This document discusses emerging technologies in wound care, focusing on hyperbaric oxygen therapy, advanced cell-based therapies using mesenchymal stem cells and bioengineered skin substitutes, and intermittent pneumatic compression devices. It reviews evidence that hyperbaric oxygen therapy significantly increases wound healing rates compared to placebo treatment. New cell-based therapies utilize fibroblasts, keratinocytes, and mesenchymal stem cells from sources like bone marrow and amniotic membrane to reduce inflammation and promote proliferation, angiogenesis, and collagen deposition. Intermittent pneumatic compression enhances lymphatic return, arterial perfusion, and oxygen delivery to wounds.
A 25-year-old male presented with a swollen and painful calf following exercise. He was suspected of having a deep vein thrombosis (DVT) and was given therapeutic anticoagulation with Fragmin. Six hours later, he developed severe leg pain and swelling. He was diagnosed with compartment syndrome requiring emergency fasciotomy. The administration of anticoagulation for a suspected DVT precipitated acute compartment syndrome in this case, as the actual diagnosis was a gastrocnemius tear. This case highlights the risks of preemptive anticoagulation when the diagnosis is not definitively DVT and complications such as compartment syndrome can result from hemorrhage.
Anatomy of the anterior & lateral compartments of the legMohamed Ahmed Eladl
This document discusses the anatomy of the leg. It begins by describing the cutaneous nerve supply to the front and back of the leg, including the saphenous, common peroneal, musculocutaneous, and sural nerves. It then outlines the three compartments of the leg separated by intermuscular septa, containing the anterior, lateral, and posterior muscle groups. Several pages provide details on the muscles, arteries, and nerves of the anterior and lateral compartments. The document concludes with descriptions of the extensor and peroneal retinacula and their functions in maintaining tendon positions.
1) The document discusses using transdermal carbon dioxide (CO2) delivery via a handheld device called D'Oxyva to increase microcirculation and promote wound healing.
2) It provides background on how CO2 acts as a vasodilator and how increased CO2 levels via this device can boost oxygen delivery and tissue perfusion.
3) Several case studies and observations are presented showing accelerated wound healing in patients using the D'Oxyva device to deliver transdermal CO2.
Non-invasive Transdermal Delivery of Medical Carbon Dioxide with D`OXYVA® Boo...Circularity
Transdermal delivery of medical carbon dioxide via D'OXYVA has been shown to boost microcirculation and balance the autonomic nervous system. A study delivering CO2 to participants' thumbs found significant increases in skin perfusion pressure in their toes for up to 4 hours after, indicating improved remote microvascular function and wound healing potential. Further research suggests D'OXYVA delivery balances sympathetic and parasympathetic nerve activity by initially decreasing sympathetic activity during delivery and potentially extending parasympathetic activity afterwards. These effects were seen without adverse events and show promise for conditions involving microvascular dysfunction.
This chapter introduces the concept of redefining resuscitation to focus on early detection of physiological deterioration in at-risk patients rather than solely focusing on cardiopulmonary resuscitation (CPR) after cardiac arrest. Studies show the majority of in-hospital cardiac arrests are predictable, with signs of deterioration in the hours prior. Early warning scores can help identify at-risk patients and trigger appropriate escalation of care to prevent further decline. Understanding the generic altered physiology that can accompany acute illness (A - airway and breathing, B - circulation, C - disability/neurology, D - exposure/temperature) provides important context for managing deteriorating patients.
This document provides information on peritonsillar abscess (quinsy). It defines peritonsillar abscess as a collection of pus between the tonsil capsule and superior constrictor muscle. Key points include:
- It is a common deep neck infection with an incidence of 1 in 10,000 cases.
- If left untreated, it can lead to complications like airway obstruction, abscess rupture, or sepsis.
- Proper management through surgical drainage and antibiotics is important.
- Clinical features include pain, difficulty swallowing, and a bulging on the soft palate. Diagnosis is usually made through history and exam but imaging may be used. Treatment involves incision
This document discusses factors to consider when prescribing hemodialysis, including machine settings, filter selection, and patient characteristics. It covers dialysis targets, complications to prevent, and how blood and dialysate flow rates impact filtration coefficient. The goal is to individualize treatment and achieve a balanced dialysis prescription that addresses clearance needs while preventing harm.
