This document discusses endovascular procedures for treating lower extremity vascular disease. It begins with an overview of basic endovascular techniques including pre-procedural evaluation and planning, selective angiography, and crossing lesions. It describes diagnostic imaging that can be used pre-procedurally including duplex ultrasound, ankle-brachial indices, CT angiography, and MRI angiography. Alternative contrast agents like carbon dioxide and gadolinium are also discussed. Troubleshooting tips provided include using hydrophilic wires and catheters when crossing bifurcations or lesions. The document provides guidance on technique, equipment, and strategies for performing endovascular interventions in the lower extremities.
This case report describes a late pseudoaneurysm that developed at the puncture site in a 30-year old male with systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APLA) who underwent coronary angiography. Two weeks after the procedure, an enlarging pulsatile bulge was detected at the puncture site. Ultrasound-guided thrombin injection resolved the pseudoaneurysm. The authors speculate that patients with chronic inflammatory diseases treated with anticoagulation and steroids may be predisposed to late pseudoaneurysm formation due to vessel wall weakness. Close follow-up is recommended for high-risk patients.
This document summarizes advances in imaging for ischemic stroke. It discusses the role of CT angiography (CTA) in detecting vessel occlusion and infarct core. Several major clinical trials demonstrated the benefits of endovascular therapy for certain patients. Guidelines now recommend endovascular treatment for those meeting specific criteria within 6 hours of onset. CT perfusion can identify penumbra and guide patient selection. While MRI is most accurate for core imaging, the time required may delay treatment. Faster door-to-treatment times are important to improve outcomes. Advanced imaging like CTA helps identify patients most likely to benefit from endovascular intervention.
Endovascular Management of DCI – Strategies for successDr Vipul Gupta
Vipul Gupta discusses strategies for managing delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH). Vasospasm, occurring 3-14 days post-bleed, is a major cause of DCI. The document outlines preventive measures including oral nimodipine and hydration. Therapeutic options discussed include HHH therapy, intravenous milrinone, and intra-arterial nimodipine and milrinone. The author's protocol involves early detection using monitoring, imaging, and angiography followed by HHH, IV milrinone, and intra-arterial dilatation if needed. Results show intra-arterial dilatation successfully improved perfusion in all
Blister aneurysms- Evolution of Endovascular management Dr Vipul Gupta
This document discusses blister aneurysms, which are rare lesions characterized by a hemispherical shape and fragile walls located in non-branching sites of arteries like the internal carotid artery. It notes that blister aneurysms are very small and atypical in location, making them difficult to treat surgically or with endovascular coiling. The document presents the author's experience using flow diverters like the Enterprise stent to treat 17 patients with blister aneurysms, finding a high rate of complete occlusion and no rebleeding or need for retreatment compared to other methods. It emphasizes the importance of detecting and recognizing small blister/dissecting aneurysms and having a careful antiplatelet protocol when using flow diverters in their
Stentectomy of detached Solitaire – Novel techniquesDr Vipul Gupta
This document describes two cases of stent retrieval (stentectomy) during mechanical thrombectomy procedures. In the first case, a detached stent was successfully retrieved using a "deploy and engage" technique with another stent. In the second case, a detached stent was retrieved using a "loop and snare" technique. The document also discusses the use of prasugrel and aspirin loading prior to flow diverter placement for an acutely ruptured aneurysm, with good occlusion results.
This document summarizes a panel discussion on endovascular stroke treatment techniques. It discusses various stent retriever devices for clot removal, such as Solitaire and Trevo. It also discusses direct aspiration techniques like ADAPT and ARTS (SOLUMBRA). The document then reviews case examples of endovascular procedures including recanalization times. It discusses considerations for antiplatelet protocols after stenting and issues around emergency carotid stenting. Overall, the document provides an overview of different endovascular stroke treatment options and techniques.
Acs0623 Endovascular Procedures For Renovascular Diseasemedbookonline
This document discusses endovascular procedures for renovascular disease. It covers technical considerations for contrast arteriography used to evaluate renal arteries, including patient preparation, arterial access routes, optimal imaging views, and findings associated with atherosclerotic disease and fibromuscular dysplasia. It also summarizes preoperative evaluation, operative planning including patient preparation, and correlation of angiographic findings with clinical information to guide treatment.
This document discusses various complications that can occur during neurointerventional procedures to treat cerebral aneurysms, along with their causes and management strategies. Some key complications mentioned include aneurysm rupture during the procedure, thromboembolic events, coil prolapse, and stent thrombosis. Risk factors and techniques to minimize complications are provided. The importance of early detection and appropriate management of complications is emphasized to prevent clinical sequelae.
This case report describes a late pseudoaneurysm that developed at the puncture site in a 30-year old male with systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APLA) who underwent coronary angiography. Two weeks after the procedure, an enlarging pulsatile bulge was detected at the puncture site. Ultrasound-guided thrombin injection resolved the pseudoaneurysm. The authors speculate that patients with chronic inflammatory diseases treated with anticoagulation and steroids may be predisposed to late pseudoaneurysm formation due to vessel wall weakness. Close follow-up is recommended for high-risk patients.
This document summarizes advances in imaging for ischemic stroke. It discusses the role of CT angiography (CTA) in detecting vessel occlusion and infarct core. Several major clinical trials demonstrated the benefits of endovascular therapy for certain patients. Guidelines now recommend endovascular treatment for those meeting specific criteria within 6 hours of onset. CT perfusion can identify penumbra and guide patient selection. While MRI is most accurate for core imaging, the time required may delay treatment. Faster door-to-treatment times are important to improve outcomes. Advanced imaging like CTA helps identify patients most likely to benefit from endovascular intervention.
