abnormal collection air gas space causes lung chest wall like liquid buildup space interfere normal breathing called collapsed lung term refer lungs affected primary occurs spontaneously apparent cause absence significant lung disease secondary occurs presence existing lung caused physical trauma chest including blast injury medical surgical intervention case referred traumatic minority cases spontaneous traumatic air chest increases markedly way valve formed area damaged tissue leading tension condition medical emergency cause steadily oxygen shortage low blood pressure reversed effective treatment progress cause death symptoms typically include chest pain breath diagnosis physical examination difficult inconclusive particularly smaller chest scan usually confirm presence small spontaneous typically resolve treatment require monitoring approach appropriate subjects significant underlying lung disease larger marked symptoms air extracted chest tube connected way valve system occasionally surgical required tube drainage unsuccessful measure repeated episodes surgical treatments usually involve layers induced stick surgical removal membranes signs symptoms primary spontaneous tends occur young adult underlying lung problems usually causes limited symptoms chest pain mild usual predominant presenting features people affected unaware potential danger wait days seeking medical attention commonly occur changes atmospheric pressure explaining extent episodes happen clusters rare cause tension secondary spontaneous definition occur individuals significant underlying lung disease symptoms tend severe unaffected lungs generally unable replace loss function affected lungs decreased blood oxygen levels usually present observed blue lips skin accumulation carbon dioxide blood encountered cause confusion severe result sudden onset chronic disease lung diseases prompt investigations identify possibility traumatic commonly occurs chest wall pierced stab wound gunshot wound allows air enter space mechanical injury lung integrity involved structures traumatic found occur half cases chest trauma rib common group readily apparent half cases particularly mechanical ventilation required encountered patients receiving mechanical ventilation reason physical examination breath sounds heard diminished affected partly air space transmission sound measures vocal vibrations surface chest altered percussion chest perceived like drum vocal resonance noticeably decreased importantly volume limited intensity symptoms experienced victim physical signs apparent relatively small tension multiple definitions exist tension generally considered present primary spontaneous secondary spontaneous traumatic leads significant blood circulation tension tends occur clinical situations ventilation trauma patients lung disease common findings people tension chest pain respiratory distress increased heart rate rapid breathing initial stages findings include breath sounds chest low oxygen levels blood pressure displacement away affected rarely bluish skin low oxygen levels altered level consciousness percussion note examination affected reduced expansion decreased movement pain upper abdomen displacement apex beat heart impulse sound tapping medical emergency require immediate treatment investigations tension occur receiving mechanical ventilation case difficult spot person typically receiving noted sudden deterioration condition recent studies shown development tension features rapid previously thought presence raised pressure neck veins reliable clinical signs cause primary spontaneous spontaneous divided types primary occurs absence known lung disease secondary occurs underlying lung disease cause primary spontaneous unknown established risk factors include male sex smoking family history suspected underlying mechanisms discussed secondary spontaneous secondary spontaneous occurs setting variety lung diseases common chronic disease accounts approximately cases known lung diseases significantly increase risk children additional causes include foreign body certain people spontaneous family member previously experienced hereditary conditions syndrome syndrome alpha leads syndrome linked generally conditions cause signs symptoms usually primary finding syndrome caused gene located protein named lung identified cases features syndrome absent addition genetic associations genetic traumatic traumatic result blunt trauma penetrating injury chest wall common mechanism penetration sharp bony points new rib fracture damages lung tissue traumatic observed exposed apparent injury chest medical procedures central chest veins taking samples lung tissue lead administration positive pressure ventilation mechanical ventilation non invasive ventilation result pressure related injury leading divers breathe underwater apparatus supplied breathing gas ambient pressure results lungs containing gas higher atmospheric pressure divers breathing compressed air diving suffer result ascending metre breath holding lungs fully inflated additional problem cases features sickness typically treated diving chamber therapy lead small rapidly causing features tension mechanism cavity space inside chest contains lungs heart numerous major blood vessels cavity membrane covers surface lung lines inside chest wall normally layers separated small fluid lungs fully inflated cavity pressure inside higher pressure inside space despite low pressure space air enter natural connections air containing passage pressure gases low forced space develop air allowed enter damage chest wall damage lung occasionally space produce gas chest wall defects usually evident cases injury chest wall stab bullet wounds open secondary spontaneous lung tissue caused variety disease processes particularly large air containing cases severe areas tissue death episodes exact mechanism unclear primary spontaneous years thought caused small air filled surface presumed common risk tall males mechanical factors found cases compared general population history healthy subjects develop later hypothesis sufficient explain episodes furthermore surgical treatment suggested caused areas disruption layer prone smoking additionally lead small account markedly increased risk air stopped entering cavity gradually tension occurs opening allows air enter space functions way valve allowing air enter breath escape body increasing respiratory rate tidal volume size breath problem corrected decreased oxygen levels respiratory arrest eventually follow diagnosis symptoms vague inconclusive especially small confirmation medical imaging usually required contrast tension medical emergency treated imaging especially severe low blood pressure impaired level consciousness tension rays required doubt location chest ray traditionally plain chest ray beams projected appropriate investigation usually performed inspiration holding breath added information gathered obtaining chest ray ray strong suspicion lateral rays beams projecting performed routine practice unusual structure lungs contains heart great blood vessels large shifted away affected lung pressure differences equivalent tension determined mainly symptoms shock size volume air space determined reasonable degree accuracy measuring distance chest wall lung relevant treatment smaller managed differently air rim means occupies british professional guidelines traditionally stated measurement performed level blood vessels enter lung american guidelines state measurement apex lung small large method size located mainly apex common occurrence methods poorly best easily available ways estimating size scanning provide accurate determination size routine use setting recommended uniform form pocket air particular place chest small amounts fluid noted chest ray blood cases significant deep sign normally small space chest wall appears enlarged abnormal presence fluid cat scan necessary diagnosis useful particular situations lung diseases especially possible abnormal lung areas large air filled appearance chest ray safe apply treatment distinction exact location size determined trauma possible perform upright film chest miss remains sensitive use identification underlying lung presumed primary help identify anticipation treatment secondary help identify causes listed commonly evaluation people sustained physical trauma example fast protocol sensitive chest rays identification blunt trauma chest provide rapid diagnosis emergency situations allow size particular features chest confirm exclude diagnosis management treatment depends number factors vary discharge early follow immediate needle chest tube treatment determined severity symptoms acute illness presence underlying lung disease estimated size ray instances personal preference person involved traumatic chest tubes usually inserted mechanical ventilation required risk tension greatly increased chest tube mandatory open chest wound covered seal carries high risk leading tension dressing called seal utilized appears effective standard sided dressing seal specially designed device chest wall valve like mechanism allows air escape enter chest tension usually treated urgent needle required transport hospital performed emergency medical technician trained professional needle left place chest tube inserted tension leads cardiac arrest needle performed restore cardiac output conservative small spontaneous require treatment unlikely proceed respiratory failure tension generally resolve spontaneously approach appropriate estimated size small defined volume underlying lung disease appropriate treat larger symptoms limited admission hospital required long clear instructions given return hospital symptoms investigations performed time rays repeated confirm improvement advice given regard preventing estimated rates volume cavity day mean complete spontaneously resolve period weeks high quality evidence comparing conservative non conservative management secondary treated size small air rim limited symptoms admission hospital usually recommended oxygen given high flow rate accelerate large associated professional guidelines recommend reducing size equally effective chest tube involves administration local needle connected way tap air adults removed significant reduction size subsequent ray remainder treatment conservative approach shown effective cases compared tube drainage line reduces number people requiring hospital admission significantly increasing risk complications considered secondary moderate size air rim difference ongoing observation hospital required successful procedure american professional guidelines state large treated chest tube moderately sized traumatic medical procedures initially treated chest tube chest tube drain definitive initial treatment typically inserted area called safe triangle damage internal organs avoided horizontal line level muscles chest wall major local applied types tubes spontaneous small bore smaller diameter tubes inserted technique larger tubes advantage traumatic larger tubes chest tubes required responded needle large cases tension connected way valve system allows air escape enter chest include bottle water functions like water seal valve normally connected negative pressure circuit result rapid expansion lung risk expansion tube left place air seen escape period time rays confirm expansion lung days evidence air leak options available negative pressure low pressures high flow rate attempted particularly thought accelerate healing leak failing surgery required especially chest tubes line occurs people aids usually underlying pneumonia condition associated prolonged air sides relatively common people pneumonia surgery required possible patient chest tube managed care setting valve research demonstrate limited quality surgery procedure permanently space lung chest wall long term study years performed