This document summarizes key points from a presentation on managing septic shock given by Dr. R. Phillip Dellinger. It discusses definitions of sepsis, severe sepsis, and septic shock. It reviews guidelines from the Surviving Sepsis Campaign for initial resuscitation, including administering antibiotics within 1 hour, achieving hemodynamic goals, and considering early goal-directed therapy. Vasopressor choices of norepinephrine and dopamine are recommended. Steroids may be considered for nonresponsive shock. Activated protein C was previously suggested but is no longer recommended. Guidelines aim to improve care through protocols and performance improvement programs.
A 25-year-old male presented with a swollen and painful calf following exercise. He was suspected of having a deep vein thrombosis (DVT) and was given therapeutic anticoagulation with Fragmin. Six hours later, he developed severe leg pain and swelling. He was diagnosed with compartment syndrome requiring emergency fasciotomy. The administration of anticoagulation for a suspected DVT precipitated acute compartment syndrome in this case, as the actual diagnosis was a gastrocnemius tear. This case highlights the risks of preemptive anticoagulation when the diagnosis is not definitively DVT and complications such as compartment syndrome can result from hemorrhage.
Anatomy of the anterior & lateral compartments of the legMohamed Ahmed Eladl
This document discusses the anatomy of the leg. It begins by describing the cutaneous nerve supply to the front and back of the leg, including the saphenous, common peroneal, musculocutaneous, and sural nerves. It then outlines the three compartments of the leg separated by intermuscular septa, containing the anterior, lateral, and posterior muscle groups. Several pages provide details on the muscles, arteries, and nerves of the anterior and lateral compartments. The document concludes with descriptions of the extensor and peroneal retinacula and their functions in maintaining tendon positions.
1) The document discusses using transdermal carbon dioxide (CO2) delivery via a handheld device called D'Oxyva to increase microcirculation and promote wound healing.
2) It provides background on how CO2 acts as a vasodilator and how increased CO2 levels via this device can boost oxygen delivery and tissue perfusion.
3) Several case studies and observations are presented showing accelerated wound healing in patients using the D'Oxyva device to deliver transdermal CO2.
Non-invasive Transdermal Delivery of Medical Carbon Dioxide with D`OXYVA® Boo...Circularity
Transdermal delivery of medical carbon dioxide via D'OXYVA has been shown to boost microcirculation and balance the autonomic nervous system. A study delivering CO2 to participants' thumbs found significant increases in skin perfusion pressure in their toes for up to 4 hours after, indicating improved remote microvascular function and wound healing potential. Further research suggests D'OXYVA delivery balances sympathetic and parasympathetic nerve activity by initially decreasing sympathetic activity during delivery and potentially extending parasympathetic activity afterwards. These effects were seen without adverse events and show promise for conditions involving microvascular dysfunction.
This chapter introduces the concept of redefining resuscitation to focus on early detection of physiological deterioration in at-risk patients rather than solely focusing on cardiopulmonary resuscitation (CPR) after cardiac arrest. Studies show the majority of in-hospital cardiac arrests are predictable, with signs of deterioration in the hours prior. Early warning scores can help identify at-risk patients and trigger appropriate escalation of care to prevent further decline. Understanding the generic altered physiology that can accompany acute illness (A - airway and breathing, B - circulation, C - disability/neurology, D - exposure/temperature) provides important context for managing deteriorating patients.
This document provides information on peritonsillar abscess (quinsy). It defines peritonsillar abscess as a collection of pus between the tonsil capsule and superior constrictor muscle. Key points include:
- It is a common deep neck infection with an incidence of 1 in 10,000 cases.
- If left untreated, it can lead to complications like airway obstruction, abscess rupture, or sepsis.
- Proper management through surgical drainage and antibiotics is important.
- Clinical features include pain, difficulty swallowing, and a bulging on the soft palate. Diagnosis is usually made through history and exam but imaging may be used. Treatment involves incision
This document discusses factors to consider when prescribing hemodialysis, including machine settings, filter selection, and patient characteristics. It covers dialysis targets, complications to prevent, and how blood and dialysate flow rates impact filtration coefficient. The goal is to individualize treatment and achieve a balanced dialysis prescription that addresses clearance needs while preventing harm.
This document summarizes key points from a presentation on managing septic shock given by Dr. R. Phillip Dellinger. It discusses definitions of sepsis, severe sepsis, and septic shock. It reviews guidelines from the Surviving Sepsis Campaign for initial resuscitation, including administering antibiotics within 1 hour, achieving hemodynamic goals, and considering early goal-directed therapy. Vasopressor choices of norepinephrine and dopamine are recommended. Steroids may be considered for nonresponsive shock. Activated protein C was previously suggested but is no longer recommended. Guidelines aim to improve care through protocols and performance improvement programs.
