This document discusses the use of tourniquets in orthopaedics. It defines a tourniquet and outlines their history, from their original use in the 18th century to modern pneumatic devices. Tourniquets are commonly used in orthopaedic surgery to provide a bloodless surgical field. Complications can include nerve palsies, muscle injury, and pain. Proper application and monitoring of pressure levels can help reduce risks. Tourniquets remain a useful tool but require careful use to minimize complications.
This is a lecture presentation on applying external fixator on open fracture specially on tibia. This method is a classical method. Various new and dynamic fixators are there but the basics are the same.
different type of lower limb amputation with indication, peri-operative care, surgical steps, post op care complication and different type of prosthesis
Surgical hemostasis is one of the pillars of modern surgery. Adequate hemostasis in a surgical patient involves a detailed perioperative clinical evaluation and investigation, and various intra operative techniques and options. Ensuring adequate surgical hemostasis reduces morbidity and mortality by modulating the metabolic response to trauma, decreasing the incidence of post operative anemia, reduces rates of surgical site infection and ultimately improving wound healing
A tourniquet can be defined as a constricting or compressing device used to control arterial and venous blood flow to a portion of an extremity for a period of time. ... In emergency settings, a tourniquet is used stop traumatic bleeding such that medical care can be provided in time before the injured person bleeds out.
The pneumatic tourniquet system consists of a pressure regulated control unit, hose assembly and an inflatable tourniquet cuff. The cuff inflates with air to a preset pressure to compress the patient's blood vessels during surgical procedures, thus ensuring a bloodless operative field
This is a lecture presentation on applying external fixator on open fracture specially on tibia. This method is a classical method. Various new and dynamic fixators are there but the basics are the same.
different type of lower limb amputation with indication, peri-operative care, surgical steps, post op care complication and different type of prosthesis
Surgical hemostasis is one of the pillars of modern surgery. Adequate hemostasis in a surgical patient involves a detailed perioperative clinical evaluation and investigation, and various intra operative techniques and options. Ensuring adequate surgical hemostasis reduces morbidity and mortality by modulating the metabolic response to trauma, decreasing the incidence of post operative anemia, reduces rates of surgical site infection and ultimately improving wound healing
A tourniquet can be defined as a constricting or compressing device used to control arterial and venous blood flow to a portion of an extremity for a period of time. ... In emergency settings, a tourniquet is used stop traumatic bleeding such that medical care can be provided in time before the injured person bleeds out.
The pneumatic tourniquet system consists of a pressure regulated control unit, hose assembly and an inflatable tourniquet cuff. The cuff inflates with air to a preset pressure to compress the patient's blood vessels during surgical procedures, thus ensuring a bloodless operative field
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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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
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A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
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Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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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.
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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
2. Definition
• A tourniquet is a constricting or compressing
device used to control venous and arterial
circulation to an extremity for a period of
time.
• Pressure is applied circumferentially upon the
skin and underlying tissues of a limb; this
pressure is transferred to the walls of vessels,
causing them to become temporarily
occluded.
3. History
• Jean Louis Petit coined the word
“Tourniquet” from theFrench word
tourner (to turn) in 1718 when he
used them for lower limb
amputations to reduce blood loss.
• In 1873 , Johan friedrich august von
esmarch introduced flat rubber
tube wrapped repeatedly around
the limb as tourniquet
• In 1904 Harvey cushing introduced
pneumatic tourniquet to limb
surgery
Johan friedrich august von
esmarch
5. TOURNIQUET
SURGICAL EMERGENCY
TOURNIQUET TOURNIQUET
• Surgical Tourniquets prevent blood flow to a limb and
enable surgeons to work in a bloodless operative field
and are frequently used in orthopaedic surgery.
• Emergency Tourniquets are used in emergency bleeding
control to prevent severe blood loss from limb trauma.
6. Uses in Orthopedics
Reduction of certain fractures.
Kirschner wire removal.
Replacement or revision of the joints of the
knee, wrist, digits, hand, or elbow.
Arthroscopy of the knee, elbow, wrist, hand, or
digits.
Repair of traumatic nerve damage.
7. Cont’d
Bone grafts.
Graft and repair of lacerated tendons.
