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I dont think any "bed" is worth what you have to pay for it nowadays. but by comparison this one was in the top. We were there for our wedding anniversary and chose the hotel for its proximity to the Waterway which we intended to spend most of our time and in walking distance. there is nothing romantic or special about the hotel, just a clean comfortable room. not bad for the money...by comparison to anything else. We would stay there again.
- Official Description (provided by the hotel):
- The Hilton Garden Inn Houston/The Woodlands hotel is in the peaceful northern Houston suburb of The Woodlands. It is near local companies, such as Chevron Phillips Chemicals and Anadarko Petroleum, and attractions, such as the Woodlands Mall and Waterway Square. The hotel rooms and suites have an adjustable bed, free WiFi, 32-inch LCD TV, refrigerator, and microwave. There's also a fitness center, outdoor pool, business center, meeting room, and onsite restaurant. The Great American Grill offers breakfast, dinner, and evening room service. ... more less
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- Also Known As:
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- The Woodlands Hilton


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Dear, Heavenly Father, I pray for a financial break through for me and my family. Lord I know I've messed up a lot of me money through these last months that have put me in debt poorly. Jesus, please me help me manage my income better and bless me with a little financial blessing for me and my child to be able to enjoy life without, wondering if we have a enough money to make it through my next pay period.
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Former immigration minister Philip Ruddock has said that traumatised refugees with psychological problems are part of any humanitarian refugee program, as attention focused on the background of Man Haron Monis.
Monis, who carried out the Sydney siege that left him and two hostages dead, fled his native Iran and arrived in Australia seeking asylum in 1996. He was eventually granted refugee status in 2001.
Monis made grandiose claims in a 2001 ABC interview about being an Iranian spy and witnessing torture, saying his government had turned on him and he would be executed if he returned to Tehran. His former lawyer, Manny Conditsis, described him as "damaged goods" on Tuesday, in the aftermath of the siege.
Mr Ruddock, who was immigration minister across the period in which Monis' refugee status was being considered, said he didn't recall the case, but generally many people claiming persecution suffered psychological problems.
"If there were flaws in the decision-making, I'd be keen to know, but my judgment would be that decision-making is about a claim for protection and one assumes that some of the people you do give protection to are people who may have significant psychological and other problems," Mr Ruddock said.
"The (Refugee) Convention doesn't exclude them. In fact what we do is put very considerable effort into trying to deal with people who have suffered torture and trauma and to ensure they are adequately cared for and treated, recognising it is highly likely that people, if they have been through such circumstances, may be the sort of people who have been entitled to refugee status."
After Monis achieved notoriety by sending offensive letters to the families of Australian soldiers killed in Afghanistan, then prime minister Kevin Rudd said he would consider reviewing Australia's immigration and citizenship laws.
But Mr Ruddock said it was impossible to deport a recognised refugee because they cannot be returned to the country in which they have been persecuted, nor sent to any other country.
The only exception, he said, would be if it were proved that the refugee status had been obtained by fraud.


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U.S. copyright law Edit
Under the 1976 Copyright Act, teachers are exempt from copyright infringement claims for performing copyrighted works in certain contexts. Performance of a work done in the course of face-to-face instruction in a classroom (or a similar place devoted to instruction), or performances done as part of instructional activities of a nonprofit institution, may not be a copyright infringement.[1]
Another teaching exemption removes particular works from infringement of the performance right in the context of distance education.[2]
References Edit
- ↑ Id. §110(2). This provision is known as the Technology, Education, and Copyright Harmonization Act (TEACH Act).


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» Sabah, Borneo
Sabah, Borneo
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February 18th 2009
Published: February 26th 2009
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mt kinabalu
Someone stole my new flip flops. They'd only cost me eight quid yet I was a bit irrational about it and couldn't hear mention of their disappearance for about the next three hours. I think it was because I'd gotten comfortable not having to worry about things like petty theft happening in Kuching and I suppose I was surprised someone had actually stolen something here. They went from the stairway of the Singgahsana Lodge where it's polite that everybody remove their footwear before going into reception. I've no suspicion that it could have been any of the staff at the Singhahsana, recently an Australian girl told me and Lynn that in many parts of Asia its not the locals you need to watch out for, its other travelers. I think she's right. Are thieves going to come from societies built on manners and respect or are they going to come from back home? Of course not all Asian cities are Kuching.
