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國際/院前 創傷生命支援術, TCCC 戰術醫療 / RISC 記者版

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發表於 2013-6-5 22:26:18 |顯示全部樓層
ITLS 國際創傷生命支援術 Basic Provider 課程
有幾位 CVST 的成員已報讀 AETC 2013 7月的 ITLS。我地已經有 PHTLS、WFA 和山藝底,歡迎在這裡的朋友一齊報讀和溫書。
http://www3.ha.org.hk/aetc/enrollment.htm
下星期我會 post d  有關的網上參考資料。
=====
28-7-2013
恭喜三位 CVST 的內部成員順利完成這個課程,及獲主辦機構頒發 ITLS Basic Provider 證書。有興趣的朋友請不斷地學習和進修,我們會繼續在這裡與大家分享一些與野外急救有關的討論和消息。請大家繼續努力和加油,謝謝 !!
ITLS patch AETC HK.jpg
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發表於 2013-6-11 23:20:00 |顯示全部樓層
我已上了 WFA ITLS 但未有山藝
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發表於 2013-7-22 13:00:36 |顯示全部樓層
johncamposhk 發表於 2013-6-11 23:20
我已上了 WFA ITLS 但未有山藝

如果有興趣上山藝,最好有二級或相等課程的程度 (一級只是體驗模式),三級就更好 (有多晚露營和長途導行的經驗)。
你可以在網上 google 山藝班。記得出席每兩個月一次的交流會。
有無任何 ITLS 溫書或考試心得可以分享? 謝謝

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發表於 2013-7-22 13:52:49 |顯示全部樓層
ITLS 有關的網上參考資料, 這些資料會持續更新 (31 July 2013):
這些都是溫書時在網上 google 到的公眾資料, 並不代表本文和香港任何創傷課程的內容有任何關係。
What's New in This Edition (7 ed., 2012): http://www.itrauma.org/education/documents/ITLS_Whats_New_7e.pdf
Rapid Trauma Survey (7ed., 2012): https://www.facebook.com/photo.php?fbid=533735160015961&set=pb.415954371794041.-2207520000.1374469611.&type=3&theater
ITLS 2012 Flashcards: http://www.flashcardexchange.com/cards/itls-2012-2185760
ITLS Basic Provider study guide: http://www.kyitls.com/files/Basic_Prov_ITLS_STUDY_GUIDE_7thEd.doc
ITLS Adv Provider study guide: www.kyitls.com/files/Advanced_Prov_ITLS_STUDY_GUIDE_7thEd.doc
ITLS Class Guide: http://www.ncitls.org/guide.pdf
7ed pre-test and key: http://www.itlsaz.org/resources.php
Coordinator and Instructor Guide, 6 ed: http://itraumaalabama.org/itls/InstructorGuide_000.pdf
Coordinator and Instructor Guide, 7 ed (See the Scenario Grade Sheet on p133, p157, or p155, respectively):
   http://www.itraumamissouri.org/documents/ITLS7eInstructorGuide.pdf
   http://www.johnmohler.com/documents/ITLS%20docs/InstructorGuide%20%20ITLS%207e.pdf
   http://www.ncitls.org/itlsman.pdf
推荐 Don't miss this one! Other misc doc 其它雜項文件 (7ed ppt...etc): http://www.itraumamissouri.org/documents/

== Fin ==
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發表於 2013-7-23 10:55:57 |顯示全部樓層
Tactical Combat Casualty Care TCCC / TC-3, 戰術醫療 / 戰地中的戰術性傷患處理 / 戰術戰鬥傷患照顧規範
Care Under Fire = 槍戰中的傷患處理
Tactical Field Care = 戰術場地的傷患處理