Subcutaneous fasciotomy.
Carpal tunnel release.
Traumatic or non traumatic amputation.
Correction of a hammer toe.
8. Parts of tourniquet
• Inflatable cuff
• Gas source ( nitrogen
or air )
• Pressure display
• Pressure regulator
(within 2-6 mmHg)
• Connection tubing
9. Proper application
• should be applied very carefully to the
proximal part of the limb at the greatest
circumference.
• Adequate padding should be done at that site
but no loose cotton .
• 3 inches to 6 inches overlap.
10. Exsanguination
• Exsanguination before inflation of the tourniquet improves
the quality of the bloodless field and minimizes pain.
• Normally done by limb elevation, maximal exsanguination can
be achieved by elevation of the arm or leg for 5 min at 90◦and
45◦ respectively, without mechanical compression.
• or using an elastic wrap of the extremity.
• Malignancy, infection thrombi, fracture – simple elevation or
nothing – no wrapping
11. Tourniquet Cuff Pressure
• LOP can be defined as the minimum pressure
required to stop the flow of arterial blood into the
limb distal to the cuff.( limb occlusion pressure)
Not well defined
Preop LOP
Safety in kids - ??
12. Inflation or occlusion time
• One hour
• Not yet defined but may be up to three hours
• 10 minute deflation interval every one hour
• Pediatric patients – better less than 75
minutes
14. Local
• Normal physiological conduction block in fifteen
minutes
Nerve injuries – 0.37%
• The radial nerve, followed by the ulnar and median
nerves in the upper limb.
• The sciatic nerve in the lower limb are most commonly
involved.
• Large diameter nerve fibers are more commonly
affected.
15. Muscle injury
• Tends to be greatest beneath the tourniquet
because of the combination of ischaemia and
mechanical deformation.
• May persist after tourniquet deflation as a
result of micro- vascular congestion
• Post tourniquet syndrome – weakness palsy
without anesthesia
• Three weeks – usually normalize.
16. Excess bleeds intra op
• under-pressurized cuff, insufficient exsanguination,
improper cuff selection, loosely applied cuff, calcified
vessels or too slow inflation or deflation.
• Bleeding may occur despite a properly applied and
inflated tourniquet, in a patient with noncalcified
vessels. (the phenomenon of tourniquet ooze.)
17. • Vessel bypasses the tourniquet through the
medulla of the humerus or femur.
• It typically starts about 30 minutes after
tourniquet inflation
• Increasing the tourniquet pressure does not
help
18. Tourniquet pain
• The smaller unmyelinated C-fibers are more resistant
to LA induced conduction block as compared A-fibers
• C-fibers start conducting impulses before the A-fibers,
resulting in a Dull aching poorly localized tight pain.
• Increased HR and BP ( tourniquet hypertension)
• Difficult to prevent and treat this – even in spinal and
dense blocks
19. Tourniquet pain
• Eutectic mixture of local anesthetic (EMLA)
cream application, LAs given via the neuraxial
route with or without opioids have been used
to attenuate tourniquet-induced pain.
• Adjuvants – Magnesium sulfate, ketamine,
ketorolac and clonidine
• Alternative techniques like electro puncture
and meditation.
20. Pre-application precautions
• The pressure source, cuff, regulator, tubing,
and connectors need to be checked before use
• as wide a cuff as possible should be used.
• The cuff should not directly overlie bony
prominences.
• The cuff should overlap at least 3 inches, but
not more than 6 inches as it may cause
generation of high pressures.
21. • The extremity should be exsanguinated before
inflation of the tourniquet.
• Tourniquet inflation pressure should be kept
to the minimum effective pressure.
23. Contraindications
• Peripheral vascular disease
• Arteriovenous (AV) fistula
• Peripheral neuropathy
• DVT in the limb
• Severe infection of the limb
• Severe trauma to the limb
• Poor skin condition of the limb
• Sickle cell haemoglobinopathy
24. Conclusion
• Tourniquets are useful aids for limb procedures.
• Pre-determination of LOP and inflating
tourniquets accordingly can help reduce the
complications.
• Proper patient monitoring and care after
deflation for neurological deficit postoperatively
can minimize the complications.