By Michael Connelly
Harry Bosch is assigned a murder name in South L.A. that takes him to Fortune Liquors, the place the chinese language proprietor has been shot to demise in the back of the counter in an obvious robbery.
Joined by way of individuals of the department's Asian Crime Unit, Bosch relentlessly investigates the killing and shortly identifies a suspect, a l. a. member of a Hong Kong triad. yet ahead of Harry can shut in, he will get the observe that his younger daughter Maddie, who lives in Hong Kong along with her mom, is missing.
Bosch drops every little thing to trip around the Pacific to discover his daughter. might her disappearance and the case be hooked up? With the stakes of the research so excessive and so own, Bosch is up opposed to the clock in a brand new urban, the place not anything is at it sort of feels.
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Extra resources for 9 Dragons (Harry Bosch, Book 15)
Case Continued A short course of sodium nitroprusside brings the patient’s blood pressure below 140 mm Hg with a pulse rate of 68 bpm. He is restarted on his chronic betablocker, and discharged to home on postoperative day one. However, 48 hours 33 Case 7 postoperatively, he returns to the hospital, complaining of a severe unilateral right orbital and frontal headache, for which he receives acetaminophen without relief. Four hours later he vomits, then suffers a grand mal seizure. Differential Diagnosis Neurologic symptoms after a CEA may be driven by extracranial etiologies such as artery-to-artery thromboemboli (platelet-rich emboli from the surface of the endarterectomized artery) or complete thrombosis of the endarterectomized artery.
His peripheral upper extremity pulses are all palpable. A duplex ultrasound scan of the carotid arteries is recommended. ■ Carotid Duplex Ultrasound Scan Figure 6-1A Figure 6-1B Figure 6-1C 26 Case 6 Carotid Duplex Ultrasound Scan Report Right carotid scan: bulb and internal carotid artery (ICA) show evidence of heterogeneous plaque with 87% diameter stenosis. (Arrows denote extent of plaque on Fig. ) Figure 6-1B demonstrates plaque with color Doppler. ICA systolic velocity/end diastolic velocity: 338/149 cm/sec; 80% to 99% diameter stenosis (see Fig.
When these defects are identified, a decision must be made regarding the type of repair; if an obvious defect is detected and appears to be the cause of the thromboembolism, or platelet aggregation, local repair with tacking sutures or removal of residual plaque is indicated. If no obvious defect is detected, and platelet fibrin deposition is the presumed etiology, consideration must be given to replacing the proximal internal carotid artery with an interposition saphenous vein graft. In either situation, postoperative antiplatelet therapy with high-molecular-weight dextran and/or another oral antiplatelet agent is recommended.