After buying more footwear we went to an internet cafe to book some flights and the crushing dissapointment of the flip flop saga was forgotten when we booked some really cheap flights with the budget airline Air Asia, one
mt kinabalu
at only 9 pounds per person. No flight so far with Air Asia has been over 45 quid, I say god bless them and their extensive ozone layer depleting flight schedule.
After a flight to Kota Kinabalu we took a taxi directly to MT Kinabalu National Park. There was a problem during the taxi journey. It was dark and foggy on the roads, our taxi driver was being cautious but there were many taking really silly chances in a rush to overtake the heavy goods vehicles that were struggling up the steeper sections of road. Finally almost inevitably we turned a corner and there in front was the aftermath of a road accident. A 4 by 4 vehicle had tried to overtake a truck on a bend and collided with an oncoming truck and ended up spun round and wedged between the two trucks. The inhabitants of the car hadn't even got out of the vehicle at this point so it must only just have happened seconds before. Lynn went into nurse mode and went to see if she could help. There was no one seriously injured but a girl had a broken arm and a guy had a
after the storm
The morning sun forcing steam from the jungle after a night of heavy rain
head injury. The police and ambulance were called but we were told on this mountain road that meant was from 60 kms away. I went to have a look at the state of the car wedged in between the trucks and it was clear the road would be closed for a long time, possibly all night. The taxi driver thought so to and told me he wasn't waiting around and was off back home but not before he'd pass our fair on to another taxi cab which is what he did. This next taxi guy spoke no English. We'd been in the previous taxi nearly 2 hours and we knew we were only 20 kms from our destination. So I thought I'd walk around the accident site and see if there were people bored and frustrated enough with the delay to be turning their vehicles back the way they'd come in the hope I could fix a lift with one of them. But that didn't happen, people were out of their vehicles and happy enough to sit and smoke the night away as though this happened every day, which it probably does. So I thought I'd walk the line and
the truth of overtaking on corners
luck one day runs out
find someone to give us a lift but of the twenty or so parked vehicles there was no one who spoke English. Eventually after an hour a guy pulled up who spoke a little English and with his grasp of English and the International language of cash I sorted a lift for us and our bags.
As we left all this behind I saw an evidently poor man and his wife stood dejectedly on the grass verge of the road with their two kids sat in their pyjamas with their heads folded on their arms trying to sleep. It was a sorry sight. I'd seen them earlier and I'm not sure but I think they may have been passengers in one of the trucks involved in the accident. I was thinking, at what time if at all that night would his kids get to bed, and could he afford to just to dip his hand into his wallet and bribe another man to take him to where he wanted to go which is effectively what I did?
In the actual moment though I didn't think about it too much as I was just feeling relief for myself and Lynn.
wild banana plant
Just like bananas all over Africa these are fully grown, although in this photo not yet ripe. They are less than half the size of bananas in UK supermarkets but twice as tasty. What do bananas that end up in the supermarkets have done to them to end up twice as big yet tasteless?
But an hour later sat comfortably with my old friends beer and cigarettes I became introspective. Thinking, if I was really that bothered about the man and his predicament I could have offered him my ride out of there. It had only cost me 10 quid and I could have always sorted out another one. I thought to myself, you can't pat yourself on the back just because you feel sympathy for someone, what use is feeling compassion if you don't act on it? Its a circular argument that other peoples circumstances brought to the front of my mind on a daily basis in South Africa and on previous trips in Africa and Asia. It ends with the truth that even if you gave just a dollar to everyone you met who needed one here and in Africa very soon you'd be the one skint by side of the road and in need of financial assistance yourself............Life eh?
Our accommodation outside but not far from the entrance to Mt Kinabalu national park was called the Rose Cabin. The food was rubbish and overpriced as are most things in and around the park. Its because of tour companies. Most people
like the cartoon character
are ferried in just long enough for the time it takes to climb Mt Kinabalou (over 5000 metres, the highest point in Asia) then they go and other bus loads of people replace them. So the hotels can take the piss because no one's here long enough to care to complain. The saving grace of the Rose Cabin is the view of the mountain you get from your balcony in the morning. Looking at this view I could almost but not quite forgive them for the microwaved mushrooms they sold Lynn under the guise of stirfried.
