關於 major trauma ，我們在網路上蒐集到這些相關的討論、資訊與評價

ALHAMDULILLAH, TETAPI KAMI HARUS BEKERJA LEBIH KERAS LAGI DEMI KEBAJIKAN DAN KESEJAHTERAAN RAKYAT TERJAMIN.

Hasil mesyuarat pada hari ini :

Saya telah berjumpa dengan YAB Dato’ Haji Hasni bin Mohammad, Menteri Besar Johor, YB Dato’ Haji Azmi bin Rohani, Setiausaha Kerajaan Johor, Dato’ Haji Mohd Noh Bin Ibrahim, Timbalan Setiausaha Kerajaan Johor (Pengurusan), YB Dato' Haji Mohd. Noorazam Bin Dato' Haji Osman, Datuk Bandar Johor Bahru, YB Datuk Onn Hafiz bin Ghazi, EXCO Pelancongan, Belia dan Sukan, dan YB Dato’ Dr. Aman bin Rabu, Pengarah Kesihatan Negeri Johor pada hari ini untuk mendapat laporan terkini mengenai isu kekurangan vaksin di PPV Educity, pembatalan temu janji untuk vaksinasi dan program vaksinasi pekerja kilang.

Susulan perjumpaan ini, PPV Educity (dibawah program PIKAS dan dikawal selia oleh MITI) akan mendapat 70 ribu dos vaksin pada hari Khamis ini. Inisiatif Pemimpin Advokasi Covid-19 (IPA-C) juga telah dimulakan dengan kerjasama kerajaan negeri Johor, JKNJ, dan pemimpin komuniti tempatan untuk melaksanakan aktiviti pendidikan kesihatan, pematuhan SOP dan membantu melaksanakan ujian saringan secara bersasar.

Kerajaan negeri juga telah menyediakan khemah yang lebih besar untuk Covid-19 Temporary Treatment Centre (CTTC) berhadapan Jabatan Kecemasan dan Trauma Hospital Sultan Ismail Johor Bahru. JKNJ juga telah memulakan sistem perkhidmatan CAC secara maya (VCAC) bagi membolehkan pesakit mendapatkan perkhidmatan kesihatan di rumah masing-masing.

Adalah hasrat saya perjumpaan ini dapat membuka ruang untuk mencari penyelesaian terhadap isu-isu yang dihadapi oleh program vaksinasi di Johor supaya rakyat dapat diberi vaksin secepat mungkin.

DYAM Mejar Jeneral Tunku Ismail Ibni Sultan Ibrahim, Tunku Mahkota Johor

———

ALHAMDULILLAH, BUT WE MUST WORK HARDER TO ENSURE THE WELFARE AND WELL-BEING OF THE PEOPLE ARE TAKEN CARE OF

As a result of today's meeting:

I met with Menteri Besar of Johor YAB Dato' Haji Hasni bin Mohammad, Johor State Secretary YB Dato' Haji Azmi bin Rohani, Johor Deputy State Secretary (Management) Dato' Haji Mohd Noh Bin Ibrahim, Johor Bahru Mayor YB Dato' Haji Mohd. Noorazam Bin Dato' Haji Osman, EXCO for Tourism, Youth and Sports YB Datuk Onn Hafiz bin Ghazi and Johor State Health Director YB Dato' Dr. Aman bin Rabu today to get the latest reports on the vaccine shortage issue at PPV Educity, cancellation of vaccination appointments and the vaccination programme for factory workers.

Following the meeting, the Educity PPV (under the PIKAS programme and regulated by MITI) will get 70 thousand doses of vaccine this Thursday. The IPA-C (Inisiatif Pemimpin Advokasi Covid-19) has also been initiated in collaboration with the Johor state government, JKNJ and local community leaders to carry out health education activities, SOP compliance and help targeted screening test.

The state government has also provided a larger tent for the Covid-19 Temporary Treatment Center (CTTC) in front of the Emergency and Trauma Department of the Sultan Ismail Hospital in Johor Bahru. JKNJ has also used a virtual CAC service system (VCAC) to allow patients to get health services at their respective homes.

I hope this meeting would open avenues for solutions to the issues faced by the vaccination programme in Johor so that the people can get vaccinated as soon as possible.

