extremity vascular injury, arterial injury, causes of arterial injury, mechanisms of arterial injury, investigations for arterial injury, treatment of arterial injury, , extremity vascular injuryfor medical students
extremity vascular injury, arterial injury, causes of arterial injury, mechanisms of arterial injury, investigations for arterial injury, treatment of arterial injury, , extremity vascular injuryfor medical students
Vascular Injuries and Principles of ManagementVascular Surgery Workshop 2018
Joel Arudchelvam,MBBS (Col), MD (Sur), MRCS (Eng),Consultant Vascular and Transplant Surgeon Teaching Hospital Anuradhapura.
Causes, Mechanism of injury, Arterial Level injuries, Signs of vessel injury -Hard signs,Soft sign, Principles of management
vascular trauma, mannar medical association, causes,Data from Teaching Hospital Anuradhapura Sri Lanka 2015 - 2016, pathology, signs and symptoms, hard and soft signs, investigations, management
Vascular injuries occur
• Unexpected
• Young and fit
• Results in loss of limb or life
• Loss of earning capacity, economic
Our experience at Anuradhapura
Mean age - 36.9 years (17–69)
Arterial injury following trap gun - 25% amputation rate (Sriharan P, Arudchelvam JD, Marasinghe A. Outcome of major lower-limb arterial injuries presenting to a single unit in a peripheral setting in Sri Lanka. Indian J Vasc Endovasc Surg 2019;6:266-8
Causes - Road Traffic Accidents – 54.2%,Trap Gun – 33.3%,Iatrogenic - 8.33%,Other- 4.2% (Sriharan P, Arudchelvam JD, Marasinghe A. Outcome of major lower-limb arterial injuries presenting to a single unit in a peripheral setting in Sri Lanka. Indian J Vasc Endovasc Surg 2019;6:266-8)
Mechanism of injury
• Sharp / penetrating
• Blunt
“Vascular injury” is a nonspecific term. Because this is used to describe the injuries
to blood vessels in all parts of the body that includes neck vascular injuries, thoracic and
abdominal vascular injuries, and injuries to the blood vessels of the limbs. And in addition
vascular injury also describes injuries to the arteries and veins. Injuries to the blood vessels of
the limbs are called extremity vascular injury. This chapter will concentrate on the extremity
vascular injuries.
Vascular Trauma
Joel Arudchelvam
Consultant Vascular and Transplant Surgeon
Teaching Hospital Anuradhapura
Extremity Vascular Injuries
causes
Signs of a vessel injury hard and soft
Mechanism of disruption of flow at arterial level
Problems with diagnosing ischaemia after trauma
Investigations
How soon we should we repair
Surgical Repair
Compartment Syndrome
FASCIOTOMY
Reperfusion effects
• Reperfusion injury
• Post perfusion syndrome
Vascular Injuries and Principles of ManagementVascular Surgery Workshop 2018
Joel Arudchelvam,MBBS (Col), MD (Sur), MRCS (Eng),Consultant Vascular and Transplant Surgeon Teaching Hospital Anuradhapura.
Causes, Mechanism of injury, Arterial Level injuries, Signs of vessel injury -Hard signs,Soft sign, Principles of management
vascular trauma, mannar medical association, causes,Data from Teaching Hospital Anuradhapura Sri Lanka 2015 - 2016, pathology, signs and symptoms, hard and soft signs, investigations, management
Vascular injuries occur
• Unexpected
• Young and fit
• Results in loss of limb or life
• Loss of earning capacity, economic
Our experience at Anuradhapura
Mean age - 36.9 years (17–69)
Arterial injury following trap gun - 25% amputation rate (Sriharan P, Arudchelvam JD, Marasinghe A. Outcome of major lower-limb arterial injuries presenting to a single unit in a peripheral setting in Sri Lanka. Indian J Vasc Endovasc Surg 2019;6:266-8
Causes - Road Traffic Accidents – 54.2%,Trap Gun – 33.3%,Iatrogenic - 8.33%,Other- 4.2% (Sriharan P, Arudchelvam JD, Marasinghe A. Outcome of major lower-limb arterial injuries presenting to a single unit in a peripheral setting in Sri Lanka. Indian J Vasc Endovasc Surg 2019;6:266-8)
Mechanism of injury
• Sharp / penetrating
• Blunt
“Vascular injury” is a nonspecific term. Because this is used to describe the injuries
to blood vessels in all parts of the body that includes neck vascular injuries, thoracic and
abdominal vascular injuries, and injuries to the blood vessels of the limbs. And in addition
vascular injury also describes injuries to the arteries and veins. Injuries to the blood vessels of
the limbs are called extremity vascular injury. This chapter will concentrate on the extremity
vascular injuries.
