You're not meant to be focused on killing stuff. You don't need extra damage, bigger mags or negligible poison damage that just makes affected zeds harder to headshot. I'm sorry, but Medics who use the right side skills are a waste of space and should just switch to Commando or any other class (where you can just buy the 401 and have all the bonuses for it). Your main job and number one priority is to keep your team alive, so why would you not want to have the skills that let you do just that, and more? Up to Date, version 17.1: online, 2009.Combat Medic is completely counter-productive to the perk. ![]() "Neonatal circumcision: risks and benefits ". " Epidemiology of complications of male circumcision in Ibadan, Nigeria". " Male neonatal circumcision: indications, controversies, and complications". " Buried penis after newborn circumcision". " Revision of circumcision in children: report of 56 cases". " Complications of circumcision in Israel: a one year multicenter survey". ![]() " Lubrication of circumcision site for prevention of meatal stenosis in children younger than 2 years old". AAP, " Circumcision Policy Statement".Keeping the instrument used to remove adhesions in the plane of tissue between the glans and the foreskin and avoiding rubbing against the underside of the skin is one useful way to minimize edema. It should be noted that tissue edema puts increased stress on a crushed edge and can lead to oozing, so care should be taken during the procedure to minimize trauma of the sensitive foreskin. With both clamp devices (Gomco and Mogen), hemostasis is dependent on the adequacy of the crush injury. Of the three commonly used techniques (Gomco, Mogen, and Plastibell), the Plastibell has the lowest incidence of bleeding as the suture remains in place for a few days after the procedure. The most devestating reports of bleeding (leading to blood transfusion or death) during or after circumcision occur in boys who have underlying blood dyscrasias, so it is critical to inquire specifically about a family history of bleeding disorders before considering the procedure. Too aggressive measures can lead to necrosis of the fragile tissue and the creation of a urethrocutaneous fistula. Because of the close proximity of the urethra to the ventral surface of the penis, great care must be taken with any clamping or suturing in this area. In rare cases when the frenular artery is bleeding, pressure and gel foam may not be sufficient and a small "figure of eight" suture may be required. ![]() (Gelfoam ® is an absorbable gelatin sponge that promotes blood clot formation). At times, the addition of a Gelfoam ® wrap can speed clot formation and stop the cut edge from oozing. In many cases, bleeding can be controlled by applying direct pressure to the site for a minute or two. The expected blood loss during neonatal circumcision is just a few drops (easily handled with one 4 x 4 " gauze pad), so bleeding that exceeds this expectation is a complication.įortunately, almost all cases of bleeding with neonatal circumcision are very mild. Bleeding is the most commonly encountered complication of circumcision.
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