HRH Major General Tunku Ismail Ibni Sultan Ibrahim, Crown Prince of Johor

Saya telah mengadakan perjumpaan hari ini bersama YAB Datuk Haji Hasni Bin Mohammad, Menteri Besar Johor, YB Tuan Vidyananthan A/L Ramanadhan, EXCO Kesihatan dan Alam Sekitar, YB Dato’ Dr. Aman bin Rabu, Pengarah JKNJ, YBhg Dato’ Prof. Adeeba Kamarulzaman dan Dr. Dhesi Baha Raja susulan paparan media sosial viral mengenai keadaan pusat kuarantin pesakit Covid-19 di Hospital Sultan Ismail, Johor Bahru.

Hasil daripada perjumpaan ini, saya telah menitahkan agar pengurusan situasi Covid-19 ditambahbaik dan penyumberan luar pesakit bukan Covid-19 ke hospital swasta bagi meringankan bebanan terhadap sistem kesihatan awam dimulakan secara berperingkat. Pesakit bukan Covid-19 dari Hospital Sultan Ismail akan dipindahkan ke Hospital Columbia Asia, manakala pesakit dari Hospital Sultanah Aminah akan dipindahkan ke Hospital KPJ. YAB Menteri Besar Johor juga telah mengumumkan penambahan katil di wad Covid-19 Hospital Sultan Ismail dan kemudahan khemah di hadapan Jabatan Kecemasan dan Trauma akan ditambah baik.

Satu inisiatif baru, IPA-C (INISIATIF PEMIMPIN ADVOKASI COVID-19) akan dilaksanakan melalui kerjasama kerajaan negeri Johor, Jabatan Kesihatan Negeri Johor dan pemimpin-pemimpin komuniti tempatan. Objektif inisiatif ini adalah untuk mencegah penularan wabak COVID-19 dengan mengutamakan konsep tanggungjawab Collective Responsibility dalam menggerakkan dan memperkasakan komuniti, memantapkan konsep RISK Communication yang berkesan untuk meningkatkan tahap kesedaran masyarakat dan memperkukuhkan usaha-usaha pemantauan terhadap pematuhan SOP.

Proses vaksinasi juga harus dipercepatkan dan sentiasa dipantau oleh agensi-agensi dan pihak berkuasa agar proses vaksinasi dapat dijalankan secara baik, cepat, selamat dan tidak membebankan rakyat yang datang ke PPV. Selain daripada mempercepatkan proses vaksinasi, kita juga perlu beri tumpuan kepada pesakit Covid-19 supaya mereka mendapat jagaan rapi yang sebaiknya.

DYAM Mejar Jeneral Tunku Ismail Ibni Sultan Ibrahim, Tunku Mahkota Johor

—-

I had a meeting today with the Menteri Besar of Johor YAB Datuk Haji Hasni Bin Mohammad, Health and Environment EXCO YB Tuan Vidyananthan A/L Ramanadhan, JKNJ director YB Dato' Dr. Aman bin Rabu, YBhg Dato' Prof. Adeeba Kamarulzaman and Dr. Dhesi Baha Raja following a viral social media post on the condition of the Covid-19 patient quarantine center at the Sultan Ismail Hospital, Johor Bahru.

As a result of this meeting, I decreed for the management of the Covid-19 situation be improved and the transfer of non-Covid-19 patients to private hospitals to ease the burden on the public health system to start in stages. Non-Covid-19 patients from the Sultan Ismail Hospital will be transferred to the Columbia Asia Hospital, while those from the Sultanah Aminah Hospital will be transferred to the KPJ Hospital. YAB Menteri Besar of Johor also announced the addition of beds in the Covid-19 ward of the Sultan Ismail Hospital and the tent facilities in front of the Emergency and Trauma Department will be improved.

A new initiative called IPA-C (INISIATIF PEMIMPIN ADVOKASI COVID-19) will be implemented in collaboration with the Johor state government, Johor State Health Department and local community leaders. The initiative's objective is to prevent the spread of Covid-19 by prioritizing the concept of Collective Responsibility in mobilizing and empowering communities, strengthening the concept of effective RISK Communication to increase public awareness and strengthen SOP compliance monitoring efforts.

The vaccination process should also be expedited and constantly monitored by agencies and authorities so that the vaccination process can be carried out properly, quickly, safely and without burdening the people visiting PPVs. Apart from speeding up the vaccination process, we also need to focus on Covid-19 patients so that they get the best intensive care possible.

