Viagra Super Active

Despite a high clinical index of suspicion in this circumstance order 100mg viagra super active amex erectile dysfunction age 32, a new order viagra super active visa erectile dysfunction pills side effects, regurgitant murmur may not be audible discount viagra super active 100mg on line erectile dysfunction statistics nih. Larger paravalvular leaks may result in significant volume overload and heart failure, to an extent that reoperation might be indicated. Management can prove challenging, and a conservative approach with medical therapy is often chosen, in part related to the risks associated with reoperation in some patients. Thromboembolism and Bleeding Thromboemboli are a major source of morbidity in patients with prosthetic heart valves. Thromboembolic incidence rates are similar for non-anticoagulated patients with bioprostheses and appropriately anticoagulated patients with mechanical valves. The risk of bleeding, estimated at 1% per patient-year, increases with age and the intensity of anticoagulation. In patients with uncontrollable bleeding who require reversal of anticoagulation, administration of fresh-frozen plasma or prothrombin-complex concentrate is reasonable. Reoperation to implant a less thrombogenic valve is rarely undertaken for patients with recurrent thromboemboli despite aggressive antithrombotic therapy. Prosthetic Valve Thrombosis The incidence of mechanical valve thrombosis is estimated at 0. Thrombosis of a mechanical heart valve can have devastating consequences (see Figs. Bioprosthetic (surgical or transcatheter) valve thrombosis is less common, with a reported incidence of 0. Clinical suspicion of prosthetic valve thrombosis should be raised by symptoms of heart failure, thromboembolism, or low cardiac output, coupled with a decrease in the intensity of the valve closure sounds (mechanical valves), new and pathologic murmurs, or documentation of inadequate anticoagulation. Thrombosis is more common in the mitral and tricuspid positions than in the aortic position. Although differentiation from pannus formation can be difficult, the clinical context usually 4,5 allows accurate diagnosis. In patients with mechanical valves, confirmation of abnormal leaflet or disc excursion in the 5 presence of an occluding thrombus can also be obtained with cinefluoroscopy. Fibrinolytic therapy is generally 2 recommended for patients with right-sided prosthetic valve thrombosis. An encouraging report of the efficacy of low-dose, slow- infusion tissue plasminogen activator in pregnant women with prosthetic valve thrombosis should prompt 39 investigation of this approach in other patient subsets. Reoperative surgery or catheter closure of the defect is indicated when heart failure, a persistent transfusion requirement, or poor quality of life intervenes. Empiric medical measures include iron and folic acid replacement therapy and beta-adrenoreceptor blockers. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. Utilization and mortality trends in transcatheter and surgical aortic valve replacement: the New York State experience—2011 to 2012. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging, endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography and the Brazilian Department of Cardiovascular Imaging. Long-term durability of bioprosthetic aortic valves: implications from 12,569 implants. Very long-term outcomes of the Carpentier-Edwards Perimount valve in aortic position. Meta-analysis of valve hemodynamics and left ventricular mass regression for stentless versus stented aortic valves. Long-term outcomes after autograft versus homograft aortic root replacement in adults with aortic valve disease: a randomised controlled trial. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Aortic valve replacement: a prospective randomized evaluation of mechanical versus biological valves in patients ages 55 to 70 years. Long-term safety and effectiveness of mechanical versus biologic aortic valve prostheses in older patients: results from the Society of Thoracic Surgeons Adult Cardiac Surgery National Database. Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years. Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. Valve prosthesis-patient mismatch, 1978 to 2011: from original concept to compelling evidence. Prosthesis-patient mismatch in high-risk patients with severe aortic stenosis: a randomized trial of a self-expanding prosthesis. Cerebral microembolization after bioprosthetic aortic valve replacement: comparison of warfarin plus aspirin versus aspirin only. Incidence, timing and predictors of valve hemodynamic deterioration after transcatheter aortic valve replacement: multicenter registry. Impact of aortic valve replacement on outcome of symptomatic patients with severe aortic stenosis with low gradient and preserved left ventricular ejection fraction. Positron emission tomography/computed tomography for 18 diagnosis of prosthetic valve endocarditis: increased valvular F-fluorodeoxyglucose uptake as a novel major criterion. Association between transcatheter aortic valve replacement and subsequent infective