pancreatic injury is very common in case of road traffic accident and it needs to be evaluated promptly and decision to be taken as early aas possible .this presentation will give an overview of pancreatic injury management.
pancreatic injury is very common in case of road traffic accident and it needs to be evaluated promptly and decision to be taken as early aas possible .this presentation will give an overview of pancreatic injury management.
Association of Surgeons of Great Britain and Ireland 2022, Congress, 3 - 5 May, Liverpool.
Hall 1B: Symposium - Gallstones
11:00 - 12:30 Wednesday, 4th May, 2022. Symposium. Invited speakers:
Chairs: Mr Nick Maynard & Miss Trish Duncan
1. A nationwide analysis of gallbladder surgery in England between 2000 and 2019 - Mr Ray Lunevicius
2. What makes a gallbladder difficult and strategies to deal with them - Professor Alberto Ferreres
3. C-Gall Study - Professor Jane Blazeby
4. When to refer to a HPB Centre - Dr Shayam Menon.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Management of liver trauma in adults, 2018, by R. Lunevicius
1. Management of liver trauma in
adults
Raimundas Lunevicius
Consultant Surgeon
Liverpool University Hospitals NHS FT, Aintree site
Mersey and Cheshire Major Trauma Centre
University of Liverpool
19th July 2018
1
8. Aim of this lecture:
summarize the basics of management of liver trauma in adults
Agenda:
Definition
Classifications
Its descriptors
Liver trauma radiology
Principles of management
8
9. Definition of traumatic injury to the liver
Traumatic injury to the liver is
any intentional / unintentional,
blunt / penetrating / impaled damage to the
liver and / or major perihepatic vessels
resulting from acute exposure to external,
mostly mechanical, energy.
9
10. 1. Liver trauma classification,
By Abbreviated Injury Scale / AIS 2005, Update 2008
NB! for epidemiologists / science, as AIS grades are taken into account calculating ISS (0 - 75)
6 AIS
grade
6 Descriptors Codes: Assigned to a 6-digit unique numerical identifier
(UNI) to the left of the decimal point (known as the predot code)
1 Minor
2 Moderate 541810.2 (for superficial hematoma)
541812.2 (for intraparenchymal hematoma ≤10 cm )
541820.2 (for laceration)
3 Serious 541814.3 (for hematoma)
541824.3 (for laceration)
4 Severe 541826.4 (for hematoma)
541840.4 (for laceration)
5 Critical 541828.5
6 Maximal:
untreatable
541830.6
The original AIS was defined in 1971, by AAM (Association for the Advancement of Automotive Medicine)
10
11. 2. Liver trauma classification,
The American Association for Surgery of Trauma (AAST)
FOR DAILY CLINICAL USE
AAST gr. Description / Definition
Grade I Parenchymal laceration (fracture, rupture) < 1 cm deep
Capsular avulsion with superficial hematoma ≤ 10 cm
Grade II Parenchymal laceration 1 – 3 cm deep
Intraparenchymal (subcapsular) hematoma ≤10 cm in diamether
Superficial hematoma >10-50%
Grade III Parenchymal laceration > 3 cm deep
Intraparenchymal (subcapsular) hematoma > 10 cm in diameter
Central penetrating wound
Grade IV Destruction of one hemiliver tissue (25-75% of the lobe or 1-3 S)
Massive central hematoma (‘burst’ injury)
Grade V Extensive disruption of both hemilivers tissue
Extensive disruption of > 3 S or >75% of a single lobe
Injury to major hepatic veins or retrohepatic IVC injury
Grade VI Hepatic avulsion (ie total separation of all vascular attachments)
11
13. 3. WSES Liver Trauma classification is beneficial
in practical surgery
WSES Grade Definition Utilization of AAST grade system
Grade 1 Minor: if stable AAST grade I – II
Grade 2 Moderate: if stable AAST grade III
Grade 3 Severe: if stable AAST grade IV – V
Grade 4 Severe: if unstable AAST grade I – VI
(1) It shows that importance of AIS or AAST grades in surgery is relative
(2) It delineates the patient who should proceed to immediate laparotomy:
Grade 4
However, it doesn’t stress the importance of borderline physiology
WSES liver trauma classification covers physiological status PARTIALLY
13
14. Liverpool, Aintree:
S+B+U+E classification + physiology and physiological response
Type Physiology Initial management Utilisation of AAST grade
S Stable CT: Conservative (SNOM) Any but Grade VI
B Borderline MHP + CT: all options to consider Any but Grade VI
U Unstable MHP + CT, if responsive:
ALL OPTIONS to consider
Any but Grade VI
E In extremis Surgery immediately Any (Grade I – VI)
MHP =
Immediate Hemostatic Resuscitation using Belmont Rapid Infuser
0(-) warmed blood 750 (3 units) ml a minute =
5 L in 5 minutes in AE Resus
at Aintree: 3L Reservoir and Heat Exchange Set for 4 packs
14
68. Non-operative management
• Admit all pts with gr. 2-4 injuries to monitored bed (Ht < 32% to ICU)
• When Ht is stable
– Transfer to regular flow + advance diet
– Ht and Hg daily, Liver enzymes and bilirubin on day 2
– Mobilize when stable
• Grade I and II: discharge on day 1 – 2
• Grade III and IV or V: re-CT-scan on Day 4 (3-5)
• After discharge
– No school / work for a week
– No physical education for six weeks
– No major contact sports
• Grade I and II – for six weeks
• Grade III–V – for three months
– Instruct to return immediately to the ED if
• Worsening RUQ pain, fever, jaundice,...
• If so, consider biloma, UGI bleeding, secondary hemorrhage; avoid laparotomy.....
68
69. Operative management
Operative management when
– ‘grossly unstable (gr. 3 shock = 30% blood loss):
NO CT-scan is required – OPERATING THEATRE
– Hemodynamically bordeline patient
When NOT RESPONSIVE to
haemostatic resuscitation via Belmont® Rapid Infuser
69
70. Operative management
Immediately to Theatre: 2 ASSISTANTS / 2 scrub nurses
Prepare from chin to mid-thigh / two large suction devices
Midline incision + suction + quick gentle inspection
- Split lig. teres hepatis (not Falciform ligament !)
Firstly, assess hepatoduodenal ligament (for portal bleeding),
Secondly, assess liver AND classify bleeding into 2 classes:
(1) If it is bleeding from Portal Vein:
compress vein anatomically with fingers of L hand (50% JOB DONE);
use a pack/compression (as the alternative) / tourniquet
(2) NOT from PV: pack peri-hepatically / compress / wait
TEMPORAL CONTROL achieved: relax a moment and think
70