The higher altitude of the park meant that humidity wasn't a problem for a change. (Lynn's had enough of humidity, after washing there's no way for to dry her hair out properly so it frizzes and causes her much consternation) In the park we walked a 7km trail by a river that was through temperate forest and felt pleasantly warm, like a summers day in England. I'd expected to see the carniverous pitcher plants that David Attenbrough on TV told me grew here. But they apparently only grow at a higher altitute on the mountain itself. The largest flower in the world grows here
the Paganakan Dii guesthouse
(the 'Rafflesia' up to one metre across) although it only flowers briefly once a year so we hadn't expected to see one in flower and didn't.
After this we took a bus to Sepilok to base ourselves for a trip up the Kinabatabgan River. Lynn found the Paganakan Dii guesthouse on the internet www.paganakandii.com Its a newish guesthouse built on stilts and surrounded by rainforest, it was cheap, clean, served good food and had only a few other guests staying there that had bothered to find the place like us. Another good find by Lynn, instead of the usual black eye this year I really should sort her out with a Christmas bonus to recognise her work as my accommodation finding secretary.
The Kinabatangan was not flooded when we went but swollen with recent heavy rain. It is weird weather here in Sabah, thunder storms start after hot afternoons in most places around the world but here thunder storms start during the night and last the whole night, and sometimes all the next day. The Kinabatagan is a monster of a river, in a boat low in the water you can see the swirling currents and eddies and
Why is a young muslim girl wearing this shirt? no one spoke English so I'll never know. * The Exploited are a hardcore punk band from the 1980's. I saw them many times, they are still gigging, they wern't known for their subtlety.
feel the power of the enourmous amount of water your being carried on.
The Kinabatangan is wildlife rich, but the bad news is its because the Kinabatangan is beset on both sides by palm oil plantations that the wildlife is hemmed into patches and corridors on either side of the long and winding river. You can see this plainly in arial photos of the area. The good news is the expansion of palm oil plantations and logging was made illegal in 1999. That doesn't mean it doesn't go on illegally though.
A trip down the river through the ancient forest is a thing in itself. We had hoped to but not expected to see wild Orangutans, amazingly we saw them from the boat twice. They were camera shy and stayed in the uppermost branches of the riverside trees, but this is how it should be. In the state of Sabah there are only 3000 Orangutans in the wild. To look at it in context commercial logging only started in Borneo in the 1950's and before this the whole massive island was forest entire and the Orangutan's habitat for 100,000's of years. So it felt great to see some in the
Orinental Hornbill
An improbabe looking bird, but very gracful in flight, like an open chinese fan gliding from tree to tree
wild as they should be, and an achievment for the guide to have spotted them at all. Hopefully the recent swing towards consevation will prevail in Sabah and guarentee their immediate future.
The best thing about the boat trip for us was going up a tributary of the Kinabatangan called the black water river. So called because leaf acids dye the water black. The jungle really crowds over the river here over-shadowing and squeezing out the natural light. This combined with the river that really does appear black and the monkeys hooting and braking branches up ahead to show their displeasure at your arrival gives the place a real primeval feel. Like sailing into a lost world. It was the scene I'd pictured in my mind of Borneo months ago and it was the first time I felt we were in the 'real' forest.
Here we saw what must be two of the worlds most distinctive birds based on shape and colour. Oriental hornbills and Pelican billed Kingfishers, the kingfisher is Borneo's largest and it looks like a colour mad lunatic has spray painted it when you frst see it sat still on a branch, in flight it has
The Kinabatangan River
a blue neon blaze across its wings and back. These and the hornbills looked all the more vivid against the gloomy backdrop in this part of the forest where they choose to live.
The next day we had yet another jungle walk and then were transferred back to Sepilok. It was muddy climb and we saw nothing of interest. I didn't think we would, I know by now you don't see much walking in the forest because, your in a forest. At the end of the walk I felt my legs were shot, I think me and Lynn have both done enough jungle walking for the while. This walk had leeches by the trail, I took a photo of one but deleted it as they are just too disgusting to look at. They're about 2 inches long and hang off leaves with one end ready to attach itself to your clothes as you pass. As you approach the free end of the thing waggles about madly as if blindly searching for you. And if you stand still within a metre of them they detach themselves from their leaves and come wriggling towards you across the forest floor. Its disconcerting
The Black Water River
to know something so small is that aware of your proximity and is willing make its way towards you just as fast as it can with its malevolent ambitions.
Borneo's wildlife mainly centres around primates of which I think we've seen eight types, the scenery is more or less the same all over the whole island, it can be a bit one dimensional. Borneo for me comes in behind Southern or East Africa for diversity of plant life, bird life and changing scenery.