Endovascular Management of DCI – Strategies for successDr Vipul Gupta
Vipul Gupta discusses strategies for managing delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH). Vasospasm, occurring 3-14 days post-bleed, is a major cause of DCI. The document outlines preventive measures including oral nimodipine and hydration. Therapeutic options discussed include HHH therapy, intravenous milrinone, and intra-arterial nimodipine and milrinone. The author's protocol involves early detection using monitoring, imaging, and angiography followed by HHH, IV milrinone, and intra-arterial dilatation if needed. Results show intra-arterial dilatation successfully improved perfusion in all
Blister aneurysms- Evolution of Endovascular management Dr Vipul Gupta
This document discusses blister aneurysms, which are rare lesions characterized by a hemispherical shape and fragile walls located in non-branching sites of arteries like the internal carotid artery. It notes that blister aneurysms are very small and atypical in location, making them difficult to treat surgically or with endovascular coiling. The document presents the author's experience using flow diverters like the Enterprise stent to treat 17 patients with blister aneurysms, finding a high rate of complete occlusion and no rebleeding or need for retreatment compared to other methods. It emphasizes the importance of detecting and recognizing small blister/dissecting aneurysms and having a careful antiplatelet protocol when using flow diverters in their
Stentectomy of detached Solitaire – Novel techniquesDr Vipul Gupta
This document describes two cases of stent retrieval (stentectomy) during mechanical thrombectomy procedures. In the first case, a detached stent was successfully retrieved using a "deploy and engage" technique with another stent. In the second case, a detached stent was retrieved using a "loop and snare" technique. The document also discusses the use of prasugrel and aspirin loading prior to flow diverter placement for an acutely ruptured aneurysm, with good occlusion results.
This document summarizes a panel discussion on endovascular stroke treatment techniques. It discusses various stent retriever devices for clot removal, such as Solitaire and Trevo. It also discusses direct aspiration techniques like ADAPT and ARTS (SOLUMBRA). The document then reviews case examples of endovascular procedures including recanalization times. It discusses considerations for antiplatelet protocols after stenting and issues around emergency carotid stenting. Overall, the document provides an overview of different endovascular stroke treatment options and techniques.
Acs0623 Endovascular Procedures For Renovascular Diseasemedbookonline
This document discusses endovascular procedures for renovascular disease. It covers technical considerations for contrast arteriography used to evaluate renal arteries, including patient preparation, arterial access routes, optimal imaging views, and findings associated with atherosclerotic disease and fibromuscular dysplasia. It also summarizes preoperative evaluation, operative planning including patient preparation, and correlation of angiographic findings with clinical information to guide treatment.
This document discusses various complications that can occur during neurointerventional procedures to treat cerebral aneurysms, along with their causes and management strategies. Some key complications mentioned include aneurysm rupture during the procedure, thromboembolic events, coil prolapse, and stent thrombosis. Risk factors and techniques to minimize complications are provided. The importance of early detection and appropriate management of complications is emphasized to prevent clinical sequelae.
Retrograde access to seal a large coronary perforationRamachandra Barik
The sealing of a large vessel coronary perforation during percutaneous coronary intervention typically requires the
deployment of 1 or more covered stents. A novel approach to seal a life-threatening perforation caused by unnoticed
wire-exit and balloon dilation, utilizing retrograde techniques, without a covered-stent is described.
Push and Puff Technique for Mechanical ThrombectomyDr Vipul Gupta
This document describes the push and puff technique for mechanical thrombectomy and one physician's experience using this technique with the Solitaire stent retriever. It summarizes a case study of a 65-year-old female patient who presented with left-sided weakness and was found to have a right terminal ICA occlusion that was successfully treated with mechanical thrombectomy using the push and puff technique. The physician's early experience using this technique with the Solitaire device in 7 patients demonstrated a 100% first pass reperfusion rate and modified TICI 3 reperfusion in 85% of patients. Commonly encountered challenges after stent retrieval included vessel spasm and residual thrombus. The conclusion is that the push and puff technique appears very promising for improving outcomes
A technical modification of carotid endarterectomy experience with 400 pati...uvcd
This document discusses techniques for carotid endarterectomy based on the experience of 400 patients. It finds that eversion carotid endarterectomy had a lower restenosis rate of 1.7% compared to 9.3% for primary closure and 6.5% for patch angioplasty. Additionally, eversion carotid endarterectomy had a faster mean operative time of 31 minutes compared to 39 minutes for primary closure and 46 minutes for patch angioplasty. Finally, a study of over 1,900 carotid endarterectomies found primary closure was associated with significantly higher risks of perioperative stroke at 5.6% and stroke or death at 6.0% compared to 2.2-2.5% for
07 stemi treatment in areas remote from primary pci centresNPSAIC
1) In remote areas far from PCI centers, it is impossible to perform PCI within recommended time limits. For these patients, fibrinolysis should be the primary reperfusion treatment.
2) Following fibrinolysis, patients should be transferred to a PCI center as soon as possible for rescue PCI or routine angiography and PCI if needed. Recent trials suggest performing routine angiography 2-12 hours after fibrinolysis.
3) A well-organized STEMI network is needed to identify patients for on-site fibrinolysis or transfer for PCI, ensure therapies are available 24/7, and allow early transfer after fibrinolysis. Such networks can improve outcomes by minimizing treatment delays.
This document discusses treatment options for middle cerebral artery (MCA) aneurysms, specifically clipping versus coiling. It provides data from multiple studies showing improved outcomes with coiling compared to clipping, including lower rates of poor outcome, complications, and rebleeding. The document also reviews new endovascular devices that have increased the feasibility of coiling for more complex MCA aneurysms. It concludes that while both treatments are reasonable options, coiling is now generally preferred for MCA aneurysms due to improved outcomes demonstrated in clinical trials and registry data.
