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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Frostbite is when exposure to low temperatures causes freezing of the skin or other tissues. The initial symptom is typically numbness. This may be followed by clumsiness with a white or bluish color to the skin. Swelling or blistering may occur following treatment. The hands, feet, and face are most commonly affected. Complications may include hypothermia or compartment syndrome.
People who are exposed to low temperatures for prolonged periods, such as winter sports enthusiasts, military personnel, and homeless individuals, are at greatest risk. Other risk factors include drinking alcohol, smoking, mental health problems, certain medications, and prior injuries due to cold. The underlying mechanism involves injury from ice crystals and blood clots in small blood vessels following thawing. Diagnosis is based on symptoms. Severity may be divided into superficial (1st and 2nd degree) or deep (3rd and 4th degree). A bone scan or MRI may help in determining the extent of injury.
Prevention is by avoiding low temperatures, proper clothing, maintaining hydration and nutrition, and staying active without becoming exhausted. Treatment is by rewarming. This should only be done when refreezing is not a concern. Rubbing or applying snow to the affected part is not recommended. The use of ibuprofen and tetanus toxoid is typically recommended. For severe injuries iloprost or thrombolytics may be used. Surgery is sometimes necessary. Amputation, however, should generally be delayed for a few months to allow determination of the extent of injury.
The number of cases of frostbite is unknown. Rates may be as high as 40% a year among those who mountaineer. The most common age group affected is those 30 to 50 years old. Evidence of frostbite occurring in people dates back 5,000 years. Frostbite has also played an important role in a number of military conflicts. The first formal description of the condition was in 1814 by Dominique Jean Larrey, a physician in Napoleon's army.
Areas that are usually affected include cheeks, ears, nose and fingers and toes. Frostbite is often preceded by frostnip. The symptoms of frostbite progress with prolonged exposure to cold. Historically, frostbite has been classified by degrees according to skin and sensation changes, similar to burn classifications. However, the degrees do not correspond to the amount of long term damage. A simplification of this system of classification is superficial (first or second degree) or deep injury (third or fourth degree).
Signs and symptoms vary depending on the degree of hypothermia, and may be divided by the three stages of severity. Infants with hypothermia may feel cold when touched, with bright red skin and an unusual lack of energy.
There are several terms which were in general use, but are no longer recommended.
Diving disorders, or diving related medical conditions, are conditions associated with underwater diving, and include both conditions unique to underwater diving, and those that also occur during other activities. This second group further divides into conditions caused by exposure to ambient pressures significantly different from surface atmospheric pressure, and a range of conditions caused by general environment and equipment associated with diving activities.
Hypothermia is often defined as any body temperature below . With this method it is divided into degrees of severity based on the core temperature.
Another classification system, the Swiss staging system, divides hypothermia based on the presenting symptoms which is preferred when it is not possible to determine an accurate core temperature.
Other cold-related injuries that can be present either alone or in combination with hypothermia include:
- Chilblains: superficial ulcers of the skin that occur when a predisposed individual is repeatedly exposed to cold
- Frostbite: the freezing and destruction of tissue
- Frostnip: a superficial cooling of tissues without cellular destruction
- Trench foot or immersion foot: a condition caused by repetitive exposure to water at non-freezing temperatures
The normal human body temperature is often stated as . Hyperthermia and fever, are defined as a temperature of greater than .
Drowning is most often quick and unspectacular. Its media depictions as a loud, violent struggle have much more in common with distressed non-swimmers, who may well drown but have not yet begun to do so. In particular, an asphyxiating person is seldom able to call for help. The instinctive drowning response covers many signs or behaviors associated with drowning or near-drowning:
- Head low in the water, mouth at water level
- Head tilted back with mouth open
- Eyes glassy and empty, unable to focus
- Eyes open, with fear evident on the face
- Hyperventilating or gasping
- Trying to swim in a particular direction but not making headway
- Trying to roll over on the back to float
- Uncontrollable movement of arms and legs, rarely out of the water.