endocarditis and in-hospital death. First, a transcatheter therapy can avoid the risks associated with more invasive surgical approaches, particularly those associated with cardiopulmonary bypass and median sternotomy, while preserving or enhancing outcomes. Second, the patient wants to avoid the invasiveness and prolonged recovery associated with major surgery. However, these factors must always be balanced with the efficacy of the transcatheter approach. In this regard, the patient will always prefer a transcatheter approach that is less invasive, provides a faster patient recovery, and has similar efficacy to a more invasive surgical approach. Aortic Stenosis (See Chapter 68) Paul Dudley White stated in 1931 that “there is no treatment for aortic valve disease. Early feasibility and safety were accomplished with a modicum of success and modest improvement in valve area and clinical symptomatic relief. Transcatheter Aortic Valve Replacement The idea of implanting a prosthetic valve to prevent restenosis after balloon valvuloplasty is credited to Henning Andersen, a Danish cardiologist who fashioned a stent from stainless steel surgical wires and mounted a bioprosthetic valve inside the stent. His initial animal experiments demonstrating feasibility were presented at the European Society of Cardiology in 1992 (see Classic References, Andersen). The ensuing decade led to improvements in valve and stent design along with development of a delivery system, culminating in the first successful human implantation by Cribier in 2002 (see Classic References).

25mg viagra super active fast delivery

Inspect the posterior pharynx for peritonsillar cel- lulitis order viagra super active 25 mg without prescription erectile dysfunction lifestyle changes, retropharyngeal abscess 25 mg viagra super active with visa erectile dysfunction 31 years old, or other intraoral pa- Listen for Voice Changes thology that might be causing obstruction 25 mg viagra super active for sale erectile dysfunction age. Paralysis of the vocal cords results with micrognathia, depressed airway refexes, or an 166 Chapter 14 • Dyspnea enlarged tongue, will diminish with this maneuver those with cystic fbrosis, cyanotic congenital heart because the tongue will be lifted off the posterior phar- disease, thyrotoxicosis, and in celiac disease. If epiglottitis is suspected, do not examine the oral develops rapidly with infective endocarditis. Edema of the lower ex- tremities can be a sign of increased right-heart flling Inspect the Nose pressure caused by primary lung disease or left- Assess the patency of the nares. In children, the location of An infant who has nasal faring is using a compensatory peripheral edema is age dependent. Noisy, diff- edema occurs as hepatomegaly and periorbital or fank cult breathing in an infant, especially while feeding, can edema. Palpate the Neck Check skin perfusion by pressing on the skin of Neck masses caused by intraoral, paratracheal, or a fnger or sole of a foot and saying “capillary refll” intrathoracic malignant disease can cause respira- after removing the pressure. To color returns to the skin in 2 seconds or before you can assess the trachea for lateral displacement, position fnish saying the words. If the trachea has muscles are working at their maximum level to over- shifted to the side, you will feel the wall on one side come increased resistive and elastic forces, the child but only soft tissue on the other. This is most likely will sweat, especially on the forehead and above to occur with pneumothorax. Palpate the Chest Using the palmar surface of the hands, palpate the en- Examine the Skin and Extremities tire chest for tenderness, depressions, bulges, and Note cyanosis. Bluish color seen in the lips and crepitus (presence of air in the subcutaneous tissues). Cyanosis implies more paralysis of the diaphragm will result in reduced ex- than 5 g/100 mL of desaturated hemoglobin, but its pansion of one side of the chest wall, and chest wall absence does not imply that hypoxemia is not pre- motion will be decreased. Bluish Fremitus is diminished in pneumothorax, asthma, em- color of the extremities (peripheral cyanosis) may physema, and other conditions that trap air in the lung. Pallor of sclera or nail beds can be a manifestation Percuss the Chest of severe anemia. Sounds produced by percussion indicate the density of Note clubbing, which is characterized by the loss of lung tissue (see Chapter 11). Clubbing is a a percussion note and assessment of the quality of trans- manifestation of chronic tissue hypoxia that occurs with mitted sound are useful to reveal an area of consolida- lung cancer and other chronic lung diseases but can also tion or effusion that would be diffcult to auscultate with be idiopathic. Dullness to manual percus- regarding the accuracy of the physical examination in assess- sion increased the likelihood of pleural effusion. If tactile techniques were evaluated: manual percussion; auscultatory fremitus is not decreased in a patient at low risk for pleural percussion (tapping on the manubrium and listening to effusion, a chest x-ray