The field of transcatheter mitral valve repair (TMVr) for
mitral regurgitation (MR) is rapidly evolving. Besides the
well-established transcatheter mitral edge-to-edge repair
approach, there is also growing evidence for therapeutic
strategies targeting the mitral annulus and mitral valve
chordae. A patient-tailored approach, careful patient
selection and an experienced interventional team is crucial
in order to optimise procedural and clinical outcomes. With
further data from ongoing clinical trials to be expected,
consensus in the Heart Team is needed to address these
complexities and determine the most appropriate TMVr
therapy, either single or combined, for patients with severe
MR
Carotid artery disease is a major cause of stroke. Left untreated, carotid stenosis over 75% carries a risk of stroke of 2-5% per year. Carotid endarterectomy has been shown in clinical trials such as NASCET and ACAS to significantly reduce stroke risk compared to medical management alone, with perioperative stroke or death rates of less than 6% for symptomatic patients and 3% for asymptomatic patients. Carotid artery stenting is an alternative treatment that utilizes embolic protection devices and stent placement to treat carotid stenosis, but requires technical expertise to achieve outcomes comparable to surgery.
Hybrid tevar for the treatment of aortic dissectionuvcd
- Hybrid TEVAR involves using open surgery and endovascular stent grafting to treat aortic dissection.
- It can be used for acute type A dissection to allow total arch repair followed by TEVAR for the descending thoracic aorta. It is also indicated for chronic type B dissection when there is no suitable proximal landing zone by creating one through open surgery.
- The author presents results from their hospital demonstrating the safety and effectiveness of hybrid TEVAR for both acute type A and chronic type B dissection, with favorable outcomes including high rates of false lumen thrombosis and regression.
This document summarizes a presentation on whether early surgery improves outcomes for patients with poor-grade aneurysmal subarachnoid haemorrhage compared to delayed surgery. No randomized controlled trials have evaluated this question directly. The presentation reviews several observational studies that found early surgery (within 24 hours) was associated with mortality rates around 30% and favorable outcome rates around 50% for poor-grade patients. While the evidence is limited, indirect comparisons across studies suggest early surgery may reduce risks of rebleeding compared to delayed surgery, though individual patient factors still need consideration.
Valsalva manoeuvre in drug refractory ventricular tachycardiaRamachandra Barik
Ventricular tachycardia (VT) is a cardiac emergency exerting significant morbidity and mortality. Differentiation between VT and supraventricular tachycardia with aberrancy (SVT-A) can be challenging,necessitating awareness of the salient lectrocardiogram (ECG)criteria1 and at times, proven refractoriness to adenosine. Despite well-established guidelines and evidence-based anti-arrhythmic medications for VT management, the role of Valsalva manoeuvre (VM) as
an effective treatment for VT remains controversial.2,3 In this case report, we describe a patient who presented with multiple
drug-refractory VTs, one of which repeatedly terminated by VM.
Management of aaa clinical practice guidelines of the esvsuvcd
This document provides guidelines for the management of abdominal aortic aneurysms (AAA). It includes 130 recommendations across 7 chapters covering topics such as screening, decision-making for repair, pre- and post-operative imaging, management of ruptured and non-ruptured AAAs, and follow-up after repair. The guidelines are based on a systematic review of the literature and aim to standardize care and improve outcomes for AAA patients across Europe.
This case report describes the resection of a large carotid artery aneurysm under cervical epidural anesthesia in a 22-year-old woman. Cervical blockade was not possible due to the location and size of the aneurysm. The patient underwent cervical epidural anesthesia, which allowed for continuous neurological monitoring during the surgery and early detection of any brain ischemia when the carotid artery was clamped. The large aneurysm was successfully resected over the course of a two hour surgery. The patient recovered well with no neurological defects. The report concludes that cervical epidural anesthesia performed by an experienced anesthetist provides safe neurological monitoring and is an acceptable approach for resecting carotid artery aneurysms when other methods are not possible.
A sixty five year old female presented at five hours after symptom onset with a NIHSS score of 22. Imaging showed a right middle cerebral artery occlusion. The patient underwent mechanical thrombectomy using a stent retriever. Follow up imaging showed reperfusion of the previously occluded vessel and the patient was discharged with mild residual aphasia and a modified Rankin score of 2. Factors such as rapid triage protocols, minimizing delays from imaging to treatment, and standardized approaches can help reduce time to recanalization and improve outcomes in acute ischemic stroke.
Post Myocardial infarction vsd repair by infarct exclusion techniqueJyotindra Singh
This case study examines outcomes of 26 patients who underwent surgical repair of a post-myocardial infarction ventricular septal defect (PMIVSD) over a 15-year period. 20 patients underwent defect closure with concomitant coronary artery bypass grafting (CABG), while 6 had defect closure alone. In-hospital mortality was 30.9%, with higher mortality seen in those with cardiogenic shock, posterior defects, and surgery over 3 weeks after infarction. 15 of the 20 patients who had CABG survived, compared to 3 of the 6 who had defect closure alone. Residual shunts occurred in 5 patients but did not require reoperation. Predictors of poor prognosis included cardiogenic shock, timing of surgery, and total
Anestesia para px con aneurisma (colocación de stent)kiria5
This document discusses anesthesia considerations for patients undergoing endovascular stenting for aortic aneurysms. Endovascular stenting carries less risk than open surgery by avoiding aortic dissection, blood loss, and fluid shifts. However, long term outcomes remain uncertain compared to open surgery. Anesthesia aims to properly place the stent graft to seal tears, decompress false lumens, and reduce rupture risk while monitoring for complications. Transesophageal echocardiography is used to guide the procedure and ensure exclusion of lesions. Care is taken to exclude initial intimal tears in dissections. Endovascular stenting is generally preferred over open surgery for patients with multiple comorbidities.