Frank Pia, a lifeguard and researcher of rescue techniques and drowning, notes that drowning begins at the point a person is unable to keep their mouth above water; inhalation of water takes place at a later stage. Most people demonstrating the instinctive drowning response do not show obvious prior evidence of distress.
Many diving accidents or illnesses are related to the effect of pressure on gases in the body;
Barotrauma is physical injury to body tissues caused by a difference in pressure between a gas space inside or in contact with the body, and the surroundings .
Barotrauma occurs when the difference in pressure between the surroundings and the gas space makes the gas expand in volume, distorting adjacent tissues enough to rupture cells or damage tissue by deformation. A special case, where pressure in tissue is reduced to the level that causes dissolved gas to come out of solution as bubbles, is called "decompression sickness", "the bends", or "caisson disease".
Several organs are susceptible to barotrauma, however the cause is well understood and procedures for avoidance are clear. Nevertheless, barotrauma occurs and can be life-threatening, and procedures for first aid and further treatment are an important part of diving medicine.
- Barotraumas of descent (squeezes)
- Barotraumas of ascent (overexpansion injuries)
Fractures of facial bones, like other fractures, may be associated with pain, bruising, and swelling of the surrounding tissues (such symptoms can occur in the absence of fractures as well). Fractures of the nose, base of the skull, or maxilla may be associated with profuse nosebleeds. Nasal fractures may be associated with deformity of the nose, as well as swelling and bruising. Deformity in the face, for example a sunken cheekbone or teeth which do not align properly, suggests the presence of fractures. Asymmetry can suggest facial fractures or damage to nerves. People with mandibular fractures often have pain and difficulty opening their mouths and may have numbness in the lip and chin. With Le Fort fractures, the midface may move relative to the rest of the face or skull.
Radiography, imaging of tissues using X-rays, is used to rule out facial fractures. Angiography (X-rays taken of the inside of blood vessels) can be used to locate the source of bleeding. However the complex bones and tissues of the face can make it difficult to interpret plain radiographs; CT scanning is better for detecting fractures and examining soft tissues, and is often needed to determine whether surgery is necessary, but it is more expensive and difficult to obtain. CT scanning is usually considered to be more definitive and better at detecting facial injuries than X-ray. CT scanning is especially likely to be used in people with multiple injuries who need CT scans to assess for other injuries anyway.
A strain can occur as a result of improper body mechanics with any activity (e.g., contact sports, lifting heavy objects, overstretching) that can induce mechanical trauma or injury. Generally, the muscle or tendon overstretches and is placed under more physical stress than it can exert. Strains commonly result in a partial or complete tear of a tendon or muscle, or they can be severe in the form of a complete tendon rupture. The most common body location for strains to occur is in the foot, leg, or back.
- Acute strains are more closely associated with recent mechanical trauma or injury.
- Chronic strains typically result from repetitive movement of the muscles and tendons over a long period of time.
Degrees of Injury (as classified by the American College of Sports Medicine)
• First degree (mildest) – little tissue tearing; mild tenderness; pain with full range of motion.
• Second degree – torn muscle or tendon tissues; painful, limited motion; possibly some swelling or depression at the spot of the injury.
• Third degree (most severe) – limited or no movement; pain will be severe at first, but may be painless after the initial injury
Typical signs and symptoms of a strain include pain, functional loss of the involved structure, muscle weakness, contusion, and localized inflammation. A strain can range from mild annoyance to very painful, depending on the extent of injury.
Climber's finger is one of the most common climbing injuries within the sport of rock climbing. It is an overuse injury that usually manifests in a swollen middle or ring finger due to a damaged flexor tendon pulley, normally the A2 or A4 pulley. It is caused by a climber trying to support his or her body weight with one or two fingers, and is particularly common after a repeated utilization of small holds. Continued climbing on an injured finger may result in increased downtime in order to recover.
Degloving and avulsion injuries involve the removal of the penis skin, which is a serious medical emergency. Treatment of these injuries involves either closure of the torn skin, or a skin graft to replace the skin lost in the injury. Skin grafts are constructed to attempt to preserve erectile function and sensation.
