This document outlines the initial management of life-threatening trauma. It discusses prehospital care including interventions on scene to control bleeding and protect the spine. It recommends transporting critically injured patients directly to a Level I or II trauma center. In the emergency department, it describes arriving under active cardiopulmonary resuscitation and evaluating for a resuscitative thoracotomy. It provides guidelines for terminating resuscitation based on mechanism of injury, duration of CPR, and presence of asystole.
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.
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 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.
Ct scan , self care, rehab after traumatic brain injuryConnie Dello Buono
This study examined the association between early CT scan findings and needs for assistance with ambulation, self-care, and supervision at rehabilitation discharge and 1 year after traumatic brain injury (TBI). The study analyzed CT scans from 1839 TBI patients taken during the first week after injury and recorded findings such as midline shift, subcortical contusions, and bilateral frontal or temporal contusions. It found that a midline shift greater than 5mm or subcortical contusions were associated with greater needs for assistance at discharge, and subcortical contusions were also associated with needs at 1 year. Bilateral frontal or temporal contusions were associated with needs for greater supervision at discharge but not for ambulation or self-care
1) The document discusses perioperative nursing, including types of surgical procedures, classifications of procedures, informed consent, preoperative medications and teachings, and the surgical team.
2) It also discusses postoperative complications involving various body systems like respiratory, circulatory, and wounds. Principles of surgical asepsis and PACU/RR care are outlined.
3) Oncology nursing is discussed, differentiating benign and malignant neoplasms. Recommendations for cancer screening and warning signs of cancer are provided. Internal radiation therapy and nursing management are summarized.
This document summarizes guidelines for thromboprophylaxis from the 7th ACCP conference. It discusses the rationale for thromboprophylaxis, including the high prevalence and adverse consequences of unprevented VTE. It outlines risk factors for VTE and basic principles of thromboprophylaxis. It provides recommendations for prophylaxis in different patient groups based on risk level, including for different surgical procedures. It discusses strategies to improve implementation of guidelines in clinical practice.
This document discusses perioperative nursing. It covers the three phases of perioperative care: preoperative, intraoperative, and postoperative. It describes goals and assessments for the preoperative phase, including physiologic and psychologic evaluation of the patient and providing education. Surgical procedures are classified based on purpose, urgency, degree of risk, and whether they are performed as ambulatory/same-day surgery. Risks and the patient's fears and concerns are addressed. Informed consent is also discussed.
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.
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 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.
Ct scan , self care, rehab after traumatic brain injuryConnie Dello Buono
This study examined the association between early CT scan findings and needs for assistance with ambulation, self-care, and supervision at rehabilitation discharge and 1 year after traumatic brain injury (TBI). The study analyzed CT scans from 1839 TBI patients taken during the first week after injury and recorded findings such as midline shift, subcortical contusions, and bilateral frontal or temporal contusions. It found that a midline shift greater than 5mm or subcortical contusions were associated with greater needs for assistance at discharge, and subcortical contusions were also associated with needs at 1 year. Bilateral frontal or temporal contusions were associated with needs for greater supervision at discharge but not for ambulation or self-care
1) The document discusses perioperative nursing, including types of surgical procedures, classifications of procedures, informed consent, preoperative medications and teachings, and the surgical team.
2) It also discusses postoperative complications involving various body systems like respiratory, circulatory, and wounds. Principles of surgical asepsis and PACU/RR care are outlined.
3) Oncology nursing is discussed, differentiating benign and malignant neoplasms. Recommendations for cancer screening and warning signs of cancer are provided. Internal radiation therapy and nursing management are summarized.
This document summarizes guidelines for thromboprophylaxis from the 7th ACCP conference. It discusses the rationale for thromboprophylaxis, including the high prevalence and adverse consequences of unprevented VTE. It outlines risk factors for VTE and basic principles of thromboprophylaxis. It provides recommendations for prophylaxis in different patient groups based on risk level, including for different surgical procedures. It discusses strategies to improve implementation of guidelines in clinical practice.
This document discusses perioperative nursing. It covers the three phases of perioperative care: preoperative, intraoperative, and postoperative. It describes goals and assessments for the preoperative phase, including physiologic and psychologic evaluation of the patient and providing education. Surgical procedures are classified based on purpose, urgency, degree of risk, and whether they are performed as ambulatory/same-day surgery. Risks and the patient's fears and concerns are addressed. Informed consent is also discussed.