may not be necessary. In summary, the posterior chest with a stethoscope simultaneously) for dullness to percussion and tactile fremitus are the most use- decreased resonance; auscultation for breath sounds, crack- ful fndings when evaluating a patient for pleural effusion. Auscultate Breath Sounds Wheezing is frequently described as a whistling Auscultation of bronchial or bronchovesicular breath sound and may be heard during inspiration, expiration, sounds over the peripheral lungs can indicate consoli- or both. In addition, localized If breath sounds are diminished over all lung felds, wheezing can accompany incomplete obstruction of the suspect shallow breathing, lack of air movement, neu- airway by a foreign body. Breath sounds A wheeze of fxed pitch occurring with inspiration and will be inaudible in areas of pneumothorax. Wheezes of Abnormal lung sounds are superimposed on normal varying pitch occurring predominantly throughout expira- sounds and can be auscultated over any area of the lung tion refect the narrowing of airways of different calibers. Documentation of Rhonchi are continuous, deep-pitched, coarse breath abnormal lung sounds should include type of sound, sounds usually heard during expiration. Rhonchi are location where it is heard, and the phase(s) of respiration frequently present when the patient has bronchitis or in which it is noted. Listening Pleural friction rub is a grating or squeaking sound with the stethoscope over the nose or mouth, and then usually heard in the lateral lung felds during inspiration returning to the lungs, can help to identify the fndings. It indicates that parietal and visceral Crackles or rales are discontinuous popping sounds pleural linings are infamed and are rubbing together as heard most often during inspiration. They are caused by can occur with pneumonia, pleural effusion, pleuritis, the explosive equalization of gas pressure between two and tumors. It is often accompanied by limited chest compartments of the lung when a closed section of the expansion because of pain. They indi- If abnormal lung sounds are detected, additional cate the presence of fuid, mucus, or pus in the smaller auscultation for bronchophony, egophony, and whis- airways. In egophony, instruct the patient to say ling is heard on inspiration caused by a mix between the “ee. To test whispered pectoriloquy, instruct the ways that are swollen and narrowed, such as in asthma patient to whisper a sentence. Whispered sounds are or bronchiolitis, generalized medium or coarse crackles louder and clearer than normal. S3 Echocardiography (ventricular gallop) is an early sign of heart failure and An echocardiogram is performed when cardiac disease is heard best at the apex of the heart. S (atrial gallop)4 is suspected; this test can defne the cause of dyspnea in children typically indicates a stressed heart and heart related to heart chamber size, valves, pericardial disease, failure. A summation gallop can also occur with heart failure; this is the result of Hemoglobin and Hematocrit S , S , and rapid rate. Incom- Erythrocytosis can indicate chronic hypoxia resulting petent heart valves can be the cause of heart failure. Spirometry about the delivery of oxygen from the atmosphere to that indicates restrictive disease or mixed obstructive re- the pulmonary capillaries. The partial pressure of oxy- strictive disease should have follow-up studies to test for gen in arterial blood (PaO ) in healthy adults ranges2 lung volumes with either helium dilution, body plethys- from 80 to 103 mm Hg, and more than 95% saturation mography, and/or a diffusion capacity. In children, a pulse oximetry reading of 95% to 98% is normal, 90% Additional Testing to 95% is mild hypoxia, 85% to 90% is moderate hy- Additional diagnostic tests may be indicated after the poxemia, and less than 85% is severe hypoxemia. They can also provide clues to other causes mal fndings rule out thrombosis; abnormal fndings of dyspnea such as cardiomegaly, deformities of the may indicate thrombosis but do not rule out other chest bones and musculature, and the position of the potential causes. When a foreign body is suspected, both in- bolic disease where the probability is low. Renal insuffciency frequently pres- diopulmonary exercise testing can be done if the severity ents with dyspnea as a result of the combined effects of the dyspnea is disproportionate to objective tests, there of volume overload and anemia. Spontaneous tained to determine the presence of an infectious pneumothorax can also occur, with the highest inci- agent. There is sudden severe chest pain and dyspnea aggravated by normal respiratory movement. Croup, or laryngotracheobronchitis, is a parainfuenza infection that is usually preceded by symptoms of an Emergent Conditions Manifested by Dyspnea upper respiratory tract infection. The illness is usually Pulmonary Embolus gradual in onset and includes a hoarse, seal-bark cough A patient reporting severe dyspnea, cough, fever, he- and fever. It typi- cally has a rapid onset with stridor, high fever, drool- Foreign Body Aspiration ing, muffed voice, and sore throat.