HRH Major General Tunku Ismail Ibni Sultan Ibrahim, Crown Prince of Johor

多謝呢位醫生既分享
祝願周同學大步擸過😭😭😭😭
同時強烈譴責港警每次出動都不斷攻擊市民頭部！！直接造成嚴重傷害！！！
解散警隊！刻不容緩🖕🏿🖕🏿🖕🏿🖕🏿🖕🏿🖕🏿
#願榮光稱香港
#一齊集氣
#香港人不能麻木

[腦疝]

喺講腦疝之前，希望大家為周同學祈禱打氣，希望佢可以大步檻過。呢篇比較深，但希望大家可以睇哂佢。之前講過嘅腦硬膜外出血 (epidural haematoma)，以及腦硬膜下出血 (subdural haematoma)、蛛網膜下出血 (subarachnoid haematoma)，致死嘅原因都可以係腦疝。

疝，指器官受外力影響、而被迫入偏離本身位置嘅空間。腦疝，就係大腦或者小腦因為顱內壓上升，而被迫出本來嘅位置。

如圖，大腦同小腦由唔同嘅結構分開，形成唔同區域：大腦鐮 (falx cerebri) 分開左右兩邊大腦半球，小腦幕 (tentorium cerebelli) 將大腦半球與該邊嘅小腦半球分開。當顱內壓急速上升時，大腦小腦就會由原來嘅區域，被外力「啫」去另一區域，形成腦疝，從而壓住其他結構。

腦疝可分為四類：
一．大腦鐮下腦疝 (subfalcine herniation)。呢種腦疝嘅臨床病徵較輕微。通常嘅後續係大腦前動脈 (anterior cerebral artery) 比腦疝壓住，形成缺血性中風。
二．中央腦疝 (central herniation)。腦幹被外力向下壓，引起徵狀。最常見係第六腦神經 (外展神經, abducens nerve) 麻痺，引致斜視同埋複視。
三．顳葉鈎回腦疝 (uncal herniation)、亦稱小腦幕切蹟疝 (tentorial herniation)。指大腦顳葉 (temporal lobe, 旁邊靠近顳骨的部分) 中嘅鈎回 (uncus) 結構受壓而被擠出小腦幕。病徵有三：瞳孔擴大、郁唔到隻眼 (第三腦神經 (動眼神經, oculomotor nerve) 受壓麻痺)；半身不遂 (大腦腳 (cerebral peduncle) 受壓，其中嘅下行運動神經亦受牽連)；昏迷 (中腦網狀系統 (midbrain reticular formation) 結構受損)。大腦後動脈 (posterior cerebral artery) 亦有機會受壓，形成缺血性中風。
四．小腦扁桃體疝 (tonsillar herniation)。當壓力夠大，小腦可由枕骨大孔 (foramen magnum) 外疝。咁就嚴重啦，因為腦幹會因此受壓，其中控制呼吸同心跳嘅中心會受損，導致呼吸停頓、心跳停頓、血壓不穩，繼而死亡。

任何頭部創傷都可能引起顱內出血，繼而使顱內壓上升，最後腦疝。腦疝係可以致命嘅。所以希望大家為周同學打氣之餘，唔好忘記暴政曾經無數次向人民嘅頭顱攻擊，嘗試奪去我哋嘅性命。但係筆者亦都喺到呼籲：大家唔好絕望、唔好麻木，因為咁樣無異於自己用手向嘅頭顱使出致命一擊。要「毋忘初衷」呀，我哋繼續行落去啦。

***

[Brain herniation]

Before all, please pray for Mr. Chow - may he be safe and sound. The content of this post is a bit advanced, but I hope you can take some time and go through the whole passage. Conditions like epidural haematoma, subdural haematoma and subarachnoid haematoma can all lead to brain herniation, a serious and possibly fatal condition.

Herniation is the phenomenon where an organ is pushed to another location due to external pressure and forces. Brain herniation occurs when intracranial pressure (ICP) increases, and the brain parenchyma shifts its location.

As in the figure, we can see that the cerebrum and cerebellum are situated in different compartments, separated by different structures. The falx cerebri separates the bilateral cerebral hemispheres, and the tentorium cerebelli separates the cerebral hemisphere from the ipsilateral cerebellar hemisphere. When ICP increases, these structures will herniate into different spaces, compressing other structures.