Vascular Trauma
Joel Arudchelvam
Consultant Vascular and Transplant Surgeon
Teaching Hospital Anuradhapura
Extremity Vascular Injuries
causes
Signs of a vessel injury hard and soft
Mechanism of disruption of flow at arterial level
Problems with diagnosing ischaemia after trauma
Investigations
How soon we should we repair
Surgical Repair
Compartment Syndrome
FASCIOTOMY
Reperfusion effects
• Reperfusion injury
• Post perfusion syndrome
La rivascolarizzazione degli arti inferiori nel paziente anziano: rischi e va...ASMaD
Presentazione a cura del Professor Angelo Cioppa - XII° Congresso Nazionale FIMeG 2018 - The Silver Tsunami: l'anziano fra appropriatezza e farmaeconomia
Principles of management of Neck vascular trauma
Pre Congress Workshop on
Vascular Trauma
September 2023
Joel Arudchelvam
Causes
Impalement
Signs of neck vascular injuries
Anatomy and neck zones
Management
Factors to consider
Preoperative imaging
Changing concepts
Ligation Vs Repair
Neurological status and carotid repair
Diabetic foot and Foot care
Dr Joel Arudchelvam
Definition
Prevalence
Teaching Hospital Anuradhapura [THA]
High risk foot
Neuropathy
Pathogenesis of neuropathy
Charcot foot
Testing for neuropathy
Local Ulcer care
Managing Venous Ulcers Pre-congress Workshop
Wound Care in the Elderly
Scientific Conference of the Sri Lankan Association of Geriatric Medicine
Dr Joel Arudchelvam
Chronic Venous Diseases
CEAP Classification
Chronic Venous Ulcer
Pathophysiology
Investigations
Venous Duplex Scan
Treatment
LASER - Light Amplification by Stimulated Emission of Radiation
Sclerotherapy
Multi layer compression dressing (strapping)
Compliance
Cost and problems
Methods of leg elevation
Annual Academic Conference
SLSVS 23
Joel Arudchelvam
MBBS, MD ( SUR ), MRCS (ENG), FCSSL
Consultant Vascular and Transplant Surgeon
Aortic aneurysms
Abnormal focal dilatation of a vessel of more than 50 % of its normal diameter
Abdominal aorta more than 3 cms (normal diameter - 2 cms)
Open AAA repair
Endo Vascular Aneurysm Repair (EVAR)
Arch de-branching
Sri Lankan Experience
15 Vascular and transplant units
Emergency AAA repair
Open TAA repair
Future directions
ORGAN
TRANSPLANTATION
Definition
Donor
Recipient
Graft
Organs usually transplanted
Tissues, cells usually transplanted
Types of organ donors
HISTORY OF TRASNPLANTATION
HISTORY OF TRANSPLANTATION IN SRI LANKA
Transplantation procedure
Live donor nephrectomy
Organ preservation
Renal transplantation
Donor
Post operative management
RECIPIENT – SURGERY
POST-OPERATIVE CARE
Cadaveric Transplantation
Organ ischemia
Immunological complications
Carotid artery injuries, Joel Arudchelvam, SLSC 2022, Carotid artery injuries
Causes
Hard signs of vascular injury
Associated signs
Anatomy and neck zones
Management
Factors to consider
Preoperative imaging
Management – changing concepts
Vascular surgical intervention
Open surgery
Certificate in Teaching in Higher Education (CTHE) 2022
Post ward round discussion in medical student teaching results in better understanding
Joel Arudchelvam
Advantages of ward round teaching
Problems related to the wards
The responses from the students
Future plans
Joel Arudchelvam
Definition
Donor types
HISTORY OF TRASNPLANTATION in Sri Lanka
Transplantation procedure
Organ preservation
BASIC COMPONENTS OF PRESERVATION SOLUTIONS
135TH ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS 2022
30th September 2022
At BMICH, Colombo.