purchase 100mg viagra super active free shipping

The urine concentration then remains higher than the blood values during the declining blood alcohol concentra- tions viagra super active 25 mg with visa erectile dysfunction at the age of 24. By virtue of this order 100 mg viagra super active otc erectile dysfunction pump youtube, urine alcohol concentrations are not useful for predicting blood alcohol buy 100mg viagra super active visa erectile dysfunction treatment non prescription. Alcohol impairs visual acuity, adaption to both light and darkness, discrimination of colors, persistence or speed of response to visual stimulation, focusing, etc. It has been known since 1919 that the effects of acute alcohol intoxication are more pronounced when the blood level is rising than falling (the Mellanby effect). In regard to alcohol’s effect on the personality, some people become sleepy, placid, and friendly, whereas others become antagonistic, hostile, and violent. The best indication of reaction would be an account of how they have reacted at prior times when intoxicated. Of all the organ systems in the body, the most affected by alcohol is the central nervous system. Chronic alcoholics are often able to mask many of the signs of acute alcohol intoxication, though there is still physiological impairment. Thus, a chronic alcoholic with a blood level of 150 mg% may superficially appear sober, though there is still impairment in the reflexes, visual acuity, memory, con- centration, and judgment. Most deaths caused by acute alcohol intoxication occur with blood alcohol levels of 400 mg% or greater. Chronic alcoholics have been apprehended operating motor vehicles with blood alcohols of 450–500 mg% and have actually survived alco- hol levels as high as 600–700 mg%. In such a case, one may see blood alcohol levels in the 300 mg% or high 200 mg% range. The vitreous, however, will show significantly higher alcohol levels, indicating that the individual is in the metabolizing phase. Methanol is oxidized by the liver to formaldehyde, which in turn is oxidized to formic acid. Symptoms of acute methanol poisoning are weakness, nausea, vomiting, headache, epigastric pain, dyspnea, and cyanosis. The symptoms may occur within half an hour after ingestion or may not appear for 24 h. If a fatal amount of methyl alcohol has been ingested, the afore- mentioned symptoms will be followed by stupor, coma, convulsions, hypo- thermia, and death. If the individual does survive, he may be permanently blind, due apparently to a specific toxicity for the retinal cells. Formic acid is the primary agent responsible for the severe metabolic acidosis and ocular toxicity of methanol. Ingestion of 70–100 mL of methyl alcohol is usually fatal, though death may occur with ingestion of as little as 30–60 mL. Of 725 cases of meth- anol poisoning caused by ingestion reported by Keeney and Mellinkoff, 54% of the individuals died, 12% were blinded, and 12% had visual impairment. The minimum lethal blood level in methyl alcohol poisoning is approximately 80 mg%. Isopropanol Isopropanol is available to the public as rubbing alcohol in a 70% aqueous solution. It should be noted that the appearance of small amounts of isopropanol in the blood is not necessarily indicative of ingestion of this alcohol. In diabetics with ketoaci- dosis, and in cases of starvation with high levels of acetone, acetone may be converted to isopropyl alcohol. In such cases, there will be a high level of acetone and a low level of isopropyl alcohol. In humans, it is metabolized to a number of compounds, the most important of which is oxalic acid. Upon ingestion, individuals develop central nervous system depression with severe metabolic acidosis. Microscopic sections of the kidneys viewed under polarized light show deposition of oxalate crystals in the renal tubules and brain. Minimum lethal dose is estimated at 100 mL for an adult, though individuals have survived significantly higher amounts. The clinical manifestations of acute ethylene glycol intoxication can be divided into neu- rological, cardiorespiratory, and renal. Originally developed as an intravenous anesthetic, it is no longer legally manufactured. While it does have certain therapeutic advantages over morphine and codeine, heroin is much more addictive. Until the widespread introduction of cocaine to the American population, heroin was probably the most popular of the “hard” drugs. Depending on geo- graphical area, it is sold in small plastic envelopes, capsules, or balloons. The typical “bag” of heroin traditionally contained a 1–2% concentration of the drug. With the intro- 522 Forensic Pathology duction of the cheaper black tar form of heroin from Mexico, the