This document summarizes a randomized controlled trial that investigated whether stable patients with infective endocarditis could be safely treated with oral antibiotics rather than continued intravenous antibiotics. The trial involved 400 patients across multiple centers in Denmark who had infective endocarditis of the left heart caused by common bacterial species. Patients received either continued intravenous antibiotics according to guidelines or a partial oral antibiotic treatment regimen. The primary outcome was to show non-inferiority of oral treatment. Results showed that oral antibiotic treatment was found to be non-inferior to continued intravenous treatment for stable patients.
This document provides an overview of extracorporeal membrane oxygenation (ECMO) and its use in Hong Kong. It discusses the history and development of ECMO, how it works, common configurations including veno-venous and veno-arterial ECMO. It also outlines indications for ECMO use, important clinical studies that have supported its use, worldwide trends showing increased adoption of ECMO in recent years. Specifically for Hong Kong, it details the milestones in establishing ECMO programs across public hospitals to provide 24/7 ECMO services, statistics on ECMO use in Hong Kong, and the role of ECMO during public health crises including SARS and H1N1 influenza.
This document summarizes a randomized controlled trial that investigated whether stable patients with infective endocarditis on the left side of the heart could be safely treated with oral antibiotics instead of continued intravenous antibiotics. The trial involved 400 patients randomized to either continued intravenous or oral antibiotic treatment according to predefined regimens. The primary outcome was a composite of death, embolic events, or recurrence of infection. The results showed that oral antibiotic treatment was noninferior to continued intravenous treatment.
1) Paediatric intensive care involves some differences compared to adult intensive care, including specific considerations for airway management, ventilation, fluids, and vasopressors in children.
2) Management of conditions such as sepsis, cardiac disease, and traumatic brain injury also has some distinctions in paediatric patients, including earlier use of interventions like ECMO and different drug choices or dosing.
3) Conditions particularly seen in paediatric intensive care include bronchiolitis, pertussis, and non-accidental injury, which present challenges in diagnosis and optimal treatment approaches.
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
Marcelo Cypel - Canada - Tuesday 29 - Organ Donor Care. New Alternativesincucai_isodp
- The document discusses principles for managing multi-organ donors to optimize organ preservation for transplantation. It emphasizes cardiovascular and pulmonary management to minimize donor organ injury.
- The SALT protocol increased lung donors and transplants by improving donor lung recruitment and classification. It showed donor lungs previously deemed "poor" could be used if given recruitment maneuvers.
- New approaches like ex vivo lung perfusion now allow for evaluating and potentially repairing marginal donor lungs before transplantation instead of immediate decline. This may help increase the utilization and outcomes of donor lungs.
Argo Medical aims to fundamentally change the lives of individuals with spinal cord injuries. The document discusses the negative impacts of spinal cord injuries based on a 1947 quote, including issues with bladder, bones, blood, skin, bowels, and mental health. It provides statistics on the prevalence and costs of spinal cord injuries. Argo Medical's exoskeleton technology aims to allow independent walking, individual control, and all-day use to improve health, independence, and social inclusion for users. Clinical studies show benefits like increased lean muscle mass, decreased fat mass, and improved bowel function for users. The technology has significant potential cost savings for health systems and a large potential commercial market.
Fran Lockie, a Paediatric Emergency and retrieval specialist, gives an update on paediatric resuscitation. This talk was given at the Bedside Critical Care Conference 2012 on Daydream Island.
Dr. Jeffrey Milsom and Dr. Fred Cornhill lead the Minimally Invasive New Technologies (MINT) program at NewYork-Presbyterian/Weill Cornell Medical Center to develop new endolumenal surgical techniques and technologies. Their goal is to transform digestive disease surgery by performing procedures entirely within the intestine using their Endolumenal Surgical Platform (ESP). ESP and future platforms will allow complex procedures to be done without incisions, improving patient outcomes and safety while lowering costs. The MINT team's innovations have the potential to redefine care for common digestive diseases and conditions that currently require open or laparoscopic surgery.
This document provides an overview of vascular ulcers, including their classification, etiology, pathophysiology, and management. The main types of vascular ulcers are venous ulcers, arterial ulcers, and mixed arteriovenous ulcers. Venous ulcers are the most common and are usually located over the medial gaiter region of the leg. Arterial ulcers are suggested by diminished or absent peripheral pulses and often have a gray or black wound base. Treatment involves conservative measures like compression therapy for venous ulcers and endovascular procedures or bypass grafts for arterial insufficiency. Proper wound care, infection control, and patient education are important for management.