We came to Borneo for the widlife but more than that we've enjoyed the interaction with the local people, they're generally hospitable and polite and its been a pleasure, especially in Sarawak.
It sometimes felt like because you're foreign you have minor celebrity status in Borneo, especially on public buses where groups of achingly shy school kids would try and make eye contact with you just to exchange a wave or try a word or two of their English on you. Or the random old men I've had come up to me in the street and ask us where we're from then personally welcome us to their country. We've not long left Borneo but are
The Guide
Whenever anyone asked about leeches he laughed his head off, he had no plan A or plan B about what to do if they get on your clothes. I burnt mine off with a lighter and what a fight they put up, I nearly set my clothes alight.
already thinking of making time to visit there again before we leave Asia.
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During the late 18th and 19th centuries, Great Britain established colonies and protectorates in the area of current Malaysia; these were occupied by Japan from 1942 to 1945. In 1948, the British-ruled territories on the Malay Peninsula formed the Fe...
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polo mint eye
We saw these close up on the Kinabatangan River, the eye looks like something from a box of licorice allsorts glued to the side of its head.
The Bus Shouter
he's good looking enough to have been a gigalo but there's nowhere to apply for the job in Borneo. So he has the job of leaning out of the bus door at the bus stop shouting "aaahhhhTHEBUS!THEBUS!THEBUS!THEBUS!" as though everyone at the bus stop must be blind as well as deaf
Probiscus Monkey
When it decides to rain in a Bornean rainforest, your left in no doubt that, its raining.
1st March 2009
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John I am now addicted to your blog... feel like i have been travelling with you and Lynn...
27th January 2011
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shirt for job
this shirt is workwear
29th January 2011
John & Lynn
the shirt
Ok it's work wear, but go and google punk band 'The Exploited', you'll see they are not type of music group you would expect to see on a young Muslim girls shirt.
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Configuring PayPal Express IntegrationLast Update: August 3, 2014
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4 Comments...
|(October 11, 2015 at 06:39 PM)
how do i redirect my customer back to my custom thank you page after they purchase on pay pal?
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Is anyone else having customers not able to make payments via a Jotform with PayPal express?
|(December 29, 2016 at 05:29 PM)
Paypal tells me new accounts can no longer do digital goods :(
|(July 20, 2017 at 09:11 PM)
This procedure should be updated. Paypal's UI does not look like the screenshots anymore.


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By Mayyouneverfindpleasureinavagina - / Saturday 1 June 2013 04:31 / United States - Garden Grove
Today, I found out that the girl I've been talking to online and sending certain pictures to is actually my ex's new boyfriend. He ended up telling me he'd just wanted to see how he compared to me down below because my ex refused to go into detail about it. FML
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Today, a woman drove through my house. She was texting and eating watermelon at the same time. I didn't know that was even possible, but now my house is condemned. FML
By Fitz - / Sunday 12 April 2009 13:53 / United States
Today, I found out the unionized cleaning people that empty the garbage and clean the toilets make $19/hr and have more paid time off than I do with my college degree. FML
By Anonymous / Saturday 7 September 2013 04:37 / United States - West Hartford
Today, I had to clean human excrement at work when the fitting room turned into the shitting room. FML
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Twelve-year-old Alistair Cleary has washed up on shore. But where? It seems to be Aquavania, the magical realm where children create entire worlds from their imaginations. There's something wrong, though. The creators have disappeared, and the worlds are falling apart.