NAEMT TCCC Guidelines & Curriculium: http://www.naemt.org/education/TCCC/guidelines_curriculum.aspx
TCCC Guidelines 2011: http://www.health.mil/Libraries/110808_TCCC_Course_Materials/TCCC-Guidelines-110808.pdf
US Army TCCC Handbook (2010): http://info.publicintelligence.net/ArmyCasualtyHandbook.pdf
US Army TCCC Handbook (2012): http://www.globalsecurity.org/military/library/report/call/call_12-10.pdf
Instructor Guide for Tactical Fieldcare 120917:
   http://www.health.mil/Libraries/120917_TCCC_Course_Materials/020403-Tactical-Field-Care-IG-120917.pdf
TCCC Train-the-Trainer Course: http://www.med.navy.mil/sites/nmotc/nemti/Pages/TCCC.aspx
Bringing combat medicine to the wilderness (W Smith, 2012,  http://www.wildernessdoc.com/ ):
http://www.wildernessdoc.com/assets/lectures/2012/2012Sep%20ExpedMed%20Combat%20Med%20to%20Wilderness%20slides.pdf
Tactical Medicine - The Isreali Revised Protocol (M Waldman et.al., 2012):  
   http://www.terrormedicine.com/publications_files/Tactical_Medicine_Article.pdf
2003灣戰中的美軍戰地醫院 Combat Support Hospital: http://www.youtube.com/watch?v=XeRHDQDm3L0
Frontline Medicine- episode 1 (有兩集):   http://www.youtube.com/watch?v=_8rKzUk1wPg
Clinical Guidelines for Operation「軍事行動中的臨床指引」(UK MoD 英國國防部, JSP999, 2012):
  https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/79106/20121204-8-AVB-CGO_Online_2012.pdf
The War on Trauma, Lessons Learned from a Decade of Conflict (2008): http://www.jems.com/sites/default/files/nar_supp32_new_tcm16-171092.pdf
Combat Lifesaver Course: Student Self-Study IS0871-C: http://www.me.ngb.army.mil/units/rti/resources/IS0871_Edition_C_ALMS.pdf
Amputees in Action First Person On The Scene FPOSI - PGI Training: https://www.youtube.com/watch?v=tB_eB6MEn3g

=====
RISC  Reporters Instructed in Saving Colleagues: http://risctraining.org/
記者戰地救死扶傷訓練 (新聞, 四月2013): http://www.epochtimes.com/b5/13/4/3/n3837767.htm
Reporters Instructed in Saving Colleagues (2012):  http://www.youtube.com/watch?v=S1kgUE0HFOU&feature=c4-overview&list=UUu2umBACjkdo4Dkz-sw9KNw   DJ : " It's what you don't see that counts."

== Fin ==
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發表於 2013-8-10 16:32:52 |顯示全部樓層
Jackwabbit 發表於 2013-7-22 13:52
ITLS 有關的網上參考資料, 這些資料會持續更新 (31 July 2013):
What's New in This Edition (7 ed): http: ...

創傷技能參考 trauma skills references:
這些都是溫書時在網上 google 到的公眾資料, 並不代表本文和香港任何創傷課程的內容有任何關係。

1)   患者評估 /  限制脊柱移動術 SMR ( 脊柱固定術 Spinal Immobilization )
The new term is "spinal motion restriction, SMR" not "spinal immobilization".  
All of the information in Chinese depicts the SMR technique originated from JIBC.
七大固定術: http://www.youtube.com/watch?v=RKirw_QqCJw
七大固定術: http://dyna.hcc.edu.tw/campus/data/web/270/files/201204261643111.pdf
脊椎制動術 (HKSJ): http://staffweb.hkbu.edu.hk/johnny/Resource/Spinal_Immobilization.pdf
最新版七大固定術及創傷處理-1: http://www.tcc.nurses.org.tw/modules/tadnews/index.php?op=dlfile&fsn=122&nsn=20
最新版七大固定術及創傷處理-2: http://www.tcc.nurses.org.tw/modules/tadnews/index.php?op=dlfile&fsn=123&nsn=20
(AMS) 初步評估(個案1): http://www.youtube.com/watch?v=lwIcPusFbrE
(AMS) 初步評估(個案2): http://www.youtube.com/watch?v=agxn6dn9ZXk
(AMS) 進一步評計: http://www.youtube.com/watch?v=hixe31qNNS0
(AMS) 初步評估 - 仰翻法: http://www.youtube.com/watch?v=G7F-U9Gu1pE
(AMS) 初步評估 - 俯翻法: http://www.youtube.com/watch?v=ryuEMrzk8uk
(AMS) 硬頸套 + 仰翻及蜘蛛帶固定法 HD: http://www.youtube.com/watch?v=HyJXb_Jym3k
(AMS) 硬頸套 + 俯翻及蜘蛛帶固定法 HD: http://www.youtube.com/watch?v=8VU5Q7sma4s
OUMS Initial Assessment of a Trauma Patient - Multi-System Injury (Part 1): http://www.youtube.com/watch?v=n5DUC1Lit08
OUMS Initial Assessment of a Trauma Patient - Multi-System Injury (Part 2): http://www.youtube.com/watch?v=PzyTXXQp2j8
T Schimelpfenig (2013), Why We Teach Spine Immobilization?  http://rendezvous.nols.edu//content/view/2674/964/
T Schimelpfenig (2013), Why Do We Teach Log Rolls? http://rendezvous.nols.edu//content/view/2650/964/