Damage control orthopaedics is a staged approach to treating patients with multiple severe injuries or poor physiological status. The initial goal is temporary fracture stabilization to preserve life, followed by patient resuscitation and optimization, and finally definitive fixation. It involves three stages - first, early temporary stabilization through techniques like external fixation; second, stabilizing the patient's physiology through resuscitation; and third, definitive fixation once the patient is stable. It allows for delayed definitive care of orthopaedic injuries until a patient's medical condition has improved, reducing the risks of early definitive fixation. Key indications include underlying head injuries, cardiac issues, low GCS, high injury severity scores, polytrauma, and low body temperature or high interleukin levels
Early stabilization of fractures was found to reduce complications, but later studies showed increased risks with early reamed intramedullary nailing. The goal of damage control orthopedics (DCO) is to rapidly stabilize fractures through temporary external fixation to limit the "second hit" while optimizing the patient's physiology. DCO utilizes staged treatment, with initial external fixation, resuscitation in the ICU, and delayed definitive management between 6-8 days when the patient's condition has stabilized.
1. Trauma management involves coordinated care across multiple phases including pre-hospital care, acute care in the hospital, and post-hospital rehabilitation.
2. In the hospital, trauma is initially managed by an organized trauma team using an approach focused on treatment before diagnosis and stabilization of vital organs.
3. Further care involves additional phases like damage control surgery to rapidly control bleeding and contamination followed by intensive care, as well as definitive later surgeries once the patient is stabilized. The goal is to prevent death from hemorrhaging, hypothermia, coagulopathy and metabolic acidosis.
Control Orthopedics (DCO) provides guidelines for treating orthopedic injuries in polytrauma patients. It recognizes that definitive surgical stabilization can worsen a physiologically compromised patient's condition. DCO aims to 1) control hemorrhage and provisionally stabilize fractures, 2) avoid further physiological insult through delayed definitive repair, and 3) get the patient's condition optimized before further surgery. For unstable patients, DCO relies on external fixation and temporary stabilization rather than immediate internal fixation to minimize surgical impact. The approach balances fracture management with the overall goal of stabilizing the patient's physiology.
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.
The document provides an overview of perioperative nursing care. It discusses the three phases of surgery: preoperative, intraoperative, and postoperative. In the preoperative phase, the nurse conducts assessments, provides education to the client, and ensures informed consent is obtained. During surgery, nurses manage risks and ensure proper technique is maintained. In post-op, nurses monitor for complications and promote recovery. Perioperative nursing aims to provide excellent care before, during, and after surgery by addressing clients' physical and psychosocial needs.
The document discusses the chain of survival and approach to cardiovascular resuscitation for a patient experiencing cardiac arrest. The chain of survival involves 4 steps: 1) activating emergency services, 2) beginning CPR, 3) early defibrillation if needed, and 4) providing advanced care. For a patient in cardiac arrest, rescuers should confirm unresponsiveness, call for emergency help, begin CPR, and use an automated external defibrillator or defibrillator when available to analyze the patient's rhythm and administer shocks if ventricular fibrillation or pulseless ventricular tachycardia is detected. The likelihood of survival increases when each step in the chain of survival is quickly followed.
The document discusses anesthesia and resuscitation, covering topics like the ABCs of airway management, breathing, and circulation. It describes techniques for securing the airway like intubation, different types of anesthesia like general and regional, and considerations for special patient populations. Tracheal intubation is discussed in detail, outlining indications, equipment, positioning, techniques like rapid sequence induction, and ways to confirm proper tube placement.
This document provides an overview of topics relevant to an anesthesiology clerkship rotation, including:
1) A definition of general anesthesia and discussion of associated risks.
2) Guidelines for preoperative assessment and optimization of patient medical conditions such as cardiovascular, respiratory, endocrine, and renal diseases.
3) Descriptions of important hereditary conditions like malignant hyperthermia that require special anesthetic considerations.
Perioperative nursing care involves several key aspects:
I. Types of surgery include diagnostic, therapeutic, palliative, preventive, and cosmetic procedures.
II. Preoperative nursing focuses on patient assessment and education prior to surgery. Assessments include medical history, habits, medications, and physiological status. Education covers procedures, pain management, and postoperative expectations.
III. Postoperative care begins in the recovery room with initial assessments of vital signs, wounds, tubes/drains, and pain levels. Ongoing care addresses potential
This document discusses the management of polytrauma patients. It defines polytrauma as multiple injuries exceeding a severity threshold that can lead to organ dysfunction. Scoring systems like the Glasgow Coma Scale, Abbreviated Injury Scale, and Injury Severity Score are used to assess polytrauma patients. The physiological response to trauma involves systemic inflammatory and compensatory anti-inflammatory responses. Clinicians evaluate polytrauma patients using ATLS protocols, assess various systems, and provide resuscitation as needed. Orthopedic injuries may be managed with early total care or damage control orthopedics to minimize additional insults from surgery in unstable patients.