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Head & Spinal Trauma. Lesson Goal. Lesson Objectives 9/10/2012
- Benjamin Nash
- 2 years ago
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1 Head & Spinal Trauma Lesson Goal Learn assessment of patients with head or spinal injuries and how to treat those injuries Lesson Objectives State nervous system components List central nervous system (CNS) functions Define structure of skeletal system as it relates to nervous system Relate MOI to potential head & spinal injuries 1
2 Lesson Objectives Explain implications of not properly caring for potential spinal injuries State signs & symptoms of potential spinal injury Describe method of determining whether a responsive patient may have a spinal injury Lesson Objectives Relate airway emergency medical care techniques for a patient with suspected spinal & head injuries Describe how to stabilize the cervical spine Discuss indications for immobilizing the spine using various devices (e.g., cervical immobilization device, spine board) Lesson Objectives Identify different types of helmets and indicate when to remove and when to leave on patient Explain preferred and alternate methods for removing a helmet Demonstrate how to open the airway in a patient with suspected spinal cord injury 2
3 Introduction Thorough and proper assessment and treatment can have a positive affect on the outcome for a patient with a head or spinal injury Nervous System Review Seat of control of body functions Major function communication between body & environment Well protected by skull & vertebral column Significant forces can result in injury Nervous System Review Central nervous system Brain Spinal cord Peripheral nervous system Motor & sensory nerves outside brain & spinal cord 3
4 Central Nervous System (CNS) Cerebrum controls Vision Speech Balance Emotion Cerebellum coordinates fine motor skills Brainstem controls vital vegetative functions CNS Pathways of the Brain Central Nervous System Spinal cord Extends from brainstem, through opening in floor of skull, into spinal column Continues to level of L2 4
5 CNS Nervous tissue cannot regenerate if damaged Brain is protected by several layers of tissue Muscle underlies scalp, covering skull Meninges Dura mater Arachnoid Pia mater Cerebrospinal fluid Peripheral Nervous System (PNS) Cranial & spinal nerves Somatic (voluntary) nervous system Autonomic (involuntary) nervous system Peripheral Nervous System 12 Pairs of cranial nerves 31 Pairs of spinal nerves Sensory impulses Motor impulses Reflex arc 5
6 Skeletal System Review Skeletal System Review Spinal column Skeletal System Review 33 vertebrae Separated by intervertebral disks 7 Cervical 12 Thoracic 5 Lumbar 5 (fused) Sacral 4 (fused) Coccygeal 6
7 Injuries to the Spine Activities with significant energy can lead to injury MVCs Contact sports Falls Injuries to the Spine Mechanisms producing injury: Axial loading Hyperflexion Hyperextension Excessive lateral bending Hyperrotation Distraction Axial Loading Compression of the spine Shallow water diving Jumping from height Injuries Ruptured disks Vertebral fractures 7
8 Excessive Range of Motion Hyperflexion Hyperextension Hyperrotation Lateral bending Distraction Injuries Mechanism pulls head and body in opposite directions Separation of vertebrae may occur Spinal cord may be stretched or torn Injuries to the Spine 8
9 Suspicious Mechanisms Significant force to head, neck, torso, pelvis Vehicle or motorcycle crash Pedestrian-vehicle crash Sudden acceleration, deceleration, or lateral bending forces Fall from significant height Suspicious Mechanisms Fall in which one part of the body is suddenly stopped Unrestrained victim in rollover, ejection Explosion Shallow water diving Blunt or penetrating trauma to head, neck, or torso Suspicious Findings Unconscious trauma victim Head injury with LOC changes Significant helmet damage Legs and hips fractures Injuries to spinal area 9
10 Assessment Assessment begins as you approach scene and patient Evaluate MOI Assess ABCs and intervene as needed Determine patient s mental status Assessment: Specific Questions Does your neck or back hurt? Do you know what happened? Where does it hurt? Can you move your hands and feet? Do you feel me touching your fingers? Do you feel me touching your toes? DCAPBTLS Check for symmetry Assessment Obtain information from family and/or bystanders 10
11 Assessment: Complications Paralysis Loss of sensation Incontinence Impaired breathing Spinal Immobilization When spinal injury is suspected, immobilize body from head to foot Long backboard Begin with neutral, inline, manual stabilization Two types Open anteriorly Full face Helmet Removal Helmet removal Is patient able to breathe adequately with helmet in place? Can I access and control patient s airway without removing helmet? Does helmet fit well enough to ensure that patient s head will not move inside it? 11
12 Skill 29-1: Motorcycle Helmet 1. EMT 1 takes position above patient s head and stabilizes helmet, head, and neck in as close to a neutral inline position as helmet allows EMT 2 kneels at patient s side, opens or removes face shield, if necessary, and undoes or cuts chin strap Skill 29-1: Motorcycle Helmet 2. EMT 2 grasps patient s mandible between thumb and first two fingers at angle of mandible. EMT s other hand is placed under patient s neck, on occiput of the skull, to take control of manual stabilization. EMT s forearms should be resting on floor, ground, or his/her thighs for additional support Skill 29-1: Motorcycle Helmet 3. EMT 1 pulls sides of helmet slightly apart, away from patient s head, and rotates helmet with up-and-down rocking motions while pulling it off patient s head. Helmet is moved slowly and deliberately, and care is taken as helmet clears patient s nose. 12