Symposium on
Solid Organ transplantation
Kidney transplantation - Challenges and
Experiences
Kidney transplantation
Causes for chronic kidney dise
Chronic Kidney Disease of unkn
Paediatric kidney transplant
Teaching Hospital Anuradhapura
The university transplant unit
Live donor nephrectomy
Organ preservation
Iliac vessel mobilisation
Renal vessels ananstomosis
Ureter anastomois
Surgical aspects
user experience
Relationship of live donors (T
Area of residence of donors
Live Donor profile
Donor vascular variations
Vascular reconstruction
Jaffna Medical association
Annual Scientific Sessions September, 2022
Professor C.Sivagnanasundaram memorial oration
Introduction
Vascular injuries are potentially life or limb threatening. Vascular trauma occurs in 1.6% of civilian injuries (1) and 6.8% to 10.8% in war related injuries (Afghanistan, Iraq and Lebanon war). In a study done at the National hospital of Sri Lanka Colombo (NHSL) out of 5802 trauma admissions there were 93 patients with vascular injuries (VI). Therefore the incidence of VI in civilian trauma is 1.6% (1). After the end of civil war in Sri Lanka in 2009 there is a reduction in the number of war related vascular injuries. But due to the increase in the number of Road Traffic Accidents (RTA), the number of vascular trauma also increased (i.e. from 1938 to 2013 road traffic injuries increased from 35.1 to 98.6 per 100 000 population in Sri Lanka). One of the reasons for this is the increased number two and three wheeled vehicles which are involved more with accidents (2). Trauma and vascular injuries often involve young males. They are the breadwinners of the family. In one study done at the Teaching Hospital Anuradhapura (THA) among patients presenting with popliteal arterial injuries, 18 (90%) were males with a mean age of 38.7 years (2). And in another study done at the same institution among patients with major lower limb arterial injuries, 22 (87.5%) were males and the mean age was 36.9 years (3). These studies confirm the fact of young males often getting involved with vascular injuries.
Acute limb ischaemia
Joel Arudchelvam
MBBS (COL), MD (SUR). MRCS (ENG)
Consultant Vascular and Transplant Surgeon
The National Hospital of Sri Lanka , Colombo
Definition
Causes
Differentiating thrombosis and embolism
More from Joel Arudchelvam MBBS, MD, MRCS, FCSSL (20)
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
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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
2. Injury to the popliteal vessels
Common
Amputation rates are highest.
Our experience
Popliteal arterial injury – 32.5% of all injuries –commonest vascular
injury (during war time 21%)
34.8% amputation rate.
•WHY?
3. Anatomy
it is tethered to the distal
femur (adductor hiatus)
and to tibia by the
tendinous soleal arch.
This collateral network is
frail and subject to
obliteration and
thrombosis by disruption
or soft tissue swelling.
4. Popliteal vein travels proximally in a dense sheath
with the popliteal artery
surrounding artery with venous communication
This proximity explains the frequent coexistence of
popliteal venous trauma when the artery is injured.
5. The popliteal artery is an end artery
with a tenuous collateral supply.
The popliteal vein provides the bulk of lower leg and
foot drainage.
6. HISTORY
The first use of a vein graft to repair on a traumatic
aneurysm of the popliteal artery in 1906.
Ligation remained a standard management through
World Wars I and II
72.5% amputation rate
32% amputation rate during the Korean War .same
rate in the Vietnam conflict
7. Reasons given
lack of
transportation
unsanitary conditions
absence of effective blood banking
Antibiotics
anesthesia
prevented repair on a large scale.
8. Significant improvement in limb salvage has
continued since Vietnam war.
These results were extrapolated quickly to the civilian
sector, where further improvements in limb salvage
9. PROGNOSTIC FACTORS
Time interval – common cause of limb loss in most series
Mechanism
penetrating wounds better outcomes than from blunt injury
because surrounding tissue damage to be less severe.
