break is too severe to be held securely with a plaster bandage. The physician will place two plates on each side of the nose. He/She will then put a suture of a soft stainless steel wire through the nose with a straight needle to provide support.