The technique of pulmonary resection had dramatically changed from mass ligation of pulmonary hilum to individual ligation of hilar structures and recently to video-assisted thoracoscopic pulmonary resection. However, the safe performance of lung resection requires a perfect knowledge of hilar anatomy and a technique with which the surgeon is familiar.
The technique of pulmonary resection had dramatically changed from mass ligation of pulmonary hilum to individual ligation of hilar structures and recently to video-assisted thoracoscopic pulmonary resection. However, the safe performance of lung resection requires a perfect knowledge of hilar anatomy and a technique with which the surgeon is familiar.
the slide describes femoral fracture with case presentations as well as rediological diagnosis ,when opened and closed .the management from emergency period and through to stabilization
CHEST INJURY- BLUNT/ Trauma Surgery
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on CHEST INJURY- BLUNT- an important topic in trauma. Even the blunt chest trauma can turn into penetrating one because of jagged edges of the broken ribs. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about pathophysiology, clinical approach, symptoms, signs, investigations, different individual types of Chest injuries and management of all the varieties of Chest injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of chest injury and should also be able to institute immediate lifesaving treatment to the patients if there is a need. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
thoracic aortic injuries are very rare, this presentation will give a brief idea regarding the presentation of Thoracic aortic injury and its management
The Americal Association for the Surgery of Trauma - guidelines for intestinal injury- grading and a brief description of duodenal injury and few Most common Questions
Short eye Examination components - that will tell you the main headings of an eye examination in trauma victims.
drawaneeshkatiyar@gmail.com - for further communication.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
1. Incision and Chest
Exposure in emergency
DR AWANEESH KATIYAR
M.Ch. Senior Resident
Trauma Surgery & Critical Care
All India Institute of Medical Sciences
Rishikesh, UK
2. Overview of presentation
1. Anatomy overview
2. Incisions and site
3. Exposure
4. Summary
5. Take home massage.
1
6. Overview of presentation
1. Anatomy overview
2. Incisions and site
3. Exposure
4. Summary
5. Take home massage.
5
7. Incisions and Site
Anterolateral
Left anterolateral (MOST COMMON)
Right anterolateral
Clamshell (AL – Extended to other
side)
High Anterolateral
Posterolateral
Right PL
Left PL
6
Median sternotomy
Extended neck exploration
Thoracolaparotomy
Book/Trapdoor thoracotomy
1. Anatomy overview
2. Incisions and site
3. Exposure
4. Summary
5. Take home massage.
8.
9.
10. Overview of presentation
1. Anatomy overview
2. Incisions and site
3. Exposure
4. Summary
5. Take home massage.
7
11. 8
Left Anterolateral thoracotomy
• Utility emergency thoracotomy- for unstable patient
• It is made from the sternal edge, under the mammary
fold, and in a curvilinear fashion toward the axilla,
staying in close proximity to the fourth or fifth
intercostal space.
• This incision should not be a straight line incision nor
be carried through the female breast
• Provides exposure – Heart, Aorta and Left Lung with
hilum and any time can be extended to other side.
1. Anatomy overview
2. Incisions and site
3. Exposure
4. Summary
5. Take home massage.
12. Clamshell thoracotomy
• Most of the time its extended
from Left AL thoracotomy
• Provides better exposure to
Both side lung with hilum,
heart and descending aorta.
• Not good for Superior
mediastinum, trachea, other
great vessels.
• Avoid to cut breast tissue in
female patient.
9
13. High Left Anterolateral thoracotomy-
Left subclavian artery injury
Very specifically - should be
done in left subclavian artery
injury – to take proximal
control
10
14. Median sternotomy
• Its time taking procedure
over Anterolateral
thoracotomy
• Preferred in superior
mediastinum hematoma,
precordial stab, to take
proximal control for other
bleeding vessels
• May be part of neck
exploration, thoraco-
laparotomy.
Median sternotomy avoided in EDT, Precordial Gunshot, trachea-bronchial injuries 11
16. Posterolateral thoracotomy
• Provides better exposure to posterior
mediastinum
• Most preferred – stable patient for
exposure esophagus, trachea, retained
hemothorax
12
17. Overview of presentation
1. Anatomy overview
2. Incisions and site
3. Exposure
4. Summary
5. Take home massage.
13
18. Summary
Indications Preferred incision Remarks
Emergency thoracotomy
(EDT )
Left anterolateral (AL)
Utility thoracotomy –
Pericardiotomy , cross
clamp, hilar twist, hilar
clamp, cardiac massage.