quality of heroin being sold increased dramatically. Bags of heroin showing 20–30% purity, with some up to 50%, are now routine in some parts of the country (personal communication Samantha A. For many years, people hypothesized that deaths due to heroin were caused by an allergic reaction to some component used as a cutting agent. In virtually all cases, individuals who die of an overdose of heroin are either under the influence of alcohol or intoxicated at the time of death. More recently, we have seen a number of deaths caused by “speed- balls,” a combination of heroin and cocaine. The addict places the powder in either a bottle cap or spoon, adds water, and then heats the mixture over a flame (Figure 23. With repeated injection into veins, the addicts will develop “needle tracks” (Figure 23. These are raised hyperpigmented scars pro- duced by the repeated intravenous injection of the solutions, usually with a dull contaminated needle. Needle tracks are often more prominent in geo- graphical areas where the addict has a difficult time acquiring syringes and needles. Thus, in this population, needle tracks are not as prominent as on the East Coast. At autopsy of an individual who has died of an overdose of heroin, the lungs are heavy and show congestion, though the classic pulmonary edema mentioned in some of the older textbooks is not always present. Microscopic examination of the lungs commonly reveals foreign-body granulomas with talc crystals and cotton fibers. Microscopic examination of the liver will reveal a chronic triaditis with a mononuclear cell infiltrate. Following injection, heroin (diacetylmorphine) is almost immediately metabolized to monoacety1morphine (half-life 9 min). Because of this, if one performs a toxicologic analysis on an individual who died from an overdose of heroin, one does not detect heroin in the blood, but rather morphine and monoacetyl morphine.

discount 50mg viagra super active

On frontal impact buy viagra super active on line erectile dysfunction drugs patents, the head and chest will jackknife over the belt such that the driver’s head can impact the steering wheel and the front passenger’s head the dashboard purchase viagra super active overnight delivery erectile dysfunction treatment penile implants. Lap belts also prevent rear passengers from impacting or being propelled over the front seats discount generic viagra super active canada impotence blog. While successful in reducing mortality and injury, on occasion, a lap belt can also cause injury. If the belt is worn too high (above the pelvis), the body can violently jackknife, producing compression fractures of the lumbar ver- tebrae; transverse fractures of the vertebral bodies; as well as fractures of the pedicles, transverse processes and lamina of the lumbar vertebrae. Soft tissue injuries produced by lap belts consist of contusions and lacerations of the duodenum, jejunum and ileum and lacerations of the spleen and pancreas. In intestinal injuries, the lacerations are on the anti-mesenteric side of the bowel. While all of the aforementioned injuries occur from wearing the lap belt too high, such injury can still take place if it is worn properly through a phenomenon called “submarining,” where, at impact, the pelvis sinks down into the seat and slides under the belt. Most abdominal and spinal injuries, however, are caused by wearing the lap belt too high. Injuries to the small intestine, colon and lumbar spine, in the plane of the lap belt, are referred collectively to as the“seat belt syndrome. However, the three-point restraint still can produce injuries such as rib fractures (single more likely than multiple), fractures of the clavicles, and sternum and cervical spine fractures. Air Bags Air bags were introduced to reduce serious injuries and deaths in automobile crashes, especially in those individuals not using seat and lap belts. They are intended to provide protection only in frontal crashes and to be used in con- junction with seat belts. Thus, airbags alone have an estimated effectiveness Deaths Caused by Motor Vehicle Accidents 299 of 14% in reduction of fatalities in drivers in crashes of all types compared with 45% for lap–shoulder belts used alone. As with any life-saving device or drug, there is the potential for adverse side effects. There is a wide variance in the design of air bags including: • Collision speed that triggers deployment • Speed of deployment • Distance of extension • Physical characteristics of the airbag, etc. Deployment of airbags occurs when crash sensors detect an impact equivalent to hitting a solid barrier at 10–15 mph. Some suggest that 18 mph should be used for the threshold for deployment, at least for belted