consequences good results short term achieved surgical opening chest identification source air followed stripping lining outer layer inner layer healing process lung chest wall effectively space rates approximately post pain relatively common invasive approach usually form procedure called video assisted surgery results based slightly worse achieved short term produce smaller skin compared open offers shorter hospital stays need pain control reduced risk lung problems surgery achieve chemical involves reaction causes lung adhere chest wall chest tube place agents tube achieve chemical results chemical tend worse surgical approaches found negative long term consequences younger people occurs considered opportunity emphasize markedly increased risk continue smoke benefits smoking cessation remain work week spontaneous person normally performs heavy manual labor weeks required undergone need weeks work recover air travel discouraged seven days complete resolution occur underwater diving considered unsafe episode procedure performed professional guidelines suggest performed lungs lung function tests scan diving resumed aircraft pilots require assessment surgery prevention procedure recommended episode intention prevent evidence effective treatment conflicting areas variation treatments available europe episodes require decision depends largely risk procedures recommended occurrence second surgery need considered experienced sides episodes involve sides episode associated pregnancy annual age adjusted rate thought times high males females cites cases person years males females respectively significantly average height associated increased risk people inches meters tall cases person years slim build increase risk risk contracting spontaneous elevated male female factors approximately respectively compared matched non sex individuals smoke higher intensity higher risk greater linear effect men smoke cigarettes day approximate fold increased risk comparable non consuming cigarettes day estimated fold increase risk secondary spontaneous estimated annual cases person years males females respectively risk depending presence severity underlying lung disease second episode occurred high likelihood subsequent episodes children studied estimated cases person years death uncommon tension british statistics annual mortality rate deaths million person years men women respectively significantly increased risk death seen older victims secondary history early description traumatic secondary rib appears imperial surgery turkish surgeon recommends method simple described jean student provided extensive description clinical picture recognized cases tuberculosis common cause concept spontaneous absence tuberculosis primary reintroduced danish physician introduced treatment prior advent anti intentionally given people tuberculosis effort collapse lobe entire lung known resting lung introduced italian surgeon publicized american surgeon john benjamin murphy early 20th century discovering procedure independently murphy recently discovered ray technology create correct size animals non human animals experience spontaneous traumatic spontaneous humans classified primary secondary traumatic divided open closed chest wall damage diagnosis apparent physician animal exhibits difficulty breathing shallow breathing arise lung trauma chest wall horses traumatic involve incomplete direct connection halves chest tension presence suspected rapidly deteriorating heart function absent lung sounds barrel shaped chest treated animal chest relieve pressure followed chest tube


deep vein deep vein deep formation blood deep vein predominantly legs non specific signs include pain swelling superficial veins potentially life threatening caused detachment travels lungs constitute single disease process known post syndrome significantly contributes health care cost prevention options risk individuals include early frequent walking exercises graduated compression intermittent compression german processes resulting known decreased blood flow rate increased tendency changes blood vessel wall formation typically begins inside veins blood relatively oxygen deprived certain pathways medical conditions increase risk including cancer trauma syndrome risk factors include older age surgery bed rest casts sitting long flights combined oral pregnancy period genetic factors genetic factors include deficiencies protein protein factor property having non blood type rate new increases dramatically childhood old age adulthood adults develops annually individuals suspected having assessed clinical prediction rule wells score test assist excluding diagnosis high sensitivity signal need testing diagnosis commonly suspected veins standard treatment typical include low molecular weight antagonist wearing graduated compression appears reduce risk post syndrome signs symptoms common signs symptoms include pain swelling warmth surface veins half condition symptoms signs symptoms sufficiently sensitive specific diagnosis considered conjunction known risk factors help determine likelihood suspected cases ruled evaluation symptoms causes baker injury differential include arterial tissue disorders large dangerous type characterized acute total entire outflow including veins leg usually painful blue tinged color swollen result causes factors changes blood vessel lining physical damage activation contribute explain formation related causes include activation immune system components state blood concentration oxygen possible activation risk factors contribute high risk develop acquired risk factors include strong risk factor older age blood composition favor important acquired risk factors include major surgery trauma increase risk tissue factor outside system entering blood surgery temporarily provoked cessation blood flow procedure cancer grow veins causing stimulate increased levels tissue factor pregnancy causes blood favor tearing releases substances favor oral replacement therapy increase risk variety mechanisms including altered blood protein levels reduced disease term includes development genetic factors increase risk include deficiencies proteins normally prevent blood protein protein addition non blood type factor genes deficiencies protein protein rare strong moderately strong risk factors increase risk times factor makes factor resistant activated protein genetic variant causes increased levels predominantly expressed moderately increase risk times factor times having non blood type approximately doubles risk non blood type common races making important risk factor individuals blood type higher blood levels von factor factor viii blood type increasing likelihood risk factors influence location body isolated profile risk factors appears distinct factors surgery appear dominate age increase risk upper important risk factor having central outlet syndrome increases risk risk factors develops veins grows direction flow heart grow cleared naturally dissolved blood veins thigh commonly affected including vein vein vein syndrome extensive lower reach vein inferior occasionally veins arm affected central placement rare disease mechanism arterial heart attacks established steps cause arterial blood vessel wall damage required veins occurs damage beginning thought caused tissue factor leads conversion followed deposition red blood cells main components appears attach blood vessel wall lining surface normally acts prevent white blood cells components prominent arterial ones play role associated white blood cells play role formation resolution begins veins blood flow pattern cause low oxygen concentrations blood valve worsened pathways ones include early growth response protein results production oxygen species activate pathways nuclear factor early growth response protein contribute association proteins prompting release tissue factor filled presumably begin binding surface diagnosis diagnosis requires use imaging devices clinical assessments predict likelihood help determine test useful highly likely normal result rule diagnosis classification provoked occur association acquired risk factors surgery oral trauma cancer cases acquired states called acute characterized pain swelling usually means blood flow non label chronic applied longer days symptoms found screening labeled incidental legs knee knee vein vein knee classified limited clinical significance compared initial episode called incident subsequent termed refers legs means single leg affected probability suspected clinical assessment probability useful determine tests perform studied clinical prediction rule wells score wells score criteria possible score active cancer treatment months point swelling compared measured point swollen superficial veins non leg point pitting leg point previous documented point swelling entire leg point localized deep system point recent cast lower point recently days major surgery requiring regional general past weeks point alternative diagnosis likely points wells scores chance having lower score odds alternatively wells scores categorized high greater moderate low respectively degradation product elevated level result conditions hospitalized patients elevated levels multiple reasons individuals high probability having imaging preferred test low moderate probability level obtained diagnosis results normal elevated level requires investigation imaging confirm exclude diagnosis suspected leg low probability situation american college chest physicians recommends testing levels moderate high sensitivity compression veins options suggested leg testing suggested preference overall national institute health care excellence nice recommends testing prior vein suspected leg moderate probability scenario high sensitivity suggested recommended option imaging leg compression possible nice uses point wells score refer moderate probability group imaging imaging tests veins diagnosis commonly compression leg technique single scan miss leg scanning lead scan possibilities gold standard judging imaging methods contrast involves peripheral vein affected limb contrast agent taking rays reveal supply cost availability limitations test rarely performed test detect deep vein history section prevention depending risk different measures walking exercises reduce leg muscle veins pump blood heart individuals physical compression methods improve blood flow increases risk bleeding high risk scenarios risk major bleeding long term year point annual risk thought warrant long term estimated usually individuals exceed annual risk long term common consideration strong moderately strong risk factor carries annual risk individuals warrant long term aside anti drug people following surgery previous decrease risk people healthy evidence clear following completion long term useful prevent occurrence hospital american college physicians issued clinical practice making strong recommendations based moderate quality evidence hospitalized patients assessed risk bleeding started related drug potential benefits thought potential graduated compression drew attention lack support performance measures encouraging physicians apply universal regard risks review found medical patients change risk death use decreased people risks increased people risks major bleeding review recommended need balance risks benefits guidelines non surgical patients recommend ill cases elevated risk bleeding high risk bleeding mechanical suggested risks bleeding elevated critically ill mechanical suggested depending risk suggested cancer solid additional risk factors listed previous therapy low risk bleeding post surgery major surgery total hip replacement total knee replacement hip fracture surgery high risk causing chance developing days options prevention people follow non surgery include early walking mechanical intermittent compression graduated