The document provides a summary of the history and operations of the Mayo Clinic in Rochester, Minnesota from its founding in 1883 to present day. It details the Clinic's expansion to additional locations, contributions to medical research and innovations, education programs, and status as a renowned medical center focused on patient-centered care.
This document provides information about gas exchange and interventions to optimize it. It begins by defining gas exchange as the process of oxygen transport to cells and carbon dioxide transport from cells. It then lists goals of understanding gas exchange, risk factors for impairment, signs of compromise, and appropriate interventions. Key terms related to gas exchange are defined. The document discusses categories of gas exchange including perfusion, ventilation, and transport. Causes of hypoxia and associated interventions are outlined. Assessment of gas exchange and common diagnostic tests are reviewed. Finally, the document discusses various nursing and collaborative interventions to optimize gas exchange, including oxygen therapy devices, airway clearance techniques, and positioning.
Pathology and management of compartment syndrome in orthopedics 1EnejoJoseph
The document provides an overview of pathology and management of compartment syndrome in orthopedics. It discusses the definition, classification, risk factors, pathophysiology, clinical presentation, diagnosis, and treatment of compartment syndrome. The main treatment is surgical fasciotomy to decompress the pressure in the affected compartment. Early diagnosis and treatment are important to prevent permanent muscle and nerve damage. Complications can include paralysis, contractures, limb loss or death if not properly managed.
This document discusses the importance of the anesthesiologist in ophthalmology. It outlines the monitoring standards that should be followed during eye surgery under local anesthesia, including monitoring of vital signs, oxygenation, and ventilation. It notes the risks of eye injury during anesthesia for eye surgery, such as from patient movement or complications related to the eye block. It also lists contraindications for local/regional anesthesia techniques.
Sedation in ophtalmology,Part presented to a Ophtalmic course in Lecce,Italy,2011.There is at the end an annotated bibliography on points of interest in ophtalmology,cataract surgery in particular.
This document discusses laparoscopic appendectomy techniques and results from United Family Intermed Hospital and Gurvan Gal Hospital. It begins with a brief introduction of laparoscopic appendectomy history and the key steps of the procedure. It then summarizes results from 101 patients, noting common appendicitis types, low complication rates, and short hospital stays. It concludes with a literature review comparing laparoscopic and open appendectomy outcomes, risks for obese patients, and emerging minimally invasive techniques.
This document outlines a study protocol for evaluating a new minimally invasive laser surgery treatment for pilonidal sinus disease. The study aims to assess recurrence rates and healing times using laser surgery compared to other surgical techniques. It describes the candidate, guides, project summary, literature review, aims and objectives, materials and methods, and data collection forms for a prospective observational study comparing outcomes of patients undergoing laser surgery versus other treatments.
Scoliosis surgery can lead to several respiratory, visual, bleeding, and positioning related complications under anesthesia. This document discusses prevention strategies for these complications. It recommends preoperative breathing exercises, lung protective ventilation, fluid management, and normothermia to prevent respiratory complications. Proper positioning, blood pressure control, and fluid therapy can help prevent postoperative visual loss. The use of antifibrinolytics and careful positioning can reduce bleeding risks. Monitoring of vital signs and padding pressure points can help prevent organ injuries and neural injuries from the prone position.
This document provides details regarding a thesis presentation on comparing outcomes of laparoscopic appendicectomy using single versus double endoloop knots at the base of the appendix. The study aims to evaluate operation duration, post-operative complications, and hospital stay for the two techniques. A literature review found no consensus on whether single or double knots are superior. The study plans to enroll 90 patients undergoing laparoscopic appendicectomy and randomly assign them to single or double knot groups. Patient details, operative findings, and outcomes will be collected and statistically analyzed to compare the techniques.
Thigh Abscess Secondary to Continuous Popliteal Nerve Catheter: A Rare Compli...Jennifer Gerres, DPM
This case report describes a rare complication of a continuous popliteal nerve catheter (CPNC), where a 53-year-old woman developed a posterior thigh abscess secondary to the CPNC placed after surgery for a trimalleolar fracture. Despite removal of the catheter, her symptoms worsened with fever and increasing thigh pain. Imaging revealed a large abscess, requiring radical debridement of two-thirds of her posterior thigh compartment. Cultures grew methicillin-resistant Staphylococcus aureus. She required months of IV antibiotics and extensive physical therapy for recovery. The report reviews typical CPNC complications but highlights serious infection as rare, discussing this case and two similar reports where abscess developed secondary to MRSA from an ind
Biocartilage to Treat Osteochondral Defects of the Talus: Case Report and Tec...Jennifer Gerres, DPM
The document describes a case study and technique using BioCartilage to treat a large osteochondral defect of the talus. The key points are:
1) A 24-year old male presented with ankle pain and imaging revealed a 1.2cm x 1.6cm osteochondral defect of the talus.