2)  鏟床 scoop stretcher ( must be used in pt with pelvis fx 盆骨骨折 or bilateral femur fx 雙邊股骨骨折 ):
Ferno - Training - Immobilization Solutions (5:05 - 7:00)  http://www.youtube.com/watch?v=N4zg60JAfWw

3)  頸套 C-collar
參考: S Whitehead (2012),  Looking For Sasquatch (A Challenge) : http://theemtspot.com/2012/11/25/looking-for-sasquatch-a-challenge/

4)  KED 解救套
帶的次序:
口訣: My Baby Looks Hot Tonight” in the order of Middle (黃), Bottom (紅/綠), Legs (白), Head (頭) and Top (綠/紅).
User's Manual (2001): http://www.888maes911.com/KED_User_Manual.pdf
EMS Inventor Rickm Kendrick Demonstrates the K.O.D.E 2: https://www.youtube.com/watch?v=M3xMyzNfDpI
HKSJAB 簡易解救套: http://staffweb.hkbu.edu.hk/johnny/Resource/KED.pdf


5)  SAM splint 展性夾板
http://www.sammedical.com/products/sam-splint/
http://www.youtube.com/user/sammedical/videos


6)  盆骨固定帶  Pelvic sling/binders
Pelvic Wrap Demo (SkagitEMS, 2010): http://www.youtube.com/watch?v=Omg79Ced6s0
臨時固定帶 Pelvic Wrap (NOLS/WMI): http://www.youtube.com/watch?v=wyLGa0nkBxA
臨時固定帶 Improvised Pelvic Splint (soloedit, 2008): http://www.youtube.com/watch?v=Nwy-7PcmXqM
臨時固定帶 Improvised Pelvic Binder using SAM Splint (RMI): http://www.youtube.com/watch?v=zpPAHBYQMjM
臨時固定帶 The Pelvic Sling (Real First Aid): http://www.realfirstaid.co.uk/pelvic-sling/
SAM Pelvic Sling II Intro and General Application Technique: http://www.youtube.com/watch?v=KVOk1WB2yhM
The Adventures of Sam Medic, SAM Pelvic Sling II: http://www.youtube.com/watch?v=XIUgZj7oUMc&feature=youtu.be&annotation_id=annotation_2630402179&feature=iv&src_vid=KVOk1WB2yhM
Initial Assessment of a Trauma Patient - Pelvic Fracture (OUMS): http://www.youtube.com/watch?v=A7pNak8_2gs&list=TLU4qeYU5vfNg
左盆骨骨折;右前臂大量出血 (急救包紮訓練): http://www.youtube.com/watch?v=MLk1tqzYsw0
臨時固定帶 Field Treatment of Pelvic Fractures (P Nicolazzo, WMTC Blog, 2012):  http://www.wildmedcenter.com/1/post/2012/12/field-treatment-of-pelvic-fractures.html
Situation Critical Feature Dr. Talat Chughtai Case Pelvic Fracture (2012): http://www.youtube.com/watch?v=iDbAQCfa0CM
Trauma Day Away 2012 - Pelvic Fractures (UCSDTraumaBurn, 2012): http://www.youtube.com/watch?v=y1kPy-Ik6O8