Excessive exposure to hand arm vibrations can result in various patterns of diseases casually known as HAVS or VWF. This can affect nerves, joints, muscles, blood vessels or connective tissues of the hand and forearm:
- Tingling 'whiteness' or numbness in the fingers (blood vessels and nerves affected): This may not be noticeable at the end of a working day, and in mild cases may affect only the tips of the fingers. As the condition becomes more severe, the whole finger down to the knuckles may become white. Feeling may also be lost.
- Fingers change colour (blood vessels affected): With continued exposure the person may suffer periodic attacks in which the fingers change colour when exposed to the cold. Initially the fingers rapidly become pale and feeling is lost. This phase is followed by an intense red flush (sometimes preceded by a dusky bluish phase) signalling the return of blood circulation to the fingers and is usually accompanied by uncomfortable throbbing.
- Loss of manual dexterity (nerves and muscles affected): In more severe forms, attacks may occur frequently in cold weather, not only at work, but during leisure activities, such as gardening, car washing or even watching outdoor sports and may last up to an hour causing considerable pain and loss of manual dexterity and reduced grip strength.
In extreme cases, the sufferer may lose fingers. The effects are cumulative. When symptoms first appear, they may disappear after a short time. If exposure to vibration continues over months or years, the symptoms can worsen and become permanent.
Penile fractures are the result of rupture of the tunica albuginea. They are fairly rare and can co-occur with partial or complete urethral rupture, though this is rare. Urethral damage occurs in 10–38% of cases. Fractures are treated with emergency surgery, and can be diagnosed with ultrasound, especially in pediatric cases. Penile fractures are caused by trauma to the erect penis, typically by suddenly bending it laterally during penetrative intercourse with the receptive partner on top of the penetrating partner, or during masturbation. They can be diagnosed by the "eggplant sign" and are characterized by a loud popping sound at the time of the injury, the result of the tunica albuginea rupturing. Other symptoms include severe pain, loss of erection, and swelling. Symptoms of urethral injury include hematuria, blood at the meatus, and dysuria. If left untreated, complications result in 28–53% of cases; these include permanent curvature of the penis, fistula, urethral diverticulum, priapism, and erectile dysfunction.
The history of a centipede bite is fairly straightforward; the victim typically sees and identifies the characteristic centipede before, or soon after being bitten.
Symptoms which are most likely to develop include:
- severe pain, which is usually in proportion to the size of the centipede
- swelling and redness. Possible 'bullseye'
- skin necrosis
- swollen, painful lymph nodes in the regions of the bitten limb
- headache
- palpitations or a racing pulse
- nausea and vomiting
- anxiety
- local itching and burning sensations
The wound left by the bite may be accompanied by swelling, redness, and small puncture wounds which may form a circular pattern. This wound may be susceptible to local ulcerations and necrosis.
A severe bite from a large centipede on a child, senior or person with a weakened heart can cause heart attack if untreated. This is exceptionally rare.
Symptoms of a broken nose include bruising, swelling, tenderness, pain, deformity, and/or bleeding of the nose and nasal region of the face. The patient may have difficulty breathing, or excessive nosebleeds (if the nasal mucosa are damaged). The patient may also have bruising around one or both eyes.
As with other forms of pulmonary edema, the hallmark of SIPE is a cough which may lead to frothy or blood-tinged sputum. Symptoms include:
- Shortness of breath out of proportion to effort being expended.
- Crackles, rattling or ‘junky’ feelings deep in the chest associated with breathing effort – usually progressively worsening with increasing shortness of breath and may be cause for a panic attack
- Cough, usually distressing and productive or not of a little pink, frothy or blood-tinged sputum (hemoptysis)
The wetsuit may feel as though it is hindering breathing ability.
