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shut up
aamus
Ultimo aggiornamento 2020-12-08
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be quiet/shut up
naga amuus
Ultimo aggiornamento 2021-02-24
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shut your bitch ass up
Ultimo aggiornamento 2023-07-21
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indeed it will be shut over them.
waana lagu dabooli naartaas gaalada.
Ultimo aggiornamento 2014-07-03
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many forms of transportation reduced or shut down
magaca rasmi ah oo lagu qoro kaadhka lagu raacayo gaadiidka oo waajib ah
Ultimo aggiornamento 2020-08-25
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bitch shut up ill slash ur dumb ass head nigga
bitch shut up ill slash ur dumb ass head nigga
Ultimo aggiornamento 2023-06-11
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hello i want you too shut your fucking mouth!
bitch shut up ill slash ur dumb ass head niggyo
Ultimo aggiornamento 2023-06-11
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why would your computer shut down only 20 minutes after you start it
sabab uu u damaa kombutuutarkaaga kadib 20 daqiiqo maka aad shido kadib
Ultimo aggiornamento 2016-04-06
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by no means! verily on that day from their lord they will be shut out.
waxaa sugan in eebohood maalintaas (qiyaame) laga xijaabi.
Ultimo aggiornamento 2014-07-03
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"indeed are we shut out (of the fruits of our labour)"
mase waa nala hoojiyay.
Ultimo aggiornamento 2014-07-03
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Attenzione: contiene formattazione HTML nascosta
the iranian parliament was shut down, with 23 of its 290 members reported to have had tested positive for the virus on 3 march.
12kii maarso, hay'ada xuquuqda aadanaha ayaa ku dhiiri galisay madaxda xabsiyada iran in si shuruud la'aan ah u sii daayaan difaacayaasha xuquuqda aadanaha ee loo xiray kala duwanaanshaha fikradeed, iyo sidoo kale dhamaan in si ku meel-gaar ah loo sii daayo maxaabista u qalma.
Ultimo aggiornamento 2020-08-25
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many countries have shut down or severely limited flights, ships, and border crossings, especially to and from affected areas.
xataa dalal badan ayaa soo roday xadidaad marka ay dadku gaadhan, kuwaas oo caqabad saaran soo gelida (marka laga reebo dadka deegaanka iyo haysta deganaanshaha) ama waxaa loo baahan karaa in lagu karantimeeyo, caadiyan 14 maalmood.
Ultimo aggiornamento 2020-08-25
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and they will be shut off from that which they will eagerly desire, as shall be done with the likes of them of yore. verily they have been in doubt perplexing.
waana la kala ooday iyaga iyo waxay doonayeen sidii lagu falay kuwii la midka ahaa ee ka horeeyay, waxayna ahaayeen kuwo shaki daran ku sugan.