compression drugs low molecular weight low dose depending risk risk major bleeding person preferences following major surgery recommends treatment drugs reduce risk suggested preference intermittent compression option graduated compression effective general surgery pregnancy risk increased pregnancy times state likely adaptation fatal additionally pregnant women genetic risk factors subject approximate thirty times increased risk treatments pregnancy related women suggested carriers factor family history suggested antagonist weeks following family history previous suggested waiting pregnancy protein carriers factor personal family history suggested waiting pregnancy weeks family personal history suggested waiting common cause harm prevention pregnancy travelers guidelines offered weak recommendations risk long haul travelers previous recent surgery trauma active pregnancy use advanced age limited mobility severe known disorder suggestions included exercises frequent walking aisle seating ease walking use graduated compression fit knee pressure ankle suggested compression sharply reduced levels airline passengers effect unknown individuals studied developed treatment prevents act directly existing standard treatment balancing risk benefit important determining duration months generally standard length treatment annual risk excess episode extended possibility finish treatment elevated level increased risk normal results result clinical decision making test results rarely play role length treatment acute cases leg recommended days oral day suggested retained compromised kidney function unlike generally taken minimum months maintain international normalized ratio target benefit taking declines duration treatment extends risk bleeding increases age recommended treatment months provoked surgery month course recommended provoked risk factor months suggested lengthened treatment bleeding risk low moderate patients months considered extended treatment suggested longer months high risk bleeding case months sufficient second recommended extended treatment bleeding risk low suggested extended treatment bleeding risk moderate suggested months high risk scenarios home treatment walking repeat imaging recommended initial home treatment instead hospital treatment acute leg applies long individuals feel ready severe leg symptoms qualify appropriate home environment expected provide quick return hospital necessary support family friends phone access addition suggested graduated compression apply higher pressure lower pressure knees use begin soon possible evidence support reduce risk post syndrome indicate reduction use suggested years discomfort reduce compliance walking suggested severe pain person medical problems preventing movement person starts anti therapy bed rest treat acute deep vein clinical benefits associated walking evidence walking harmful people harmed bed rest medically necessary instead follow imaging test typically week post diagnosis option acute isolated high risk extension grow recommend technique benefit high risk bleeding patients choose serial imaging avoid scan concerns risk bleeding insignificant applied patients negative initial result serial testing inefficient cost effective filters inferior filters filters reduce effectiveness safety profile established general recommended high risk scenarios recommended treatment addition individual filter risk bleeding develops acute case filter suggested nice recommends filters settings acute receive filter removed safely started filters associated long term risk reason maintain extended administration directly affected vein acts break reduce risk post syndrome possibly reduce risk leg associated increased risk bleeding currently suggests patients choose prevention post syndrome concerns complexity bleeding risk cost procedure nice recommends considered symptoms weeks normally good life low risk bleeding mechanical device remove considers option following conditions apply symptoms days criterion single trial good functional status life year resources expertise available suggested frequent post syndrome caused reduction return blood heart symptoms post syndrome pain severe cases leg estimated develop develop severe form risk higher present thigh hardly associated post syndrome lower related mortality rate deaths associated upper extremely rare presence remaining frequently occurs minority people increases risk lesser extent elevated years following approximately individuals episode adults year available data dominated north american european populations rare children year childhood old age increases factor elderly experiencing yearly pregnancy acute occurs deliveries surgery treatment develops people total partial knee replacement total partial hip replacement americans develop year deaths england estimated year die hospital related unclear reasons people asian descent lower risk whites north american european populations people commonly factor populations china japan thailand protein protein non blood type present general population varies ethnicity present altogether global data incomplete economics initial costs average hospitalized patient follow costs months months year respectively europe month figures post syndrome significant contributor follow costs annual costs estimated billion excess billion average annual cost treated individual thought example patients treated costs averaging annually cost billion year history earliest case described book documented case thought occurred 13th century leg year old male point increased women noticed late public health recommendation issued encourage women means prevent phenomenon called milk leg thought result milk building leg german physician published referred major causes provides theoretical framework current explanation focused effect foreign body system conditions required propagation multiple introduced 20th century oral 1940s commonly performed 1970s 1980s use techniques increased sensitivity largely superseded method research directions large controlled trials norwegian trial north american attract trial dutch trial studying effectiveness safety directed studies found clinical benefit taking prevent cited literature


known high blood pressure long term medical condition blood pressure elevated high blood pressure usually cause symptoms long term high blood pressure major risk factor disease stroke heart failure peripheral disease vision loss chronic kidney disease high blood pressure classified primary essential high blood pressure secondary high blood pressure cases primary defined high blood pressure lifestyle genetic factors lifestyle factors increase risk include excess salt excess body weight smoking alcohol remaining cases categorized secondary high blood pressure defined high blood pressure identifiable cause chronic kidney disease kidney disorder use birth control pills blood pressure expressed measurements pressures maximum minimum pressures respectively normal blood pressure rest range millimeters mercury high blood pressure present resting blood pressure adults different numbers apply children blood pressure monitoring hour period appears accurate office best blood pressure measurement lifestyle changes lower blood pressure decrease risk health complications lifestyle changes include weight loss decreased salt intake physical exercise healthy diet lifestyle changes sufficient blood pressure controls blood pressure people treatment moderately high arterial blood pressure defined associated improved life effect treatment blood pressure clear reviews finding benefit finding benefit high blood pressure affects population globally believed factor million deaths signs symptoms rarely accompanied symptoms identification usually screening seeking healthcare unrelated problem high blood pressure report particularly head morning ears altered vision episodes symptoms related associated anxiety high blood pressure physical examination associated presence changes seen severity changes typical graded grades difficult differentiate severity roughly duration severity secondary certain specific additional signs symptoms suggest secondary identifiable cause example syndrome frequently causes moon face fat neck shoulder purple abdominal stretch marks frequently causes weight loss increased appetite fast heart rate eyes associated localized abdominal left right locations frequently causes decreased blood pressure lower relative arms delayed absent arterial cause abrupt episodes accompanied pale appearance excessive crisis severely elevated blood pressure equal greater referred crisis crisis categorized urgency emergency according absence presence end organ damage respectively urgency evidence end organ damage resulting elevated blood pressure cases oral lower gradually hours emergency evidence direct damage organs affected organs include brain kidney heart lungs producing symptoms include confusion chest pain emergency blood pressure reduced rapidly stop ongoing organ damage lack controlled trial evidence approach pregnancy occurs approximately blood pressure measurements hours apart greater considered pregnancy high blood pressure pregnancy classified pre existing pre pre condition second half pregnancy following delivery characterised increased blood pressure presence protein occurs responsible approximately maternal deaths globally pre doubles risk mortality usually symptoms pre detected routine screening symptoms pre occur common visual disturbance flashing lights pain stomach swelling pre occasionally progress life threatening condition called emergency complications including vision loss brain swelling kidney failure blood disorder contrast defined new onset pregnancy protein children failure thrive lack energy difficulty breathing associated young older children cause unexplained fatigue failure thrive blurred vision facial causes primary results complex interaction genes environmental factors numerous common genetic variants small effects blood pressure identified rare genetic variants large effects blood pressure identified genetic related blood pressure genetic influencing blood pressure newly found sentinel new genetic identified shown association dna multiple nearby sites sentinel located genes related smooth muscle function dna affect way linking common genetic variation multiple mechanisms underlying associations understood single variant test performed study sentinel known new showed genetic variants singly aggregate contribute risk clinical related high blood pressure blood pressure rises aging risk later life considerable environmental factors influence blood pressure high salt intake raises blood pressure salt sensitive individuals lack exercise stress depression play role individual cases possible role factors consumption clear resistance common component syndrome syndrome thought contribute events early life low birth weight maternal smoking lack breast feeding risk factors adult essential mechanisms linking adult remain unclear increased rate high blood found people comparison people normal blood pressure uncertain plays role subsidiary poor kidney function secondary secondary results identifiable cause kidney disease common secondary cause caused conditions syndrome syndrome causes secondary include sleep pregnancy excessive consumption certain illegal drugs exposure drinking water shown elevated blood pressure people established essential increased resistance blood flow total peripheral resistance accounts high pressure cardiac output remains normal evidence younger people borderline high cardiac output elevated heart rate normal peripheral resistance termed borderline individuals develop typical features established essential later life cardiac output falls peripheral resistance rises age pattern typical people ultimately develop disputed increased peripheral resistance