Musculoskeletal disorders (MSDs) are injuries or pain in the human musculoskeletal system, including the joints, ligaments, muscles, nerves, tendons, and structures that support limbs, neck and back. MSDs can arise from a sudden exertion (e.g., lifting a heavy object), or they can arise from making the same motions repeatedly repetitive strain, or from repeated exposure to force, vibration, or awkward posture. Injuries and pain in the musculoskeletal system caused by acute traumatic events like a car accident or fall are not considered musculoskeletal disorders. MSDs can affect many different parts of the body including upper and lower back, neck, shoulders and extremities (arms, legs, feet, and hands). Examples of MSDs include carpal tunnel syndrome, epicondylitis, tendinitis, back pain, tension neck syndrome, and hand-arm vibration syndrome.
A nasal fracture, commonly referred to as a broken nose, is a fracture of one of the bones of the nose. Symptoms may include bleeding, swelling, bruising, and an inability to breath through the nose. They may be complicated by other facial fractures or a septal hematoma.
The most common causes include assault, trauma during sports, falls, and motor vehicle collisions. Diagnosis is typically based on the signs and symptoms and may occasionally be confirmed by plain X-ray.
Treatment is typically with pain medication and cold compresses. Reduction, if needed, can typically occur after the swelling has come down. Depending on the type of fracture reduction may be closed or open. Outcomes are generally good. Nasal fractures are common, comprising about 40% of facial fractures. Males in their 20s are most commonly affected.
A centipede bite is an injury resulting from the action of a centipede's forcipules, pincer-like appendages that pierce the skin and inject venom into the wound. Such a wound is not technically a bite, as the forcipules are modified first pair of legs rather than true mouthparts. Clinically, the wound is viewed as a cutaneous condition characterized by paired hemorrhagic marks that form a chevron shape caused by the large paired forcipules of the centipede.
The centipede's venom causes pain and swelling in the area of the bite, and may cause other reactions throughout the body. The majority of bites are not life-threatening to humans and present the greatest risk to children and those who develop allergic reactions.
Vibration white finger (VWF), also known as hand-arm vibration syndrome (HAVS) or dead finger, is a secondary form of Raynaud's syndrome, an industrial injury triggered by continuous use of vibrating hand-held machinery. Use of the term "vibration white finger" has generally been superseded in professional usage by broader concept of HAVS, although it is still used by the general public. The symptoms of vibrating white finger are the vascular component of HAVS.
HAVS is a widespread recognized industrial disease affecting tens of thousands of workers. It is a disorder that affects the blood vessels, nerves, muscles, and joints, of the hand, wrist, and arm. Its best known effect is vibration-induced white finger (VWF), a term introduced by the Industrial Injury Advisory Council in 1970. Injury can occur at frequencies between 5 and 2000Hz but the greatest risk for fingers is between 50 and 300Hz. The total risk exposure for hand and arm is calculated by the use of ISO 5349-1, which stipulates maximum damage between 8-16Hz and a rapidly declining risk at higher frequencies. The ISO 5349-1 frequency risk assessment does not match the estimated risks for vibration-induced white finger well.
"Trench foot " is a medical condition caused by prolonged exposure of the feet to damp, unsanitary, and cold conditions. The use of the word "trench" in the name of this condition is a reference to trench warfare, mainly associated with World War I. Affected feet may become numb, affected by erythrosis (turning red) or cyanosis (turning blue) as a result of poor vascular supply, and feet may begin to have a decaying odour due to the possibility of the early stages of necrosis setting in. As the condition worsens, feet may also begin to swell. Advanced trench foot often involves blisters and open sores, which lead to fungal infections; this is sometimes called tropical ulcer (jungle rot).
If left untreated, trench foot usually results in gangrene, which can cause the need for amputation. If trench foot is treated properly, complete recovery is normal, though it is marked by severe short-term pain when feeling returns. As with other cold-related injuries, trench foot leaves sufferers more susceptible to it in the future.
Limber tail syndrome, or acute caudal myopathy, is a disorder of the muscles in the tail, usually affecting working dogs.
It is an injury occurring mostly in sporting or working dogs such as English Pointers, English Setters, Foxhounds, Beagles, and Labrador Retrievers. Limber tail syndrome is also known as swimmer's tail, cold water tail, broken tail, dead tail, "happy tail" or broken wag.