Ultimo aggiornamento 2014-07-03
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acknowledgment ................................................................................................................... i table of contents .................................................................................................................. ii chapter one: shock ............................................................................................................. 1 introduction ................................................................................................. 1 classification .............................................................................................. 1 patho physiology of shock ......................................................................... 2 management of shock ................................................................................ 3 complications of shock .............................................................................. 4 chapter two: fluid and electolytes ..................................................................................... 5 introduction ................................................................................................. 5 normal distribution of body fluids .............................................................. 5 disturbances of fluid and electrolytes ........................................................ 7 acid – base balance ................................................................................... 12 review questions ....................................................................................... 15 references .................................................................................................. 16 chapter three: blood transfusion ....................................................................................... 17 indications for blood transfusion ............................................................... 17 compatibility tests ...................................................................................... 17 component therapy ................................................................................... 18 review questions ....................................................................................... 21 references .................................................................................................. 22 chapter four: pre-operative and post-operative care ...................................................... 23 introduction ................................................................................................. 23 general consideration ............................................................................... 23 assessment and minimization of surgical risks ........................................ 24 post-operative care, complications and their treatment ......................... 26 post operative intestinal obstruction ......................................................... 31 hematoma, abscess and seromas ............................................................ 33 review questions ....................................................................................... 34 references .................................................................................................. 35 chapter five: aseptic and antisepic techniques ................................................................ 36 introduction ................................................................................................. 36 choice of antiseptic ................................................................................... 37 review questions ....................................................................................... 41 references .................................................................................................. 42 chapter six: suture materials and suturing ......................................................................... 43 types of suture materials ........................................................................... 43 suturing techniques ................................................................................... 44 iii chapter seven: wounds- wound healing and care ........................................................... 47 introduction ................................................................................................. 47 wound healing ............................................................................................ 47 wound assessment and classification ....................................................... 49 wound management ................................................................................... 50 crush and avulsion wounds ....................................................................... 53 wound complications ................................................................................. 55 review questions ....................................................................................... 57 key to the review questions ..................................................................... 59 references .................................................................................................. 60 chapter eight: surgical infections ........................................................................................ 61 introduction ................................................................................................. 61 classification .............................................................................................. 62 pathogenesis .............................................................................................. 62 specific types of infections ........................................................................ 64 review questions ....................................................................................... 73 key to the review questions ..................................................................... 75 references .................................................................................................. 76 chapter nine: trauma .......................................................................................................... 77 introduction ................................................................................................. 77 treatment priorities ..................................................................................... 78 road traffic accidents ................................................................................ 79 firearm injuries ........................................................................................... 80 burn injuries ......................................................................................... 81 review questions ....................................................................................... 84 references .................................................................................................. 85 head and spinal injuries ............................................................................ 86 head injury .................................................................................................. 86 brain injuries ............................................................................................... 87 spinal cord injuries ..................................................................................... 90 review questions ....................................................................................... 92 references .................................................................................................. 93 chapter ten: orthopedic surgery ........................................................................................ 94 introduction ................................................................................................. 94 infections of bones and joints .................................................................... 94 fractures ..................................................................................................... 97 dislocations ................................................................................................. 102 amputations ................................................................................................ 103 review questions ....................................................................................... 105 references .................................................................................................. 106 chapter eleven: anesthesia................................................................................................. 107 pre-anesthetic patient evaluation and preparation .................................... 107 iv cardiopulmonary resuscitation .................................................................. 111 systemic (general) anesthesia .................................................................. 115 regional anesthesia ................................................................................... 118 review questions ....................................................................................... 124 references .................................................................................................. 125 systemic surgery chapter one: the thyroid gland ......................................................................................... 126 thyroid enlargement: goiter ....................................................................... 126 neoplasms of the thyroid ........................................................................... 130 review questions ....................................................................................... 132 references .................................................................................................. 133 chapter two: the breast ..................................................................................................... 