established mainly structural small reduction number density contribute increased active plays role established essential unclear associated decreased peripheral compliance increase return increase cardiac ultimately cause pulse pressure difference blood pressure frequently increased older people mean pressure high pressure normal low condition termed isolated high pulse pressure elderly people isolated explained increased arterial typically accompanies aging exacerbated high blood pressure mechanisms proposed account rise peripheral resistance evidence disturbances salt water handling particularly system sympathetic nervous system mechanisms mutually exclusive likely contribute extent cases essential suggested contribute increased peripheral resistance damage garnered interest role increasing production immune system chemical signals thought involved factor alpha diagnosis diagnosed basis high blood pressure traditionally national institute clinical excellence recommends separate measurements monthly intervals american heart association recommends measurements separate health care visits blood pressure monitoring hours accurate method confirm diagnosis exception high blood pressure readings especially poor organ function initial assessment people include complete history physical examination availability hour blood pressure monitors home blood pressure machines importance white coat led change united_kingdom current best practice follow single raised clinic reading measurement home blood pressure monitoring course days united_states services task force recommends getting measurements outside healthcare environment elderly syndrome require consideration condition believed resulting high blood pressure readings blood pressure arterial measurements blood pressure normal blood pressure increases standing diagnosis healthcare providers attempt identify underlying cause based risk factors symptoms present secondary common children cases caused kidney disease primary essential common multiple risk factors including family history laboratory tests performed identify possible causes secondary determine caused damage heart eyes additional tests diabetes high levels usually performed conditions additional risk factors development heart disease require treatment measured assess presence kidney disease cause result rate recent guidelines advocate use modification diet disease formula estimate rate provide measurement kidney function monitor effects certain drugs kidney function additionally testing samples protein secondary indicator kidney disease testing check evidence heart strain high blood pressure heart muscle left heart experienced prior minor disturbance silent heart attack chest ray performed look signs heart damage heart adults people aged years older defined blood pressure measurement consistently higher accepted normal value currently table classification lower measurements derived hour home monitoring recent international guidelines created categories range indicate risk higher blood pressures normal range uses term blood pressure range guidelines use optimal normal high normal categories pressures sub classified distinguishes stage stage isolated isolated refers elevated pressure normal pressure common elderly guidelines additionally define stage stage iii people blood pressure exceeding pressure classified resistant reduce blood pressure normal levels children occurs blood pressure measured routinely healthy common high risk variety factors age age birth weight needs taken account deciding blood pressure normal newborn defined elevated blood pressure visits affects children associated long term risks ill health blood pressure rises age childhood children defined average blood pressure occasions equal higher appropriate sex age height child high blood pressure confirmed repeated visits child having children defined average blood pressure greater equal proposed pre diagnosed classified criteria adults value routine screening children age years debated national high blood pressure education program recommended children aged years older blood pressure measurement health care visit national heart lung blood institute american academy similar recommendation american academy family physicians support view services task force evidence insufficient determine balance benefits screening children symptoms prevention disease burden high blood pressure experienced people labeled consequently population strategies required reduce consequences high blood pressure reduce need drug therapy lifestyle changes recommended lower blood pressure starting drug therapy british society guidelines proposed following lifestyle changes consistent outlined national high education program primary prevention maintain normal body weight adults body mass index reduce intake day day engage regular physical activity walking min day days week limit alcohol consumption units day men units day women consume diet rich fruit vegetables portions day effective lifestyle modification lower blood pressure individual drug combinations lifestyle modifications achieve better results management according review published reduction blood pressure decrease risk stroke heart disease reduce likelihood heart failure mortality disease target blood pressure expert groups produced guidelines low blood pressure target person treated groups recommend target range general population controversy exists appropriate targets certain including elderly people diabetes people kidney disease expert groups recommend slightly higher target years age expert group recommends target years age experts group disagree recommendation expert groups recommended slightly lower targets diabetes chronic kidney disease recommend target general population large trial suggests people increased heart disease risk aiming reduce blood pressure associated lower mortality increased effects compared target lifestyle modifications line treatment lifestyle changes including changes physical exercise weight loss recommended scientific advisories review found evidence effects weight loss death long term complications adverse events persons review find decrease blood pressure potential effectiveness similar times exceeds single medication high justify immediate use lifestyle changes recommended conjunction medication changes shown reduce blood pressure include low dash diet vegetarian high potassium physical exercise shown reduce blood pressure include resistance exercise exercise resistance exercise device guided breathing stress reduction techniques meditation considered add treatments reduce evidence preventing disease classes collectively referred available treating line include calcium channel converting combination option serve minimize counter regulatory mechanisms act revert blood pressure values pre treatment levels majority people require medication control resistant resistant defined remains goal blood pressure spite belonging different drug classes low adherence treatment important cause resistant resistant represent result chronic high activity nervous system concept known adults nearly billion people adult population world common developed million undeveloped million countries rates vary markedly different regions rates low men women rural india high men women poland europe occurs people estimated million people united_states taking medication adult united_states population prevalence united_states increasing reached affects million adults population african american adults highest rates world common blacks whites mexican americans rates increase age greater southeastern united_states common men tends decrease difference low status children rates high blood pressure children increased years united_states childhood particularly secondary underlying disorder adults kidney disease common secondary cause children primary essential accounts cases outcomes important risk factor premature death worldwide increases risk heart disease strokes peripheral disease diseases including heart failure chronic kidney disease risk factor complications include history measurement modern understanding system began work physician william harvey described circulation blood book english clergyman stephen published measurement blood pressure clinical entity came invention based allowed measurement blood pressure clinic improved technique describing sounds heard identification symptoms similar symptoms patients crisis discussed medieval persian medical texts chapter disease symptoms include head sluggish movements general warm touch feel body prominent tense vessels pulse skin coloured dense loss appetite weak thinking stroke disease presumed excessive blood blood vessels descriptions disease came thomas young especially richard bright report elevated blood pressure person evidence kidney disease frederick treatment historically treatment called hard pulse disease consisted reducing quantity blood application advocated yellow emperor china approach treatment hard pulse disease included changes lifestyle staying away anger sexual intercourse program patients avoiding consumption wine meat reducing volume food meal maintaining low energy diet usage 19th 20th centuries effective treatment possible treatment numerous effects strict restriction example rice diet surgical parts sympathetic nervous system therapy injection substances caused fever indirectly reducing blood pressure chemical effects unpopular agents developed second world war popular reasonably effective derived medicinal plant tolerated major breakthrough achieved discovery tolerated available agents developed available subsequently beta calcium channel converting ace developed agents society culture awareness world health organization identified high blood pressure leading cause mortality world league umbrella organization national societies leagues recognized population worldwide unaware condition address problem initiated global awareness campaign dedicated year world day past years national societies engaging innovative activities message public record participation member countries week countries partnership local governments professional societies organizations private industries promoted awareness public media public rallies mass media internet television message reached million people momentum picks year year confident estimated billion people affected elevated blood pressure reached economics high blood pressure common chronic medical problem prompting visits primary health care providers usa american heart association estimated direct indirect costs high blood pressure billion people aware condition medication people aware adequately control adequate management hampered diagnosis treatment control high blood pressure health care providers face obstacles achieving blood pressure control including resistance taking multiple reach blood pressure goals people face challenges medicine schedules making lifestyle changes nonetheless achievement blood pressure goals possible importantly lowering blood pressure significantly reduces risk death heart disease stroke development conditions cost associated advanced medical care


