c7 spinal cord injury hypoventilation

WebAssessment of C7 Motor Function Assess and document motor function using motor scale from 0-5. MDPI and/or Boyles R, Toy P, Mellon J, Hayes M, Hammer B. Contact Us C3-C7 Home; Our Team; Resources; Footer Navigation. Author to whom correspondence should be addressed. Although all of these are appropriate nursing diagnoses for a patient with a spinal cord injury, respiratory needs are always the highest priority. This report describes a case of spinal cord injury that occurred after CIESI was performed without following the above-described recommendations. [Updated 2018 Dec 6]. The site is secure. The nurse performs discharge teaching for a 34-year-old male patient with a T2 spinal cord injury resulting from a construction accident. c. Encourage him to verbalize his feelings. If nonsurgical treatments do not provide relief, surgery may be considered. 2. As a result, individuals may experience low lung volume and a weakened cough, which increases their risk of developing respiratory complications. c. assist with transfer activities. Rehabilitation is an interdisciplinary endeavor carried out with a team approach to teach and enable the patient to function at the patient's highest level of wellness and adjustment. Menu. Traumatic central cord syndrome: Results of surgical management. ---dopamine Rehabilitation potential, 1. often fatal, movement only in neck or & above, no diaphragm ability, loss of independent respiratory function Arch. Evaluation of a patient with suspected CCS includes a complete medical history, thorough general and neurological examinations, cervical magnetic resonance imaging (MRI), computed tomography (CT) scan and plain cervical spine X-rays, including supervised flexion and extension views. J Emerg Med. and C.H.L. Maintaining a patent airway is the most important goal for a patient with a high cervical fracture.

4. Rathmell, J.P.; Benzon, H.T. Pressure sores typically develop in bony areas such as the elbows, sit bones, tailbone, hip bones, heels, ankles, and knees. These factors create an area of increased stress at the CTJ, both at rest and during movement. Hip extension with a nerve transfer (nerve transfer only used for those with some hip movement). Incidence of intravascular penetration in transforaminal cervical epidural steroid injections. Benny, B.; Azari, P.; Briones, D. Complications of Cervical Transforaminal Epidural Steroid Injections. \end{array} The exact site of stimulation is critical for obtaining the desired effects. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. In rehabilitation, monitoring every 15 minutes is not needed unless he is on a suicide watch. ; Kim, C. Distribution range of cervical interlaminar epidural injections: A comparative study with 2.5 mL, 5 mL, and 10 mL of contrast. Respiratory complications include hypoventilation, a reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Two months after the procedure, shoulder strength was almost fully restored (5/5), left-hand motor weakness slightly improved further (4/5), and sensory function had almost returned to normal; however, the patient complained of persistent paresthesia in her left hand. ---antihistamines (famotidine), treating hypomotility in patients with SCI, 1. insert NG-tube Kelly JC, Groarke PJ, Butler JS, Poynton AR, OByrne JM. 4. When all four limbs are affected, this is called tetraplegia or quadriplegia. You seem to have javascript disabled. Resident, Neurological Surgery WebMany patients with CCS make a spontaneous recovery of motor function, while others experience considerable recovery in the first six weeks after injury. ---often caused by distended bladder or rectum (noxious stimuli), clinical manifestations of autonomic dysreflexia, 1. severe HYPERTENSION (up to 300 mmHg) 1. 2005;17(2):84-90. doi:10.1053/j.semss.2005.05.005. As the symptoms of PDPH nearly resolved at 48 h after the procedure, an epidural blood patch was not performed. Those who don't want to be dependent on a ventilator have the option of a surgically implanted phrenic nerve simulator. b. feed self with hand devices. Before In such situations, the canal through which the spinal cord travels can be narrow, so that if the neck is forcefully extended (head tilted back), such as in a car accident, the spinal cord can be squeezed. 2. In addition, left C7/8 radiculopathy with acute denervation was confirmed by electromyography that was performed at 6 months after the procedure.

Metoclopramide is used to treat delayed gastric emptying. A high prevalence of sleep-disordered breathing (SDB) after spinal cord injury (SCI) has been reported in the literature; however, the underlying mechanisms are not well understood. Movement remaining A dull ache or burning pain may occur in the lower cervical area, often accompanied by neck stiffness. C4H8(g)+H2(g)C4H10(g), Hc/kJmol1C4H8(g)2717C4H10(g)2877H2(g)286\begin{array}{|l|c|} 2 3401 Civic Center Blvd. the more dysfunction can occur. T1 connects to the first rib with costovertebral joints.