The document provides information on polytrauma, including definitions, pathophysiology, pre-hospital and in-hospital management, and damage control orthopedics. It defines polytrauma as injuries exceeding an ISS of 17 with systemic inflammatory response for at least one day that can lead to organ dysfunction. The pathophysiology involves an immune response and genomic storm. Pre-hospital care focuses on airway, breathing, circulation, disability and exposure management. In-hospital care includes further assessment, resuscitation and stabilization using a damage control approach if needed.
1. Damage control orthopedics (DCO) is an approach used for multiply injured trauma patients that involves temporarily stabilizing orthopedic injuries to avoid worsening the patient's condition through a major surgery, known as the "second hit".
2. DCO is recommended for unstable patients or those in extremis, as well as borderline patients meeting certain criteria, to delay definitive fracture repair until the patient's overall condition is optimized.
3. DCO involves four phases - acute life-saving procedures, temporary skeletal stabilization and soft tissue management, intensive care monitoring, and finally definitive fracture fixation between 6-10 days.
Anesthetic risk, quality improvement and liability●๋•αηкιтα madan
This document discusses anesthesia risk and mortality. It provides estimates from various studies that anesthesia-related mortality rates range from less than 1 per 10,000 anesthetics to 1 per 1,560 anesthetics historically. Common complications discussed include nerve injuries, awareness during general anesthesia, eye/dental injuries, and postoperative cognitive dysfunction in elderly patients. Risk management strategies to minimize liability like adherence to standards of care, vigilance, documentation, and informed consent are also outlined.
This document discusses perioperative care and defines the three phases as preoperative, intraoperative, and postoperative. It outlines nursing responsibilities and goals in each phase, including assessment, monitoring for complications, education, and promoting patient well-being and recovery.
1) Anesthesia safety has greatly improved over time, with mortality decreasing from 1 in 5,000 anesthetics in the 1970s to 1 in 200,000-300,000 in 1999. Current trends show further decreases in complication rates.
2) Factors influencing anesthesia risk include patient status, procedure invasiveness, facility resources and equipment, and the skills of the anesthesiologist and surgeon. Monitoring equipment, safer drugs and equipment, airway management skills, and adherence to guidelines have all contributed to increased safety.
3) Anesthesiology is considered a high-risk specialty, but patients have a higher chance of dying from a car accident than from general anesthesia according to WHO statistics. Contin
1. The patient care plan outlines criteria for discontinuing mechanical ventilation including maintaining normal ABG levels and keeping indwelling devices intact until discontinued.
2. It identifies potential nursing problems related to mechanical ventilation like alterations in cognitive function from medications or unfamiliar environment. Expected outcomes include returning to baseline mental status and understanding intubation needs.
3. Weaning procedures are described including slow, moderate, and quick methods and criteria for extubating based on assessment of respiratory effort and readiness.
Primary Prevention Of Sudden Cardiac Death - Role Of DevicesArindam Pande
ICD is most cost‑effective when used for patients at high‑risk of arrhythmic death and low‑risk of other causes of death.
Specific patient populations are now recognized for whom the benefit of ICD therapy outweighs any risks
Categorizing patients on the basis of only LVEF and NYHA Functional Class can aid in identification of patients who have highest benefit from primary preventions
This document provides details on pre-operative evaluation for neurosurgery patients. It outlines the importance of gathering a thorough history including neurological symptoms, prior surgeries/treatments, and general medical conditions. A focused physical exam is also described which evaluates neurological function, signs of increased intracranial pressure, and other system involvement. The goal is to assess risk factors and develop an appropriate anesthesia management plan.
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.
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.
Acs0521 Cholecystectomy And Common Bile Duct Exploration 2009medbookonline
1) The document discusses preoperative evaluation, patient selection, positioning, and techniques for laparoscopic cholecystectomy.
2) Key aspects of preoperative evaluation include patient history, physical exam, imaging such as ultrasound and MRCP to assess for gallstones and bile duct anatomy, and lab tests. Patient risk for CBD stones is assessed as high, moderate, or low.
3) Outpatient cholecystectomy is appropriate for low-risk, healthy patients. Technically challenging patients include those who are obese, have had prior abdominal surgery or acute cholecystitis, or have anatomic distortions.