2) The defect was excised and microdrilled. BioCartilage, a micronized hyaline cartilage allograft, mixed with blood or PRP was used to fill the defect.
3) BioCartilage offers advantages over other techniques like autografts in eliminating donor site morbidity and over ACI in being a single-stage procedure without wait time.
This document summarizes a randomized controlled trial that investigated whether stable patients with infective endocarditis could be safely treated with oral antibiotics rather than continued intravenous antibiotics. The trial involved 400 patients across multiple centers in Denmark who had infective endocarditis of the left heart caused by common bacterial species. Patients received either continued intravenous antibiotics according to guidelines or a partial oral antibiotic treatment regimen. The primary outcome was to show non-inferiority of oral treatment. Results showed that oral antibiotic treatment was found to be non-inferior to continued intravenous treatment for stable patients.
This document provides an overview of extracorporeal membrane oxygenation (ECMO) and its use in Hong Kong. It discusses the history and development of ECMO, how it works, common configurations including veno-venous and veno-arterial ECMO. It also outlines indications for ECMO use, important clinical studies that have supported its use, worldwide trends showing increased adoption of ECMO in recent years. Specifically for Hong Kong, it details the milestones in establishing ECMO programs across public hospitals to provide 24/7 ECMO services, statistics on ECMO use in Hong Kong, and the role of ECMO during public health crises including SARS and H1N1 influenza.
This document summarizes a randomized controlled trial that investigated whether stable patients with infective endocarditis on the left side of the heart could be safely treated with oral antibiotics instead of continued intravenous antibiotics. The trial involved 400 patients randomized to either continued intravenous or oral antibiotic treatment according to predefined regimens. The primary outcome was a composite of death, embolic events, or recurrence of infection. The results showed that oral antibiotic treatment was noninferior to continued intravenous treatment.
1) Paediatric intensive care involves some differences compared to adult intensive care, including specific considerations for airway management, ventilation, fluids, and vasopressors in children.
2) Management of conditions such as sepsis, cardiac disease, and traumatic brain injury also has some distinctions in paediatric patients, including earlier use of interventions like ECMO and different drug choices or dosing.
3) Conditions particularly seen in paediatric intensive care include bronchiolitis, pertussis, and non-accidental injury, which present challenges in diagnosis and optimal treatment approaches.
A neglected topic for way too long, the interest in fluid therapy seems to be quickly rising as the medical community is making a shift from looking at fluids as a mere method of stabilization towards the appreciation of its relevant side effects.
Many questions remain to be answered indeed:
Is the upgrade from saline 0.9% to balanced crystalloids worth the extra cost?
Does HES still have a place in the OR?
Do we have to fill the gap left by HES on ICU with crystalloids, other colloids or even albumin?
Is it really impossible to avoid fluid overload by using only crystalloids?
Is there still a definitive place for human albumin?
How do we treat and monitor specific patient populations, like patients with trauma, liver failure, brain edema and right heart failure among others?
How do we avoid a one-size-fits-all regimen in perioperative goal-directed therapy?
What with the fluids beyond resuscitation?
And what do the authors of the big fluid trials do in real life themselves?
The 9th International Fluid Academy Day will again be a 1 day concise meeting on all aspects of fluid managament and hemodynamic monitoring in the critically ill.
Date: October 26th 2019, 8:00 - 18:00
Marcelo Cypel - Canada - Tuesday 29 - Organ Donor Care. New Alternativesincucai_isodp
- The document discusses principles for managing multi-organ donors to optimize organ preservation for transplantation. It emphasizes cardiovascular and pulmonary management to minimize donor organ injury.
- The SALT protocol increased lung donors and transplants by improving donor lung recruitment and classification. It showed donor lungs previously deemed "poor" could be used if given recruitment maneuvers.
- New approaches like ex vivo lung perfusion now allow for evaluating and potentially repairing marginal donor lungs before transplantation instead of immediate decline. This may help increase the utilization and outcomes of donor lungs.