Rehabilitation potential, 1. full biceps with elbow flexion, low respiratory reserve An official website of the United States government. A survivor of a C7 SCI will likely have full neck movement but may sense tingling and numbness in the hands and fingers, as well as referred pain in Respiratory manifestations, decreased level of consciousness, and gastrointestinal manifestations are not characteristic manifestations. 2. degree of injury, used when CT is unavailable, not as accurate, 1. assess for neurologic changes "I want to be rehabilitated for my daughter's wedding in 2 weeks."

d. "With rehabilitation, I will be able to function at my highest level of wellness." Basic arm function (elbow flexion) using a nerve transfer. https://www.mdpi.com/openaccess. a. Bradycardia Chen J, Eismont FJ. Indicate by circling the T or F whether each of the following conditions is true or false: Calculate the enthalpy change for the following reaction, given the data in the table: C4H8(g)+H2(g)C4H10(g)\mathrm{C}_4 \mathrm{H}_8(\mathrm{~g})+\mathrm{H}_2(\mathrm{~g}) \rightarrow \mathrm{C}_4 \mathrm{H}_{10}(\mathrm{~g}) The patient with a spinal cord injury and neurogenic bowel should eat 20-30 g of fiber and drink 1800 to 2800 mL of water or juice each day. --> rectal examination 1. and C.H.L. Would you like email updates of new search results? The result is a breathing pattern thats more natural than a mechanical ventilator. Cervical Rib Prevalence and its Association with Thoracic Outlet Syndrome: A Meta-Analysis of 141 Studies with Surgical Considerations. Schultz, D.M. and transmitted securely. To determine whether you are a candidate for epidural spinal cord stimulation, you will first undergo trial stimulator placement. WebC7 injury Nerves control elbow extension and some finger extension. The patient in the current report also received interlaminar epidural steroid injections at the C5/6 level.

Severe trauma to this level may also injure the spinal cord. ---bradycardia In: StatPearls [Internet]. Learn more about treatments and procedures below. ; validation, C.H.L. Visit our dedicated information section to learn more about MDPI.

Cervical Transforaminal Epidural Steroid Injections. If the above symptoms develop after an accident or injury, seek urgent medical attention at a local emergency department. d. elevate the head of the bed to 90 degrees. Produced by Shepherd Center and KPKinteractive in collaboration with the American Trauma Society, Epub 2020 Feb 20. Isspinal cord stimulation right for you? 2018;110:e965-e978. A C7 spinal cord injury results in loss of movement and sensation, which can affect other functions in the body. ; supervision, H.K., S.S.C. Watch Cervical Spinal Cord Anatomy Animation. ; Maybin, S.; Sturos, E. Safety and Complications of Cervical Epidural Steroid Injections. Using epidural spinal cord stimulation, we can improve standing and walking in people who have cervical and thoracic level injury. Clin.

The tungsten filament of a light bulb has a resistance of 0.070.07 \Omega0.07. Which clinical manifestation would the nurse interpret as a manifestation of neurogenic shock in a patient with acute spinal cord injury? After 2 weeks, the manually tested left upper extremity muscle power recovered slightly to 3/5 proximally and 4/5 distally, with a slight improvement in sensory change; gait disturbances were not observed. If the filament is 27cm27 \mathrm{~cm}27cm long, what is its diameter? 1. In 1998, Hodges et al. Neck: strong neck stability; Shoulder: assess ability to rotate shoulder; assess ability to abduct arm at shoulder (away from body) assess abduction against examiner resistance assess ability to adduct arm at shoulder (toward body) If the underlying cause is edema or swelling in the spinal cord, recovery may occur relatively soon after an initial period of weakness. Neurosurgical Focus. d. Ineffective airway clearance caused by high cervical spinal cord injury Sleep disordered breathing in chronic spinal cord injury. Analysis of the growth of epidural injections and costs in the Medicare population: A comparative evaluation of 1997, 2002, and 2006 data. 2. determine cause & remove noxious stimuli BID However, in elderly patients the prognosis is not as favorable, with or without surgical intervention. WebASIA was created to promote and establish standards of excellence for all aspects of healthcare of individuals with spinal cord injury, educate the public on all aspects of spinal cord injury, and promote research. An analysis of 4,396 fluoroscopic interlaminar epidural injections. 2 It can affect a small or large area, just one side of the body, and can be permanent or temporary. Respiratory Complications After Spinal Cord Injury: Key Points. 2 LARGE-BORE IV with normal saline or lactated ringer's solution If the underlying cause is edema or swelling in the spinal cord, recovery may occur relatively soon after an initial period of weakness. A traumatic spinal cord injury can stem from a sudden, traumatic blow to your spine that fractures, dislocates, crushes or compresses one or more of your vertebrae. a. call the physician. b. Please note that many of the page functionalities won't work as expected without javascript enabled. Please enable it to take advantage of the complete set of features! Unauthorized use of these marks is strictly prohibited. Hand movement and finger dexterity improve last. Left and right arrows move across top level links and expand / close menus in sub levels. Horner Syndrome. a. Headache and rising blood pressure Keywords: 5. interesting to readers, or important in the respective research area. To help him with his coping and prevent self-harm, the nurse should create a therapeutic patient environment that encourages his self-expression and verbalization of thoughts and feelings. eCollection 2020 Mar. Tetraplegia is a risk factor for central sleep apnea.

Effect of acetazolamide on susceptibility to central sleep apnea in chronic spinal cord injury. This patient is at high risk for depression and self-injury because he is likely to lose function below the umbilicus involving lost motor and sensory function. b. 2. mechanical ventilation, electric wheelchair, able to instruct others, 24 hr/day care, C4 Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Electrodes are strategically placed into the space outside of the dura (covering of spinal cord). Prevention of urinary tract infections and facilitating bowel evacuation with the gastrocolic reflex will be important but not as important as helping him cope. Spinal (subarachnoid) neural blockade. A survivor of a C7 SCI will likely have full neck movement but may sense tingling and numbness in the hands and fingers, as well as referred pain in c. Encourage him to verbalize his feelings. Injuries generally result in some loss of function in the hips and legs. A C7 spinal cord injury results in loss of movement and sensation, which can affect other functions in the body. 6. Contrast-enhanced brain and cervical spine MRIs were performed on the second day of the procedure. Spinal cord injuries can result from damage to the vertebrae, ligaments or disks of the spinal column or to the spinal cord itself. Penn State Hershey Medical Center and Penn State College of Medicine World Neurosurgery. What is the priority of care for him? 7. obtain CT SCAN or spine X-RAY, ---life threatening complication of tetraplegia (quadriplegia) Case report: A 35-year-old woman presented Veritas Health, LLC, 520 Lake Cook Road, Suite 350, Deerfield, IL, 60015, All About the C6-C7 Spinal Motion Segment. Daily oral laxatives may cause diarrhea and are avoided unless necessary. WebAssessment of C7 Motor Function Assess and document motor function using motor scale from 0-5. Enoxaparin (Lovenox) for DVT/VTE New frontiers in obstructive sleep apnoea. C6-C7 Treatment. Oxybutynin (Ditropan) Sleep onset hypoventilation may contribute to the development SDB in the SCI population. Bowel evacuation time is usually established 30 minutes after the first meal of the day to take advantage of the gastrocolic reflex induced by eating. The patient's BP is 84/50 mm Hg, his pulse is 38 beats/min, & he remains orally intubated. \hline \mathrm{H}_2(\mathrm{~g}) & -286 \\

Drink more milk. c. "I will be able to do all my normal activities after I go through rehabilitation." CCS affects males more frequently than females. Numbness in the palm, index finger, and middle finger. For more information, please refer to Rarely, C8 nerve injury may cause Horners syndrome characterized by drooping eyelids, small pupils, and sunken eyeballs usually affecting one side of the face. There may also be changes in bowel and/or bladder functions. Our surgeons use the latest surgical techniques and treatments to improve the level of functioning. The nurse's first priority is to Neck: strong neck stability; Shoulder: assess ability to rotate shoulder; assess ability to abduct arm at shoulder (away from body) assess abduction against examiner resistance assess ability to adduct arm at shoulder (toward body) Six months after the procedure, abduction of the fifth finger continued to decrease and sensory deterioration in the dorsum of the left hand remained.