This document discusses indications and techniques for carotid artery stenting (CAS). It notes that symptomatic stenosis over 70% on non-invasive imaging or over 50% on catheter angiography are indications for revascularization. Asymptomatic stenosis over 70% may also be treated if life expectancy is over 5 years and stenosis is over 80%. The technique involves pre- and post-dilation of stents with the use of protection devices to prevent embolic strokes. Results depend on the operator's experience and complications include strokes, hypotension, and restenosis. Larger trials found CAS and CEA to have similar outcomes, with CAS preferred for younger patients, though CEA is preferred in certain high risk cases.
Mechanical thrombectomy devices show some advantages for treating deep vein thrombosis (DVT) but have limitations as standalone therapies. When used in combination with thrombolytics, mechanical thrombectomy can speed lysis, potentially reduce lytic doses and treatment time, and allow treatment of patients who cannot receive thrombolytics. However, data on their long-term safety and efficacy compared to thrombolysis alone is still limited. Standalone mechanical thrombectomy often provides only partial clot removal for DVT.
The document discusses carotid artery disease and treatment options such as carotid angioplasty and stenting. It notes that stroke is a major cause of death and disability in the US. Carotid artery stenosis over 75% poses a high risk of stroke without treatment. Newer techniques like carotid stenting aim to achieve low stroke/death rates of less than 6% for symptomatic patients and 3% for asymptomatic patients. Success requires choosing the right tools, techniques, and protection devices tailored to each patient's anatomy and plaque characteristics. Ongoing studies evaluate newer neuroprotection systems to further reduce embolic risks of carotid stenting.
This document provides an overview of non-operating room anesthesia (NORA) and discusses various related topics. It begins with objectives for the presentation, which include comparing NORA to anesthesia inside the OR, reviewing NORA procedures and considerations, understanding different stroke types and treatments, and discussing anesthesia options for stroke patients. The document then discusses various NORA locations, indications for anesthesia support, considerations for NORA, and risks associated with remote locations. Specific imaging modalities like MRI, CT, and interventional radiology are reviewed. Guidelines for contrast allergy are presented. Finally, anesthesia implications for stroke and endovascular treatment are discussed.
This document discusses interventions for acute ischemic stroke. It summarizes that intra-arterial recanalization can provide good outcomes when performed by experts in high-volume centers. Recent trials show stent retrievers like Solitaire provide high recanalization rates of 80-90% compared to older devices like MERCI. However, case selection using imaging of penumbra is important, and speed of treatment is crucial, as delays can reduce chances of independence. Ongoing randomized trials continue to refine techniques and selection criteria for endovascular stroke interventions.
This document outlines the lesson distribution and schedule for periods 1 through 7 at a school. It shows that subjects like Math, English, Science, and Thai are taught 3-4 periods per week. It also lists enrichment activities, technology resources, exams, and special events at the school like field trips, sports day, and activities with parents.
Retrograde access to seal a large coronary perforationRamachandra Barik
The sealing of a large vessel coronary perforation during percutaneous coronary intervention typically requires the
deployment of 1 or more covered stents. A novel approach to seal a life-threatening perforation caused by unnoticed
wire-exit and balloon dilation, utilizing retrograde techniques, without a covered-stent is described.
Push and Puff Technique for Mechanical ThrombectomyDr Vipul Gupta
This document describes the push and puff technique for mechanical thrombectomy and one physician's experience using this technique with the Solitaire stent retriever. It summarizes a case study of a 65-year-old female patient who presented with left-sided weakness and was found to have a right terminal ICA occlusion that was successfully treated with mechanical thrombectomy using the push and puff technique. The physician's early experience using this technique with the Solitaire device in 7 patients demonstrated a 100% first pass reperfusion rate and modified TICI 3 reperfusion in 85% of patients. Commonly encountered challenges after stent retrieval included vessel spasm and residual thrombus. The conclusion is that the push and puff technique appears very promising for improving outcomes
A technical modification of carotid endarterectomy experience with 400 pati...uvcd
This document discusses techniques for carotid endarterectomy based on the experience of 400 patients. It finds that eversion carotid endarterectomy had a lower restenosis rate of 1.7% compared to 9.3% for primary closure and 6.5% for patch angioplasty. Additionally, eversion carotid endarterectomy had a faster mean operative time of 31 minutes compared to 39 minutes for primary closure and 46 minutes for patch angioplasty. Finally, a study of over 1,900 carotid endarterectomies found primary closure was associated with significantly higher risks of perioperative stroke at 5.6% and stroke or death at 6.0% compared to 2.2-2.5% for
07 stemi treatment in areas remote from primary pci centresNPSAIC
1) In remote areas far from PCI centers, it is impossible to perform PCI within recommended time limits. For these patients, fibrinolysis should be the primary reperfusion treatment.
2) Following fibrinolysis, patients should be transferred to a PCI center as soon as possible for rescue PCI or routine angiography and PCI if needed. Recent trials suggest performing routine angiography 2-12 hours after fibrinolysis.
3) A well-organized STEMI network is needed to identify patients for on-site fibrinolysis or transfer for PCI, ensure therapies are available 24/7, and allow early transfer after fibrinolysis. Such networks can improve outcomes by minimizing treatment delays.
This document discusses treatment options for middle cerebral artery (MCA) aneurysms, specifically clipping versus coiling. It provides data from multiple studies showing improved outcomes with coiling compared to clipping, including lower rates of poor outcome, complications, and rebleeding. The document also reviews new endovascular devices that have increased the feasibility of coiling for more complex MCA aneurysms. It concludes that while both treatments are reasonable options, coiling is now generally preferred for MCA aneurysms due to improved outcomes demonstrated in clinical trials and registry data.