Argo Medical aims to fundamentally change the lives of individuals with spinal cord injuries. The document discusses the negative impacts of spinal cord injuries based on a 1947 quote, including issues with bladder, bones, blood, skin, bowels, and mental health. It provides statistics on the prevalence and costs of spinal cord injuries. Argo Medical's exoskeleton technology aims to allow independent walking, individual control, and all-day use to improve health, independence, and social inclusion for users. Clinical studies show benefits like increased lean muscle mass, decreased fat mass, and improved bowel function for users. The technology has significant potential cost savings for health systems and a large potential commercial market.
Fran Lockie, a Paediatric Emergency and retrieval specialist, gives an update on paediatric resuscitation. This talk was given at the Bedside Critical Care Conference 2012 on Daydream Island.
Dr. Jeffrey Milsom and Dr. Fred Cornhill lead the Minimally Invasive New Technologies (MINT) program at NewYork-Presbyterian/Weill Cornell Medical Center to develop new endolumenal surgical techniques and technologies. Their goal is to transform digestive disease surgery by performing procedures entirely within the intestine using their Endolumenal Surgical Platform (ESP). ESP and future platforms will allow complex procedures to be done without incisions, improving patient outcomes and safety while lowering costs. The MINT team's innovations have the potential to redefine care for common digestive diseases and conditions that currently require open or laparoscopic surgery.
This document provides an overview of vascular ulcers, including their classification, etiology, pathophysiology, and management. The main types of vascular ulcers are venous ulcers, arterial ulcers, and mixed arteriovenous ulcers. Venous ulcers are the most common and are usually located over the medial gaiter region of the leg. Arterial ulcers are suggested by diminished or absent peripheral pulses and often have a gray or black wound base. Treatment involves conservative measures like compression therapy for venous ulcers and endovascular procedures or bypass grafts for arterial insufficiency. Proper wound care, infection control, and patient education are important for management.
The document provides a summary of the history and operations of the Mayo Clinic in Rochester, Minnesota from its founding in 1883 to present day. It details the Clinic's expansion to additional locations, contributions to medical research and innovations, education programs, and status as a renowned medical center focused on patient-centered care.
This document provides information about gas exchange and interventions to optimize it. It begins by defining gas exchange as the process of oxygen transport to cells and carbon dioxide transport from cells. It then lists goals of understanding gas exchange, risk factors for impairment, signs of compromise, and appropriate interventions. Key terms related to gas exchange are defined. The document discusses categories of gas exchange including perfusion, ventilation, and transport. Causes of hypoxia and associated interventions are outlined. Assessment of gas exchange and common diagnostic tests are reviewed. Finally, the document discusses various nursing and collaborative interventions to optimize gas exchange, including oxygen therapy devices, airway clearance techniques, and positioning.
Pathology and management of compartment syndrome in orthopedics 1EnejoJoseph
The document provides an overview of pathology and management of compartment syndrome in orthopedics. It discusses the definition, classification, risk factors, pathophysiology, clinical presentation, diagnosis, and treatment of compartment syndrome. The main treatment is surgical fasciotomy to decompress the pressure in the affected compartment. Early diagnosis and treatment are important to prevent permanent muscle and nerve damage. Complications can include paralysis, contractures, limb loss or death if not properly managed.
This document discusses the importance of the anesthesiologist in ophthalmology. It outlines the monitoring standards that should be followed during eye surgery under local anesthesia, including monitoring of vital signs, oxygenation, and ventilation. It notes the risks of eye injury during anesthesia for eye surgery, such as from patient movement or complications related to the eye block. It also lists contraindications for local/regional anesthesia techniques.
Sedation in ophtalmology,Part presented to a Ophtalmic course in Lecce,Italy,2011.There is at the end an annotated bibliography on points of interest in ophtalmology,cataract surgery in particular.
This document discusses laparoscopic appendectomy techniques and results from United Family Intermed Hospital and Gurvan Gal Hospital. It begins with a brief introduction of laparoscopic appendectomy history and the key steps of the procedure. It then summarizes results from 101 patients, noting common appendicitis types, low complication rates, and short hospital stays. It concludes with a literature review comparing laparoscopic and open appendectomy outcomes, risks for obese patients, and emerging minimally invasive techniques.
This document outlines a study protocol for evaluating a new minimally invasive laser surgery treatment for pilonidal sinus disease. The study aims to assess recurrence rates and healing times using laser surgery compared to other surgical techniques. It describes the candidate, guides, project summary, literature review, aims and objectives, materials and methods, and data collection forms for a prospective observational study comparing outcomes of patients undergoing laser surgery versus other treatments.