134 introduction ................................................................................................. 134 anatomy ..................................................................................................... 134 breast lumps .............................................................................................. 135 carcinoma of the breast ............................................................................. 137 review questions ....................................................................................... 140 references .................................................................................................. 141 chapter three: the chest ................................................................................................... 142 introduction ................................................................................................. 142 upper airway obstruction ........................................................................... 142 tracheostomy ............................................................................................. 143 chest injuries .............................................................................................. 146 pneumothorax ............................................................................................. 149 hemothorax ................................................................................................. 149 tube thoracostomy (chest tube) .............................................................. 150 empyema and lung abscess ..................................................................... 152 lung abscess .............................................................................................. 154 review questions ....................................................................................... 156 references .................................................................................................. 157 chapter four: gastrointestinal tract .................................................................................... 158 introduction ................................................................................................. 158 upper gastrointestinal bleeding ................................................................. 159 colorectal tumors ....................................................................................... 164 common perianal conditions ..................................................................... 166 anal fissure (fissure in ano) .................................................................... 170 hemorrhoids (piles) .................................................................................... 171 references .................................................................................................. 175 acute abdomen ........................................................................................... 176 intestinal obstruction .................................................................................. 177 sigmoid volvulus ......................................................................................... 179 v appendicitis ................................................................................................. 180 peritonitis .................................................................................................... 183 hepato biliary diseases .............................................................................. 185 hydatid cyst of the liver ............................................................................. 187 diseases of gall bladder and biliary tree .................................................. 189 obstructive jaundice................................................................................... 193 review questions ....................................................................................... 197 abdominal wall hernias ............................................................................. 198 introduction ................................................................................................. 198 risk factors for abdominal wall hernia development ............................... 199 specific types of hernia ............................................................................. 200 review questions ....................................................................................... 204 references .................................................................................................. 205 stomach and duodenum ............................................................................ 206 introduction ................................................................................................. 206 peptic ulcer disease ................................................................................... 206 gastric cancer ............................................................................................ 211 review questions ....................................................................................... 213 dysphagia ............................................................................................. 214 introduction ................................................................................................. 214 dysphagia ................................................................................................... 214 carcinoma of the esophagus...................................................................... 215 review questions ....................................................................................... 218 references .................................................................................................. 219 chapter five: urology .......................................................................................................... 220 introduction ................................................................................................. 220 urinary symptoms and investigations of urinary tract problems .............. 220 acute renal failure (anuria/oliguria) ......................................................... 222 disorder of the kidneys and ureters ........................................................... 223 urinary tract infection ................................................................................. 224 renal tuberculosis ..................................................................................... 226 urinary bladder ........................................................................................... 230 bladder cancer ........................................................................................... 231 benign prostatic hyperplasia ...................................................................... 231 the urethra and penis ................................................................................ 233 urethral stricture ......................................................................................... 234 review questions ....................................................................................... 238 references .................................................................................................. 239 1 chapter one shock learning objectives at the end of this chapter, each student should be able to: • state the clinical definition of shock • list the chief characteristics and causes of all types of shock • describe the clinical symptoms and signs that are indicative of shock • list the immediate treatment measures to prevent complications introduction shock is a life-threatening condition which occurs when the circulatory system fails to deliver oxygen and nutrients to the body tissues and becomes unable to remove waste products from the body. it is a descriptive term based on the symptoms and signs secondary to one or more of a wide range of problems. if not recognized and corrected as early as possible, shock may rapidly progress to an irreversible state with subsequent multi-organ failure and death. definition shock is defined as a pathological state causing inadequate oxygen delivery to the peripheral tissues and resulting in lactic acidosis, cellular hypoxia and disruption of normal metabolic condition. classification shock is generally classified into three major categories: 1. hypovolemic shock 2. cardiogenic shock 3. distributive shock distributive shock is further subdivided into three subgroups: a. septic shock b. neurogenic shock c. anaphylactic shock hypovolemic shock is present when marked reduction in oxygen delivery results from diminished cardiac output secondary to inadequate vascular volume. in general, it results from loss of fluid from circulation, either directly or indirectly. 2 e.g. ▪ hemorrhage loss of plasma due to burns loss of water and electrolytes in diarrhea third space loss (internal fluid shift into inflammatory exudates in the peritoneum, such as in pancreatitis.) cardiogenic shock is present when there is severe reduction in oxygen delivery secondary to impaired cardiac function. usually it is due to myocardial infarction or pericardial tamponade. septic shock (vasogenic shock) develops as a result of the systemic effect of infection. it is the result of a septicemia with endotoxin and exotoxin release by gram-negative and gram-positive bacteria. despite normal or increased cardiac output and oxygen delivery, cellular oxygen consumption is less than normal due to impaired extraction as a result of impaired metabolism. neurogenic shock results primarily from the disruption of the sympathetic nervous system which may be due to pain or loss of sympathetic tone, as in spinal cord injuries. patho physiology of shock shock stimulates a physiologic response. this circulatory response to hypotension is to cons
download mymemory free ingiriisi in somali
Ultimo aggiornamento 2016-01-17
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