4) The goal of cholecystectomy is safe gallbladder removal while minimizing bile duct injury
Damage control orthopaedics is a staged approach to treating patients with multiple severe injuries or poor physiological status. The initial goal is temporary fracture stabilization to preserve life, followed by patient resuscitation and optimization, and finally definitive fixation. It involves three stages - first, early temporary stabilization through techniques like external fixation; second, stabilizing the patient's physiology through resuscitation; and third, definitive fixation once the patient is stable. It allows for delayed definitive care of orthopaedic injuries until a patient's medical condition has improved, reducing the risks of early definitive fixation. Key indications include underlying head injuries, cardiac issues, low GCS, high injury severity scores, polytrauma, and low body temperature or high interleukin levels
Early stabilization of fractures was found to reduce complications, but later studies showed increased risks with early reamed intramedullary nailing. The goal of damage control orthopedics (DCO) is to rapidly stabilize fractures through temporary external fixation to limit the "second hit" while optimizing the patient's physiology. DCO utilizes staged treatment, with initial external fixation, resuscitation in the ICU, and delayed definitive management between 6-8 days when the patient's condition has stabilized.
1. Trauma management involves coordinated care across multiple phases including pre-hospital care, acute care in the hospital, and post-hospital rehabilitation.
2. In the hospital, trauma is initially managed by an organized trauma team using an approach focused on treatment before diagnosis and stabilization of vital organs.
3. Further care involves additional phases like damage control surgery to rapidly control bleeding and contamination followed by intensive care, as well as definitive later surgeries once the patient is stabilized. The goal is to prevent death from hemorrhaging, hypothermia, coagulopathy and metabolic acidosis.
Control Orthopedics (DCO) provides guidelines for treating orthopedic injuries in polytrauma patients. It recognizes that definitive surgical stabilization can worsen a physiologically compromised patient's condition. DCO aims to 1) control hemorrhage and provisionally stabilize fractures, 2) avoid further physiological insult through delayed definitive repair, and 3) get the patient's condition optimized before further surgery. For unstable patients, DCO relies on external fixation and temporary stabilization rather than immediate internal fixation to minimize surgical impact. The approach balances fracture management with the overall goal of stabilizing the patient's physiology.
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.
The document provides an overview of perioperative nursing care. It discusses the three phases of surgery: preoperative, intraoperative, and postoperative. In the preoperative phase, the nurse conducts assessments, provides education to the client, and ensures informed consent is obtained. During surgery, nurses manage risks and ensure proper technique is maintained. In post-op, nurses monitor for complications and promote recovery. Perioperative nursing aims to provide excellent care before, during, and after surgery by addressing clients' physical and psychosocial needs.
The document discusses the chain of survival and approach to cardiovascular resuscitation for a patient experiencing cardiac arrest. The chain of survival involves 4 steps: 1) activating emergency services, 2) beginning CPR, 3) early defibrillation if needed, and 4) providing advanced care. For a patient in cardiac arrest, rescuers should confirm unresponsiveness, call for emergency help, begin CPR, and use an automated external defibrillator or defibrillator when available to analyze the patient's rhythm and administer shocks if ventricular fibrillation or pulseless ventricular tachycardia is detected. The likelihood of survival increases when each step in the chain of survival is quickly followed.
The document discusses anesthesia and resuscitation, covering topics like the ABCs of airway management, breathing, and circulation. It describes techniques for securing the airway like intubation, different types of anesthesia like general and regional, and considerations for special patient populations. Tracheal intubation is discussed in detail, outlining indications, equipment, positioning, techniques like rapid sequence induction, and ways to confirm proper tube placement.
This document provides an overview of topics relevant to an anesthesiology clerkship rotation, including:
1) A definition of general anesthesia and discussion of associated risks.
2) Guidelines for preoperative assessment and optimization of patient medical conditions such as cardiovascular, respiratory, endocrine, and renal diseases.
3) Descriptions of important hereditary conditions like malignant hyperthermia that require special anesthetic considerations.
Perioperative nursing care involves several key aspects:
I. Types of surgery include diagnostic, therapeutic, palliative, preventive, and cosmetic procedures.
II. Preoperative nursing focuses on patient assessment and education prior to surgery. Assessments include medical history, habits, medications, and physiological status. Education covers procedures, pain management, and postoperative expectations.
III. Postoperative care begins in the recovery room with initial assessments of vital signs, wounds, tubes/drains, and pain levels. Ongoing care addresses potential
This document discusses the management of polytrauma patients. It defines polytrauma as multiple injuries exceeding a severity threshold that can lead to organ dysfunction. Scoring systems like the Glasgow Coma Scale, Abbreviated Injury Scale, and Injury Severity Score are used to assess polytrauma patients. The physiological response to trauma involves systemic inflammatory and compensatory anti-inflammatory responses. Clinicians evaluate polytrauma patients using ATLS protocols, assess various systems, and provide resuscitation as needed. Orthopedic injuries may be managed with early total care or damage control orthopedics to minimize additional insults from surgery in unstable patients.