Obtain Long Term Pain Relief. Therefore, in accordance with the recommendations of the Multisociety Pain Workgroup, we strongly suggest performing CIESI at the C6/7 or C7/T1 level, where the epidural space is relatively large, rather than at the C5/6 level or higher. Patients may also note a lack of sensation and difficulty urinating. BRADYCARDIA (30-40 beats/min) Nonsurgical treatment consists of immobilization of the neck with a rigid cervical collar and rehabilitation with physical and occupational therapy. WebWatch: Spinal Motion Segment: C7-T1 (Cervicothoracic Junction) Animation. Advantages of phrenic nerve stimulators over mechanical ventilators: *NOTE: All patients with some movement in lower extremities may be considered as candidates for epidural stimulation to improve movement or reduce spasms. b. Altered patterns of urinary elimination caused by tetraplegia In addition, persistent neurological deficits may occur, particularly intrathecal perforation or drug administration during CIESI.

That was performed at 6 months after the procedure, an epidural blood patch was not performed of on. In chronic spinal cord stimulation, you will first undergo trial stimulator placement downward... Needed unless he is on a ventilator have the option of a light bulb has a resistance of \Omega0.07... American trauma Society, Epub 2020 Feb 20 Lovenox ) for DVT/VTE New in. With a high cervical fracture P. ; Briones, d. Complications of cervical Steroid... Extension and some finger extension Junction ) Animation that many of the procedure compression... Male patient with a high cervical fracture: Key Points ( Lovenox ) DVT/VTE. Angle and may not be able to do all my normal activities after I go through rehabilitation. relief surgery! Is significant for tobacco, alcohol, and middle finger projects at local. Extension with a T2 spinal cord injury sleep disordered breathing in chronic spinal injury. And KPKinteractive in collaboration with the American trauma Society, Epub 2020 Feb.! Bladder functions not needed unless he is on a ventilator have the option a! Which increases their risk of developing respiratory Complications after spinal cord injury results in of. Surfactant production, mucus plugging, atelectasis, and cardiac arrest in Severe cases or own! Functionalities wo n't work as expected without javascript enabled or large area, often accompanied by neck stiffness neck... Burning pain may occur in the respective research area resolved at 48 h after the procedure, epidural... The dura ( covering of spinal cord injury that occurred after CIESI was performed without following above-described... Sleep ; spinal cord injury, seek urgent Medical attention at a more downward angle and may not be prominent. Please enable It to take advantage of the complete set of features array } the site! Day of the lower limbs and areflexic bowel and bladder ; Sturos, E. Safety and of. Surgical treatment in favor of non-surgical management of CCS vertebrae, ligaments disks! Ineffective airway clearance caused by high cervical spinal cord injury more natural than a ventilator... Downward angle and may not be as prominent, Diagnostic studies for spinal cord injury that occurred CIESI... Also be changes in bowel and/or bladder functions filament is 27cm27 \mathrm { ~cm } 27cm long, what its. Cord injury, seek urgent Medical attention at a local emergency department ; Resources ; Footer.! On susceptibility to central sleep apnea in chronic spinal cord injury, survivors are more. Hours of injury maintaining a patent airway is the most distal cord and nerve roots, resulting in flaccid of. Using motor scale from 0-5 first six weeks after injury have sustained neck. Epidural spinal cord stimulation, we can improve standing and walking in people have. ( FL ): StatPearls Publishing ; 2019 Jan- sub levels for epidural spinal cord injury resulting from construction. Thats more natural than a mechanical ventilator Hershey Medical Center and KPKinteractive in with. Medical Center and KPKinteractive in collaboration with the American trauma Society, Epub 2020 20... Affect other functions in the SCI population studies for spinal cord ) a. Is critical for obtaining the desired effects: a Meta-Analysis of 141 studies with surgical Considerations, epidural... Home ; our Team ; Resources ; Footer Navigation down to the vertebrae, ligaments or disks the! In sub levels apnea in chronic spinal cord stimulation, we can improve standing and in. Sustained a neck ( cervical ) hyperextension injury the second day of the to... To other infections development SDB in the body, and a decreased cardiac output in people have! Affected, this is called tetraplegia or quadriplegia administered within 8 hours injury. Or bladder movements and some finger extension rehabilitation, monitoring every 15 minutes is not unless! Is 84/50 mm Hg, his pulse is 38 beats/min, & he remains orally intubated a Meta-Analysis 141! ; Resources ; Footer Navigation the palm, index finger, and cardiac arrest Severe! ; spinal cord ) disordered breathing in chronic spinal cord injury that occurred after CIESI performed! State College of Medicine World Neurosurgery respiratory needs are always the highest priority research area facilitating evacuation!, E. Safety and Complications of cervical epidural Steroid Injections a ventilator have the option a. Large area, just one side of the page functionalities wo n't work as expected without javascript.! Affected, this is called tetraplegia or quadriplegia menus in sub levels as c7 spinal cord injury hypoventilation as him. Experience considerable recovery in the palm, index finger, and marijuana.. Cervical fracture bladder movements a candidate for epidural spinal cord injury that occurred CIESI... Cord injury that occurred after CIESI was performed at 6 months after procedure. 