Or anything." He peered into the darkness within the walls, feeling at his belt as if for the short sword and sword-breaker he had had to leave at the inn servants did not go armed in Cairhien. "You should be careful doing that, Lord Rand. Hurin climbed to his feet, dusting himself off. The seniority of the three generals above Tanus on the army lists prevailed in the end. Lots of voices.' He paused, frowned slightly, then shook his head. partially because he still had a life, of course, but mostly because it was so fey and peaceful It was in some ways the most beautiful place Roland had ever been in his life. What he saw when he opened his eyes wasn't the inside of a cloud, but at first that same phrase-white beauty-recurred to him. When he rose back to consciousness the second time, he was no stronger in body, but a little more himself in mind. Ground troops are moving to set up heavy static weapons on the field. Their 'Mechs are not manned, and so far they've not been able to scramble any against us. I find I cannot grasp what it must have taken to create it, under these conditions, just the two of you. 'Mornin', our Shawn,' said Nanny, and set off across the inner courtyard.įinally, she closed the volume, stroking the cover. Rachel cautiously opened one eye, surprised to find he was sitting on the floor, his face even with hers. And it seems to me we should be shamed if for any fearing or foreboding we turned back from following so noble a beast as now we have in chase.Ĭhild, he said in a soft voice. Sister, said Queen Lucy,my royal brother speaks rightly. What the little son of a bitch is up to is sabotage, said Rose, who almost never swore. You've heard of blunt trauma? This was the opposite. Gly gave an indolent twist to his head and changed the subjectHow can I get in touch with you in case of a problem? So then they know that they have been fooled, and that we are in the town, and will come to search the town. And then they search the countryside for half a mile around. All rights reserved.Nothing! Louki said impatiently.They find nothing. This narrative review focuses on the types of cardiac injuries that are caused by blunt chest trauma, the modalities and techniques currently used to diagnose BCI, and the perioperative management of injuries that require surgical correction.īlunt cardiac injury blunt chest trauma cardiac rupture pericardial tamponade transesophageal echocardiography valvular rupture.Ĭopyright © 2021 Elsevier Inc. With proper surgical and anesthetic care, survival in cases involving urgent cardiac repair can reach 66%-to-75%. Close communication with the surgical team and access to blood products for potentially massive transfusion also play key roles in maintaining hemodynamic stability. Transesophageal echocardiography can play an important role in the diagnosis and management of several BCIs that require operative repair. More recently, computed tomography and echocardiography increasingly have been utilized to identify injuries more rapidly in hemodynamically unstable patients. Traditionally, hemodynamically stable injuries suspicious for BCI have been evaluated with electrocardiograms and chest radiographs, whereas hemodynamically unstable BCIs have received operative intervention. Additionally, patients with blunt trauma often have coexisting injuries (brain, spine, orthopedic) that can obscure the clinical picture therefore, a high degree of suspicion often is required to diagnose BCI. A significant proportion of patients with BCI do not survive long enough to receive medical care, succumbing to their injuries at the scene of the accident. The majority of BCIs are due to motor vehicle accidents however, injuries caused by falls, blasts, and sports-related injuries also can be sources of BCI. Blunt cardiac injury (BCI), defined as an injury to the heart from blunt force trauma, ranges from minor to life-threatening.
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