Scoliosis surgery can lead to several respiratory, visual, bleeding, and positioning related complications under anesthesia. This document discusses prevention strategies for these complications. It recommends preoperative breathing exercises, lung protective ventilation, fluid management, and normothermia to prevent respiratory complications. Proper positioning, blood pressure control, and fluid therapy can help prevent postoperative visual loss. The use of antifibrinolytics and careful positioning can reduce bleeding risks. Monitoring of vital signs and padding pressure points can help prevent organ injuries and neural injuries from the prone position.
This document provides details regarding a thesis presentation on comparing outcomes of laparoscopic appendicectomy using single versus double endoloop knots at the base of the appendix. The study aims to evaluate operation duration, post-operative complications, and hospital stay for the two techniques. A literature review found no consensus on whether single or double knots are superior. The study plans to enroll 90 patients undergoing laparoscopic appendicectomy and randomly assign them to single or double knot groups. Patient details, operative findings, and outcomes will be collected and statistically analyzed to compare the techniques.
Thigh Abscess Secondary to Continuous Popliteal Nerve Catheter: A Rare Compli...Jennifer Gerres, DPM
This case report describes a rare complication of a continuous popliteal nerve catheter (CPNC), where a 53-year-old woman developed a posterior thigh abscess secondary to the CPNC placed after surgery for a trimalleolar fracture. Despite removal of the catheter, her symptoms worsened with fever and increasing thigh pain. Imaging revealed a large abscess, requiring radical debridement of two-thirds of her posterior thigh compartment. Cultures grew methicillin-resistant Staphylococcus aureus. She required months of IV antibiotics and extensive physical therapy for recovery. The report reviews typical CPNC complications but highlights serious infection as rare, discussing this case and two similar reports where abscess developed secondary to MRSA from an ind
Biocartilage to Treat Osteochondral Defects of the Talus: Case Report and Tec...Jennifer Gerres, DPM
The document describes a case study and technique using BioCartilage to treat a large osteochondral defect of the talus. The key points are:
1) A 24-year old male presented with ankle pain and imaging revealed a 1.2cm x 1.6cm osteochondral defect of the talus.
2) The defect was excised and microdrilled. BioCartilage, a micronized hyaline cartilage allograft, mixed with blood or PRP was used to fill the defect.
3) BioCartilage offers advantages over other techniques like autografts in eliminating donor site morbidity and over ACI in being a single-stage procedure without wait time.
This document discusses subtalar dislocations, including:
- There are four main types - medial, lateral, posterior, and anterior. Medial dislocations are most common.
- Mechanisms of injury vary but often involve high-energy trauma like motor vehicle accidents or falls. Associated injuries are common.
- Treatment involves closed or open reduction depending on the situation, followed by immobilization for 4-6 weeks.
- Prognosis depends on factors like time to reduction and associated injuries. Most patients regain good function but arthritis and stiffness are common long-term.
A 32-year-old male presented to the emergency department with swelling, pain and redness in his right big toe. He was initially diagnosed with gout but his symptoms worsened. It was later discovered that 17 years prior he had stepped on a nail which punctured his toe. For years after, the joint would periodically flare up with symptoms. Cultures from the joint grew Pseudomonas aeruginosa, indicating latent osteomyelitis from the prior puncture wound injury. He underwent surgical debridement and continued IV antibiotics for treatment.
Mycobacterium Chelonae Abscessus Lower Extremity Infection in the Double Tran...Jennifer Gerres, DPM
- Mycobacterium chelonae abscessus is a rare but drug-resistant bacterial infection that caused pain and swelling in the right fourth toe of a 56-year-old male double transplant patient.
- Six weeks of IV antibiotics did not improve the infection. Further testing identified M. chelonae abscessus and long-term combination antibiotic therapy along with wound care was started.
- M. chelonae abscessus has a propensity for infecting immunocompromised patients like solid organ transplant recipients. It is a challenging infection to diagnose and treat due to its drug resistance and variable treatment durations needed.
The Murphy Modification to Offload Ulceration Secondary to Digital DeformityJennifer Gerres, DPM
The document summarizes a novel approach to offloading the distal digits of patients with diabetes using an extrinsic modification to custom molded insoles. It presents 4 case studies where the modification was used to successfully treat pre-ulcerative lesions, recurrent ulcerations, and blisters on the toes. The modification involves adding layers of cork and polypropylene to the insole to redistribute pressure away from contracted toes. This simple, reproducible approach helps reduce plantar pressures and supports healing in a less invasive way than surgery.