13 Skill 29-1: Motorcycle Helmet 4. Continue manual stabilization after removing helmet. Place padding behind patient s head to maintain a neutral inline position and apply properly sized cervical collar NOTE: 2 key elements in helmet removal: At no time should both EMTs be moving their hands (while one EMT maintains manual stabilization of the patient s head and neck, the other EMT moves) EMT must rotate helmet in different directions, first to clear patient s nose and then to clear back of patient s head Skill 29-1: Motorcycle Helmet Video Clip coming soon Skill 29-2: Bicycle Helmet 1. While EMT 1 stabilizes head and cervical spine, EMT 2 releases chin strap 13
14 Skill 29-2: Bicycle Helmet 2. EMT 2 supports back of head and chin so that EMT 1 can remove helmet Skill 29-2: Bicycle Helmet 3. After helmet is removed, EMT 2 continues to support patient s head and neck. EMT 1 applies cervical collar and uses padding to stabilize head and neck Skill 29-2: Bicycle Helmet Video Clip coming soon 14
15 Skill 29-3: Football Helmet 1. While EMT 1 stabilizes head and neck, EMT 2 releases face piece by unscrewing clasps or cutting them 2. After face piece has been cleared, EMT 2 supports head and neck so EMT 1 can remove helmet Skill 29-3: Football Helmet 3. After helmet is removed, EMT 1 stabilizes head and neck while EMT 2 provides padding and applies cervical collar Skill 29-3: Football Helmet Video Clip coming soon 15
16 Spinal Immobilization Before applying cervical collar (C-collar): Assess distal neurovascular function Assess neck Select properly sized collar C-collar limits movement but does not immobilize neck Spinal Immobilization Improperly sized C-collar can do more harm than good C-collar must not restrict breathing or mouth opening Spinal Immobilization Log roll EMT positioning: Head, shoulders, waist, knees EMT at head directs moves 16
17 Spinal Immobilization Secure the patient: Torso Legs Head Reassess distal neurovascular status Skill 29-4: Log Roll Suspected Spinal Injury 1. While EMT 1 stabilizes head & neck, EMT 2 applies C-collar Skill 29-4: Log Roll Suspected Spinal Injury 2. EMT 1 stabilizes head & neck; EMTs 2 and 3 take position at patient s side placing their hands in position to evenly distribute patient s weight 3. Patient is rolled onto side on 3-count by EMT 1 17
18 Skill 29-4: Log Roll Suspected Spinal Injury 4. While patient is in this position, an EMT should examine patient s back Skill 29-4: Log Roll Suspected Spinal Injury 5. EMT 4 moves backboard into position; patient is lowered onto board on 3-count 6. Patient is strapped to board in this order: chest, pelvis, legs, head Skill 29-4: Log Roll Suspected Spinal Injury 7. Head & neck are stabilized by placing head blocks or rolls to maintain proper position 18
19 Skill 29-4: Log Roll Suspected Spine Injury Video Clip coming soon Skill 29-5: Log Roll Suspected Spinal Injury from Prone Position 1. While EMT 1 maintains manual inline stabilization of head & neck, two beside patient and position hands at patient s shoulder, hip, and upper & lower leg Skill 29-5: Log Roll Suspected Spinal Injury from Prone Position 2. On EMT 1 s count, patient is rolled toward other two EMTs as single unit 3. On EMT 1 s count, patient is rolled farther onto back as single unit; manual stabilization of head and neck is continued throughout 19
20 Skill 29-5: Log Roll Suspected Spinal Injury from Prone Position Video Clip coming soon Spinal Immobilization Pad voids between body and backboard Adult patients may need to pad beneath head Pediatric patient pad beneath shoulders Spinal Immobilization Seated patients Noncritical short immobilization device Critical rapid extrication 20
21 Skill 29-6: Short Spine Board 1. Don BSI; manually immobilize spine and apply C-collar; assess pulse, motor function, and sensation in all extremities; document findings Skill 29-6: Short Spine Board 2. Slide immobilization device behind patient. Position device so that top is level with top of patient s head. If device has body flaps, fold them toward front of patient and lift device to fit securely in armpits. Minimize patient movement as much as possible. Skill 29-6: Short Spine Board 3. Secure patient s torso to device using board straps. If device has leg straps, secure at this time. Verify that device is securely fastened to torso by checking tightness of all straps without excessive movement of patient 21
22 Skill 29-6: Short Spine Board 4. Pad behind patient s head as needed to maintain neutral inline position; secure patient s head to device Note: Always secure head last Skill 29-6: Short Spine Board 5. Prepare to move patient to long backboard. Place end of backboard under patient s buttocks. Using short immobilization device, rotate and lay patient down on backboard. If unable to slip backboard under patient s buttocks, lift patient to backboard using short immobilization device Skill 29-6: Short Spine Board 6. Reassess patient s pulse, motor function, and sensation in all extremities. Compare results with previous ones and document findings. Forward information to receiving facility 22
