recursal/Fanatic-Fandom huggingface dataset:
Wundversorgung

## Arten von Wunden

Rissquetschwunde - Vuln lac (kurz Vlc)

Schnittwunde - Vuln sciss

Stichwunde - Vuln ict

Schusswunde - Vuln sclopet

Bisswunde - Vuln mors

Katze - V. mors. felicis

Hund - V. mors. canis

Mensch - V. mors. hominis

mit Fremdkörper - cum corp alienum

Holz - ligneum

Glas - vitreum

Eisen/Metall - ferrum

## Wundverschluss

Ein primärer Wundverschluss, d.h. Versorgung mit Nähten, Steristrips
oder Wundkleber kann unter einer der folgenden Bedingungen durchgeführt
werden:

-> Wunde nicht älter als 6 Stunden

-> nicht kontaminiert

-> nicht infekt/Abszess

-> im Gesicht

alles andere sollte der sekundären Wundheilung zugeführt werden
(post sekundam, p.s.), bei grossen oder massiv infekten Wunden ist
eventuell auch ein VAC (Link einfügen) notwendig!

Beispiel:

Gesicht, die maximal 1-2 Nähte erfordern ev auch ohne LA -> Pat
fragen! )

* Anziehen der sterilen Handschuhe
* 3x steriles Waschen mit Octenisept von Wunde ausgehend
* steriles Abdecken der Wunde mit Lochtuch
* vorsichtiges Kneifen der Wundränder mit Hautpinzette zur Überprüfung der LA, sonst steril nochmalige Injektion
* Ausschneiden von nekrotischen Wundrändern mit Skalpell (nicht im Gesichtsbereich!)
* Revision der Wunde bis an die Schädelkalotte durch Schnitt mit Skalpell
* Einsetzen des Wundspreizers, Inspektion der Schädelkalotte (Periost abschieben! )
* Falls Stufen/Fraktur erkennbar -> Assistenzarzt/Oberarzt beiziehen.
* Ansonst: Spülung mit NaCl 0,9%
* Wundverschluss: 2/0 Mersilene mit tiefgreifenden Nähten am behaarten Teil des Schädels, 5/0 Ethilon im Gesichtsbereich,
* bei Bedarf Blutstillung mit bipolarer Pinzette (nur selten notwendig)
* Entfernen von Nadeln/Skalpellklingen durch Operateur
* Eintragen in OP Buch in der Wundversorgung, Unterschreiben des Pflegeprotokolls, Ambulanzkarte diktieren

## Nachbehandlung

* Wundkontrolle am nächsten Tag/übernächsten Tag, unkomplizierte

Wunden (nicht infekt, keine Sehnen-/Nerven-/Gefässverletzung) auch zum
Hausarzt!

* Nahtentfernung: Gesicht 5-7d, ansonsten 10-14d

## Revisionen

Revisionen von Wunden immer gemeinsam mit Assistenzarzt/Oberarzt!

Folgende häufige Wunden sollten revidiert werden und dabei diese Strukturen unter Schonung der Anatomie aufgesucht werden:

 Beugeseitige Hand/Finger
 Schädel (nur behaarter Kopfteil)
 Streckseitiger Fuss
 Ellbogen
 Knie
 Fremdkörper
Wenn röntgendichtes Material leistet Bildwandler unschätzbare Dienste!!
Frakturen des oberen Sprunggelenks

## Ätiologie/Anamnese

Pro- oder Supinationstrauma (Weber B/C Verletzung vs Weber A/B Verletzung)?

Direktes Anpralltrauma?

## Diagnose

Röntgen in 2 Ebenen, ev Schrägaufnahmen oder CT bei unklarem intraartikulärem Frakturverlauf. Unterschenkelröntgen bei Verdacht auf Maissoneuvefraktur!

http://www.dgu-online.de/en/patienteninformation/haeufige-diagnosen/sportler/sprunggelenksfraktur.html?newsCatFilter=9

Weber A: Fraktur unterhalb der Syndesmose

Weber B: Fraktur im Bereich der Syndesmose

Weber C: Fraktur oberhalb der Syndesmose, Extremfall: subcapitale Fibulafraktur (Maisonneuve Fraktur)

Bimalleoläre Fraktur: Innen- und Aussenknöchel gebrochen

Trimalleoläre Fraktur: zusätzlich Abriss an der Hinterkante der Tibia

Pilon tibiale Fraktur: Fraktur der tibialen Gelenksfläche

DMS Kontrolle und Dokumentation!

## Therapie

bei klinisch massiver Dislokation und gefährdeten Weichteilen: primär Reposition vor Röntgen durch vorsichtigem Längszug bei leicht flektiertem Knie (wie "Stiefelausziehen"):

https://www.youtube.com/watch?v=ANA2b-g3qaw

konservativ: Weber A, Weber B wenn distales Fragment nicht über doppelte Corticalisbreite verschoben und Talus zentriert. USSG für 6 Wochen, Abrissfrakturen an der Spitze des Aussenknöchels ev auch nur mit SPG Orthese für 6 Wochen.

operativ: Weber B bei Verschiebung, Weber C, bi- und trimalleoläre Frakturen, Maissoneuvefrakturen, Pilon tibiale Frakturen.

Zeitpunkt der OP:

-> sofort: irreponible Luxationsverletzung, offene Fraktur

-> fakultativ sofort: wenn sehr rezent und ohne Weichteilschwellung

ansonsten Abschwellen abwarten! (7-10 Tage)

## Nachbehandlung

konservativ: USSG für 6 Wochen, Ziko Tag 1, umgipsen auf geschlossenen Gips nach 1 Woche. Belastung nach 2-3 Wochen wenn unverschoben. Röko: Woche 1,2, 1 Woche nach Belastung, nach Abnahme

operativ: Procedere wie konservativ, Naht ex in 2 Wochen, bis dahin Spaltgips!

## Literatur

Weigel et al "Praxisbuch Unfallchirurgie", 2011, 2. Auflage

Wiss et al "Fractures", 2013, 3. Auflage
Verletzungen der Lendenwirbelsäule

## Ätiologie/Anamnese

Unterscheidung osteoporotische/pathologische/Mb. Bechterew assoziierte Frakturen von Frakturen bei Hochrasanztrauma (cave Kettenverletzung bei Sturz aus grosser Höhe mit den Füssen voran!)

## Diagnose

Röntgen in 2 Ebenen, bei Druckdolenz im thorakolumalen Übergang ist dieser auch auf einem Röntgenbild abzubilden! (häufige Verletzungslokalisation aufgrund vermehrtert Mobilität in diesen Segmenten!)

Genauer Neurostatus! Vor allem Kraft, Sensibilität, Reithosen-/Conus-/Caudasymptomatik sind zu erheben genau zu dokumentieren.

Biophysikalisch liegt den Frakturen das sogenannte 3 Säulenprinzip zugrunde.

Die vorderen 2 Säulen (Wirbelkörper und Facettgelenke) nehmen Druckkräfte auf, während die hintere Säule (Processi spinosi und hinteres Längsband) Zugkräfte ausüben. Bei Verletzung von 2 oder mehr Säulen besteht eine Instabilität, die operativ stabilisiert werden muss.

Einteilung der Frakturen:

Typ A: nur Vorderkante oder Hinterkante um 15 % im Vergleich zu benachbarten Wirbelkörpern in der Höhe verringert

Typ B: kyphotischer Knick, Vorder-und Hinterkante betroffen, Subluxation/Frakturen im Facettgelenksbereich

Typ C: translatorische Fehlstellung in allen 3 Ebenen möglich, Alignment der Dornfortsatzreihe unterbrochen

http://orthopaedie-unfallchirurgie.universimed.com/artikel/diagnostik-und-logistik-schweres-wirbels%C3%A4ulentrauma

MRT: bei Verdacht auf osteoporotische Frakturen (Signal zeigt "Frische" der Fraktur an) und neurologischen Ausfällen

CT: bei Patienten unter 65 Jahren (Beurteilung der knöchernen Strukturen

## Therapie

Prellung: lokal Wärmetherapie, Schmerzmittel, Observanz

Mieder: bei stabilen Frakturen für 6-8 Wochen, zusätzlich physikalische Therapie, Thromboseprophylaxe

Kypho-/Vertebroplastie: A- Frakturen, vor allem bei osteoporotischen und pathologischen Frakturen. Kyphoplastie (mit Ballon zur Aufrichtung) indiziert bei jungen Patienten, bei denen das sagittale Profil wiederhergestellt werden soll.

https://www.youtube.com/watch?v=2phEd8kZOOU

Stabilisierung: Goldstandard ist die 360° Stabilisierung von B- und C-Frakturen. Da diese Eingriffe eine hohe Zugangsmorbidität aufweisen (Thorakotomie/Laparotomie) aufweisen, erfolgt zunächst nur eine dorsale Stabilisierung.

Laminektomie: zur Entlastung von nervalen Strukturen bei neurologischer Symptomatik, darauf folgend Stabilisierung! Notfallmässig bei Querschnitts/Conus- oder Caudasymptomatik!

Nur knöcherne Einengungen ohne Neurologie müssen nicht laminektomiert werden (Selbstresorption der Fragmente)

Nur bei Bedarf erfolgt auch dann eine ventrale Stabilierung (Cage).

## Literatur

Weigel et al: "Praxisbuch Unfallchirurgie", 2011, 2. Auflage
Olecranonfraktur

## Ätiologie/Anamnese

Direkter Sturz auf den gebeugten Ellbogen. Oft auch eröffnete Bursa!

Seltener sind Avulsionsfrakturen bei Überstreckung (Speerwerfen, Sturz auf ausgestreckten Unterarm etc.)

## Diagnose

Röntgen in 2 Ebenen. Neben Kortikalisunterbrechungen wird gesucht nach:

Rogerlinie: M. triceps zieht das distale Fragment des Humerus nach dorsal, daher schneidet die Rogerlinie (grüne Linie) die Trochlea humeri nicht mehr!

http://www.radiologyassistant.nl/en/p4214416a75d87/elbow-fractures-in-children.html

Fat Pad Sign: Hinweis auf intraartikulären Erguss

http://www.gentili.net/signs/11.HTM

Aligment der Unterarmknochen: 'Linie durch Radiusschaft und Radiusköpfchen soll sich auf Trochlea humeri projizieren

Cave: Verletzung des N. ulnaris oder N. radialis!

## Therapie

Konservativ bei nicht dislozierten Frakturen: Oberarmgips für 3 Wochen

Sonst Domäne der operativen Therapie (Zuggurtung bei 1 grossem Fragment, ansonsten Hakenplatte)

## Nachbehandlung

Konservativ:

Ziko am Folgetag, umgipsen + Röko nach 1 Woche, Gipsabnahme + Röko nach 3 Wochen.

OAG sollte nicht länger als 3 Wochen belassen werden, da die Gefahr einer Gelenkeinsteifung besteht -> stattdessen dann Bewegungsschiene!

Operativ: wenn stabil: ohne Schiene, bei fraglicher Stabilität: OAG für 1-3 Wochen, dann Bewegungsschiene.

Naht ex nach 2 -3 Wochen.

## Literatur

Weigel et al: "Praxisbuch Unfallchirurgie", 2011
Ultraschall

Schnellste
 Methode um festzustellen, ob sich freie Flüssigkeit im Abdomen
befindet, bietet dadurch Hilfestellung ob eine Not-Laparotomie indiziert
 ist.

NB:
 es kann nur festgestellt werden, dass freie Flüssigkeit vorhanden ist,
aber nicht, welche (cave Blasenruptur, St.p. Peritonealdialyse erzeugen
falsch positive Resultate!)

## Quickguide Hitachi Aloka

-> Starten: Ein/Aus Taste, dann Drücken der Taste "ID". Wenn einmal gedrückt, kann ein Name eingeben werden, beim 2. Mal drücken wird automatisch eine ID vergeben. CAVE: ohne ID kann ein Schall durchgeführt werden!

->
 Drücken von Preset: Auswahl eines Programms (Abdomen/small parts...),
dadurch auch automatisch Auswahl des richtigen Transducers. Weitere
Programme (Fingersehnen etc) können noch installiert werden!

-> Fusstaste: Verstellen der Höhe des Bildschirms

-> Pfeil im Bild auf der rechten Seite zeigt Zone der besten Bilddarstellung, kann mit "Depth" verändert werden

->
 B/B: 2 Bilder können nebeneinander gestellt werden, der volle Punkt im
linken oberen Eck zeigt an, welches Bild gerade erzeugt wird

->
 Doppler/Farbdoppler: zur Gefässdarstellung: Drücken der Taste "F" (für
Farbdoppler, leichter zum Aufsuchen des Gefässes) oder "D" (für normalen
 Doppler), danach drücken von "select", mit Trackball einstellen des
Gebietes, das geschallt werden soll. Darstellung des Dopplersignals auf
der rechten Seite.

-> Einfrieren des Bildes: Drücken der Taste "GAIN" (grosser Knopf rechts unten). Mit dem Trackball kann dann ein paar Bilder zurückgefahren werden (Memoryfunktion für ein paar Sekunden)

-> Notizbuch: für Fehlermeldungen/Fragen an den Vertreter: auf dem Drucker angebracht

-> Kontakt des Vertreters
Körperverletzung

Bei Erstbegutachtung von nicht-akzitdentiellen Körperverletzungen (Raufhandel etc) gilt es folgende Punkte zu beachten:

-> genaue Dokumentation zu Unfallhergang (zusätzlich Waffen verwendet, sexuelle Gewalt?), am besten zusätzlich mit Foto (in oberster Lade beim Schwestern PC); wichtig da die Krankenakte Beweismittel in strafrechtlichen (Notwehr, Körperverletzung) oder zivilrechtlichen Verfahren (Grad der Schädigung, Schmerzengeld) ist!

-> bei Verdacht auf sexuelle Gewaltanwendung ad Gynäkologie

-> bei Gewalt an Kindern schicken ad Kinderabteilung (Tel Nr 3414) + Krankengeschichte ins Fach zu Dr. Kabicek oder Dr. Pöltl; sie sind in der Kinderschutzgruppe

-> vor allem Gewalt an Frauen und Kindern wird von Betroffenen weniger berichtet. Warnzeichen sind:

* Verletzungen passen nicht zu Unfallhergang
* verspätetes Erscheinen in der Unfallambulanz
* Partner will bei Untersuchung unbedingt dabei sein
* schon viele vorliegende Krankengeschichten mit ähnlichen Unfallhergängen
* Krankenhausshopping
* multiple, verschieden alte Verletzungen

Bei Verdacht empfiehlt sich Aufklärung und weiterverweisen an die Frauenhelpline Tel Nr 0800 222 555 (anonym und kostenlos) bzw Kontakaufnahme mit der Kinderabteilung
Kindesmisshandlung

## Ätiologie

ca. 1 von 58 Kindern (in den USA) wird an einer Ambulanz vorstellig wegen körperlicher Misshandlung, andere Daten sprechen von 1 in 10 Kindern das körperlich misshandelt wird. Es gibt eine hohe Dunkelziffer! Genaue Anamneseerhebung bei jedem Patienten!

## Diagnose

Auffällig sind folgende Zeichen (Liste aus: http://emedicine.medscape.com/article/915664-overview)

### Anamese:

* Details change, or additional scenarios are suggested, as

additional trauma is identified or as the cause of the trauma is
questioned

* Details are inconsistent among caregivers
* Caregivers give implausible details not congruent with the trauma observed on examination
* Caregivers describe minor trauma, but the child displays major injury on examination
* No history of trauma is offered
* Injury described as self-inflicted is not possible given the age/developmental abilities of the child
* Caregivers demonstrate a significant delay in seeking treatment for the child
* Serious injury is blamed on a younger sibling/playmate
* Caregiver frequently changes healthcare facilities, pediatricians, or emergency departments

### Klinische Zeichen:

* Injury pattern inconsistent with the history provided
* Multiple injuries/multiple types of injuries
* Injuries at various stages of healing
* Poor hygiene
* Presence of pathognomonic injuries including loop marks;

forced immersion burn pattern; and classic abusive head trauma findings
of subdural hematoma, retina hemorrhage, and skeletal injuries

* Involvement of multiple areas of the body beyond bony prominences
* Bruising of ears, facial cheeks, buttocks, palms, soles, neck, genitals
* Bruises at many stages of healing
* Bruises in nonambulatory child
* Patterned markings resembling objects, grab marks, slap marks, human bites, and loop marks
* Oral injury, lingular or labial frenula tears

* ANY fracture in a nonambulatory infant without clear accidental and consistent mechanism
* Metaphyseal fractures
* Multiple, bilateral, differently aged posterior rib fractures
* Multiple and complex skull fractures if only simple impact history
* Spinous process fractures
* Scapular fractures

* Patterned contact burns in clear shape of hot object (eg,

fork, clothing iron, curling iron, cigarette lighter)

* Classic forced immersion burn pattern with sharp stocking-and-glove demarcation and sparing of flexed protected areas
* Splash/spill burn patterns not consistent with history or developmental level
* Cigarette burns
* Bilateral or mirror image burns
* Localized burns to genitals, buttocks, and perineum (especially at toilet training stage)
* Evidence for excessive delay in seeking treatment, and the presence of other forms of injury

## Therapie

Zunächst medizinische Versorgung der entsprechenden Verletzung, dann Vorstellung bei Verdacht in der Kinderambulanz (3414) und in der Kinderschutzgruppe (Kontaktaufnahme mit Dr. Kabicek oder Dr. Pöltl) bzw. Kopie der Krankengeschichte ihnen ins Fach legen; Verständigung eines Facharztes.

Fotodokumentation!

## Literatur

http://emedicine.medscape.com/article/915664-overview
Ryo Hazuki

Shenmue IIShenmue IIIShenmue the AnimationESPN NFL FootballSonic & Sega All-Stars RacingSonic & Sega All-Stars Racing Transformed (PC only via DLC)Project X Zone 2KotodamanSEGA Heroes

### Actor de Voz

Masaya Matsukaze (Japonés)Corey Marshall (Ingles)

**Ryo Hazuki** (nacido el 29 de noviembre , 1968) es el protagonista principal de la serie Shenmue.

Es un joven japonés de 18 años que vive en Yamanose, Yokosuka, Japón.
Su madre murió de una enfermedad cuando tenía 3 años.
Ryo fue adiestrado en artes marciales por su padre, Iwao Hazuki, desde que tenía 7 años.
Después de que su padre fuera asesinado por Lan Di y éste se marchara robando el espejo del dragón, Ryo obtiene un deseo de venganza que le llevará a una búsqueda de aprendizaje y madurez.

## Apariencia

Ryo es un joven alto, bien formado y sorprendentemente guapo con piel bronceada, cabello oscuro con raya en el lado izquierdo y ojos castaños oscuros. Por lo general, se le ve siempre con una chaqueta cafe arriba de un playera blanca junto con unos jeans celestes acompañados de unos tenis blancos con una raya roja y negra.
Beugesehnenverletzung

## Ätiologie/Anamnese

Häufig durch Schnitt- oder Stichverletzung

## Diagnose

Funktionsverlust nicht unbedingt pathognomisch (Teilruptur!!)

Überprüfung der tiefen Beugesehne:

Überprüfung der oberflächlichen Beugesehne:

http://gutachten-hand-arm.de/Beugesehne/Diagnosefehler.htm

## Therapie

Goldstandard ist Versorgung im OP mit erfahrenen Handchirurgen in Blutsperre und atraumatischer Nahttechnik.

Eine primäre Naht ist definiert als Versorgung innerhalb von 24h, danach als "verzögert primär", "sekundär" nach 14 Tagen.

Das Outcome ist nicht abhängig vom Versorgungszeitpunkt sondern von der Qualität der Versorgung. Sollte während einer Revision in der Wundversorgung eine zu versorgende Verletzung der Beugesehne erkannt werden, ist es kein Fehler abzubrechen und die OP (ev zeitverzögert) im OP Saal fortzusetzen!

### Technik:

Schnitterweiterung entlang der Brunnerschen Schnitte um Kontrakturen zu vermeiden! Nie über ein Gelenk die Schnitte führen!

http://www.handchirurgie-hofbeck.de/10.html

Nahttechnik:

Kernnaht in Kirchmayr-Kesslertechnik mit 3/0 Serafit oder anderes polyfiles, nichtresorbierbares Nahtmaterial, Umwendelungsnaht mit 6/0 polyfil, nichtresorbierbar fortlaufend. Die Sehne möglichst nicht mit Pinzette oder anderen Instrumenten berühren (Gefahr der Adhäsionsbildung).

http://archiv.ub.uni-marburg.de/diss/z2003/0110/pdf/dmr.pdf

## Nachbehandlung

Nahtentfernung in 3 Wochen

Kleinertschiene sofort postoperativ, auch bei Nervenverletzungen die versorgt wurden. Ruhigstellung führt zu Adhäsionen, die frühfunktionelle Therapie ist für den Erfolg der Versorgung unabdingbar!

## Literatur

http://www.plastische-chirurgie.uk-erlangen.de/e730/e731/inhalt819/Beugesehnenchirurgie\_CHAZ-5.pdf

Skriptum "Handkurs Basis" der Wiener Handkurse (beim Verfasser)
Credit

**Credit** là đơn vị tiền tệ cao cấp có trong Trove. Cũng như Cubit, Credit liên kết với tài khoản và không thể trao đổi đuoợc.
Cách dễ nhất để kiếm chúng là mua bằng tiền thật ở Cửa hàng, rằng là cung cấp cho nhà phát triển trò chơi. Một lượng nhỏ Credit có thể nhận được qua một số phần thưởng ở Mastery Rank.

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Objectives

1-1 Take the Castle

2-1 Play three 3+ letter words

2-2 Play 12 tiles

2-3 Have a 5 point play

3-1 Play five 3+ letter words

3-2 Play a 4+ letter word

3-3 Play 15 tiles

3-4 Have a 6 point play

4-1 Play 18 tiles

4-2 Play two 4+ letter words

4-3 Play 10 words

4-4 Have a 7 point play

4-5 Play DO, RE, MI, FA, SOL, LA, or TI

4-6 Destroy 1 defense - Bombs don't count

5-1 Play 22 tiles

5-2 Play a 5+ letter word

5-3 Play 14 words

5-4 Destroy 2 (or half of all) permanent defenses

5-5 Play a tile in every row

5-6 Have a 9 point play

5-7 Play a tile in every column

6-1 Play 24 tiles

6-2 Destroy 3 (or half of all) permanent defenses

6-3 Have a 12 point play

6-4 Play 16 words

6-5 Play a word with 2 of the same letter

6-6 Play 5 tiles in any row

6-7 Play on each edge of the board

7-1 Play 26 tiles

7-2 Play 18 words

7-3 Have a 16 point play

7-4 Play a consonant on every row

7-5 Play 4 tiles on the left edge of the board

7-6 Spell DOG, CAT, PIG, RAT, BAT, COW, APE, or HEN

7-7 Play on a least 1 uncovered corner

8-1 Play 28 tiles

8-2 Destroy 4 (or half of all) permanent defenses

8-3 Have a 20 point play

8-4 Play a vowel on every row - Y doesn't count

8-5 Spell a number between 0-10

8-6 Play 6 tiles in any column

9-1 Have a 25 point play

9-2 Play 22 words

9-3 Play 12 tiles on edge

9-4 Play two 5+ letter words

9-5 Make a 3x3 square--middle is optional

10-1 Play a 6 letter word

10-2 Play 24 words

10-3 Spell a word with 3 vowels in it - Y doesn't count

10-4 Spell FISH, GOAT, BIRD, FROG, BOAR, or LION

10-5 Play 15 tiles on edge
Fingerkuppenverletzungen

## Diagnose

Klinisch, Röntgen zum Ausschluss knöcherner Verletzungen.

## Therapie

Substanzdefekte der Fingerkuppe, auch mit offen liegendem Knochen werden am besten mit einem Okklusivverband versorgt:

In der Wundversorgung in Blutsperre werden IV 3000 oder ähnliche transparente Folien bis an die Grundphalanx geklebt. Anlegen des Stülperverbandes, dann erst Öffnen der Blutsperre!

Bei Nagelluxationen den Nagel in LA in der Wundversorgung wieder ins proximale Nagelbett reponieren, falls er fehlt ev Kunstnagel erstellen aus einer 10 ml Spritze. Klaffende Wunden im Nagelbett mit resobierbaren 6/0 Nahtmaterial versorgen in Einzelknopftechnik.

## Nachbehandlung

Okklusivverband soll 3 Wochen angelegt bleiben und nicht abgenommen werden, lediglich der Stülperverband wird alle paar Tage gewechselt, bei Sekretion müssen neue Folien über die bereits liegenden geklebt werden.

Nach 3 Wochen Abnahme des Verbandes, ab dann offen ausgranulieren lassen. Cave: massive Geruchsentwicklung!

Antibiotikum nicht indiziert bei Infektfreiheit.

Patient bei Nagelverletzung über Verlust des Nagels aufklären! Der alte Nagel wurde erhalten als Schutz und Schiene für den nachwachsenden Nagel.

## Literatur

Skriptum "Basis Handkurs", beim Verfasser

http://link.springer.com/article/10.1007/s11678-010-0056-2#page-1
Sternoclavicularluxation

## Ätiologie/Anamnese

Nur 3 % aller Schulterverletzungen.

Meist Hochrasanztrauma bei Sport oder Strassenverkehr, üblicherweise indirekt seitlicher Anprall, dadurch Hebeln der Clavicula über die erste Rippe, meist Luxation nach ventral, sehr selten nach dorsal.

## Diagnose

Klinisch:

Grad 1: Distorsion mit Schwellung und Schmerzen

Grad 2: Subluxation, pathologische Beweglichkeit im SC-Gelenk

Grad 3: Luxation, starke Schmerzen, Arm wird innenrotiert am Körper gehalten.

CAVE: dorsale Luxationen können eine Verletzungsgefahr für mediastinale Strukturen (grosse Gefässe, Trachea, N. Vagus) darstellen!

Röntgen: Aufnahme nach Rockwood, ev CT

## Therapie

### Konservativ:

Grad 1/2 mit NSAR, ev Armtragetuch für ein paar Tage

### Operativ:

Grad 3; ventrale Luxationen lassen sich leichter reponieren, reluxieren allerdings häufiger!

Technik:

Narkose, OP Bereitschaft; Hohllagern beider Schultern durch eine Rolle vertikal verlaufend unter der BWS. Dann Drücken beider Schultern nach dorsal.

Bei dorsaler Luxation kann auch mit einer spitzen Repositionszange das Ende gefasst werden und bei oben beschriebener Lagerung nach ventral gezogen werden.

Eventuell bestehende Instabilitäten können offen versorgt werden mit Drahtcerclagen oder PDS 8er Schlinge.

Veraltete Luxationen können auch mit Resektionsarthroplastik versorgt werden.

## Literatur

Weigel et al: "Praxisbuch Unfallchirurgie", 2011, 2. Auflage

https://www.youtube.com/watch?v=u8TM3CPCeN8
How to Attack

Spelldom has unique attack system compared to other strategy games. Rather than deploying troops, you attack with tiles. To start your attack, you need some tiles in your Tile Bag. Tap your Castle, then tap the tile button at the bottom of the screen. We recommend filling up your entire Tile Bag, so you don't run out during battle. Then tap the attack button. You can choose between the Single Player, Multiplayer, and Daily Game Modes.

For all modes, your primary goal is to take the opponent's Castle. Most towns have an objective that must be completed before you can destroy the Castle. You can read it on the billboard. Completing the objective will remove the forcefield from around the Castle.

Your first move must be on your opponent's Portal, since that's the entrance to his town. Each move consists of placing one or more tiles in a single row or colum to spell one or more words. Each new play must connect to one of your previous plays. Tap the submit button when you're done with your word. Navigate across the board and play a word on top of the Castle to win the attack.

If you win the attack, you can get one, two, or three stars. Simply destroying the Castle earns one star. You can win a second star for destroying all of your opponent's Gold Wheels. Those all have gold in them, so that's some additional incentive to take them. The other star is for scoring at least as many points as your opponent's point goal. The higher your opponent's Castle is, the higher his point goal will be.

That's basic premise of an attack, but there are several helpful techniques to keep in mind. If you don't like the tiles in your rack, try using a discard. You can choose which tiles in your rack to replace, provided you have more tiles in your Tile Bag. You're able to do this twice per match--or more if you've upgraded your capabilities in the Market.

If you have a level 3 Portal, you can also use spells in battle.
Melpomene

**Etimologia**: do grego Μελπομένη: *cantar*, *aquela que é melódica*;

**Apelido**: *A melódica*;

**Objeto**: Máscara trágica;

**Outros objetos**: Coturno, adaga, espada, bastão de Hércules.

**Instrumentos**: Voz;

**Especialidades**: Melodia e tragédia;

**Humor**: Celebrativo.

**Estudo humano**: Inteligência intra-pessoal.

**Partes do corpo**: Estômago (sentimentos pesados).

### **Contexto**

Melpomene exerce duas funções: É patrona do canto e da tragédia teatral. Seu nome era evocado por músicas que desejavam compor frases musicais belas. Apesar de seu tom melancólico, sua arte é celebrativa: Melpomene relembra fatos tristes na história como sendo tão importantes quanto os outros.

Na tradição grega, tragédias eram peças de teatro onde um dos personagens sofria um final desastroso -não por castigo dos deuses,mas por suas próprias escolhas erradas. A musa representa a "força na tristeza", por isso domina a inteligência intra-pessoal. Talvez por isso seja retratada, às vezes, carregando o bastão de Hércules.

Em música, seu forte é a composição melódica - que pode levar o ouvinteaos prantos ou confortá-lo.

**Rasa**:

**Cor**:

**Ratna**:

### Referências corporais:

* Poses melancólicas (queixo, olhos e sobrancelhas baixos, corpo introspectivo);
* Linguagem corporal cênica/teatral;
* Gestos de auto-conforto (controlar a dor da tristeza);
* "*Tristeza*" - movimentos carregados do plexo solar (coração e estômago);
* "*Coturno*" - passos incisivos (stomps) e arrastados;
* "*Celebrativa*" - movimentos que transmitem as construções "trágicas" do corpo para o exterior;
* "*Belas melodias*" - sequências longas melódicas (com diversidade de tons);
* "*Força*" - movimentos fortes no meio de construções suaves (bastão, adaga, espada)

### Referência coreográfica:

Construções coreográficas carregadas com tom emocional.
Kahnbeinfraktur

## Ätiologie/Anamnese

Sturz auf dorsalflektierte Hand, häufigste Handwurzelfraktur (75%)

## Diagnose

Diagnosestellung aufgrund oft unspezifischer Klinik und initial unauffälligen Röntgenbildern oft schwierig! Gefahr der Pseudoarthrosenbildung bei übersehenen Kahnbeinfrakturen.

Empfohlen: Handgelenkröntgen ap und seitlich inital

Hochverdächtig ist ein Druckschmerz in der Tabatiere, dann sollte bei unauffälligen Röntgenbildern eine Ruhigstellung mit DGL + Daumenschiene für eine Woche erfolgen, dann Anfertigen einer Kahnbeinserie. Oft ist dann eine Fraktur sichtbar. Sollte weiterhin eine Kahnbeinfraktur vermutet werden trotz unauffälliger Kahnbeinserie empfiehlt sich eine CT oder MRT des Handgelenks durchzuführen.

Druckpunkt Tabatiere

https://de.wikipedia.org/wiki/Foveola\_radialis

## Therapie

Konservativ:

Frakturen im distalen Drittel ohne Dislokation

Dauer der Ruhigstellung im Kahnbeingips: 6 Wochen Tuberculumfrakturen, 12 Wochen nicht dislozierte Querbrüche

Operativ:

alle anderen Frakturen; Versorgung mit Doppelgewindeschraube nach Herbert

https://de.wikipedia.org/wiki/Herbert-Schraube#/media/File:Scaphoid-Pseudarthrose1.jpg

## Literatur

Weigel et al: "'Praxisbuch Unfallchirurgie", 2. Auflage 2011
Free City of Greyhawk

The **Free City of Greyhawk**, also known as **Greyhawk City** and often called the Gem of the Flanaess, is a powerful city-state located in the central Flanaess. The word "Greyhawk" is often used in reference to those lands controlled by the Free City, though the proper term for the entire realm is the **Domain of Greyhawk**. Greyhawk is the largest city on Oerth, and as such is it seen as the world's capital.

The Free City of Greyhawk is divided into eight Quarters. The Thieves' Quarter, the Slum Quarter, the Artisan's Quarter, Clerkburg, the Foreign Quarter, the River Quarter, the Garden Quarter, and the High Quarter. Generally speaking, the poorest sections of town are to the south, on lower ground, while the wealthier quarters are to the north, at higher elevation. The Thieves' and Slum Quarters are known collectively as Old City, while the other six quarters are referred to as New City.

## Economy

The Free City of Greyhawk controls most of the Cairn Hills, which provide the domain with great mineral wealth, such as iron, gems, and silver.

Nearby Castle Greyhawk, with its extensive dungeons, draws adventurers and traders to the Domain of Greyhawk from across the Flanaess. As such, the Castle generates significant economic benefits for the City in trade, taxation and treasure.

## Government

### Executive branch

Greyhawk's Directing Oligarchy elects one of its own as Lord Mayor, who serves as the head of state in addition to his Directorial duties. The current Lord Mayor, Nerof Gasgal, has held office since 571 CY. The Lord Mayor heads both the Directing Oligarchy and the Council of Mayors and Manorial Lords. The chief of state also officially heads the military, though actual command is most often left to the Captain General of the Watch.

### Legislative branch

The Free City of Greyhawk is ruled by the Directing Oligarchy, an executive council of twelve to eighteen members representing the city's major professional guilds and the military. In some cases, the Oligarchy may include important wizards and/or clerics. New Directors are chosen by current council members when a vacency must be filled.

The Greyhawk Public Council, in theory, serves the interests in the citizenry-at-large. This popularly-elected advisory body consists of eight representatives, one from each of the city's quarters. The Public Council meets with the Directing Oligarchy on a quarterly basis.

### Judicial branch

Major legal matters in the Free City of Greyhawk are adjudicated by a Judge of Greyhawk, one of eight such officials appointed by the Directing Oligarchy. One of these eight is chosen to serve as Chief Judge of Greyhawk. In cases of great import, three Judges of Greyhawk may preside. Appeals of major cases are always heard by a panel of three Judges of Greyhawk, though the Lord Mayor sometimes sits in place of one of the Judges.

Lesser matters in Greyhawk City are tried by magistrates from the Guild of Lawyers and Scribes.
Dez Couland

Dez Couland isn't the cleanest guy around. He smells pretty bad. He probably hasn't bathed in a week or two. He sleeps in the stable at old man Henry's farm. He works there for a decent wage, saving up his silver until he can afford to hire a carpenter to build Dez a farmhouse of his own. You see, Dez isn't from the little village of Sheafdale. He didn't grow up plowing the fields, working the land.

During the Wheat March, Dez was put in charge of a small squad in the militia.

Dez is a man with a mysterious past who got the group into some hot water during their first visit to Longspear.

While attempting to scout out any other points of entry the deurgar might be using to access the mithril mine, Dez turned and corner and felt his skin begin to burn as if he were plunged into boiling water. Dez turned to look at a likewise surprised Grim, and they both shared an expression of horror as they were drug through the dark mine against their will. Dez tried his best to free himself from the gelatinous creature that filled the hallway, but he was again consumed by the beast. With one last surge of strength, Grim pushed Dez free of the creature, but the damage had been done. Dez succumbed to his wounds and died, his body still burning from the monster's putrid acidic secretions.

The party gathered up Dez's belongings, pausing to consider whether or not to give them to his beloved wife, Francesca.
Humans

Humans can in any environment and in every city on the Flanaess. They make up roughly 80% of the population amongst the primary races. Ifinitely adaptable and tenacious, humans have taken nearly complete control of the Flanaess, with only several kingdoms not directly controlled by them. Humans are hard to define and unpredictable, which makes them exhausting to the other races. There are no "pure" humans, as each subset of humanity has intermingled endlessly. However, there are different varieties of humans that fall into broad, overlapping categories:

* **Baklunish (Arabic).** These are golden-skinned humans, less mixed than the races of the central Flanaess, who dwell mainly along the Dramidj Ocean and plains and steppes to the south. TheWolf Nomads are Baklunish with heavy Flan admixture. Baklunish hair is usually straight, dark, and very fine, and their eyes tend toward green. They have long limbs and facial features, with high cheekbones.
* **Flannae (Native Americans).** These are the aboriginal inhabitants of the Flanaess, their skin ranging from a lighter coppery hue to deep brown. Their hair tends to be wavy or curly. They have strong, broad faces and sturdy builds.
* **Oeridian (UK, Scandinavian).** These people, the descendants of proud horse nomads from central Oerik, have olive or tan skin and any color of hair from honey-blonde to black. The Oeridians founded the mighty Great Kingdom and co-founded the kingdom of Keoland, so their influence on everything from language to culture in the Flanaess is considerable. Many wear the traditional kilts of their clans.
* **Olman (Mayan).** The Olman are a brown-skinned people found mainly in the tropics of Hepmonaland and the Amedio Jungle. Their hair is straight and black, and their eyes are very dark. They have high cheek bones and high-bridged noses. Brought over mostly as slaves by the Scarlet Brotherhood.
* **Rhennee (Gypsies).** The Rhennee have olive-toned skin like the Oeridians, but darker, curlier hair. They tend to be short, but wiry and strong. They are a very different people culturally, thought to have originated on another plane of existence.
* **Suloise (German, Japanese).** The Suloise are pale, some nearly albino, with kinky or curly hair of blonde or red. They tend to be narrow and lean. They started the war that led to the human influx into the Flanaess. Many other humans distrust them due to their cruel history.
* **Touv (African).** The Touv have nearly black skin with straight black hair and startlingly blue eyes. They dwell in Hepmonaland, mostly to the south of the Olman lands. The rarest humans encountered in the Flanaess.
Goblinoids

Goblinoids are naturally stealthy and bloodthirsty creatures that live by hunting and raiding. They usually start off as a small tribe, but as they meet with other goblinoid tribes, these form into a warband. This snowballing effect can lead to massive goblinoid hordes that terrify and harass nations or entire regions. The Wheat March is a particularly poignant example of the danger imposed by goblin hordes. There are three main types of goblinoids:

Goblins are short, frail creatures that are as murderous as they are cowardly. They are generally easily dealt with, but their ability to hide in nearly any area makes them quite dangerous. Goblins utilize pack tactics to overcome larger creatures, but any hint of danger will make them scatter.

Hobgoblins are basically taller goblins, but they resemble humans. They are the ones who step up and lead goblinoid warbands, thanks to their cunning and human-like intelligence. Hobgoblins press goblins into service and ruthlessly abuse them if they try to step out of line.

Bugbears are the most vicious goblinoids. They can grow up to 7' tall, and they have surprising stealth for a creature that size. Bugbears lie in wait for victims to walk close to their hiding areas before ambushing them with brute strength. They serve as shock troops in goblinoid warbands.
Lord Nichol Ventril

Lord Nichol Ventril is a young lord of the Ventril family, one of the most prestigious and oldest families of Nyrond. He has been put in charge of Nyrond's operations on the Pomarj. His initial goal was simply to find extra avenues of income for the flagging kingdom, but he is now in a desperate bid to come up with some way to strike a blow against the Empire of the Brightlands any way that he can.

Nyrond is a nation that has bore untold strife both from within and without. Several civil wars ravaged the land, and now the Brightlands are conducting full-scale war against them. Nyrond is in a desperate situation, and they have only the fragile alliance of the eastern kingdoms to protect them.
Xynea

Xynea is commonly referred to as the swamp witch by the colonists. They fear her and speak her name in hushed tones. There are rumors that she takes bits from the corpses of the recently dead to use in dark blood magic rituals, and others say she simply eats the corpses. However, she is the only means of communication with the Yeomanry, as she employs a mystical artifact to communicate with Spokesman Alvaro directly.
The Blighted Thrust

The Blighted Thrust was the name given to the offensive Iuz mounted against the Flanaess. He first attacked

Furyondy and maintained a siege that lasted for months. At the decisive Battle of Chendl, Iuz used his considerable power to sway the fates of a group of adventurers whom he had convinced/enslaved to help him. This was when Iuz's Despoilers were created as they slew the King of Furyondy where he stood.

When Chendl fell, the rest of Furyondy was quickly conquered. Iuz pushed into neighboring kingdoms, eliciting surrender or razing keeps as he went. It seemed that the whole of the Flanaess would be enslaved by Iuz.
Translations

Several times throughout the Autumnshade narrative languages seperate of the base Tamrielic dialect are used by groups within the series, e.g. the Autumnshade Coven and the mortal tribes of the Orsimer use the language of Orsinium when referring to some individuals, locations or traditions.

This page will be constantly updated as more expressions appear within the writing. These expressions are not considered canon by way of The Elder Scrolls series.

## Orcish

### *Liesh*- Means 'Descendant' or 'Offspring'

*Liesh-Orsim-* 'Descendant of Kin'

*Liesh-Sangai-* 'Descended from fresh Blood'

*Liesh-Sangur-* 'Descended from [our] Blood'

### *Orsim-* Means 'Kin'. Short for *Orsimer*.

*Liesh-Orsim-* 'Descendant of Kin'

*Pastol-Orsim-* 'Guardian of Kin'

*Rassal-Orsim-* 'Gatherer/Gifter of Kin'

### Locations

*Alum Sharr-* 'Broken Keep'

*Dascah Lozoug-* 'Forgotten Monument'

*Masor Spectum-* 'Spirit's Forge'

*Baran Fyagii-* 'Dark Obelisk'
Autumnshade- Skyrim Fanfic Wikia

## Welcome to the Autumnshade- Skyrim Fanfic Wikia

This wikia is for the cataloging of the characters, factions and events that occur throughout my Autumnshade Coven fanfiction. I do not claim ownership of any of the above which belong to the elder scrolls series- these belong to Bethesda. Most images found on this site will also not belong to me, and belong to their respective illustrators/owners. Any articles on this wikia (unless stated otherwise) are the creations of T.Rakinson, and the right to their use remains reserved.

## Summary of the saga

This fanfic series is set in the Elder Scrolls universe, beginning roughly 19 years before what would be the events of *TES V: Skyrim*. It follows a clan of vampires who set out to establish a soverign nation for the undead, but face conflict on several occasions with rival coven's, zealous hunters of their kind and supernatural entities.