7)  Femur Fx (midshaft) / Traction splint    股骨中段骨折 / 牽引夾板
Wilderness considerations 在野外使用時的考慮要素(英文):  
Some institutions (WMI? SOLO?) teach improvised traction splint with caution, while others (WMA?) have switched to anatomical splinting (i.e. tying both legs together) and with a lot of good padding ...
WMI:  T Schimelpfenig (2011), Femur traction splints are controversial : https://www.facebook.com/note.php?note_id=10150266420721331
WMA: D Johnson (2011), Tractions Splints in Wilderness Medicine:  http://www.wildmed.com/blog/tractions-splints-in-wilderness-medicine/
Utilization of Traction Splints with Open Femur Fracture (... in isolated or austere environments):
http://www.itrauma.org/resources/documents/UtilizationofTractionSplintswithOpenFemurFracture_Nov2011.pdf

Traction splints instructions and discussions  牽引夾板使用指南和討論(英文):
Kendrick Traction Splint: http://www.nspc203.com/oec/KendrickTractionDevice-Instructions.pdf
A Hughes (2011), Management of a mid-shaft fractured femur in the field and use of the Kendrick Traction Device:   http://www.expeditionmedicine.co.uk/blog/2011/01/pre-hospital-expedition-medicine-series/
RMI | Kendricks Traction Splint (RMI 2011): http://www.youtube.com/watch?v=2_k5N-AeQIU
Ferula de Traccion | KTD - Kendrick Traction Device (EMS Mexico, 2012): http://www.youtube.com/watch?v=01EwxclwrMM

FareTec - CT-6 documents: http://www.faretec.com/CT-EMS-traction-splint.html
CT-6 Leg Traction Splint: Training Video (Lee Sackett, 2008): http://www.youtube.com/watch?v=1OxzLqn3_vY
CT-6 Splint application (Queensland Ambulance Service, 2013): http://www.youtube.com/watch?v=L1-hWv6yYpY

Sager Instructor's Manual:  http://www.sagersplints.com/pdf/Sager-InstructorsManual.pdf
Traction Splint, An EMS Relic?: http://www.swissrescue.ch/dossier/traction_splint/traction_splint_angl.pdf

Anatomical splints 肢體式夾板:
(AMS 急救包紮訓練) 大腿骨折包紮(下): http://www.youtube.com/watch?v=Anxn-lDtL6Y
(SJ
急救包紮訓練)    左小腿骨折,左大腿骨折: http://www.youtube.com/watch?v=vlc-kjwGhzU

Improvised traction splints  臨時牽引夾板:
Improvised Traction Splint: http://www.youtube.com/watch?v=KIhyRXrE__U
Building an Improvised Traction Splint in the Wilderness (Matthew Hamonko, 2013): http://www.youtube.com/watch?v=Ay-JhiQN6dw
Traction Splint with hiking stick: http://www.youtube.com/watch?v=W2H6J4fvUeQ
Traction Splint Improvisation in the Remote Pre-hospital Setting (B Watters, 2011):   http://emsdr.wordpress.com/2011/01/29/traction-splint-improvisation-in-the-remote-pre-hospital-setting/
Solo WEMT Improvised Traction Splint - 07/26/2011:  http://www.youtube.com/watch?v=iMUY04lNvqA&list=PLE79190A9DBD779DA&index=1
推荐 Don't miss this one! MSU Splinting Lab notes (2013): http://checktheleads.com/wp-content/uploads/2013/04/Final-handout-for-splinting.pdf
Wilderness Medicine Newsletter (2006): http://wildernessmedicinenewsletter.files.wordpress.com/2006/11/femur-fx-illustrations-for-blog.pdf

8)  基本氣道處理 Basic airway skills
已經移至 "在野外進行 CPR 的指引 Wilderness CPR Guidelines, BLS CPR":  http://www.hkcvst.org/forum/forum.php?mod=viewthread&tid=46&pid=148&page=1&extra=#pid148

9)  氣胸密封貼 Chest seals
Halo Seals (MedstormPMI, 2010): http://www.youtube.com/watch?v=ZcKpOI_3KR0
Treatment of an open chest injury (tacmed2003, 2008): http://www.youtube.com/watch?v=sfk6dqxMvNI&list=PL3C6683119BA7AAF6
推荐 Don't miss this one! 臨時氣胸密封貼 Improvised chest seal (Adventuredoc.net): http://adventuredoc.net/2013/01/05/improvised-chest-seal/