The document provides information on polytrauma, including definitions, pathophysiology, pre-hospital and in-hospital management, and damage control orthopedics. It defines polytrauma as injuries exceeding an ISS of 17 with systemic inflammatory response for at least one day that can lead to organ dysfunction. The pathophysiology involves an immune response and genomic storm. Pre-hospital care focuses on airway, breathing, circulation, disability and exposure management. In-hospital care includes further assessment, resuscitation and stabilization using a damage control approach if needed.
1. Damage control orthopedics (DCO) is an approach used for multiply injured trauma patients that involves temporarily stabilizing orthopedic injuries to avoid worsening the patient's condition through a major surgery, known as the "second hit".
2. DCO is recommended for unstable patients or those in extremis, as well as borderline patients meeting certain criteria, to delay definitive fracture repair until the patient's overall condition is optimized.
3. DCO involves four phases - acute life-saving procedures, temporary skeletal stabilization and soft tissue management, intensive care monitoring, and finally definitive fracture fixation between 6-10 days.
Anesthetic risk, quality improvement and liability●๋•αηкιтα madan
This document discusses anesthesia risk and mortality. It provides estimates from various studies that anesthesia-related mortality rates range from less than 1 per 10,000 anesthetics to 1 per 1,560 anesthetics historically. Common complications discussed include nerve injuries, awareness during general anesthesia, eye/dental injuries, and postoperative cognitive dysfunction in elderly patients. Risk management strategies to minimize liability like adherence to standards of care, vigilance, documentation, and informed consent are also outlined.
This document discusses perioperative care and defines the three phases as preoperative, intraoperative, and postoperative. It outlines nursing responsibilities and goals in each phase, including assessment, monitoring for complications, education, and promoting patient well-being and recovery.
1) Anesthesia safety has greatly improved over time, with mortality decreasing from 1 in 5,000 anesthetics in the 1970s to 1 in 200,000-300,000 in 1999. Current trends show further decreases in complication rates.
2) Factors influencing anesthesia risk include patient status, procedure invasiveness, facility resources and equipment, and the skills of the anesthesiologist and surgeon. Monitoring equipment, safer drugs and equipment, airway management skills, and adherence to guidelines have all contributed to increased safety.
3) Anesthesiology is considered a high-risk specialty, but patients have a higher chance of dying from a car accident than from general anesthesia according to WHO statistics. Contin
1. The patient care plan outlines criteria for discontinuing mechanical ventilation including maintaining normal ABG levels and keeping indwelling devices intact until discontinued.
2. It identifies potential nursing problems related to mechanical ventilation like alterations in cognitive function from medications or unfamiliar environment. Expected outcomes include returning to baseline mental status and understanding intubation needs.
3. Weaning procedures are described including slow, moderate, and quick methods and criteria for extubating based on assessment of respiratory effort and readiness.
Primary Prevention Of Sudden Cardiac Death - Role Of DevicesArindam Pande
ICD is most cost‑effective when used for patients at high‑risk of arrhythmic death and low‑risk of other causes of death.
Specific patient populations are now recognized for whom the benefit of ICD therapy outweighs any risks
Categorizing patients on the basis of only LVEF and NYHA Functional Class can aid in identification of patients who have highest benefit from primary preventions
This document provides details on pre-operative evaluation for neurosurgery patients. It outlines the importance of gathering a thorough history including neurological symptoms, prior surgeries/treatments, and general medical conditions. A focused physical exam is also described which evaluates neurological function, signs of increased intracranial pressure, and other system involvement. The goal is to assess risk factors and develop an appropriate anesthesia management plan.
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.
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.
Acs0521 Cholecystectomy And Common Bile Duct Exploration 2009medbookonline
1) The document discusses preoperative evaluation, patient selection, positioning, and techniques for laparoscopic cholecystectomy.
2) Key aspects of preoperative evaluation include patient history, physical exam, imaging such as ultrasound and MRCP to assess for gallstones and bile duct anatomy, and lab tests. Patient risk for CBD stones is assessed as high, moderate, or low.
3) Outpatient cholecystectomy is appropriate for low-risk, healthy patients. Technically challenging patients include those who are obese, have had prior abdominal surgery or acute cholecystitis, or have anatomic distortions.
4) The goal of cholecystectomy is safe gallbladder removal while minimizing bile duct injury
A 32-year old male security inspector presented with bleeding from his right ear and mouth after experiencing a blast from a gun. On examination, he had a facial nerve palsy on the right side, his right ear canal was filled with blood, and his soft palate had a hole with oozing blood. Imaging showed fractures to the skull and soft tissues. He was treated with antibiotics, analgesics, steroids, eye and mouth care, and underwent further management including physiotherapy, psychiatric evaluation, and surgery. The discussion section explores the possible injury mechanisms and anatomical structures involved, as well as the prognosis for facial nerve function and tinnitus.