Brain herniations can be categorised into 4 types:
1. Subfalcine herniation. Clinically this type of herniation has less symptoms. The major sequelae would be compression to the anterior cerebral artery, leading to ischaemic infarcts.
2. Central herniation. Downward compression to the brainstem leads to symptoms like strabismus and diplopia due to abducens nerve palsy.
3. Uncal / tentorial herniation. The uncus in the temporal lobe of the cerebrum are compressed and herniates through the tentorium cerebelli. Clinically there is a triad of symptoms: pupil dilation and progressive loss of eye movements (due to oculomotor nerve palsy), hemiparesis (compression to cerebral peduncle, damaging the descending motor neurons inside) and coma (damage to midbrain reticular formation). The posterior cerebral artery may also be compressed and cause ischaemic infarcts.
4. Tonsillar herniation. When ICP increases drastically, the cerebellum can herniate through the foramen magnum out of the skull. This is an extremely severe condition, in which the brainstem will be compressed, compromising its respiratory and cardiovascular control centres. This results in respiratory and cardiac arrest, fluctuation in blood pressure, and ultimately death.

Any trauma to the head can lead to intracranial haemorrhages, and that can lead to increased ICP and brain herniation, which may be fatal. We should not only pray for Mr. Chow who is suffering so much, but also remember how this government had aimed and shot at the heads of the people, trying to kill us. But it is unwise for us to be overwhelmed with hopelessness and numbness - that is even worse than a physical hit to your head! Never forget why we started - and let us walk further from here.

Figure adapted from Blumenfield H. Neuroanatomy through clinical cases, 2nd edition. Sinauer Associates, Inc. 2010.

คำเตือน: การออกกำลังกายมีความเสี่ยง หากบาดเจ็บควรพบแพทย์โดยด่วน!
พี่ฟ้าใสเป็น CPT / CES / Sports nutrition coach ไม่ใช่นักกายภาพบำบัดนะ

คลิปนี้อาจมีภาพที่น่าหวาดเสียว
จุดประสงค์ของคลิปนี้เพื่อการศึกษา

- [ ] เกิดอะไรขึ้น เกิดขึ้นได้ยังไง
- [ ] ป้องกันยังไง
- [ ] ถ้าเกิดกับเราต้องทำยังไง

เกิดอะไรขึ้น

? POINT 1: เอ็นกล้ามเนื้ออก และ Biceps ฉีกขาด
ใน Instagram @ryancrowly
บอกว่ามีการผ่าตัด 4 ชั่วโมง
นอกจาก Pecs ยังมี Biceps ฉีกขาดด้วย
ไปให้กำลังใจ Ryan ได้ที่นี่ เพิ่ง๋าตัดเสร็จ ต้องการกำลังใจ

? POINT 2: Form & Load
ในคลิปเป็นการกางศอกออก ทำให้กล้ามเนื้ออกโดนยืดออก horizontal abduction
ประกอบกับ Frontal abduction ทำให้
กล้ามเนื้อ Triceps / Anterior Deltoid ทำงานน้อยลง
ทำให้กล้ามอกส่วน Sternal head ทำงานแบบเน้นๆ

? POINT 3: อาการบาดเจ็บแบบนี้ พบได้บ่อย
ในคนยกเวท

ปกติคนทั่วไปเคยชินกับ Concentric
พอต้องฝึกด้วยน้ำหนักเยอะๆ และค้างอยู่ช่วงที่ eccentric กล้ามเนื้อถูกยืดนานๆ ทำให้ไม่ไหว

ในช่วง Eccentric กล้ามเนื้อถูกยืดออก ช่วงนี้กล้ามเนื้อฉีกขาดได้ง่าย ถ้าใช้น้ำหนักเยอะมาก
อาการฉีกขาดกล้ามอก
จะเกิดได้ช่วง Extension 30 องศา

https://www.physio-pedia.com/Pectoralis_Major_Rupture

? POINT 4: Fatigue
ในคลิปน้ำหนักที่เยอะมาก (ประมาณ 220kg) และมีการยกหลาย Set ก่อนหน้านี้จนหมดแรง (failure)
คลิปที่เล่นเวทกันมาก่อนหน้า คลิปนี้
https://youtu.be/1xGAl7IVQeA

? POINT 5: ACTIONS ป้องกันยังไง
- [ ] Warm up อบอุ่นร่างกายก่อน
- [ ] ใช้น้ำหนักเหมาะสม
- [ ] ถ้าจะกางศอกกว้างๆ ให้ ลด นน ลง
- [ ] ถ้าจะใช้น้ำหนักเยอะมากๆ ทำ PR อย่าเล่นจนหมดแรงมาจาก Set ก่อนหน้า
- [ ] สื่อสารกับ Buddy อย่าปล่อยให้หมดแรง
- [ ] ถ้าเกิดแบบนี้ขึ้น: Rupture รีบพบแพทย์ อาจจะต้องผ่าตัดด่วน