4-sided occlusive seal with 1-way valve  密封四面 +單向活辦要識得識別和處理張力性氣胸。
Pearls & Pitfalls. Sucking Chest Wound Management (L Mellick): http://www.ahcmedia.com/emreports/pearls/pearls50.html
CWS update, Chest & back seals taped on 4-sides (2010):  http://cwscurriculum.wordpress.com/2010/03/01/chest-mar-2010/
Chest Injury (NOLS WMI facebook): https://www.facebook.com/notes/nols-wilderness-medicine-institute/chest-injury/10151331994301331

10) 二氧化碳圖 Capnography
Capnography 2: http://www.youtube.com/watch?v=Zi1unIivVmE
Prehospital Capnography: http://www.youtube.com/watch?v=FVRESa_7nzg
EtCO2: Capnography Part1: http://www.youtube.com/watch?v=_mw27u6dBek (part 1 of a 7-part series)

==========
徵狀 診斷, signs/sympotms, diagnoses, Tx:

1) Flail chest 連枷胸 / Paradoxical breathing 逆理性呼吸
Flail chest: http://www.youtube.com/watch?v=0yqxfDgJ0Dc  or  http://www.medicalvideos.us/play.php?vid=1318

2) Sucking chest wound 吸入性胸部創傷
Sucking chest wound - Part 1: http://www.youtube.com/watch?v=EHSeFm89EoM
Sucking chest wound - Part 2: http://www.youtube.com/watch?v=LsRPM6jJgZc
Sucking chest wound from dog bite: http://www.youtube.com/watch?v=lWinevg0dUo
Sucking Chest Wound: How to Treat an Open Pneumothorax Part 2: http://www.youtube.com/watch?v=Xttzn-LcC6I
Sucking Chest Wound: How to Treat an Open Pneumothorax Part 3: http://www.youtube.com/watch?v=OGT-2lD9Kmg
Sucking Chest Wound: How to Treat an Open Pneumothorax Part 4: http://www.youtube.com/watch?v=rg6iHz2BoBg

3) Cardiac tamponade, Beck's triad, JVD
Pericardiocentesis: http://www.youtube.com/watch?v=BQTVqUPimdk

4) Tracheal deviation 氣道偏移
Tracheal deviation: http://www.youtube.com/watch?v=C4ASmeRvGf8

5) Pneumothorax 氣胸 / Tension Pneumothorax 張力性氣胸
Pneumothorax What Is a Pneumothorax or Collapsed Lung Video:
http://www.youtube.com/watch?v=i-sZzZ4TMnY&list=PL31956C6B78B4A0FF
Tension pneumothorax explained in 1 min: http://www.youtube.com/watch?v=NhOK97PSVH4
(ITLS Advanced skill) Decompressing A Tension Pneumothorax: http://www.youtube.com/watch?v=HbCuqpvx2EU
OUMS Initial Assessment of a Trauma Patient - Multi-System Injury (Part 1): http://www.youtube.com/watch?v=n5DUC1Lit08

6) Glasgow Coma Score (GCS) 格拉斯哥昏迷指數
格拉斯哥昏迷指數: http://imsp206.netvigator.com/~norme/Main/IS/Pathology/ComaScale.pdf
All previous posts are moved here: "LOC: GCS and AVPU" http://www.hkcvst.org/forum/forum.php?mod=viewthread&tid=134&extra=

7) Tramatic Brain Injury (TBI) 創傷性腦損傷
Concussion, Mild Traumatic Brain Injury (TBI): http://www.youtube.com/watch?v=55u5Ivx31og

=========
記憶口訣 / 重點

1) Windshield survey (ITLS 7ed, p4). 在未落救護車之前,在車中的擋風玻璃後面去評估現場的危險因素。"CCBB + 3Ts";Crash/rescue scenes, Crime scenes, Blast scenes, Bystanders + Look for Threats to you, Threats to/from patient, Threats to/from bystanders.

2) BOOTS. Predictors of difficult bag-mask ventilation (ITLS 7ed, p82)  使到使用 BVM 時有困難的因素: Beards 鬚, Obesity 肥胖, Old patients 年老, Toothlessness 無牙, Snores 打鼾 or stridor 喘鳴.