The field of transcatheter mitral valve repair (TMVr) for
mitral regurgitation (MR) is rapidly evolving. Besides the
well-established transcatheter mitral edge-to-edge repair
approach, there is also growing evidence for therapeutic
strategies targeting the mitral annulus and mitral valve
chordae. A patient-tailored approach, careful patient
selection and an experienced interventional team is crucial
in order to optimise procedural and clinical outcomes. With
further data from ongoing clinical trials to be expected,
consensus in the Heart Team is needed to address these
complexities and determine the most appropriate TMVr
therapy, either single or combined, for patients with severe
MR
Carotid artery disease is a major cause of stroke. Left untreated, carotid stenosis over 75% carries a risk of stroke of 2-5% per year. Carotid endarterectomy has been shown in clinical trials such as NASCET and ACAS to significantly reduce stroke risk compared to medical management alone, with perioperative stroke or death rates of less than 6% for symptomatic patients and 3% for asymptomatic patients. Carotid artery stenting is an alternative treatment that utilizes embolic protection devices and stent placement to treat carotid stenosis, but requires technical expertise to achieve outcomes comparable to surgery.
Hybrid tevar for the treatment of aortic dissectionuvcd
- Hybrid TEVAR involves using open surgery and endovascular stent grafting to treat aortic dissection.
- It can be used for acute type A dissection to allow total arch repair followed by TEVAR for the descending thoracic aorta. It is also indicated for chronic type B dissection when there is no suitable proximal landing zone by creating one through open surgery.
- The author presents results from their hospital demonstrating the safety and effectiveness of hybrid TEVAR for both acute type A and chronic type B dissection, with favorable outcomes including high rates of false lumen thrombosis and regression.
This document summarizes a presentation on whether early surgery improves outcomes for patients with poor-grade aneurysmal subarachnoid haemorrhage compared to delayed surgery. No randomized controlled trials have evaluated this question directly. The presentation reviews several observational studies that found early surgery (within 24 hours) was associated with mortality rates around 30% and favorable outcome rates around 50% for poor-grade patients. While the evidence is limited, indirect comparisons across studies suggest early surgery may reduce risks of rebleeding compared to delayed surgery, though individual patient factors still need consideration.
Valsalva manoeuvre in drug refractory ventricular tachycardiaRamachandra Barik
Ventricular tachycardia (VT) is a cardiac emergency exerting significant morbidity and mortality. Differentiation between VT and supraventricular tachycardia with aberrancy (SVT-A) can be challenging,necessitating awareness of the salient lectrocardiogram (ECG)criteria1 and at times, proven refractoriness to adenosine. Despite well-established guidelines and evidence-based anti-arrhythmic medications for VT management, the role of Valsalva manoeuvre (VM) as
an effective treatment for VT remains controversial.2,3 In this case report, we describe a patient who presented with multiple
drug-refractory VTs, one of which repeatedly terminated by VM.
Management of aaa clinical practice guidelines of the esvsuvcd
This document provides guidelines for the management of abdominal aortic aneurysms (AAA). It includes 130 recommendations across 7 chapters covering topics such as screening, decision-making for repair, pre- and post-operative imaging, management of ruptured and non-ruptured AAAs, and follow-up after repair. The guidelines are based on a systematic review of the literature and aim to standardize care and improve outcomes for AAA patients across Europe.
This case report describes the resection of a large carotid artery aneurysm under cervical epidural anesthesia in a 22-year-old woman. Cervical blockade was not possible due to the location and size of the aneurysm. The patient underwent cervical epidural anesthesia, which allowed for continuous neurological monitoring during the surgery and early detection of any brain ischemia when the carotid artery was clamped. The large aneurysm was successfully resected over the course of a two hour surgery. The patient recovered well with no neurological defects. The report concludes that cervical epidural anesthesia performed by an experienced anesthetist provides safe neurological monitoring and is an acceptable approach for resecting carotid artery aneurysms when other methods are not possible.
A sixty five year old female presented at five hours after symptom onset with a NIHSS score of 22. Imaging showed a right middle cerebral artery occlusion. The patient underwent mechanical thrombectomy using a stent retriever. Follow up imaging showed reperfusion of the previously occluded vessel and the patient was discharged with mild residual aphasia and a modified Rankin score of 2. Factors such as rapid triage protocols, minimizing delays from imaging to treatment, and standardized approaches can help reduce time to recanalization and improve outcomes in acute ischemic stroke.
Post Myocardial infarction vsd repair by infarct exclusion techniqueJyotindra Singh
This case study examines outcomes of 26 patients who underwent surgical repair of a post-myocardial infarction ventricular septal defect (PMIVSD) over a 15-year period. 20 patients underwent defect closure with concomitant coronary artery bypass grafting (CABG), while 6 had defect closure alone. In-hospital mortality was 30.9%, with higher mortality seen in those with cardiogenic shock, posterior defects, and surgery over 3 weeks after infarction. 15 of the 20 patients who had CABG survived, compared to 3 of the 6 who had defect closure alone. Residual shunts occurred in 5 patients but did not require reoperation. Predictors of poor prognosis included cardiogenic shock, timing of surgery, and total
Anestesia para px con aneurisma (colocación de stent)kiria5
This document discusses anesthesia considerations for patients undergoing endovascular stenting for aortic aneurysms. Endovascular stenting carries less risk than open surgery by avoiding aortic dissection, blood loss, and fluid shifts. However, long term outcomes remain uncertain compared to open surgery. Anesthesia aims to properly place the stent graft to seal tears, decompress false lumens, and reduce rupture risk while monitoring for complications. Transesophageal echocardiography is used to guide the procedure and ensure exclusion of lesions. Care is taken to exclude initial intimal tears in dissections. Endovascular stenting is generally preferred over open surgery for patients with multiple comorbidities.
This document discusses indications and techniques for carotid artery stenting (CAS). It notes that symptomatic stenosis over 70% on non-invasive imaging or over 50% on catheter angiography are indications for revascularization. Asymptomatic stenosis over 70% may also be treated if life expectancy is over 5 years and stenosis is over 80%. The technique involves pre- and post-dilation of stents with the use of protection devices to prevent embolic strokes. Results depend on the operator's experience and complications include strokes, hypotension, and restenosis. Larger trials found CAS and CEA to have similar outcomes, with CAS preferred for younger patients, though CEA is preferred in certain high risk cases.
