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What do you think of when you think of fall? I think of changing colours, cozy textures and longer hours stargazing. If you love fall, and love doing things alone, .
Table of contents
- Giamatti: The Green Fields of the Mind
- JRR Tolkien's first Middle Earth story, The Fall of Gondolin, to be published
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Reported here is an old lady who had died due to consecutive complications after a fall episode. Besides rendering the 36 hour clinical scenario that she had encountered afterwards, we have also touched upon the burden of falls in the elderly population. Falls display a surplus of complications in the geriatric population. Although they can be prevented by simple measures and education they may sometimes turn out to be an impasse.
Giamatti: The Green Fields of the Mind
In this report, presenting an old lady who had succumbed to the complications after a fall in the bathroom, we have touched upon this onerous medical condition in the light of the pertinent literature. A 65 year old lady was admitted to the emergency room -being conveyed by her relatives- after she had been found unconscious lying down in her bathroom. Her medical history comprised only hypertension for the preceding two years. The immediate physical examination revealed isochoric pupillae, increased deep tendon reflexes and Babinsky positivity on the left side.
Her eyes were open but she was not responding to painful or verbal stimuli. Increased diameter of her right thigh was also noted. Her vital functions and the electrocardiography ECG were quite normal. The laboratory analysis yielded white blood cells: Radiographies of her extremities and abdominal ultrasonography USG were unremarkable.
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The echocardiography was consistent with left ventricular hypertrophy. Cranial computed tomography CT was noncontributory. She was then transferred to the intensive care unit with the likely diagnosis of transient ischemic attack TIA. Low molecular weight heparin was accordingly started. On the second day of her hospital stay, she became conscious but could not recall any episode of falling. Further investigations for her right lower extremity were then commenced.
With the absence of pulses in that extremity and the swelling of the right thigh having not regressed, she was consulted to the orthopedists and vascular surgeons.
They have also noticed that the right leg was distended and tender to palpation. With the suspective diagnosis of deep venous thrombosis or compartment syndrome, they have ordered doppler USG which was normal. They have measured intracompartmental pressure of the right cruris which was found to be increased. Subsequently, they planned to perform fasciotomies.
JRR Tolkien's first Middle Earth story, The Fall of Gondolin, to be published
Due to a simultaneous fever of Abdominal CT was normal but CT for the right thigh depicted an adductor magnus hematoma. A wide spectrum empirical regimen of piperacilline-tazobactam was started before the results of blood and urine culture -which later on turned out to be normal. After the fasciotomies, at night, the blood analysis seemed to deteriorate even further and the urine output was progressively decreased Table 1.
Figure 1 Table 1: The consecutive laboratory analysis of the patient. With increased prothrombin time, fibrin degradation products, D-dimer and decreased fibrinogen levels she was diagnosed to have disseminated intravascular coagulation DIC.
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Vancomycine, clindamycine and amikacin were also started with the probable diagnosis of systemic inflammatory response syndrome SIRS. She was actively warmed, dopamine and dobutamine infusions were given. Arterial blood gas analysis disclosed mixed acidosis pH: Due to these findings and the likely diagnosis of rhabdomyolysis, mechanical ventilation and hemodialysis were commenced.
Despite dialysis and the mechanical ventilation she did not improve and got arrested. She did not respond to resuscitation and unfortunately died on the 36 th hour of her admission.
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Rutherford-Johnson puts forth a new approach to the study of contemporary music that relies less on taxonomies of style and technique than on the comparison of different responses to common themes of permission, fluidity, excess, and loss. Please visit our booth if you are attending, and otherwise ….
Tim Rutherford-Johnson is a London-based music journalist and critic. He was the contemporary music editor at Grove Music Online and edited the most recent edition of the Oxford Dictionary of Music. He has taught at Goldsmiths College and Brunel University, and since he has written about new music for his blog, The Rambler. List of illustrations Acknowledgments 1. Mediation and the Marketplace 3. Freedom, Choice, and the Body 4. Digital Translations, Displacements, and Journeys 5.
Worldwide Flows, Networks, and Archipelagos 6. Spectacle, Scale, and Excess 7. Ruins, Memorials, and Documents 8. Gaps between Past and Present Appendix 1: Recommended Listening Appendix 2: