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Hypertension (high blood pressure) is a disease of vascular regulation resulting from

malfunction of arterial pressure control mechanisms (central nervous system, rennin-


angiotensinaldosterone system, extracellular fluid volume.) the cause is unknown, and there is no
cure. The basic explanation is that blood pressure is elevated when there is increased cardiac
output plus increased peripheral vascular resistance.

The two major types of hypertension are primary (essential) hypertension, in which diastrolic
pressure is 90 mm Hg or higher and systolic pressure is 140 mm Hg or higher in absence of other
causes of hypertension (approximately 95 % of patients); and Secondary hypertension, which
results primarily from renal disease, endocrine disorders, and coarctation of the aorta. Either of
these conditions may give rise to accelerated hypertension – a medical emergency – in which
blood pressure elevates very rapidly to threaten one or more of the target organs: the brain,
kidney, or the heart.

Hypertension is one of the most prevalent chronic diseases for which treatment is available;
however, most patients with hypertension are unaware, untreated, or inadequately treated. Risk
factors for hypertension are age between 30 and 70; black; overweight; sleep apnea; family
history; cigarette smoking; sedentary lifestyle; and diabetes mellitus. Because hypertension
presents no over symptoms, it is termed the “silent killer.” The untreated disease may progress to
retinopathy, renal failure, coronary artery disease, heart failure, and stroke.

Hypertension in children is defined as the average systolic or diastolic blood pressure greater
than or equal to the 95th percentile for age and sex with measurement on at lease three occasions.
The incidence of hypertension in children is low, but it is increasingly being recognized in
adolescents; and it may occur in neonates, infants, and young children with secondary causes.

Gunshot wound
Risk factors:

Environment

Accident

Socioeconomic status

Heavy drinker

Misunderstanding

Pathophysiology

• The effects of bullets can result from both direct and indirect effects
• In low energy transfer wounds injury results from direct effects along bullet track
• In high energy transfer wounds indirect effects are more important
• Radial forces perpendicular to tract result in cavitation
• Generates contusions and lacerations away from tract
• Negative pressure within cavity can suck in environmental contaminants
• Rifle bullets also tumble (yaw) within the wound
• Increases presenting area and increases energy transfer
• Can result in small entry and exit wounds but large wound cavity
• Radial energy transfer can cause indirect fractures
• Bullet and bone fragmentation can cause secondary tracts and further unpredictable
damage