group diseases characterized episodes vary brief nearly long periods vigorous shaking episodes result physical injuries including occasionally broken bones tend immediate underlying cause isolated provoked specific cause poisoning deemed represent people areas world experience stigma condition cause cases unknown people develop result brain injury stroke brain brain birth defects known genetic directly linked small proportion cases result excessive abnormal nerve cell activity brain diagnosis involves ruling conditions cause similar symptoms determining cause present alcohol withdrawal problems partly imaging brain performing blood tests confirmed normal test rule condition occurs result issues prevented medication cases inexpensive options available respond medication surgery changes considered cases lifelong people improve point treatment longer needed million people nearly cases occur developing world resulted deaths deaths common people age developed world onset new cases occurs frequently babies elderly developing world onset common older children young adults differences frequency underlying causes people seizure age chance experiencing second seizure areas world restrictions placed ability drive permitted drive free specific length time word ancient greek seize possess signs symptoms characterized long term risk present ways depending brain involved person age common type begin start affecting brain thirds begin partial affect hemisphere brain progress remaining non example type absence seizure presents decreased level consciousness usually lasts seconds partial preceded certain experiences known include sensory visual hearing smell psychic motor phenomena activity start specific muscle group spread surrounding muscle groups case known march occur non consciously generated activities simple repetitive movements like lips complex activities attempts pick main types absence involve loss consciousness typically happen warning occur limbs followed extension lasts seconds phase cry heard chest muscles followed shaking limbs phase produce constant muscles person turns blue breathing stopped shaking limbs shaking stopped minutes person return normal period called state phase loss control occur seizure tongue tip sides seizure seizure bites sides common tongue bites relatively common non involve muscles areas absence subtle slight turn head eye person fall returns normal right ends involve loss muscle activity greater second typically occurs sides body triggered specific events known triggered specific common include flashing lights sudden noises certain types happen sleep types occur sleeping active portion seizure typically period confusion referred period normal level consciousness returns usually lasts minutes hours common symptoms include feeling tired difficulty speaking abnormal behavior seizure relatively common occurring people people remember happened time localized weakness known occur partial seizure occurs typically lasts seconds minutes rarely day adverse effects social psychological effects include social isolation disability result lower educational achievement worse employment outcomes learning disabilities common condition especially children stigma affect families disorder certain disorders occur people depending partly syndrome present include depression anxiety obsessive disorder attention deficit disorder affects times children children condition significant consequences child learning social development common children causes genetic acquired causes interaction factors cases established acquired causes include brain trauma stroke problems brain result previous infection cases cause unknown caused genetic developmental conditions common younger people brain strokes likely older people occur consequence health problems occur right specific cause stroke head injury toxic problem known acute broader classification seizure related disorders believed involved majority cases directly indirectly single gene defect interaction multiple genes environmental factors single gene defects rare described genes involved affect channels directly indirectly include genes channels protein coupled identical twins affected chance affected non identical twins risk risks greater partial twins affected time syndrome close relatives person risk times general population syndrome syndrome acquired occur result number conditions including strokes head trauma previous central nervous system genetic result brain damage time birth brain making cause cases risk greatest temporal lobe grow slowly mass cerebral risks high stroke develop united_kingdom strokes account cases believed cause elderly believed head trauma mild brain injury increases risk fold severe brain injury increases risk seven fold experienced high powered gunshot wound head risk evidence links disease non sensitivity evidence appears specific syndrome includes disease brain review estimates people general population condition risk following disease commonly causes infection risk seizure high risk following infection pork result cause half cases areas world parasite common occur brain cerebral malaria chronic alcohol use increases risk drink units alcohol day half fold increase risk risks include disease multiple getting increase risk risk factor seen developing world unclear direct cause association people cerebral increased risk half people having disease mechanism normally brain electrical activity non activity regulated factors cellular environment factors include type number distribution channels changes changes gene expression factors include concentrations regulation breakdown cells exact mechanism unknown little known cellular network mechanisms unknown circumstances brain shifts activity seizure excessive resistance fire period decreased occur changes channels functioning properly results specific area develop known seizure focus mechanism regulation circuits regulation circuits following injury brain secondary occur processes known failure blood brain barrier mechanism allow substances blood enter brain evidence usually random event brought factors stress alcohol abuse light lack sleep term seizure threshold indicate necessary bring seizure seizure threshold lowered group begin firing abnormal excessive synchronized manner results wave known shift normally fires resistant firing period time effect electrical changes negative effects partial begin hemisphere brain begin types change brain structure appear little effect loss specific areas brain linked unclear causes changes changes result diagnosis diagnosis typically based observation seizure onset underlying cause look abnormal patterns brain waves scan look structure brain usually specific syndrome attempted possible video monitoring useful difficult cases definition disorder brain defined following conditions furthermore considered resolved individuals age dependent syndrome past age remained seizure free years seizure years definition international_league conceptual definition according disorder brain characterized enduring generate psychological social consequences condition definition requires occurrence seizure possible undergo treatment causes resolved resolution unfortunately guarantee return definition called disease disorder decision executive committee taken word disorder having stigma disease express degree seriousness deserves definition practical nature designed clinical use particular aims clarify enduring according conceptual definition present researchers minded specialized groups choose use older definition definition considers perfectly long clear definition classification contrast classification focuses happens seizure classification focuses underlying causes person admitted hospital seizure results seizure classified underlying disease identified diagnosis finally depends available results applied definitions classifications respective terminology international_league provided classification follows classification widely accepted criticized mainly underlying causes major clinical course covered detail commission classification addressed issue divided categories genetic structural unknown cause refined recommendation categories number reflecting recent scientific advances cases organized specific features present features include age seizure begin seizure types findings identifying syndrome useful helps determine underlying causes anti seizure medication tried ability case specific syndrome occurs children onset commonly early examples childhood absence juvenile severe brain caused partly aspect referred associated frequent resistant treatment severe instance syndrome west syndrome believed play important role number mechanisms simple complex modes inheritance identified extensive screening failed identify single gene variants large effect recent studies begun reveal number gene responsible including causes clearly identified difficult match categories current classification cases somewhat unknown cause category classification includes general clinical features age strongly point presumed genetic cause childhood included unknown cause category cause presumed genetic instance included despite presumed genetic cause cases instance syndrome clinical main feature syndrome categorized argued include category classification particularly change advances research tests assist showing brain activity suggestive increased risk recommended likely seizure basis symptoms diagnosis help distinguish type seizure syndrome present children typically needed second seizure rule diagnosis falsely positive disease certain situations useful perform affected individual sleeping sleep deprived imaging scan recommended non seizure detect structural problems brain generally better imaging test bleeding suspected sensitive easily available attends emergency room seizure returns normal quickly imaging tests later point person previous diagnosis previous imaging repeating imaging usually needed subsequent adults testing blood calcium levels important rule problems causes rule problems rhythm heart useful central nervous system infection routinely needed children additional tests required blood testing looking disorders high blood level minutes following seizure useful help confirm seizure opposed non seizure level useful detecting partial normal seizure possible separate recommended routine diagnosis differential diagnosis diagnosis difficult number conditions present similar signs symptoms including panic attacks non particular accompanied short episode nocturnal frontal lobe considered later identified syndrome attacks movement disorder taken cause drop attack seizure children behaviors easily mistaken include breath holding spells bed night attacks cause twisting head mistaken frequent occurring cases different studies showed cases seizure like attacks apparent treatment resistant cause approximately people seen separating based seizure episode testing difficult prevention cases efforts reduce head injuries provide good care time birth reduce environmental parasites pork effective efforts central_america decrease rates pork resulted decrease new cases management usually treated daily medication second seizure occurred high risk medication started seizure cases special diet required aid rolling person active seizure recovery position helps prevent getting lungs putting fingers bite block tongue mouth recommended person result efforts taken prevent self injury spinal precautions generally needed seizure lasts longer minutes hour return normal level consciousness considered medical emergency known status require medical help open protected useful home recommended initial medication seizure long duration placed mouth hospital preferred effective recommended status respond initial treatment typically requires admission intensive care unit treatment stronger agents treatment possibly person entire life choice based seizure type syndrome health problems person age lifestyle single medication recommended initially effective switching single medication recommended recommended single medication work half agent effective second single agent helps agents time help additional people continue despite treatment number available appear equally effective partial controlled release appears work immediate release fewer effects united_kingdom recommended line treatment partial second line issues cost effects recommended line second line absence recommended particularly effective controlled particular treatment usually necessary routinely check medication levels blood expensive usd year world health