Mechanical thrombectomy devices show some advantages for treating deep vein thrombosis (DVT) but have limitations as standalone therapies. When used in combination with thrombolytics, mechanical thrombectomy can speed lysis, potentially reduce lytic doses and treatment time, and allow treatment of patients who cannot receive thrombolytics. However, data on their long-term safety and efficacy compared to thrombolysis alone is still limited. Standalone mechanical thrombectomy often provides only partial clot removal for DVT.
The document discusses carotid artery disease and treatment options such as carotid angioplasty and stenting. It notes that stroke is a major cause of death and disability in the US. Carotid artery stenosis over 75% poses a high risk of stroke without treatment. Newer techniques like carotid stenting aim to achieve low stroke/death rates of less than 6% for symptomatic patients and 3% for asymptomatic patients. Success requires choosing the right tools, techniques, and protection devices tailored to each patient's anatomy and plaque characteristics. Ongoing studies evaluate newer neuroprotection systems to further reduce embolic risks of carotid stenting.
This document provides an overview of non-operating room anesthesia (NORA) and discusses various related topics. It begins with objectives for the presentation, which include comparing NORA to anesthesia inside the OR, reviewing NORA procedures and considerations, understanding different stroke types and treatments, and discussing anesthesia options for stroke patients. The document then discusses various NORA locations, indications for anesthesia support, considerations for NORA, and risks associated with remote locations. Specific imaging modalities like MRI, CT, and interventional radiology are reviewed. Guidelines for contrast allergy are presented. Finally, anesthesia implications for stroke and endovascular treatment are discussed.
This document discusses interventions for acute ischemic stroke. It summarizes that intra-arterial recanalization can provide good outcomes when performed by experts in high-volume centers. Recent trials show stent retrievers like Solitaire provide high recanalization rates of 80-90% compared to older devices like MERCI. However, case selection using imaging of penumbra is important, and speed of treatment is crucial, as delays can reduce chances of independence. Ongoing randomized trials continue to refine techniques and selection criteria for endovascular stroke interventions.
This document outlines the lesson distribution and schedule for periods 1 through 7 at a school. It shows that subjects like Math, English, Science, and Thai are taught 3-4 periods per week. It also lists enrichment activities, technology resources, exams, and special events at the school like field trips, sports day, and activities with parents.
This report provides a detailed analysis of the global catheter market, including different types of catheters used for cardiovascular, urological, intravenous, and other applications. It discusses key disease conditions driving catheter usage, trends in the overall medical device industry, and projections for catheter sales by region through 2018. The report also profiles major companies in the catheter market and their product portfolios.
Shock refers to a life-threatening condition where there is failure to deliver adequate oxygen to tissues. The main causes of shock discussed in the document are hypovolemic, cardiogenic, distributive, and obstructive shock. Shock causes issues at the cellular level by inhibiting mitochondria and disrupting the Krebs cycle, which leads to a buildup of lactic acid. Clinically, shock presents with signs of decreased perfusion like tachycardia, low blood pressure, decreased urine output, and lactic acidosis. Treatment involves rapid fluid resuscitation, vasopressors, mechanical ventilation, and reversing acidosis in order to restore adequate tissue oxygen delivery. Specific causes of shock like hemorrhage
The document identifies and ranks the 50 best companies to sell for based on a survey of sales executives. Heartland Payment Systems and SunGard tied for the top spot based on their performance in customer growth and retention, hiring and compensation of salespeople, and company reputation. The rankings provide a list for salespeople to consider when looking for new sales roles or entering the sales profession.
The National Corporate Sponsorship Program was established to develop formal alliances that involve Corporate America more closely with BDPA programs, activities and goals. Corporate sponsors not only offer financial support but also participate in programs developed to enhance the technical and professional skills of the community. The investment in BDPA creates positive exposure to a technically diverse membership of African-American Information Technology professionals and students.
The program is designed to offer corporations an opportunity to partner with BDPA to meet corporate goals and objectives for recruiting, employee development, philanthropic endeavors and enhanced image in the African American Community. The program is open to all corporations with a sincere interest in pursuing the vision, mission, objectives and goals of BDPA.
The conceptual and fundamental scope of the program is to:
• Link BDPA strategic initiatives to the objectives of the corporation
• Document mutual understanding, measurements and goals
• Develop plans, assign resources and confirm milestones for viewing progress toward the goals
• Provide a forum to interact with other IT and HR industry leaders and professionals
• Increase exposure opportunities to technically competent and diverse IT professionals and students
• Enhance loyalty in the corporation amongst employees and customers
In order to pull together all the components of a successful program, BDPA partners with corporations, associations and other strategic alliance partners, but by far, corporate support is a major component of BDPA’s success. Sponsoring levels available are listed below and opportunities are detailed in our comprehensive corporate sponsorship portfolio. (2013 Corporate Opportunities Portfolio.pdf)
• Platinum Corporate Sponsor $100,000+
• Gold Corporate Sponsor $50,000+
• Silver Corporate Sponsor $25,000+
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This document provides instructions for operating the LifeCare PCA PLUS II infusion pump system. It describes the components of the pump, how to program it for intravenous or epidural drug delivery, how to start and stop infusions, and how to handle alarms, messages, battery use and cleaning. Programming options include setting a loading dose, PCA dose, lockout interval, continuous flow rate and 4 hour dose limit.
Glucerna SR is a complete and balanced nutritional powder for people with diabetes. It helps optimize glucose control. It provides all recommended macronutrients and micronutrients for diabetics, including a slow release complex carbohydrate blend to help control blood sugar levels. Glucerna SR also contains myo-inositol to help delay long-term diabetic complications. It is recommended to help meet nutritional goals in diabetes and is available in a 400g vanilla flavored tin pack.