3) Blast Injuries (ITLS 7ed, p125).  炸傷的五個要素: 「壓碎拋燒化」; overpressure 超壓, shrapnel 碎片, throw 拋離, burns 燒傷, chemicals 化學品 (生化輻射物品)。

4) Signs of cardiac tamponade  心膜填塞的病徵  =  Beck's Triad +2 more signs (ITLS 7ed, p121): 「聲沉奇脈,上跌怒張,壓收窄 」;
muffled heart sound 聲沉 , paradoxical pulse 奇脈 (台灣譯法), hypotension 上壓跌 + 下壓升 ( -->靜脈壓張,可以見到 JVD 頸靜脈怒張) =  narrow pulse pressure 脈壓收窄。

5) 脈壓 pulse pressure (ITLS 7ed, p144) = 上壓 systolic BP -下壓 diastolic BP ~ 40 mmHg = 使到血流動的壓力。

6) Tracheal deviation 氣管偏位. 記住 "deviate-away", 就是「偏離」有受傷 ( 張力性氣胸. tension pneumothorax ) 的一邊。

7) 上壓 (mmHg) : 頸 60 - 股 70 - 橈 80 (ITLS 7ed, p145). 係真定假?
S Rezaie (2013), Is ATLS wrong about palpable blood pressure estimates? http://academiclifeinem.com/is-atls-wrong-about-palpable-blood-pressure-estimates/

8) The 5P of compartment syndrome 腔室症候群 / 筋膜室綜合症 (ITLS 7ed, p252):  Pain 疼痛,Paresthesia 痲痺刺痛,Pulselessness 無脈搏 ( late 後期 ),Pallor 皮膚變白,Paralysis 癱瘓 ( late 後期 ) 最早期的兩個症狀是 (1)與傷勢不成比例的痛楚 Pain,和(2) 痲痺刺痛 Paresthesia。以其它都是較後期的症狀。 所以能夠盡早察覺這兩個早期的症狀,及盡快送院就會更好。
5P + Poikilothermia/Polar  變溫 / 外溫 / = 6P;      6P + Pressure 壓力 ( 觸診時感覺到皮膚或肌肉拉緊 tightness ) = 7P
參考:
S Whitehead (2012), The Six P's of Compartment Syndrome: http://theemtspot.com/2012/06/21/the-six-ps-of-compartment-syndrome/
Compartment Syndrome Clinical Presentation - Everything You Need To Know (N Ebraheim, 2013):  http://www.youtube.com/watch?v=nLbYGLWggUs
Compartment Syndrome vs. Crush Syndrome (Bittenbenders, 2003): http://www.ncemsf.org/about/conf2003/lectures/bittenbender_crush.pdf
Beyond the Basics: Crush Injuries vs. Compartment Syndrome (Krost et al., 2008): http://www.emsworld.com/article/10321291/beyond-the-basics-crush-injuries-and-compartment-syndrome?page=4

Source: http://sketchymedicine.com ,  my thanks to Mike/Ali for granting the use of this doodle ( http://sketchymedicine.com/using-images/ ).

Note: 6P + Pressure = 7P

Note: 6P + Pressure = 7P
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發表於 2013-10-18 14:16:25 |顯示全部樓層
顱內出血  Intracranial hemorrhage
Depressed Skull Fracture (migoper, 2013): https://www.youtube.com/watch?v=JxSOK-pRQf0
Epidural Hematoma (migoper, 2013): https://www.youtube.com/watch?v=aavyHpu6pj0
Acute Subdural Hematoma (migoper, 2013): https://www.youtube.com/watch?v=Ji7fohBEPnM
Head Injuries: https://sites.google.com/site/truckeeoecsupportpages/test-1/head-injuries  or Natasha's lesson helps save Ohio girl (2009): http://edition.cnn.com/2009/HEALTH/03/26/head.injury.emergency/index.html#

Source: http://sketchymedicine.com ,  my thanks to Mike/Ali for granting the use of this doodle ( http://sketchymedicine.com/using-images/ ).
Intracranial hemorrhage.jpg
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