84/50 mm Hg, his pulse is 38 beats/min, & he remains orally intubated increased stress at the level... 38 beats/min, & he remains orally intubated > Severe trauma to this may... Used to treat delayed gastric emptying and treatments to improve the level of.... Pain may occur in the SCI population undergo trial stimulator placement electrodes are placed! Cardiac arrest in Severe cases also injure the spinal column or to the most important goal for a patient a! To this level may also note a lack of sensation and difficulty urinating you are a candidate for epidural cord... Menus in sub levels ) for DVT/VTE New frontiers in obstructive sleep apnoea the development SDB in the lower and... Injury: Key Points Segment: C7-T1 ( Cervicothoracic Junction ) Animation Sequential compression ). The latest surgical techniques and treatments to improve the level of functioning the above symptoms after! Bowel and bladder important as helping him cope ; tetraplegia down to the vertebrae, ligaments or of... About MDPI a weakened cough, or important in the palm, index,. And may not be as prominent contrast-enhanced brain and cervical spine MRIs were performed on the second day of spinal... And cardiac arrest in Severe cases Publishing ; 2019 Jan- respiratory failure that ventilation! D. Ineffective airway clearance caused by high cervical fracture complete set of features with the American trauma Society Epub... To do all my normal activities after I go through rehabilitation. that. Causes peripheral vasodilation, venous pooling, and pneumonia ; tetraplegia and/or Boyles R, Toy,. Long, what is its diameter > Effect of acetazolamide on susceptibility to central sleep apnea in chronic spinal injury! Association with Thoracic Outlet syndrome: a Meta-Analysis of 141 studies with surgical Considerations manifestation would nurse... Of functioning c7 spinal cord injury hypoventilation stockings, Diagnostic studies for spinal cord injury the population... Webmany patients with CCS make a spontaneous recovery of motor function Assess and document motor function Assess and motor. Severe trauma to this level may also note a lack of sensation and urinating... Are a candidate for epidural spinal cord injury, 1 Thoracic Outlet syndrome: results of surgical management of management! A neck ( cervical ) hyperextension injury advantage of the lower cervical area often... ( Cervicothoracic Junction ) Animation of neurogenic shock in a patient with a cord... A manifestation of neurogenic shock in a patient with acute spinal cord injury that occurred after CIESI was without! Risk of developing respiratory Complications after spinal cord injury: C7-T1 ( Cervicothoracic Junction ) Animation just one side the. Mucus plugging, atelectasis, and cardiac arrest in Severe cases go through rehabilitation ''. Of neurogenic shock in a patient with a spinal cord ) surgical Considerations vertebrae, ligaments or disks the... < p > webassessment of C7 motor function Assess and document motor function while... Some loss of function in the current report also received interlaminar epidural Steroid Injections you first... A decreased cardiac output neurological improvement is the most compelling reason not to with... Spinal Motion Segment: C7-T1 ( Cervicothoracic Junction ) Animation { ~cm } long! I will be able to breathe on his or her own, cough, which can affect functions. Be able to breathe on his or her own, cough, which can affect a small or area. Provide relief, surgery may be considered of motor function using motor scale from 0-5 maintaining patent. Lower cervical area, just one side of the body, and c7 spinal cord injury hypoventilation., d. Complications of cervical epidural Steroid Injections c. `` I will be able to function at highest... At rest and during movement covering of spinal cord injuries can result from damage to the spinal column or the. Level injury result in some c7 spinal cord injury hypoventilation of movement and sensation, which increases their risk of developing respiratory after... Right arrows move across top level links and expand / close menus in sub.! Six weeks after injury contact Us C3-C7 Home ; our c7 spinal cord injury hypoventilation ; Resources ; Footer Navigation appropriate nursing diagnoses a! Be changes in bowel and/or bladder functions the current report also received epidural. Across top level links and expand / close menus in sub levels limbs areflexic. Would the nurse interpret as a result, individuals may experience low lung volume and a cardiac... 2018 Oct 27 ], survivors are often more vulnerable to other infections filament is \mathrm! Studies for spinal cord injury results in loss of function in the SCI.! If the filament is 27cm27 \mathrm { ~cm } 27cm long, what is diameter., survivors are often more vulnerable to other infections to readers, or important the! Top level links and expand / close menus in sub levels result individuals... Filament is 27cm27 \mathrm { ~cm } 27cm long, what is its diameter minutes not.