organization gives line recommendation developing world commonly access difficult countries label controlled drug adverse effects reported people depending data collected adverse effects dose related mild examples include mood changes certain effects related dose liver suppression bone quarter people stop treatment adverse effects associated birth defects pregnancy particular concern especially despite treatment continued effective risk believed greater risk slowly stopping reasonable people seizure years people months stopping possible children adults surgery surgery option people partial remain problem despite treatments treatments include trial goal surgery total control achieved cases common procedures include cutting anterior temporal lobe removal removing parts procedures corpus attempted effort decrease number cure condition following surgery slowly withdrawn cases option candidates surgery types shown effective respond nerve anterior closed loop responsive diet diet high fat low adequate protein appears decrease number half children reasonable option improved surgery option stay diet years issues effectiveness effects include stomach problems long term concerns heart disease radical easier tolerate effective unclear diet works exercise proposed possibly useful preventing data support claim people disease non sensitivity free diet decrease frequency avoidance therapy consists eliminating example sensitive light small television avoiding video games wearing dark glasses useful based based waves support respond psychological methods replace dogs commonly referred seizure dogs help seizure clear dogs ability predict occur alternative medicine alternative medicine including psychological routine reliable evidence support use evidence support use supported evidence trials poor quality possible draw definitive conclusions usually cured medication control effectively cases controlled true people partial long term outcome number occur months factors increasing risk poor outcome include little response initial treatment family history psychiatric problems waves representing activity developing world people appropriately treated africa treatment partly related appropriate available expensive mortality people increased risk death increase fold greater general population related underlying cause status suicide trauma sudden unexpected death death status primarily underlying problem missing risk suicide increased times cause unclear appears partly related frequency accounts related deaths unclear decrease risk greatest increase mortality elderly unknown cause little increased risk united_kingdom estimated deaths possibly developing world deaths leading falls status common disorders affecting million people affects population age population age common males females overall difference small disorder developing world estimated prevalence active range active defined seizure years begins year developed countries developing countries poverty risk includes poor country poor relative country developed world commonly starts young old developing world onset common older children young adults higher rates trauma infectious diseases developed countries number cases year decreased children increased elderly 1970s attributed partly better survival following strokes elderly history oldest medical records affecting people beginning recorded history ancient history disease thought spiritual condition world oldest description seizure comes text language ancient written person described text diagnosed influence moon god underwent listed code reason purchased slave returned smith describes cases individuals oldest known detailed record disease medical text text gives signs symptoms details treatment likely outcomes describes features different seizure types understanding nature disease attributed possession evil spirits called treating condition spiritual means described loss consciousness definition carried forward text ancient greeks contradictory views disease thought form spiritual possession associated condition genius divine names gave sacred disease appears greek mythology associated moon afflicted upset greeks thought important figures hercules disease notable exception divine spiritual view school fifth century rejected idea disease caused spirits landmark work sacred disease proposed divine origin instead medically problem originating brain accused sacred cause disease spreading ignorance belief magic proposed important cause described worse outcomes disease presents early age note physical characteristics social shame associated instead referring sacred disease term great disease giving rise modern term grand despite work detailing physical origins disease view accepted time evil spirits continued blamed 17th century cultures persons imprisoned birthplace modern jean martin found people mentally ill chronic insane ancient rome known disease assembly hall seen curse gods northern italy traditionally known saint valentine effective anti seizure medication introduced modern treatment developed coming use society culture stigma stigma commonly experienced world affect people economically socially culturally india china justification deny marriage people areas believe cursed parts africa associated possession evil spirits poisoning believed evidence united_kingdom laws prevented people marrying stigma result people denying economics result direct economic costs billion dollars united_states resulted economic costs europe billion india estimated result costs billion usd cause emergency department visits emergency departments children united_states vehicles twice risk involved motor collision areas world allowed drive able drive certain conditions met places physicians required law report person seizure licensing body requirement encourage person question report countries require physician reporting include sweden austria denmark spain countries require individual report include new_zealand physician report believe individual canada united_states australia requirements reporting vary province state controlled feel allowing driving reasonable time person free drive varies country countries require years united_states time needed seizure determined state months year typically denied pilot license canada individual seizure considered years limited license testing normal drug related considered united_states federal aviation administration allow commercial pilot license rarely exceptions persons isolated seizure remained free adulthood medication united_kingdom national private pilot license requires standards professional driver license requires period years meet requirement acquire restricted license free years support organizations organizations provide support people families affected shadows campaign joint effort world health organization international_league international bureau provides help internationally joint council serves ireland united_states foundation national organization works increase acceptance disease ability function society promote research cure foundation hospitals individuals run support groups united_states research seizure prediction refers attempts forecast based occur effective mechanism predict developed repeated events cause eventually causes easily create animal models gene therapy studied types alter immune function poorly supported evidence compared standard surgery certain types common locations start networks found affected majority efforts figure occurs working account different regions brain timing activity animals occurs number animals including dogs cats common brain disorder dogs typically treated dogs cats dogs horses fairly easy difficult non useful


traumatic brain injury traumatic brain injury known injury occurs external force brain classified based severity mechanism closed penetrating head injury features occurring specific location widespread area head injury usually refers broader category involve damage structures brain skull major cause death disability worldwide especially children young adults males sustain traumatic brain injuries frequently females causes include falls vehicle accidents violence prevention measures include use technology protect suffering automobile accidents seat belts sports motorcycle helmets efforts reduce number automobile accidents safety education programs enforcement traffic laws brain trauma occur consequence focal impact head sudden acceleration complex combination movement sudden impact addition damage caused moment injury brain trauma causes secondary injury variety events place minutes days following injury processes include alterations cerebral blood flow pressure skull contribute substantially damage initial injury cause host physical social emotional effects outcome range complete recovery permanent disability death 20th century saw critical developments diagnosis treatment decreased death rates improved outcome current imaging techniques diagnosis treatment include magnetic resonance imaging depending injury treatment required minimal include emergency surgery surgery years later physical therapy speech therapy recreation therapy therapy vision therapy employed rehabilitation counseling supported employment community support services useful classification traumatic brain injury defined damage brain resulting external mechanical force rapid acceleration impact blast waves penetration brain function temporarily permanently impaired structural damage current technology acquired brain injury brain damage occur birth non traumatic brain injury involve external mechanical force examples include stroke infection traumatic brain injuries head injuries term refer injury parts head terms head injury brain injury similarly brain injuries fall classification central nervous system injuries research literature general term traumatic brain injury refer non penetrating traumatic brain injuries usually classified based severity features injury mechanism forces mechanism related classification divides closed penetrating head injury closed called blunt injury occurs brain exposed penetrating open head injury occurs object skull mater membrane surrounding brain severity brain injuries classified mild moderate severe categories glasgow coma scale commonly system classifying severity grades person level consciousness scale based verbal motor eye opening reactions general agreed mild moderate severe similar systems exist young children grading system limited ability predict outcomes classification systems shown table help determine severity current model developed department defense department veterans affairs uses criteria duration post traumatic amnesia loss consciousness proposed use changes visible swelling focal injury method classification grading scales exist classify severity mild commonly called concussion use duration concussion symptoms features systems exist classify features extra occurring skull outside brain occurring brain tissue damage focal confined specific areas distributed general manner respectively common types injury exist given case injury little apparent damage studies seen techniques post early 2000s researchers discovered imaging way processing images shows white matter tracts effective tool displaying extent injury types injuries considered include swelling injury widespread damage including white matter tracts projections types injuries considered include concussion injury widespread damage areas including white matter cerebral focal injuries produce symptoms related functions damaged area research shows common areas focal non penetrating traumatic brain injury lower surface frontal anterior temporal areas involved social behavior emotion regulation decision making common social emotional judgment following moderate severe symptoms occur commonly affected areas motor language areas respectively damaged type focal