Difficult to diagnose because associated organ and tissue injuries
10. compilation of 1209 published cases of civilian
popliteal artery trauma from 24 series
Penetrating 56% (678/1209) - 10.5% amputation
Blunt trauma resulted in amputation in 27.5% of all
cases, ranging as high as 71%.
Our series – overall amputation rate 34.8%
NOT because of bad surgery!
12. Associated injuries
skeletal injuries (with posterior knee dislocation , popliteal vein, tibial and peroneal
nerve, and soft tissue and tendon)
chronic vascular disease
accurate diagnosis of an acute vascular injury may be obscured by the chronic
existence of pulse deficit
the clinical presentation of popliteal vascular injury
injuries that present with
frank ischemia
active hemorrhage
shock
have a poorer prognosis
13. Injury to the popliteal artery accounted for
12% of all arterial injuries -in World War I
20% of those in World War II
13 26% - in the Korean War,
21.7% of - in the Vietnam War.
Our experience –
war time – 21%
Present series - 32.5%
14. Diagnosis
Most cases of popliteal vascular trauma present with
obvious clinical manifestations, or ‘‘hard’’ signs of
vascular injury
Active bleeding
Expanding haematoma
Bruit
Evidence of distal ischaemia
the 6 Ps: in trauma????
Pain
Pallor
Paralysis
Paresthesiae
Poikilothermy or coolness
DISTAL PULSE
16. Any vascular imaging or diagnostic test is unnecessary
Doppler, ultrasound, contrast angiography
•WHY?
17. Doppler pressure measurements and duplex
ultrasonography – provide no advantage over clinical
judgment
18. But needed in
certain cases
complex trauma cause extensive bone and soft tissue
injury manifest “hard signs” that do not arise from
vascular injury but from soft tissue and bone bleeding,
nerve damage
Multiple level injury
Elderly with OAD
21. TREATMENT
Surgical Repair
prompt transport to operating room
General anesthesia
Cleaning entire leg and be able to visualize the foot
and palpate distal pulses.
Contra lateral limb – for venous harvest
Supine – knee flexed ,support under ,hip abducted
Medial approach
23. Stab wounds leading to lateral injury – patch
angioplasty, ? Lateral arteriorrhaphy
Downs AR, MacDonald P: Popliteal artery injuries: Civilian experience with
sixtythree patients during a twenty-four year period (1960 through 1984). J Vasc
Surg 4:55–62, 1986
Our series – none underwent
Extra-anatomic bypass
Severe soft tissue injury
Infection
If artery not accessible
Our series – none underwent
24. Completion angiography – show anastomotic
abnormality in 10%
Lim LT, Michuda MS, Flanigan P, et al: Popliteal artery trauma:
31 consecutive caseswithout amputation. Arch Surg 115:1307–
1313, 1980
We do not perform routinely
25. Nonoperative Observation
For non occlusive injuries i.e.
Vessel narrowing
Intimal flaps
Small false aneurysm
AVF
May progress to false aneurysm – 10%
None result in limb loss
• Callow AD, Ernst CB (eds): Vascular Surgery: Theory and Practice. Stamford, CT,Appleton & Lange, 1995, pp 985–1037
• Frykberg ER, Crump JM, Dennis JW, et al: Nonoperative observation of clinically occult arterial injuries: A prospective
evaluation. Surgery 109:85–96, 1991
• Frykberg ER, Dennis JW, Bishop K, et al: The reliability of physical examination in the evaluation of penetrating
extremity trauma for vascular injury: Results at one year. J Trauma 31:502–511, 1991
26. Popliteal vessel injury – esp high risk injury for
compartment syndrome
Liberal Fasciotomy is indicated
27. Combined Vascular and Skeletal
Extremity Trauma
higher risk for limb loss and morbidity than either
injury alone.
Revascularization should be performed before skeletal
fixation
Temporary shunting before fixation
28. Primary amputation
extensive crush injuries and soft tissue damage
multiple comminuted skeletal fractures with bone
loss
life-threatening problems
multiple failures of revascularization
sciatic or tibial nerve transection.