Lydia Rabinovich has over 30 years of experience in document control, training coordination, quality assurance, and electrical engineering. She has worked at Abbott Laboratories since 2007 as a Document Control Specialist and previously as a Professional Support/Project Manager Assistant. Prior to that, she held roles as a Record Administrator/Training Coordinator at Abbott Laboratories and worked in electrical engineering, research, and academia in Kazakhstan and Russia.
Diagnostic electrophysiology (ep) catheters global trends, estimates and fo...Research Hub
The document summarizes a report on the global diagnostic electrophysiology catheters market. Some key points:
- The global market is projected to reach $3.5 billion by 2016, with North America and Europe currently accounting for over 60% of the market. Asia-Pacific is the fastest growing region.
- Conventional EP diagnostic catheters have over 40% of the global market share currently.
- The report analyzes the market size, trends, growth rates, investment opportunities, and major players in the diagnostic electrophysiology catheters industry from 2012-2018. It provides a detailed segmentation of the market by region and product type.
El documento contiene una serie de frases y oraciones cortas sobre diversos temas, incluyendo fotografías, viajes, comida, bebidas alcohólicas, partes del cuerpo y personas. Finaliza abruptamente sin contexto que una las ideas.
SPOTLIGHT ON THE PREMIUM CHANNEL - Abbott Medical OpticsHealthegy
Presentation from OIS@ASCRS 2016
Leonard Borrmann, Divisional VP, R&D
Video Presentation:
https://www.youtube.com/watch?v=02VOUB17Xp8&list=PL1dmdBNnPTZJBhQxPOp0vdNg3s3wtN2yw&index=38
This document is Vascular Solutions' 10-Q filing for the quarter ended March 31, 2009. It includes:
1) Consolidated balance sheets showing total assets of $44.9 million as of March 31, 2009 including $8.1 million in cash and $30.9 million in current assets. Total liabilities were $6.7 million in current liabilities.
2) Consolidated statements of operations showing revenue increased to $15.8 million for the quarter including $15.4 million in product revenue. Cost of goods sold was $5.2 million and net loss was $939,000.
3) Notes to the unaudited consolidated financial statements providing additional details
This document discusses infrainguinal arterial procedures, focusing on femoropopliteal bypass surgery. It begins with an overview of preoperative testing and imaging, including duplex scanning, MRI angiography, CT angiography, and conventional angiography. The key steps of an above-the-knee femoropopliteal bypass are then described in detail, including harvesting the great saphenous vein, exposing the femoral artery, and exposing the popliteal artery distally. The bypass is performed by anastomosing the vein graft proximally to the femoral artery and distally to the popliteal artery above the knee. Precise surgical technique is important for successful bypass outcomes.
This document discusses complications that can occur during percutaneous coronary intervention (PCI), specifically contrast-induced nephropathy and coronary perforation. It defines contrast-induced nephropathy as acute kidney injury occurring after administration of radiocontrast media. Coronary perforation is defined as extravasation of contrast or blood from the coronary artery during or after PCI. The document discusses risk factors, prevention, diagnosis and management of these complications.
Acs0613 Surgical Treatment Of The Infected Aortic Graftmedbookonline
This document discusses surgical treatment options for infected aortic grafts. The primary goal is to remove all infected material while maintaining adequate circulation. Options include extra-anatomic bypass, aortic allografts, antibiotic-treated prosthetic grafts, and in situ replacement with a femoral-popliteal vein graft. The preferred method is in situ replacement with an autogenous femoral-popliteal vein graft due to its excellent long-term patency and resistance to reinfection. The procedure involves harvesting the vein, controlling the femoral vessels, removing the infected graft, and reconstructing with the vein graft. Meticulous technique is required to minimize complications.
This document discusses endovascular interventions for infrapopliteal peripheral vascular disease. Infrapopliteal disease is rising due to an aging population and increased rates of diabetes and kidney disease. Surgical and early endovascular interventions historically had high failure rates in this region. Endovascular procedures now provide an alternative to bypass surgery for treating critical limb ischemia in the infrapopliteal arteries, with the goal of establishing straight line blood flow to the foot. Success depends on factors like number of vessels opened, inflow status, and addressing more proximal disease first when needed. Complications can include access issues, vessel spasm or perforation, embolism, and contrast nephropathy.
This document provides guidelines for myocardial perfusion imaging (MPI), including:
1. MPI utilizes radiopharmaceuticals and imaging techniques to identify areas of reduced myocardial blood flow associated with ischemia or scar.
2. Common indications for MPI are to assess for presence, location, and severity of perfusion abnormalities, determine significance of angiographic findings, and detect viable ischemic myocardium.
3. Common clinical settings are for known or suspected coronary artery disease, follow-up of patients with known CAD, and known or suspected congestive heart failure.
This document provides guidelines for myocardial perfusion imaging (MPI), including:
1. MPI utilizes radiopharmaceuticals and imaging techniques to identify areas of reduced blood flow in the heart associated with ischemia or scar.
2. Common indications for MPI are to assess for presence, location, and severity of perfusion abnormalities; determine significance of angiographic findings; and detect viable ischemic myocardium.
3. Common clinical settings are for known or suspected coronary artery disease, follow-up of patients with known CAD, and evaluation of congestive heart failure.
This document discusses various interventional therapies for resistant hypertension and renal artery stenosis, including renal sympathetic nerve ablation (RDN), baroreceptor activation therapy (BAT), and arteriovenous shunt creation. It provides details on techniques such as radiofrequency ablation and ultrasound ablation for RDN. It outlines trial results showing reductions in blood pressure from RDN, BAT, and arteriovenous shunts. It also discusses limitations of renal artery stenting based on recent trials. In summary, the document reviews novel interventional approaches for treating difficult cases of high blood pressure.