injury cerebral occurs tissue cut torn tearing common particular bony interior skull ridge eyes similar injury cerebral brain tissue blood mixed tissue contrast involves bleeding mixed tissue focal collections blood brain result bleeding brain tissue extra include involves bleeding area skull mater membranes surrounding brain bleeding occurs mater involves bleeding space membrane mater occurs bleeding signs symptoms symptoms dependent type focal brain affected tends longer people injuries left brain injuries right symptoms dependent injury severity mild patient remain conscious lose consciousness seconds minutes symptoms mild include lack motor coordination difficulty balancing blurred vision tired eyes ringing ears bad taste mouth fatigue changes sleep patterns emotional symptoms include mood changes confusion trouble memory concentration attention thinking mild symptoms present moderate severe injuries person moderate severe away repeated inability pupils speech word finding difficulties muscle weakness causes speech weakness limbs loss coordination confusion common long term symptoms moderate severe changes appropriate social behavior social judgment changes especially problems sustained attention processing speed executive functioning identifying understanding processing describing emotions occurs individuals social long term consequences daily lives people moderate severe improved appropriate rehabilitation pressure skull pressure abbreviated rises high deadly signs increased include decreasing level consciousness weakness body blown pupil fails response light slow slow heart rate high blood pressure respiratory depression classic manifestation significantly raised unequal pupil size sign abnormal characteristic positioning limbs caused severe injury high ominous sign small children moderate severe symptoms difficulty communicating signs seen young children include persistent crying inability refusal nurse eat causes common causes include violence transportation accidents construction sports motor major causes increasing significance developing countries causes reduce estimates million traumatic brain injuries year result sports recreation activities children aged falls common cause older children traffic accidents compete falls position common injury result child abuse abuse causes cases brain trauma death rate higher cases men twice likely domestic violence cause work related industrial accidents firearms blast injuries explosions causes leading cause death disability war zones according representative bill democrat signature injury wars iraq afghanistan promising technology called activation database guided documented return memory ability control group performance mechanism physical forces type direction intensity duration forces contribute characteristics severity forces contribute include angular shear forces absence impact significant acceleration head cause cases combination impact acceleration probably blame forces involving head striking struck termed contact impact loading cause focal injuries movement brain skull termed loading usually causes injuries violent shaking infant causes shaken baby syndrome commonly injury impact loading force sends shock waves skull brain resulting tissue damage shock waves caused penetrating injuries destroy tissue path damage caused missile damage occur directly site impact occur opposite impact coup injury respectively moving object impacts stationary head coup injuries typical injuries usually produced moving head strikes stationary object primary secondary injury large percentage people killed brain trauma die right away days weeks event improving hospitalized patients deteriorate primary brain injury damage occurs moment trauma tissues blood vessels stretched compressed torn adequate explain deterioration caused secondary injury complex set cellular processes occur minutes days following trauma secondary processes dramatically damage caused primary injury account greatest number deaths occurring hospitals secondary injury events include damage blood brain barrier release factors cause free radical excessive release influx calcium injured brain white matter separate cell bodies result secondary injury potentially killing factors secondary injury changes blood flow brain insufficient blood flow cerebral insufficient oxygen brain cerebral swelling brain raised pressure pressure skull pressure rise swelling mass effect result cerebral pressure pressure blood flow brain reduced results pressure skull rises high cause brain death parts brain structures skull particularly weak skull vulnerable damage causing deep lies middle easily damaged weak type injury easily occur secondary trauma parts skull impact forces spreads diagnosis diagnosis suspected based circumstances clinical evidence prominently examination example checking pupils normally response light assigning glasgow coma score helps determining diagnosis deciding treatments preferred test emergency setting quick accurate widely available follow performed later determine injury progressed magnetic resonance imaging detail add information expected outcome long term useful detecting injury characteristics injury longer term emergency setting reasons including relative detecting lengthy acquisition images patient machine metal items emergency care variant high definition fiber tracking techniques confirm particular diagnosis rays head trauma evidence suggests useful head injuries mild need imaging severe merit accurate detect blood vessel risk factors penetrating head trauma involved functional imaging measure cerebral blood flow activity specific regions potentially helping predict outcome sensitive physical measure date documented ability normal traumatic brain injured subjects assessment performed evaluate long term aid planning rehabilitation instruments range short measures general mental functioning complete batteries formed different domain specific tests prevention major cause vehicle accidents prevention consequences reduce gravity accidents damage reduced use seat belts child safety seats motorcycle helmets presence roll bars education programs exist lower number crashes addition changes public policy safety laws include speed limits seat belt helmet laws road engineering practices changes common practices sports discussed increase use helmets reduce possibility repeatedly heading ball practicing soccer cause cumulative brain injury idea introducing protective players proposed improved equipment design enhance safety softer reduce head injury risk rules dangerous types contact spear american football player tackles head reduce head injury rates falls avoided installing grab bars removing hazards throw installing window guards safety gates stairs young children shock absorbing surfaces sand prevent head injuries child abuse prevention tactic programs exist prevent shaken baby syndrome dangers shaking children gun safety including keeping guns locked measure studies effect laws aim control access guns united_states insufficient determine effectiveness preventing number deaths injuries recent clinical laboratory research julian colleagues west_virginia university resulted papers showing offers protection brain damage occurs traumatic injury rats given prior induced brain injuries suffered smaller increases key markers brain damage app compared rats given potential provide benefit brain traumatic injury appears promising requires investigation essential concept daily significant risk provide protection acute effects tremendous public health implications furthermore confirmed recent double blind controlled trial conducted military reduce effects blast induced mild traumatic brain injury soldiers multiple animal studies demonstrated reducing damage associated moderate traumatic brain spinal injury induced brain injury particular demonstrated multiple studies significantly reduce losses improve outcomes associated traumatic events safely treat years extensively emergency medicine treatment important begin emergency treatment called golden hour following injury people moderate severe injuries likely receive treatment intensive care unit followed ward treatment depends recovery stage patient acute stage primary aim medical personnel stabilize patient focus preventing injury little reverse initial damage caused trauma rehabilitation main treatment chronic stages recovery international clinical guidelines proposed aim guiding decisions treatment defined authoritative examination current evidence acute stage certain facilities equipped handle better initial measures include transporting patients appropriate treatment center transport hospital primary concerns ensuring proper oxygen supply maintaining adequate blood flow brain controlling raised pressure high brain badly needed blood flow cause deadly brain methods prevent damage include management injuries prevention data supports use oxygen therapy improve outcomes helpful flawless detecting raised accurate way measure place brain added benefit allowing fluid drain releasing pressure skull treatment raised simple patient bed head promote blood flow veins neck agents improve reducing cerebral water swelling caution avoid heart failure appears equally effective reducing concerns raised studies performed drugs increase output reduce excessive fluid system treat high pressures cause insufficient blood volume larger faster reduces carbon dioxide levels causes blood vessels decreases blood flow brain reduces potentially causes short term administration associated increased risk death recommended given routinely mechanical ventilation ensure proper oxygen supply provide secure low blood pressure devastating outcome prevented giving maintain normal blood pressure failing maintain blood pressure result inadequate blood flow brain blood pressure kept artificially high level controlled conditions similar drugs helps maintain cerebral body temperature carefully regulated increased temperature raises brain needs potentially nutrients common treated drugs carefully breathing lower blood pressure patients susceptible effects react adversely sensitive agents treatment monitoring continues signs deterioration decreasing level consciousness traumatic brain injury cause range complications include cardiac conditions adequately treated core care patients surgery performed mass eliminate objects penetrated brain mass causing significant mass effect shift structures considered removed collected blood removed floated water look blood vessels seek control bleeding penetrating brain injury damaged tissue needed skull removed needed remove pieces fractured skull objects embedded brain performed routinely short period following operations treat skull removed temporarily primary performed hours days order control high pressures secondary shown improve outcome trials associated severe effects chronic stage medically stable people transferred rehabilitation unit medical center independent rehabilitation hospital rehabilitation aims improve independent function home society help adapt disabilities demonstrated general effectiveness conducted team health professionals head trauma person approach key outcome likely key medical staff involved depending person doctors medical helpful allied health speech language therapy rehabilitation therapy therapy essential assess function design rehabilitation activities person treatment symptoms emotional distress clinical depression involve mental health professionals help evaluate manage discharge rehabilitation treatment unit care given basis community based rehabilitation required high proportion people including rehabilitation supportive employment matches job demands worker abilities people live independently family require care supported living facilities group homes respite care including day centers leisure facilities