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A heart murmur is an abnormal sound that consists of a flow noise that is heard before, between, or after the lubb-dupp or that may mask the normal heart sounds. Narrowing of the mitral valve by scar formation or a congenital defect Mitral insufficiency: Valves of the heart and heart sounds 163 Hemodynamics The science of hemodynamics concerns the relation between blood flow, pressure, and resistance. The heart is a complicated pump, and its behavior is affected by a variety of physical and chemical factors. The blood vessels are multibranched, elastic conduits of continuously varying dimensions. The blood itself is a suspension of red and white corpuscles, platelets, and lipid globules suspended in a colloid solution of proteins. Despite these complicated factors, considerable insight may be gained from understanding the elementary principles of fluid mechanics as they pertain to simpler physical systems.

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No clinical evidence exists to definitively recommend the use of any neuroprotective pharmacologic agent, including steroids, in the treatment of acute spinal cord injury to improve functional recovery. Place an indwelling urinary catheter as part of the initial patient assessment unless contraindicated ii.

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The decision of need for surgery can only be made by an experienced spinal surgeon either orthopedic or neurosurgeon.

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