Precordial stab Median sternotomy
Not good for
mediastinum and
posterior cardiac surface
Precordial Gun shot
wound (GSW)
Left Anterolateral
Can reach to
mediastinum and
posterior heart
Lung GSW
Ipsilateral AL or convert
into clamshell
Better exposure and
easy to reach
14
19. Indications Preferred incision Remarks
Tracheal injury –
proximal half
Collar incision – T
shaped incision
No extra-exposure get
from full Median
Sternotomy,
Left proximal main
bronchus also visualized
better
Distal half
Right posterolateral
thoracotomy
Right main bronchus Right Posterolateral Don’t go for posterolateral
incision if patient in-
extremis.
Left distal main
bronchus
Left Posterolateral
Right subclavian
artery
Medial sternotomy
Right AL difficult to reach
at origin.
Left subclavian artery
High anterolateral
thoracotomy with neck
incision
For non bleeding artery
supraclavicular incision is
best.
15
20. Indications Preferred incision Remarks
Carotid artery injury Median sternotomy For better proximal
control
Abdominal Aortic injury Left anterolateral
thoracotomy
Aorta better visualized
from left side
Azygous vein injury Right posterolateral
thoracotomy
Its very rare and also
difficult to make the
diagnosis
Thoracic duct injury Right/ left
posterolateral
thoracotomy
Depends on side of
injury – difficult to
identify
16
21. Indications Preferred incision Remarks
Superior vena cava Right Anterolateral
thoracotomy
Always keep in the
mind patient may
require median
sternotomy for SVC
Inferior vena cava Right Anterolateral
thoracotomy
Depends on site of
injury still its better
visualized from right
side.
Upper thoracic
Esophagus
Right posterolateral
thoracotomy
Better visualize
Lower thoracic
Esophagus
Left posterolateral
thoracotomy
Upper part is poorly
visualized – great
vessels
17
22. Incision Left anterolateral Clamshell Median
sternotomy
• ED thoracotomy
(crashing, bedside
thoracotomy )
• EDT (mostly
extended from
Left ALT)
• Very selected
cases
Indication • All in-Extremis patient.
• Cardiac stab/GSW
• Cross clamping of aorta
• Left lung penetrating
injury
• Both lung
penetrating
injury
• Associated
cardiac injury
• Cardiac stab-
low velocity
• Sup mediastinal
hematoma.
18
23. CONCLUSION: We strongly recommend that patients who present pulseless with signs of life after
penetrating thoracic injury undergo EDT. We conditionally recommend EDT for patients who
present pulseless and have absent signs of life after penetrating thoracic injury, present or absent
signs of life after penetrating extra-thoracic injury, or present signs of life after blunt injury. Lastly,
we conditionally recommend against EDT for pulseless patients without signs of life after blunt
injury.
(J Trauma Acute Care Surg. 2015;79: 159Y173. Copyright * 2015 Wolters Kluwer Health, Inc. All
rights reserved.)
Review of literature
19
24. Conclusion: When the cumulative impact of penetrating injury mechanism, ED
SOL, and number of CGV(cardiac and great vessel) wounds was analyzed together,
we established that those sustaining multiple CGV GSWs (regardless of ED SOL)
were nearly unsalvageable. These results indicate that when multiple CGV GSWs
are encountered after EDT, further resuscitative efforts may be terminated without
limiting the opportunity for survival.
20
25. Overview of presentation
1. Anatomy overview
2. Incisions and site
3. Exposure
4. Summary
5. Take home massage.
21
26. Take home massage
Proper selection of incision gives – better exposure and control
Don’t hesitate to give another incision if exposure is not proper
Don’t put in harm to your team – for in-extremis patients – most of the
patients are risk of transmission of infection.
Identify early and stop resuscitation in non-survivor – save energy for next
patient.
22
27. Thank you
Or Mail me @
drawaneeshkatiyar@gmail.com
Asking questions?make you wise.