คลิปต้นเรื่อง
https://youtu.be/1xGAl7IVQeA
https://youtu.be/3NLMjbjvEMc

? References
ISSA CORRECTIVE EXERCISE

https://www.physio-pedia.com/Pectoralis_Major_Rupture

Manske RC,Prohaska D. Pectoralis major tendon repair post surgical rehabilitation. N Am J Sports Phys Ther 2007; 2(1): 22–33.

Wolfe SW, Wickiewicz TL, Cavanaugh JT. Ruptures of the pectoralis major muscle, an anatomic and clinical analysis. Am J Sports Med 1992;20:587-593.

Tietjen R. Closed injuries of the pectoralis major muscle. J Trauma 1989;20:262-4.

Butt U, Funk L, Mehta SS,Monga P. J Shoulder Elbow Surg 2015 Apr;24(4):655-62.

Chinese Ginger Wine Chicken 姜酒鸡 is a dish commonly enjoyed by women on confinement. Confinement is the period in which women go through for 30 days after the birth of their child. We Chinese believe that confinement is an important period because giving birth causes a lot trauma to a woman's body, thus it is vital to nurse her back to health. This dish is commonly prepared during confinement because ginger is known to be good for expelling wind and improve blood circulation. But fret not, even if you're not on confinement, it's perfectly fine to eat this every now and then (in fact it's a super comforting dish)-- just not too frequent as this dish is considered too heaty for our body. To make this a complete dish, we added mee sua （姜酒鸡面线）to the comforting soup, yum yum!

Refer to the ingredient list below or go to our website here http://spicenpans.com/chinese-ginger-wine-chicken-mee-sua/ for your easy reference.

We would like to give special thanks to Greenpan and Shogun by La Gourmet for letting us try out their high quality non-stick pans in the video. If you like to buy them, you can go to any of the major departmental stores in Singapore such as Isetan, Robinsons, Takashimaya, BHG, OG, Metro or Tangs.

Hope you can recreate this yummy dish in the comfort of your home. Thanks for dropping by our channel.

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Jamie
on behalf of Spice N’ Pans

Ingredients:
Serves 6

Making the soup stock - boil for 45 mins to 1 hour
=========
3L of water
1.5 kg of chicken feet - blanched
50g of old ginger - smashed lightly
2 bulbs of garlic - broken up but with skin intact
1 tablespoon of white peppercorn
Brine from 2 cans of button mushrooms

Frying the chicken
==========
1 tablespoon of sesame oil
100 g of grated ginger
1 whole chicken - approx 1.2 to 1.3 kg
2 cups of white rice wine
3 tablespoons of oyster sauce
1 tablespoon of light soy sauce
1 tablespoon of dark soy sauce
2 cans of button mushrooms
1 teaspoon of sugar
1 cup of Chinese cooking wine (Shaoxing Huatiao wine)

Other ingredients (for one bowl of mee sua - for 1 pax)
===========
1 sunny side up fried in sesame oil & a few pieces of ginger
2 pieces of mee sua
1/2 teaspoon of goji berries

-----
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Low Sodium Light Soya Sauce: https://amzn.to/2JPnyn3
Mee Sua: https://amzn.to/2taggDn
Goji berries: https://amzn.to/2MvUDpA

-----
If you like this recipe, you might like these too:

Bak Chor Mee Soup Recipe 肉脞面 Minced Meat Noodles
https://youtu.be/Af308H3rA0g

Thai Style Claypot Glass Noodles w/ Prawns 泰式冬粉虾
https://youtu.be/F1oPAXfXuLI

Crab Beehoon 螃蟹米粉 Crab Vermicelli
https://youtu.be/zu9lI5n92d8

Disclaimer:
Spice N' Pans is not related to these products and cannot guarantee the quality of the products in the links provided. Links are provided here for your convenience. We can only stand by the brands of the products we used in the video and we highly recommend you to buy them. Even then, preference can be subjective. Please buy at your own risk. Some of the links provided here may be affiliated. These links are important as they help to fund this channel so that we can continue to give you more recipes. Cheers!

とある女性の夢のなかを覗き見します。
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