Cardiac enzymes or biomarkers such as CPK, CK-MB, and troponin I are commonly ordered for patients experiencing chest pain to diagnose an acute myocardial infarction (AMI). These enzymes rise within hours of a cardiac event and are drawn in sets several hours apart to detect changes over time. Troponin I is the preferred biomarker for AMI diagnosis due to its excellent sensitivity and specificity. A critical troponin level over 0.50 requires immediate physician notification. Patients with elevated enzymes may undergo further cardiac testing to investigate the cause of their chest pain.
1) Gunshot wounds can cause serious injuries and death depending on factors like the velocity and mass of the bullet, the area of the body impacted, and extent of tissue damage.
2) Immediate management of gunshot wounds focuses on the ABCs - airway, breathing, and circulation. The airway may be obstructed by blood, swelling, or debris, so it must be cleared. Bleeding must be controlled through direct pressure, packing, or ligation. Circulation is assessed and fluid resuscitation given if shock is present.
3) After initial resuscitation, further treatment involves thorough debridement, antibiotic administration, and surgery or reconstruction if needed to address bone, soft tissue,
This document discusses firearm injuries and terminology related to forensic medicine. It describes different types of firearms including shotguns and rifled weapons like pistols, revolvers, and rifles. Shotguns fire multiple pellets while rifled weapons fire single projectiles with grooved barrels. The document details entrance and exit wound characteristics for different firearm ranges from contact wounds to long range injuries. It also discusses factors that can indicate accidents, suicides, or homicides based on wound location and patterns. Doctors have a duty to preserve any foreign materials from wounds and skin samples for potential forensic testing.
This document discusses firearm injuries and terminology related to forensic medicine. It describes different types of firearms including shotguns and rifled weapons. Shotguns fire multiple pellets while rifled weapons fire a single projectile. The document details the mechanisms of injury from firearms, characteristics of entrance and exit wounds, factors to consider when determining if a firearm injury was from accident, suicide or homicide, and the duties of doctors in cases of firearm injuries and deaths.
1. A firearm discharges a missile using expanding gases from combustion in a closed space. It consists of a barrel, action, and grip.
2. Rifling imparts spin to bullets for stability and accuracy. Rifled weapons include handguns like pistols and revolvers, as well as rifles. Shotguns have smooth bores.
3. Cartridges contain propellant, primer, casing, and a bullet or shots. Propellant burns to produce gases that accelerate the projectile down the barrel.
Thoracic trauma can result in serious injuries and accounts for over 25% of trauma deaths, with blunt trauma making up 70% of chest injuries mostly from motor vehicle accidents. Common thoracic injuries include rib fractures, pneumothorax, hemothorax, and injuries to the heart and great vessels which require stabilization of the airway, breathing, and circulation followed by diagnostic imaging and treatment of life-threatening injuries. Management involves establishing ABCs, treating tension pneumothorax and sucking chest wounds, and having a high index of suspicion to identify specific injuries like aortic injuries that require further evaluation.
This document discusses triage in trauma care. It begins by defining triage as sorting patients based on need to receive the right care at the right time. The goals of triage are to rapidly identify urgent cases and ensure treatment is timely and appropriate. Patients are assessed and assigned a priority level based on factors like vital signs, injuries, and pain level. Cultural considerations must also be taken into account. The document then describes the roles of various professionals involved in trauma situations and transport of patients to facilities that can provide the necessary care.
This document provides information on the primary survey and resuscitation of trauma patients. It discusses the importance of the ABCDE approach to assess airway, breathing, circulation, disability, and exposure. Proper cervical spine control and airway management are emphasized as the first priorities in trauma resuscitation. Basic airway maneuvers like chin lift and jaw thrust are described, as well as advanced techniques like orotracheal intubation that provide a definitive airway. The document stresses the need for rapid evaluation and treatment of life-threatening injuries according to established trauma protocols.
- The timeline concept in trauma management emphasizes that there is a critical time window to intervene before loss of compensatory mechanisms, and assessment and response should occur prior to irreversible damage.
- The primary survey follows the ATLS protocol of ABCDE to address life threats, while the secondary survey is a full head-to-toe examination.
- For physiologically compromised patients, a damage control approach may be necessary to stop bleeding and contamination before full treatment, while resuscitation continues simultaneously.
The document outlines trauma admission guidelines and response times for specialists at Monroe Carell Jr. Children's Hospital. It provides guidelines for admitting trauma patients based on their injuries and conditions. It also establishes response time requirements for specialists, including the trauma service responding within 15 minutes for level I activations, neurosurgery and spine responding within 30 minutes for indications like increased ICP or unstable spine, and orthopedics responding within 30 minutes for acute limb issues or within 1 hour for open fractures.