individuals. An example of dual threshold deployment is found in Mercedes automobiles, and has been so for driver airbags since 1988 and passenger air bags since 1989. Inflation of the air bag is usually by a pyrotechnic device with production of gas. The velocity of deployment ranges from 100 to 200-plus mph, with older air bags deploying faster than newer. In the former, tethers control the excursion of the bag toward the occupant as well as the shape. The distance that the air bag can travel from wheel to driver can range from 12 to 20 inches, with the untethered bags traveling farther. Newer air bags will be less powerful and able to modify the amount of inflation depending on the size of the driver or passenger. Just like seat belts, air bags can cause injuries, but, unlike seat belts, the injuries can be immediately lethal. Deaths are usually associated with women of small stature and children below the age of 13 years, especially when the children are unrestrained or out of position. Rear-facing infant or child restraints should never be used in front seats, as they place the child’s head and body very close to the air bag housing. Infants in the front 300 Forensic Pathology seat, in rear-facing infant seats, have predominantly craniocerebral injuries. Drivers seated too close to the steering wheel (less than 10 inches) can be seriously injured or killed by deploying air bags. Short drivers are injured more frequently because they must sit closer to the steering wheel to reach the gas and brake pedals. Pre-tensioners pull the slack out of the shoulder strap before the airbag deploys, pulling wearers back in the seat before they begin to move forward, reducing the subsequent force of impact between the air bag and the person. Fatal injuries ascribed to airbag deployment include cervical spine dis- locations or fractures, basal skull fractures, and injuries to thoracic and abdominal viscera. The injured person may show characteristic abrasions of the anterior neck and under surface of the jaw (Figure 9. In one relatively minor accident reviewed by the authors, there was blunt trauma to the right internal carotid artery, just Figure 9. Deaths Caused by Motor Vehicle Accidents 301 distal to the bifurcation of the common carotid artery. She was seen at a hospital and sent home, only to be re-admitted 12 hours later, with a history of convulsions. An angio- graph showed complete occlusion of the right internal carotid artery caused by thrombosis. She gradually deteriorated over the next few days, dying of widespread infarction of her right cerebral hemisphere. Of the 98 children fatally injured by deployment of passenger air bags: • 69 were unrestrained or improperly restrained • 18 were in rear-facing child safety seats • 5 were in forward-facing child safety seats • 6 were wearing lap and shoulder belts Of the 69 adults, 63 were drivers and six were passengers. Only 18 of the drivers were belted, and 23 of the drivers and three of the passengers were 62 inches or less in height. When they do occur, and involve fatalities or severe injuries, they almost invariably result in a major lawsuit against the automobile manufacturer. Because of this, in any motor vehicle accident where there is a fire and a burned body is removed from the vehicle, a complete and thorough autopsy should be performed. This should involve examination of the neck, both anteriorly and posteriorly, especially if there are no evident traumatic injuries to explain death. The maximum carbon monoxide level was 15,100 ppm; the carbon dioxide level 122,000 ppm. In a similar experiment, the same type of car was burned, again with the fire started in the passenger compartment, but with the windows closed. It burned for less than 1 min before it went out, presumably because of lack of oxygen. The temperature rise away from the immediate vicinity of the fire was minimum (maximum of 30°C). At the time of flash- over, the temperature rose to 29ºC on the floor, 266°C at the driver’s head level and 603°C at the headliner. Motorcycle Accidents There is a classic line that goes, “Buy your son a motorcycle for his last birthday. An accident that might result in minor injuries with an automobile can result in death with a motorcycle. Individuals dying in motorcycle accidents typ- ically die of either head or neck injuries, with the former more common. If the individuals are not wearing protective clothing, and even when they are, there can be extensive confluent scrape-like abrasions as they slide across the pavement. An incision into this area typically reveals no underlying subcuta- neous hemorrhage, because these injuries are very superficial and limited to the skin (Figure 4.

Coleman College. 2019.