The lower end of this motion segment articulates with the first vertebra of the thoracic spine (T1). , Compared to able-bodied controls, SCI subjects had a significantly greater reduction in tidal volume during the transition from wake to N1 sleep (from 0.51 0.21 to 0.32 0.10 L vs. 0.47 0.13 to 0.43 0.12 L; respectively, P < 0.05). His history is significant for tobacco, alcohol, and marijuana use. After a spinal cord injury, survivors are often more vulnerable to other infections. a. Urinary catheterization Those with SCI (C2-C8) are at great risk for developing hypoventilation, especially during sleep, and this r 2015 The Authors. Spinal cord injuries can result from damage to the vertebrae, ligaments or disks of the spinal column or to the spinal cord itself. Damage to the most distal cord and nerve roots, resulting in flaccid paralysis of the lower limbs and areflexic bowel and bladder. Schreiber, A.L. Damage to the most distal cord and nerve roots, resulting in flaccid paralysis of the lower limbs and areflexic bowel and bladder. ; investigation, H.J.P., J.H.L. This syndrome more commonly affects patients age 50 and older, who have sustained a neck (cervical) hyperextension injury. Cervical epidural steroid injections and spinal cord injuries. See Cervical Spondylosis and Cervical Myelopathy Symptoms. Khan Z, Bollu PC. Patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements. c. Anterior cord syndrome Since the spinal cord is organized with the nerves that control the movement of the arms in the center and the nerves going to the legs more toward the outside, the arms are affected more than the legs in this situation. Loss of sympathetic innervations causes peripheral vasodilation, venous pooling, and a decreased cardiac output. Eur Spine J. In cases where bony arthritis changes are causing the narrowing of the spinal canal and compression of the spinal cord, surgery is usually not performed until the patient has made significant recovery. Pain from the neck radiating to the shoulder down to the middle finger. ; Hirsch, J.A. WebMany patients with CCS make a spontaneous recovery of motor function, while others experience considerable recovery in the first six weeks after injury. Case report: A 35-year-old woman presented WebASIA was created to promote and establish standards of excellence for all aspects of healthcare of individuals with spinal cord injury, educate the public on all aspects of spinal cord injury, and promote research. This may result in respiratory failure that requires ventilation, hemodynamic instability, and cardiac arrest in severe cases. Weba. Observed neurological improvement is the most compelling reason not to proceed with surgical treatment in favor of non-surgical management of CCS.

SCDs (Sequential compression devices) or anti-embolism stockings, Diagnostic studies for spinal cord injury, 1. Apnea; hypoventilation; sleep; spinal cord injury; tetraplegia. In: StatPearls [Internet]. \hline \mathrm{C}_4 \mathrm{H}_{10}(\mathrm{~g}) & -2877 \\ In cases where instability of the CTJ occurs or when nonsurgical treatments do not provide relief, surgery may be considered.

[Updated 2018 Oct 27]. T1s spinous process projects at a more downward angle and may not be as prominent. c. Administer IV immunoglobulin (Sandoglobulin) High-dose MP should be administered within 8 hours of injury. d. Teach him about using the gastrocolic reflex. official website and that any information you provide is encrypted

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