Global Hospitals’ Advanced Heart, Lung & Vascular Institute provides all kinds of endovascular procedures including coronary intervention and peripheral intervention, heart surgery, heart bypass surgery as well as heart transplantation surgery in Hyderabad, Chennai, and Bangalore
This document summarizes the results of a study evaluating the efficacy of an approach to minimize warm ischemia time during robotic-assisted partial nephrectomy (RAPN).
The study retrospectively analyzed 48 patients who underwent RAPN by a single surgeon using a technique of over-sewing the resection bed and performing a single running suture renorrhaphy using a V-loc suture in a sliding hem-o-lok fashion. The median warm ischemia time was 14 minutes. There were no conversions to open surgery or increased risks of bleeding or urine leak. The authors concluded that this single suture renorrhaphy technique is helpful for shortening warm ischemia time during RAPN.
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This document summarizes a randomized controlled trial that evaluated the effect of remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) in patients undergoing cardiac surgery. The study found that among 240 high-risk patients, those who received RIPC had a lower rate of AKI within 72 hours compared to controls. Biomarkers also indicated less kidney damage in the RIPC group. While the study was not powered for secondary outcomes like mortality, RIPC was associated with reduced need for renal replacement therapy. The results provide preliminary evidence that RIPC may help mitigate AKI risk in cardiac surgery patients but larger trials are still needed.
Role of retrograde transpopliteal angioplasty for superficial femoral artery ...SAMEH ATTIA ALI ABDELHAMID
This document discusses retrograde transpopliteal angioplasty for treating superficial femoral artery occlusion. It provides details on:
- The inclusion/exclusion criteria for patients in the study evaluating this technique's effectiveness and safety.
- The procedure, which involves accessing the popliteal artery from behind the knee and recanalizing the femoral artery in a retrograde manner.
- The results of the study, which found the technique achieved technical success in all cases and led to significantly improved ankle-brachial indices. Post-operative complications were minor. At 6-month and 1-year follow-ups, most arteries remained patent.
- The conclusion that retrograde popliteal access is a
prophylatic inferior vena cava (IVC) filters in traumaMubasharHashmi1
This document summarizes a multicenter randomized controlled trial that evaluated the use of retrievable inferior vena cava (IVC) filters for thromboprophylaxis in severely injured trauma patients. The trial randomized 240 patients with contraindications to anticoagulation and Injury Severity Score >15 to either receive an IVC filter within 72 hours or no filter. The primary endpoints were symptomatic pulmonary embolism and death within 90 days. Secondary endpoints included DVT rates, bleeding complications, and costs. Preliminary results found the groups to be balanced at baseline. The study aims to determine if early IVC filter placement reduces pulmonary embolism rates compared to no filter in high-risk trauma patients who cannot receive antico
This document outlines principles of preoperative care. It discusses evaluating patients' medical history and comorbidities, explaining the planned procedure to obtain informed consent, optimizing high-risk medical conditions before surgery, assessing surgical risk, and preparing patients with bowel cleansing or stopping certain medications. The goal is to minimize risks and optimize outcomes through thorough preoperative evaluation, planning, and preparation.
Consecutive Aneurysms Treated by Endovascular ApproachDr Vipul Gupta
Endovascular coiling is now the primary treatment approach for ruptured intracranial aneurysms based on evidence from trials like ISAT showing improved outcomes compared to clipping. The presenter's experience with 33 patients with 35 consecutive aneurysms showed high rates of aneurysm occlusion (95%) and good clinical outcomes (87.6% had mRS 0-2) when treated using a protocol-based endovascular approach with neurosurgical and critical care support. Complications were low when meticulous techniques were used along with protocols for management of issues like vasospasm.
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This document discusses the management of small renal masses (SRMs). Key points include:
1. SRMs are detected more frequently due to increased use of imaging and are usually less than 4cm.
2. Goals for managing early stage renal cell carcinoma include cancer survival, preserving renal function, and avoiding treatment morbidity.
3. Treatment options for SRMs include radical nephrectomy, partial nephrectomy, thermal ablation, and active surveillance. Partial nephrectomy is the gold standard.
4. Cryoablation and radiofrequency ablation are emerging minimally invasive techniques for treating SRMs but long term data on oncologic outcomes is still lacking.
This document discusses interventions for saphenous vein graft (SVG) disease. It covers the natural course of SVG pathology over time, techniques for SVG interventions like thrombectomy and stenting, and complications. Distal protection devices can reduce complications by preventing embolic debris from distal vessel occlusion during interventions. Proximal occlusion devices provide embolic protection by occluding inflow before any wires or devices cross the lesion. Filter wires are frequently applicable alternatives to occlusive distal protection with advantages of maintaining blood flow.
A case report of open reduction, internal fixation and platting of clavicle f...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document discusses the evolution of treatments for acute ischemic stroke (AIS), including intravenous thrombolysis and mechanical thrombectomy. It summarizes key randomized trials that established the benefits of mechanical thrombectomy. The first-generation trials using early thrombectomy devices did not show benefit, but recent trials using stent retrievers demonstrated significantly improved recanalization rates and superior outcomes for mechanical thrombectomy combined with intravenous thrombolysis compared to intravenous thrombolysis alone in eligible patients presenting within 6 hours of stroke onset. The document concludes that mechanical thrombectomy is now a standard treatment for AIS but remains underutilized.
Similar to Acs0619 Endovascular Procedures For Lower Extremity Disease (20)
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
1) Preparing patients preoperatively by administering IV fluids/antibiotics and gastric suction.
2) Closing perforations by suturing the ulcer and reinforcing it with omentum, or sealing it if too indurated.
3) Draining subphrenic abscesses extraperitoneally by making incisions below the costal margin or through the 12th rib bed and inserting drains into the abscess cavity.
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.