This document discusses anesthetic concerns for trauma victims requiring operative intervention who are too sick to anesthetize. It covers cardiac trauma such as blunt myocardial injury, traumatic aortic injury, and cardiac tamponade. It also discusses pulmonary trauma such as pulmonary contusions, flail chest, fat embolism syndrome, and acute lung injury. The case study presented is of an obese man in shock following a motor vehicle crash requiring emergency surgery. The priorities are stabilizing the patient's hemodynamics and oxygenation through fluid resuscitation and ventilation before inducing anesthesia to improve outcomes.
This document discusses a case of blunt traumatic pericardial rupture and cardiac herniation in a 21-year old male following a motorbike accident. Key findings from imaging included a 10cm tear in the right pericardium, pneumopericardium, and herniation of the heart into the right hemithorax. The patient underwent thoracotomy for repair of the pericardial tear. Diagnosis of blunt traumatic pericardial rupture can be difficult due to subtle clinical signs and associated injuries from polytrauma. Imaging modalities like CT are useful for diagnosis. Surgical closure is usually required for moderate to large tears to prevent further herniation and hemodynamic compromise.
06 acute coronary syndromes is there a place for a real pre hospital treatmen...NPSAIC
1) The management of acute coronary syndrome (ACS) patients requires close collaboration between emergency physicians and cardiologists according to simplified protocols.
2) Key challenges for pre-hospital ACS management include precise knowledge of new drugs, developing regional hospital cooperation, organizing the healthcare network, and regularly analyzing practices.
3) The emergency physician must adapt strategies to international guidelines and the patient's needs, routing high-risk patients directly to catheterization facilities within recommended time limits.
This document discusses recent advances in the management of cardiac trauma. It begins by noting that cardiac injuries continue to cause significant mortality despite improvements in trauma care. It then covers the classification, mechanisms, clinical presentation, diagnosis and treatment of both penetrating and blunt cardiac injuries. For diagnosis, it discusses tools like FAST exam, chest X-ray, echocardiogram and CT scan. For treatment, it outlines the management of stable versus unstable patients, describing surgical interventions like thoracotomy, cardiorrhaphy and pericardiocentesis.
2015 Traumatic injuries of the thoracic aorta the role of imaging in diagno...Julio Diez
This document discusses traumatic injuries of the thoracic aorta, specifically focusing on the role of imaging in diagnosis and treatment. It provides details on:
- Road traffic accidents being the main cause, with injuries most common at the aortic isthmus.
- CT angiography playing a key role in diagnosis and assessment of injury severity to determine appropriate treatment.
- A classification system for injuries based on involvement of the aortic wall, with grades III and above generally requiring emergency treatment.
- Advances in endovascular techniques now making stent grafts the standard treatment for most injuries.
- Several imaging pitfalls that can mimic injuries, requiring careful evaluation.
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 discusses the management of polytrauma patients. It defines polytrauma as injuries involving two or more major body systems. The goals of management are to save the patient's life, salvage limbs, and restore function if possible. A team approach is needed involving surgeons, physicians, and other specialists. The initial focus is a thorough primary survey and resuscitation to address life-threatening injuries like airway obstruction, hemorrhage, and spinal cord injury.
This document discusses injuries to the chest, including initial evaluation and management of thoracic injuries during the primary survey, indications for tube thoracostomy, tension pneumothorax, retained hemothorax and empyema, and emergency department thoracotomy. It provides guidance on prioritizing airway, breathing, and circulation during the primary survey. Tube thoracostomy is recommended for tension pneumothorax, massive hemothorax, or uncontrolled air leaks. Retained blood increases risk of infection and empyema, so aggressive removal is warranted. Emergency department thoracotomy has a low survival rate for blunt trauma but higher for penetrating injuries or cardiac wounds.
Here are the triage categories I would assign to each patient based on the information provided:
1. 30 year old male with a compound fracture of left femur, bleeding significantly. Resp. rate 24. Cap. refill less than 2 sec. Alert and oriented.
Category: DELAYED
2. 44 year old male sitting up with chest pain without obvious injury. Resp. rate 24. Cap. refill less than 2 sec. Alert and oriented.
Category: DELAYED
3. 28 year old female with fracture of left wrist. Resp. rate 22. Cap. refill less than 2 sec. Alert and oriented. Decides she can walk after all.