23 Skill 29-6: Short Spine Board Video Clip coming soon Spinal Immobilization Ambulatory patients Standing immobilization Skill 29-7: Standing Long Board 1. Ensure BSI precautions are taken. EMT 1 applies manual inline stabilization by approaching patient from front and placing hands on each side of patient s head. 23
24 Skill 29-7: Standing Long Board 2. EMT 2 assesses patient s pulse, motor function, and sensation in all extremities. EMT 2 also sizes patient for C-collar, assesses neck & spine for injury, and applies collar Skill 29-7: Standing Long Board 3. EMT 2 positions long board behind patient, between EMT 1 s arms, while EMT 1 continues holding patient s neck inline. Additional EMTs place arms under patient s armpits and grasp board. Board then is placed against patient s back Skill 29-7: Standing Long Board 4. Patient is informed that EMTs will be leaning her backward; EMT in back gives order to lean patient back and onto ground 5. Patient s pulse, motor function, and sensation are reassessed; patient is secured to board as previously described 24
25 Skill 29-7: Standing Long Board Video Clip coming soon Skill 29-7: Standing Long Board Video Clip coming soon Common Pitfalls of Immobilizaiton Not securing patient adequately to prevent movement Not immobilizing head in neutral position Readjusting torso straps after head is secure 25
26 Injuries to the Brain & Skull May or may not be obvious Suspect injuries to brain & skull based on MOI All head injuries considered potentially serious Scalp Lacerations Scalp lacerations may be indications of more serious underlying injury Bleeding from scalp can be significant Most bleeding from scalp can be controlled with direct pressure Skull Fractures May be open or closed Caused by blunt or penetrating mechanisms May or may not show gross deformity Check for bruising around eyes & behind ears 26
27 Skull Fractures Brain Injuries Direct Laceration by bone fragments GSW Indirect Contusions Concussions Brain Injuries Concussion Temporary disruption in brain function without physical damage May see stars, have amnesia Contusion Bruising of brain tissue Swelling can cause an ICP 27
28 Intracranial Bleeding Collection of blood within the skull; ICP Epidural Subdural Intracerebral Epidural Hematoma Between dura mater & skull Rapid development Signs & symptoms Initial loss of consciousness Lucid interval Secondary loss of consciousness Weakness on opposite side of body Fixed, dilated pupil on same side Subdural Hematoma Collection of blood beneath dura mater but outside brain May be slower than epidural bleeding Signs & symptoms AMS or personality change Severe, persistent, or recurring headache Changes in vision One-sided changes in body function Nausea and/or vomiting Slurred speech 28
29 Intracerebral Hematoma Blood collects within brain tissue Signs & symptoms vary Seizures not uncommon General Signs & Symptoms of Head Injury Altered LOC Changes in pupil size, equality, reactivity MOI Irregular breathing patterns Scalp injuries Deformed skull Soft or depressed areas of skull Exposed brain tissue General Signs & Symptoms of Head Injury Open skull fx Blood or CSF fluid from ears and/or nose Bruising under eyes or behind ears Nausea and/or vomiting Seizure activity BP with pulse rate 29
30 Nontraumatic Conditions Medical conditions (e.g., stroke) may present similarly to head injury History of trauma is absent Treat patient s signs & symptoms Airway Breathing Circulation Management of Head Injury Provide manual stabilization of C-spine ABCs Transport without delay Obtain baseline VS and LOC; reassess every 5 min Transport Infants & Children Immobilization of pediatric patients requires adjustments 30
31 Skill 29-8: Rapid Extrication 1. EMT 1 holds manual immobilization of head & neck while EMT 2 applies C-collar 2. Manual stabilization is maintained, patient s upper torso, lower torso, and legs are rotted in a series of short, controlled movements until patient is positioned such that manual stabilization can no longer be maintained Skill 29-8: Rapid Extrication 3. Patient is rotated until he/she can be lowered from vehicle and onto long board 4. Patient is moved onto long board and secured Skill 29-8: Rapid Extrication Video Clip coming soon 31
32 Summary Injuries to the spine & head can have devastating consequences Recognition requires an understanding of anatomy & physiology and MOI Summary Proper immobilization is important in preventing further injury to a patient with spinal injury Recognize and appropriately manage patients with head injuries, paying particular attention to ABCs and spinal immobilization 32
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text:
Posts Tagged 'Discovery Place'
Charlotte Event Planner – Budget
Growing up, I was enthralled in building computers. At a young age (my teen years) I was already engaged on educating myself on how this technological marvel works – although my father did not approve any of those learning because the curriculum mainly is comprised of me breaking our home computer down. I remember back then a computer's capability is many times less capable compared to the machine we now have. Nonetheless, I still find deep fascination with those machines I dismembered. Some I was able to put back and some never made it back to life again.