As of now this fanfiction exists in an independant canon, but may be integrated into pre-existing fanfiction timelines at a later date.
Goliaths

At the highest mountain peaks—far above the slopes where trees grow and where the air is thin and the frigid winds howl—dwell the reclusive goliaths. Few folk can claim to have seen a goliath, and fewer still can claim friendship with them. Goliaths wander a bleak realm of rock, wind, and cold. Their bodies look as if they are carved from mountain stone and give them great physical power. Their spirits take after the wandering wind, making them nomads who wander from peak to peak. Their hearts are infused with the cold regard of their frigid realm, leaving each goliath with the responsibility to earn a place in the tribe or die trying.

Among goliaths, any adult who can’t contribute to the tribe is expelled. A lone goliath has little chance of survival, especially an older or weaker one. Goliaths have little pity for adults who can’t take care of themselves, though a sick or injured individual is treated, as a result of the goliath concept of fair play. A permanently injured goliath is still expected to pull his or her weight in the tribe. Typically, such a goliath dies attempting to keep up, or the goliath slips away in the night to seek the cold will of fate. In some ways, the goliath drive to outdo themselves feeds into the grim inevitability of their decline and death. A goliath would much rather die in battle, at the peak of strength and skill, than endure the slow decay of old age. Few folk have ever meet an elderly goliath, and even those goliaths who have left their people grapple with the urge to give up their lives as their physical skills decay. Because of their risk-taking, goliath tribes suffer from a chronic lack of the experience offered by longterm leaders. They hope for innate wisdom in their leadership, for they can rarely count on a wisdom grown with age.

Goliaths take on names depending on what feat they have accomplished, such as: Bearkiller, Roothewer, Twice-Killer, or Rockslinger. Any goliath who has not completed a particularly worth deed does not get a name, and they are simply referred to as it by their tribesman. When asked by outsiders what their name is, undeeded goliaths simply say, "It has no name."
Blake Surtova

Although the Pax Heironeous may have brought many of the kingdoms to work together, some tensions did remain. Ulekian logging operations in the Suss Forest along the southern Lortmil Mountains would on occasion suffer aggression from pockets of local elves, perhaps even backed by the kingdom of Celene. A task force was created to keep the peace in this area and protect the loggers and small villages, and Blake Surtova was chosen to lead it.

Blake Surtova is the son of Domani Surtova, who governs over a small and unimportant port town, White Manor, equidistant between Gryrax and Gradsul. The peace of the Flanaess and rurality of White Manor caused a lack of excitement to permeate Blake's childhood, and most of it was spent studying and training for an unlikely-to-occur war, and the chance to serve in some more important lord's army.

Blake's young adult years were spent participating in the many noble feasts and tournaments of Ulek, in which he made a name for himself as quite a charming young man and adept fighter by winning various events. Blake was in his early 20s when the wood elves on the outskirts of the kingdom of Celene began increasing their hostility toward Azbak Goldhearth's logging operations along the western edge of the Suss Forest. While looking for a man to head a task force to keep the peace, many noblemen suggested Blake Surtova for the role, and Goldhearth decided to appoint him to the position.

Under the command of Blake Surtova, Task Force 121 was overwhelmingly
successful in its mission. Using an amalgam of tactics such as brutal hit and run attacks. and psi-ops intended to convince other local elf populations that violence against Ulek was not the answer. Elven attacks were reduced by 175%, lowering to a rate even lower than before the rise of aggression on the logging camps, and Ulekian logging operations saw an increase of 50% efficiency.

When news of Tyal Coal's failure reached Stonelord Ashblood, he met with his advisors, including Azbak, to discuss who should be sent to lead the Stonelord's colony. Azbak suggested Blake for the task, and the Stonelord agreed.
Tyal Coal

Tyal Coal, born Tyal Peakess, is a devout (some would say fanatical) paladin of Pholtus, and the baron of Pholtesia. He is unable to condone any actions he believes to be offensive to his god, going so far as to turn his own father into the guards when he stole a loaf of bread to feed his family. The city guard decided eight-year-old Tyal would be happier living in an abbey, and sent him along to a nearby monastery where he studied the teachings of Pholtus.

Quickly upon beginning his studies, Tyal began to believe that he had been chosen by Pholtus at birth to be His instrument on Oearth, because he found all the holy books to offer guidance in ways he already felt and believed to be true. Tyal soon became beloved by his teachers and hated among his fellow students, as he would always inform the adults when the other kids were doing things they should not be, such as talking too loud during studying time.

Eventually, a paladin at the monastery by the name of Eli Coal decided to take Tyal as his apprentice. Tyal and Eli trained together for 15 years before Eli sent Tyal to answer Ulek's call to settle in the Pomarj.

Upon arriving in the Pomarj, one of Tyal's first acts was to kill Nettles, a sentient zombie who maintained a bridge on the peninsula. The rest of the party was not keen on this decision, and it was ultimately ambiguous as to Nettles' final fate.

After leading the Pholtesia for months into a situation the Stonelord was unhappy with, Ashblood sent Blake Surtova to replace Tyal as Baron. Tyal gave up his seat peacefully while making it clear he believed it to be a major mistake, and left the village. His current whereabouts are unknown.
Firbolgs

Firbolgs are guardians of nature who do their best to protect the natural realms and stay out of sight. They generally disguise themselves when travelling amongst the other races, so as to blend in. Typically they will live with their tribes and do their best to keep the areas under their protection free from harm.

Firbolgs have immense druidic power, and they try to coexist with nature whenever possible. Whenever intruders come, they will try to divert rivers, scare off game, or steal important tools to get them to leave.

Firbolgs are a close-knit race, and they will live with their tribe unless they are banished. They are usually only banished if they commit an unforgivable crime that damages either the tribe or nature.

Among other races, Firbolgs take Elven names, as that is their favored form to disguise themselves in. They, in fact, do not actually use names while living among their tribesmen.

Firbolg are descended from giants, though they do not share the warlike nature of their kin.
Oleg Leveton

Oleg is a merchant from the Principality of Ulek. He runs Oleg's Trading Post with his wife Svetlana. He is a hard working human who takes great pride in the fact that he has carved out his own little prosperous corner in this savage land. Oleg is an honest man who does whatever he can to keep the merchants, hunters, and others who visit his trading post safe.