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In fluid mechanics , displacement occurs when an object is immersed in a fluid , pushing it out of the way and taking its place. The volume of the fluid displaced can then be measured, and from this, the volume of the immersed object can be deduced (the volume of the immersed object will be exactly equal to the volume of the displaced fluid).

An object that sinks displaces an amount of fluid equal to the object's volume. Thus buoyancy is expressed through Archimedes' principle , which states that the weight of the object is reduced by its volume multiplied by the density of the fluid. If the weight of the object is less than this displaced quantity, the object floats; if more, it sinks. The amount of fluid displaced is directly related (via Archimedes' Principle) to its volume.

In the case of an object that sinks (is totally submerged), the volume of the object is displaced. In the case of an object that floats, the amount of fluid displaced will be equal in weight to the displacing object.

Archimedes' principle, a physical law of buoyancy, states that any body completely or partially submerged in a fluid (gas or liquid) at rest is acted upon by an upward, or buoyant, force the magnitude of which is equal to the weight of the fluid displaced by the body. The volume of displaced fluid is equivalent to the volume of an object fully immersed in a fluid or to that fraction of the volume below the surface of an object partially submerged in a liquid. The weight of the displaced portion of the fluid is equivalent to the magnitude of the buoyant force. The buoyant force on a body floating in a liquid or gas is also equivalent in magnitude to the weight of the floating object and is opposite in direction; the object neither rises nor sinks. If the weight of an object is less than that of the displaced fluid, the object rises, as in the case of a block of wood that is released beneath the surface of water or a helium-filled balloon that is let loose in the air. An object heavier than the amount of the fluid it displaces, though it sinks when released, has an apparent weight loss equal to the weight of the fluid displaced. In fact, in some accurate weighing, a correction must be made in order to compensate for the buoyancy effect of the surrounding air. The buoyant force, which always opposes gravity, is nevertheless caused by gravity. Fluid pressure increases with depth because of the (gravitational) weight of the fluid above. This increasing pressure applies a force on a submerged object that increases with depth. The result is buoyancy. [1]

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Scott continued to follow commands intermittently (he stuck out his tongue on command and squeezed, grasped, and released his left hand). He was able to track the individuals in his environment. He exhibited increased flexor tone in his left upper extremity and increased extensor tone in his right upper extremity. His pupils were equal and reactive to light and, although he opened his eyes spontaneously, he made no attempts to speak. His GCS score was 11 (eye opening = 4, verbal responsiveness = 1, motor responsiveness = 6). The storming episodes appeared to have stabilized by this time, and Scott was transferred to a subacute rehabilitation facility on day 21 after injury.

At 7-month follow-up, Scott remained in the subacute facility. Neurological examination showed him to be alert with a flat affect, oriented times 4 with poor short-term memory and fluent speech. He followed commands and moved all 4 extremities (strength grade right 4/5; left 3/5; he remained wheelchair-dependent because of coordination deficits). Scott also exhibited a total homonymous hemianopic defect on the left side and a partial homonymous hemianopic defect on the right side. His score on the Glasgow Outcome Scale was 3 (conscious but disabled/dependent for daily support). No further storming episodes had been noted and current medications included methylphenidate, fluoxetine, and enoxaparin.

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Patients with sympathetic storming must be treated promptly. Intravenous medication can provide immediate control, although the effect is generally temporary, and dosing can be extreme, thus placing the individual at greater risk for respiratory depression. These patients already have significant cerebral compromise and must be treated promptly to ensure optimal recovery.

The onset of sympathetic storming should trigger the institution of scheduled enteric medications to provide continuous dampening of activity of the sympathetic nervous system. Multiple medications may be required, as well as a period of trial and error, before the correct medication(s) and/or dosages are determined. An effective starting point is the use of scheduled oxycodone, bromocriptine, and if hypertension is present, propranolol. If hypertension and other signs and symptoms do not improve, clonidine can be added or doses can be adjusted.

The ultimate goal is rapid control of the signs and symptoms of excess activity of the sympathetic nervous system to prevent the secondary complications of prolonged stress and to facilitate rehabilitation. Each case requires individual dosing based on signs and symptoms and response to the medication.

The nurse plays a vital role in the supportive care of patients with a severe traumatic injury and is a key player in the diagnosis and management of sympathetic storming (especially in the ICU). Initially the use of sedatives and narcotics for cerebral protection can prevent signs and symptoms of sympathetic storming, and the onset of episodes frequently coincides with weaning of patients off of these medications or with the discontinuation of these medications. The nurse can be instrumental in the coordination of intravenous and enteric medications, avoiding the adverse effects of sympathetic storming, and identifying triggers so that patients can be transferred to the general neurological ward.







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