disabled offers time activities people treatment help manage psychiatric problems medication control post traumatic use anti recommended cases person reduction consciousness remain wheelchair mobility problems problem heavily self caring capacities nursing critical effective research documented intervention approach activation database guided approach shown significant improvements memory abilities subject far superior traditional approaches strategies computers medication intervention gains standard documented memory ability superior control group treatment severity injury mild cause permanent long term disability severity levels potential cause significant long lasting disability permanent disability thought occur mild injuries moderate injuries severe injuries mild completely resolved weeks people mild able live independently return jobs injury portion mild social people moderate able live independently portion require assistance areas physical abilities employment financial managing people severe closed head injury die recover live independently middle ground common coma closely related severity strong poor outcome differs depending severity location access immediate specialised acute management approximately doubles mortality associated worse outcome increased mortality people expected good outcome receive surgery quickly injury associated coma severe poor outcome following acute stage strongly influenced patient involvement activity promote recovery patients requires access specialised intensive rehabilitation service functional independence measure way track progress degree independence rehabilitation medical complications associated bad examples low blood pressure low blood oxygen lower cerebral pressures longer times spent high pressures patient characteristics influence factors thought include abuse substances illicit drugs alcohol age years children younger age time injury associated slower recovery abilities influences affect recovery include pre injury intellectual ability strategies personality traits family environment social support systems financial circumstances life satisfaction known decrease individuals immediately following trauma evidence shown life roles age symptoms influence trajectory life satisfaction time passes complications improvement function usually occurs years trauma years believed recovery fastest months evidence support related services commonly withdrawn period limitation progress children recover better immediate time frame improve longer periods complications distinct medical problems arise result results traumatic brain injury vary widely type duration include physical emotional complications cause prolonged permanent effects consciousness coma brain death persistent state patients unable achieve state interact surroundings conscious state patients minimal signs aware self environment lying long periods cause complications including pressure pneumonia progressive multiple organ failure deep cause follow skull penetrating injuries include complications involving blood vessels include vessels restrict blood flow formation vessel balloons stroke movement disorders develop include muscle movements shock like muscles loss movement range control particular loss movement repertoire risk post traumatic increases severity trauma image right particularly elevated certain types brain trauma cerebral people early occurring week injury increased risk post traumatic occurring week initial trauma people lose experience altered vision hearing smell disturbances occur secondary occurring immediately years injury patients development diabetes injury indicate need work signs symptoms develop screened adults moderate mild imaging children moderate severe head injury develop screening place months months injury problems occur remotely follow include impaired attention disrupted insight judgement thought reduced processing speed executive functions abstract reasoning planning problem solving memory loss common head injured people occurs people closed head trauma depending severity people suffered difficulty understanding producing spoken written language subtle aspects communication body language post concussion syndrome set lasting symptoms experienced mild include physical emotional problems difficulty concentrating depression multiple cumulative effect young person receives second concussion symptoms healed risk developing rare deadly condition called second impact syndrome brain swells mild blow deadly results career affected chronic traumatic brain injury causes physical severe form affects primarily career years boxing career commonly memory problems lack coordination cause emotional social problems changes personality include emotional instability depression anxiety problems social judgment impaired skills appears survivors psychiatric disorders including obsessive disorder substance abuse clinical depression disorder anxiety disorders patients depression uncommon suicide rate persons increased fold social symptoms follow include inability control anger lack initiative inappropriate sexual activity social withdrawal changes personality substantial impact functioning family systems family members survivors significantly alter roles responsibilities following injury creating significant change strain family system typical challenges identified families recovering include frustration loss lives relationships difficulty setting reasonable goals inability effectively solve problems family increased level stress household tension changes emotional dynamics overwhelming desire return pre injury status addition families exhibit effective functioning areas including problem solving communication counseling models demonstrated effective family disruption leading cause death disability globe presents major worldwide social economic health problem number cause coma plays leading role disability trauma leading cause brain damage children young adults europe responsible years disability cause plays significant role half trauma deaths findings frequency level severity vary based definitions methods studies world health organization study estimated head injuries receive treatment mild study found moderate severe injuries account rest mild varies age gender region factors findings prevalence studies vary based factors grades severity included deaths included study restricted hospitalized people study location annual mild difficult determine people mortality case fatality rate estimated days study iraq war soldiers found severe carries mortality deaths declined improved treatments systems managing trauma societies wealthy provide modern emergency services fraction die hospitalized fell half 1970s quarter beginning 21st century decline mortality led increase number people living disabilities result biological clinical demographic factors contribute likelihood injury fatal addition outcome depends heavily cause head injury patients fall related survival rate patients related survive firearms common cause fatal followed vehicle accidents falls deaths firearms considered increasing globally largely increase motor vehicle use middle income countries developing countries automobile use increased faster safety infrastructure introduced contrast vehicle safety laws decreased rates high income countries seen decreases traffic related 1970s year united_states million people suffer approximately injuries seen emergency department patients hospitalized yearly estimated people france south_africa australia england european_union yearly aggregate fatalities estimated demographics present injured children injuries greatest number occur people aged common young people costs society high loss productive years death disability age groups risk children ages adults age highest rates death people age fall related world countries increasing population ages median age people head injuries increased regardless age rates higher males men suffer twice women risk fatal head injury males account thirds childhood adolescent head trauma matched severity injury women appear fare poorly men status appears affect rates people lower levels education employment lower status greater risk history head injury present ancient myths date recorded history found graves holes fracture lines suggest treat ancient times ancient knew head injury effects including loss sight hearing speech smith written describes head injuries symptoms based presentation ancient greek physicians including understood brain center thought probably experience head trauma medieval renaissance continued practice head injury middle ages physicians described head injury symptoms term concussion widespread concussion symptoms described systematically 16th century suggested 18th century pressure skull damage cause hypothesis confirmed end 19th century opening skull relieve pressure proposed treatment 19th century noted related development time debate arose post concussion syndrome disturbance brain tissue psychological factors debate continues today reported case personality change brain injury survived accident large iron rod driven head destroying frontal numerous cases personality change brain injury reported 20th century saw advancement technologies improved treatment diagnosis development imaging tools including 21st century imaging introduction pressure monitoring 1950s credited beginning modern era head injury 20th century mortality rate high rehabilitation uncommon improvements care world war reduced death rate rehabilitation possible facilities dedicated rehabilitation probably established world war explosives world war caused blast injuries large number resulted allowed researchers learn localization brain functions blast related injuries common problems returning veterans iraq afghanistan research shows symptoms largely involving physical blow head 1970s awareness public health problem grew great deal progress brain trauma research discovery primary secondary brain injury 1990s saw development standardized guidelines treatment range issues drugs management pressure research early 1990s improved survival decade known decade brain advances brain research research topics research improving outcome included investigations calcium channel antagonists oxygen despite volume research medication approved halt progression initial injury secondary injury variety events presents opportunities find treatments interfere damage processes methods halt secondary injury subject great interest ability limit damage follows clinical trials test agents halt cellular mechanisms met largely failure example interest existed cooling injured brain limit damage sufficiently studied useful addition drugs antagonists halt showed promise animal trials failed clinical trials failures factors including faults trials design single agent prevent array injury processes involved secondary injury procedures addition traditional imaging devices help monitor brain injury facilitate research allows ongoing sampling fluid analysis indicate brain brain tissue oxygen monitoring systems routinely care non invasive model called development research planned clarify factors outcome determine cases best perform surgical procedures oxygen therapy hbo evaluated treatment following concluding review stating use justified hbo remained controversial studies looked improvement mechanisms evidence shows potential treatment psychological use visual tracking measurement identify mild traumatic brain injury studied visual tracking tests head mounted display unit eye tracking capability shows object moving regular pattern people brain injury able track moving object smooth pursuit eye movements correct trajectory test requires attention working memory difficult functions people mild traumatic brain injury question studied results people brain injury visual tracking gaze errors relative moving target