Ronald Malt performed the first successful replantation surgery in 1962. Postoperative management is crucial for successful replantation outcomes. In the first 48 hours after surgery, vascular insufficiency must be closely monitored and addressed early through re-exploration to salvage the replanted part 80% of the time. Antithrombotic medications, warming the replanted area, hydration, pain management and restricting diet in the first 24 hours are important postoperative steps to watch for vascular issues and prevent vasoconstriction. Secondary surgeries are often later needed to improve function through procedures like nerve grafting and tendon transfers.
Damage control is a Navy term defined as “the capacity of a ship to absorb damage and maintain mission integrity". Damage Control Orthopaedics (DCO) is a relatively recent concept in orthopaedic practice it means early rapid containment & stabilization of orthopedic injuries without worsening the patient general condition. It is indicated in critically ill polytrauma patient, unfavorable surgical environment, battlefield limb injuries & mass casualties.
Burns management presentation by 2nd yr MSC nursing studentSigymol John
this ppt deals with the management part of burns, mainly divided as pre-hospital care, emergent phase,acute phase and rehabilitation phase along with nursing management,nursing diagnosis and interventions.
Damage control is a Navy term defined as “the capacity of a ship to absorb damage and maintain mission integrity". Damage Control Orthopaedics (DCO) is a relatively recent concept in orthopaedic practice it means early rapid containment & stabilization of orthopedic injuries without worsening the patient general condition. It is indicated in critically ill polytrauma patient, unfavorable surgical environment, battlefield limb injuries & mass casualties.
Burns management presentation by 2nd yr MSC nursing studentSigymol John
this ppt deals with the management part of burns, mainly divided as pre-hospital care, emergent phase,acute phase and rehabilitation phase along with nursing management,nursing diagnosis and interventions.
A case study is a written analysis of an actual clinical phenomeno.docxransayo
A case study is a written analysis of an actual clinical phenomenon or problem. This assignment involves a discussion of the related topic and should include citing research and background information supporting the issue. The analysis should also include possible solutions or how the issue was resolved.
The purpose of the clinical case study is to complement didactic information and present actual patient encounters. Please follow the following guidelines. 1. Maximum of 10 pages, double – spaced, including references/ bibliography. 2. Bibliography should include current literature (within the past 5 years) as well as textbooks on anesthesia practice and should follow APA format.
Master of Science Program in Anesthesiology
SRNA: Date: JUNE 22, 2016
Pre-op Diagnosis: LT ureteral stone
Planned Surgical Procedure: Cystoscopy: ureteroscopy, laser litherotripsy and stent placement to left side
Patient Demographics
Age: 62
HT: 160cm
WT: 95kg
BMI: 37
Gender: F
NPO since: MN 9hrs
Allergies: Tramadol
Airway Assessment
Mallampati Class: 2; soft palate, faces, portion of uvula
Neck Movement: (FULL ROM)
Mouth Opening: >3 Finger-breadth
Dentition: 2 lower loose teeth
Thyromental Distance: >3 Finger-breadth
ASA Class: 2; able to see pillars and soft palate, only part of uvula
METS: <4 slow walking (2mph)
Review of Systems
RESP: B/L breath sounds clear on auscultation
CV: SR on cardiac monitor, no mummers heard. S1/ S2
CNS: AAOX4
HEP/RENAL: Kindey stone
ENDOCRINE: (—)
GI: (—)
OTHER: Rt breast cancer
HISTORY:
Medical/Surgical: Rt breast Lumpectomy
Anesthetic: GETA
Social: patient denies
Family: No family history with problems with anesthesia
Medications / Dosage / Classification
Anesthetic Implications
1. Hyzaar 100/12.5; Antihypertensive; angiotensin II receptor antagonists combined with a thiazide diuretic
2. Baby aspirin; antipyretics; nonopioid analgesics; salicylates
3. omeprazole; antiulcer agents; proton pump inhibitors
4. Pyridium; nonopioid analgesics; urinary tract analgesics
1. losartan 100 mg; given alone or with other agents in the management of hypertension. Treatment of diabetic nephropathy in patients with type 2 diabetes. Prevention of stroke in patients with hypertension and left ventricular hypertrophy. hydrochlorothiazide 12.5 mg; Increases excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule. Promotes excretion of chloride, potassium, hydrogen, magnesium, phosphate, calcium and bicarbonate. May produce arteriolar dilation.
2. Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins. Decreases platelet aggregation.
Reduction of inflammation. Reduction of fever. Decreased incidence of transient ischemic attacks and MI.
3. Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen.
4. Acts locally on the urinary tract mucosa to produce analgesic .
There are numerous types of brain surgery. The type used is based on the area of the brain and the condition being treated.
Brain surgery is a critical and complicated process. The type of brain surgery done depends highly on the condition being treated.
Intracranial surgery refers to various medical procedures that involve repairing structural problems in the brain.
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
2. Ronald Malt performed the first replantation on May 23, 1962 at Massachusetts
General Hospital on a 12-year-old boy who had his right arm amputated in a train
acciden.
Since Malt's first replant, technological advances and the use of the microscope have
made possible the replantation of other parts, including thumbs, fingers, ears, scalps,
facial parts, and genitalia.
4. Evaluation for replantation
Life before limb.
Assessment of injury (Level, mechanism, dominant hand ,age ,smoking,full medical
history And previous injury to same limb ).
Obtaining x-rays for both severd and stumb parts.
Obtain Length of ischemia of the severed part, digits can tolerate about 12 hours of
warm ischemia and more than 24 hours cold ishemia ,muscles can tolerate about 6
hours warm ishemia, so the more proximal the amputation the faster surgery it
needs.
Sharp amputations do better than crushed,avulsion or blunt cuts .
5. Amputated part should be warned in saline moistens
gaues then in sealed bag then to bag of ice to
prevent cold injury to tissue
6. Postoperative
Postoperative managment is extremely important in achieving a high success
rate in replantation.
vascular insufficiency may develop postoperatively but can frequently be
corrected if detected early.
Eighty percent of vascular occlusions occur within the first 48 hours after
surgery. The salvage rate in a failing replantation explored early ranges from
66% to 80%.
Arterial thrombi usually result from platelet aggregation and present on day 1,
whereas venous thrombi result from fibrin clotting and usually present by day 2 or
3.
Patients are restricted from eating for the first 24 hours in case they need to be
taken back to the operating room.
7. bulky dressing.
Hand should be elevated , If arterial inflow is diminished, the hand may be
lowered. If venous outflow is slow, the hand needs additional elevation.
The room is kept warm, limb should be warmed by lamp and the patient well
hydrated.
Appropriate analgesics are used to control pain and anxiety because they can lead
to an adrenergic response and vasoconstriction, especially in children.dressing
change should also done under good analgesia or even sedation.
Smoking is prohibited because it leads to hypoxia, reduction of peripheral blood
flow, and increases the risk of thrombosis, also advise patients to avoid caffinated
drinks.
Color, pulp turgor, capillary refill, and warmth should be monitored every 1
hour for the first 48 hours, then every 4 hours till 5th day postoprtive.
Leeches therapy can be used if congestion present.
PostoperativePostoperative
8.
9. Postoperative
New technology could also be used for flap monitoring including :
pulse oximetry
Doppler and duplex
Digital thermometry
Laser Doppler
Digital thermometry
11. Postoperative medications
The commonly used anticoagulants can be divided into agents that :
1. Decrease platelet function e.g. aspirin and could be used for 3 weeks.
2. Increase blood flow or decrease blood viscosity e.g. dextran , The antithrombotic effect of dextran is
thought to be due to binding to erythrocytes, platelets, and the vascular endothelium. It is
mostly thought to interfere with the formation of fibrin clot and to prevent the aggregation of
red thrombi. This effect is thought to be significantly greater than any effect on platelets.
3. Counteract the effect of thrombin on platelets and fibrinogen e.g., heparin.
Antibiotics Cover with pointing to Aeromonas hydrophila infection if leesh therapy was used.
Proper hydration,and good analgesics.
12. Postopertavie therapy
Hand therapy can be started about a week after replantation, once
anticoagulation is stopped. Therapy protocols depend on the level of the replant
and the stability of skeletal fixation. A dorsal splint is provided and the patient
started on gentle active range of motion exercises.
13. Postoperative Secondary surgery
Secondary surgery like tenolysis, nerve grafting, tendon transfer, bone, grafting,
intrinsic muscle release, and arthrodesis are frequently required in replants to
enhance function. these procedures brefered to be done approximately 3 months
after replantation.
14. EXPECTED OUTCOMES OF DIGITAL REPLANTATION
15-50% replant failure rate.
50% of patients require a blood transfusion.
10 days average hospital stay.
Cost of replantatioo is 1 ~ 15 times that of reception amputation.
36-77% chance of only protective sensation.
Motion in replanted is averages 50% of normal .
60% of patients needs additional surgery (average 2.5 procedures).
7 mo average time off work.