As the years pass, the success rate of me putting a computer back to its norm has steadily increased. Even without professional guidance, I was beginning to feel confident that somehow my skills are growing as I am. When internet finally reached our home, it would further throw more firewood at my furnace. Learning became much easier when you've got the experience of people all around the world backing you up. And so as I look back, I guess it was really my calling to be around computers. From the destroyer, to the enthusiast, gamer and now an internet freelancer; the learning I got from computers is irreplaceable.
I have mentioned all that and even got to pass points in my life because it is somehow related to the topic of why anyone should hire an event planner. As I have discussed, the background I had with personal computers gave me the expertise with the particular subject matter; thus I have developed a keen eye when people make a mistake about it all the time. One example is when I walk inside a tech shop and I find a store employee stuffing all these hardware to build a pc for a customer which has no idea he doesn't even need have of those in his machine. The employee probably does that to gain incentive but it is wrong in so many ways.
Hiring an event planner especially in our very much eventful city of Charlotte gives us the luxury of avoiding such mistakes – assuming that you'll get a legit one, but that's a different topic. One reason that you should get yourself a Charlotte event planner (which is often thought of as being a complete opposite) is budget. You might think it doesn't sound right but keeping with your budget is an advantage of hiring yourself a GOOD event planner, it always has been. Go back to the previous example I mentioned with computers. Think about it, with the numerous details one has to think of involving an event; you'll always encounter someone, someplace and something which would force you to overspend. Then let's add the fact that you'll always want to impress your bride, family, friends, clients, colleagues or whoever is invited with a particular event. Having an expert by your side is always a good thing. He can act as an agent, plus the fact that as a planner he does have the years of experience to back him up. His experience can help you navigate around the city so you can stick with your budget.
Charlotte event planners – who are we?
Special events go down to the personal history of everyone who participated in the occasion. We remember them because they only happen once in a while; they usually happen for a cause and most importantly, the reason they are usually held has some gravity of its own. Given of their importance, their planning stage is in our utmost priority. We usually regard ourselves – if we are in charge – with much of our time to carefully think ahead to get the best out of the experience.
We as Charlotte event planners would like to give you a brief background on the workings of how a special gathering unfolds. It is important to know these certain views at the early stages of an event so an organizer can better gauge if he does indeed is going to get help. Imagine if you have been tasked upon recreating a certain theme for a special gathering and of course you did accept, without even knowing the trouble that one has to go through. Initially a person rarely does accept his weaknesses. This is most often than not a trait where the problem starts. When a person accepts the responsibility even though he doesn't have the ability to foresee all the necessities a special events hold true. He might do well only up to a certain point then when things starts to build up or gets difficult, it is often too late zero in on what the event is in void of even with the help of an event planner. This scenario is what we urge people to be careful of not reaching. Events are set on an exact date, yes it is possible to move them, but it is often more costly and it will jeopardize guests' schedules, which is why it is only done as a last resort. Its impact can be of great negativity.
An event planner, sometimes also known as an event coordinator or consultant, is an individual who has engaged himself with the supervision of numerous especial events. And because of this, he has gained enough skills and techniques in order to turn it into a profession. Event planning consist of synchronizing details in which if done harmoniously enough, would ensure an event gets the festivity, fun and wholesomeness it needs. Putting together an event requires a lot of details and it is up to the event planner to stack and blow away all these challenges – some of which are the following: budget, location, guest arrival, vendor supervision, venue requirements, guest management, catering, on site management.
An event planner keeps all those things stated above and more. We as Charlotte event planners take all these responsibilities, and with our 25 years of experience, decide on each of them and treat them as our ingredients to the wonderful event that we will serve our clients. May it be about a wedding, corporate event or just a tour we hold all of these events with the same importance and the way we only how.