Category: MINOR
This document presents an algorithm for managing traumatic cardiac arrest (TCA) in a physician-staffed helicopter emergency service. The key elements of the algorithm include prioritizing catastrophic hemorrhage control through tourniquets, direct pressure, hemostatic agents, and splinting of long bones and pelvis. Blood is the preferred resuscitation fluid when available. Good airway management and use of open thoracostomies rather than needle decompression is essential for oxygenation. Cardiac ultrasound can help assess for cardiac tamponade, pulse presence, and cardiac motion. Penetrating trauma to the chest or epigastrium within 10 minutes of TCA warrants immediate thoracotomy. Adrenaline and chest
Response to Trauma And Blast and Gunshot Injuries harshamss
This document discusses the response to trauma and management of missile, blast, and gunshot injuries. It begins with an introduction that defines trauma and describes different injury mechanisms. It then covers the metabolic and medical responses to trauma, including the neuroendocrine stress response, immune response, and concepts like the golden hour and platinum minutes. The document outlines the assessment and management of obvious and hidden injuries, as well as the trauma response process involving triage, the MIST protocol, trauma center levels, and trauma teams. It concludes by describing the mechanisms and types of blast injuries.
Thoracic trauma can cause life-threatening injuries like tension pneumothorax, cardiac tamponade, and uncontrolled hemorrhage. Pre-hospital management focuses on identifying and treating these immediately life-threatening conditions through assessment of airway, breathing, and circulation. Additional assessments identify injuries like rib fractures, lung contusions, and injuries to major blood vessels. Proper positioning, splinting of injuries, analgesia, and rapid transport to the hospital can help manage thoracic trauma in the pre-hospital setting.
Ninety percent of combat fatalities die before reaching medical treatment. Traditional trauma care like ATLS is not directly applicable to combat settings which involve prolonged evacuations, limited resources, and hostile conditions. Tactical Combat Casualty Care was developed to address the unique prehospital challenges of combat medicine. It focuses on controlling hemorrhage, airway management, and shock treatment at the point of injury through various stages of evacuation. Understanding the operational environment is essential, as standard procedures designed for civilian and hospital settings may not apply to combat prehospital care.
Acs0702 Injuries To The Central Nervous Systemmedbookonline
The document discusses injuries to the central nervous system, including head injuries and spinal cord injuries. It provides guidelines for initial management of severe head injuries, including resuscitation to stabilize airway, breathing, and circulation. It recommends intubation for patients with a Glasgow Coma Scale score of 8 or lower. Computed tomography is used to identify surgical lesions like subdural hematomas, which require urgent evacuation. For critically injured patients, treatment in a neurosurgical intensive care unit is indicated to prevent secondary injuries through monitoring of intracranial pressure, cerebral blood flow, oxygenation and other parameters. Outcomes are correlated with the duration and degree of jugular desaturation.
Similar to Acs0701 Initial Management Of Life Threatening Trauma (20)
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.
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.
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.
This document provides reference values for many common clinical chemistry analytes measured in various specimens like plasma, serum, urine, and whole blood. The analytes include metabolic panels, lipids, proteins, electrolytes, vitamins, and more. Reference ranges are given in conventional and SI units for each analyte. The purpose is to provide clinicians with the normal expected ranges to interpret laboratory results at the Massachusetts General Hospital.
Acs0905 Gynecologic Considerations For The General Surgeonmedbookonline
This document discusses several gynecologic conditions and considerations for general surgeons:
- Gynecologic emergencies like bleeding from ovarian cysts, adnexal torsion, pelvic inflammatory disease, and ectopic pregnancy. Diagnosis and treatment approaches are outlined.
- Outpatient gynecologic problems including evaluating pelvic masses and abnormal uterine bleeding.
- Gynecologic malignancies like ovarian and cervical cancer that some general surgeons may encounter.
- Most conditions can be initially managed conservatively but may require surgery depending on patient stability or response to treatment. Diagnostic tools like ultrasound, CT, and laparoscopy are discussed.
Acs0904 Urologic Considerations For The General Surgeonmedbookonline
This document discusses urologic considerations for general surgeons. It begins with an overview of genitourinary anatomy, including the kidneys, ureters, bladder, prostate, seminal vesicles, penis, and urethra. It then discusses common urologic injuries general surgeons may encounter, such as those resulting from multiple trauma or iatrogenic injuries during other operations. Urologic malignancies and benign prostatic hyperplasia are also briefly mentioned.
1) The document discusses the management of pregnant patients requiring surgery or experiencing trauma. It notes special considerations for pregnant patients, including physiological changes and the need to care for both mother and fetus.
2) In trauma situations, the initial focus is stabilizing the mother to benefit both patients. Penetrating injuries often directly threaten the fetus while blunt trauma poses less direct risk, usually resulting in placental abruption or preterm labor.
3) Surgical decisions must weigh fetal viability against maternal stability, with non-urgent cases delayed if possible. Monitoring includes fetal heart monitoring and ultrasound to detect issues like abruption.