This document summarizes a case presentation of a patient who developed a serious infection following placement of a continuous popliteal nerve catheter for pain management after surgery. Despite antibiotics and drainage of multiple abscesses, the patient's condition deteriorated requiring intensive care. Extended surgical debridement was performed and the patient eventually recovered after prolonged rehabilitation. The case illustrates the potential for severe infectious complications from regional nerve catheters despite their overall low reported rates.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
This presentation was provided by Rebecca Benner, Ph.D., of the American Society of Anesthesiologists, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
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This presentation was provided by Racquel Jemison, Ph.D., Christina MacLaughlin, Ph.D., and Paulomi Majumder. Ph.D., all of the American Chemical Society, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
Jemison, MacLaughlin, and Majumder "Broadening Pathways for Editors and Authors"
What's New on the Wound Care Horizon?
1. 9/4/13
1
What’s New
on the
Wound Care Horizon?
Georgeanne Botek, DPM FACFAS
Orthopaedic and Rheumatologic Institute
WHAT’S
NEW
on
the
WOUND
CARE
HORIZON
3. 9/4/13
3
WHAT’S
NEW
on
the
WOUND
CARE
HORIZON
WHAT’S
NEW
on
the
WOUND
CARE
HORIZON
Wound
Healing
Moisture
Balance
Perfusion
Offloading
Infec8on
Control
Edema
Control
5. 9/4/13
5
PITFALLS
of
HYPERBARIC
OXYGEN
• Availability
• Cost
– $50,000
to
$200,000
• Time
Consuming
– 60
hours
• Pa8ent
Percep8on
• Adverse
effects
• Is
it
worth
it?
HYPERBARIC
OXYGEN:
EVIDENCE
Significantly
healed
ulcers
in
the
short
term,
but
long
term
benefit
unproven.
Major
amputaLon
may
be
reduced,
but
lacked
staLsLcal
significance
Cochrane
Library
April
2012
6. 9/4/13
6
HYPERBARIC
OXYGEN
EVIDENCE
• 94
pa8ents
randomized
• Pa8ent
baseline
similar
– Average
age:
68
– DM
dura8on:
21
years
– Ulcer:
• Most
Wagner
3-‐4
• 10
month
dura8on
• 55%
had
previous
Vascular
IntervenLon
performed
on
affected
limb
Löndhal
M
et
al.
Diabetes
Care
2010
HYPERBARIC
OXYGEN
EVIDENCE
• At
end
of
treatment:
– Complete
ulcer
healing:
61%
HBOT
vs.
27%
Placebo
• At
1
year:
– Complete
ulcer
healing:
52%
of
HBOT
vs.
27%
Placebo
• Number
Needed
to
Treat:
4.2
• Conclusion:
– Adjunc8ve
treatment
that
facilitates
wound
healing
Löndhal
M
et
al.
Diabetes
Care
2010
10. 9/4/13
10
MESENCHYMAL
STEM
CELLS:
AMNIOTIC
MEMBRANE
• Advantages:
– Availability
– Easy
procurement
– Ease
of
isola8on
and
expansion
in
culture
prior
to
transplanta8on
• Limita8ons:
– Cost
to
pa8ent
– Steriliza8on
techniques
– Collec8on
– LITERATURE
1980s 1990s 2000s 2010s
WOUND
CARE
TIMELINE
Wet-‐to-‐Dry
Dressings
Silver
Dressings
Advanced
Biologics
Bioengineered
Skin
products
Total
Contact
Cast
Hydrocolloids
Subatmospheric
Pressure
(VAC)
Regranex
Hyperbaric
Oxygen
Accuzyme,
Panafil
PRFE
Ultrasound
Arterial
Perfusion
11. 9/4/13
11
INTERMITTENT
PNEUMATIC
COMPRESSION:
ARTERIAL
COMPRESSION
PUMPS
How
Does
It
Work?
• Enhances
lympha8c
return
• Disengorges
the
8ssue
• Allows
arterioles
to
open
• Improves
arterial
perfusion
• Triggers
release
of
Nitric
Oxide
• Reduces
edema
• Oxygenates
wound
• Delivers
inflammatory
cells
INTERMITTENT
PNEUMATIC
COMPRESSION:
CIRCULATOR
BOOT
• Synchronized
with
the
heartbeat
• Uses
a
leg
bag
rather
than
cuff
– Allows
any
por8on
of
leg
to
be
treated
• Limits
compression
pressure
to
diastole
– Providing
pressure
to
disseminate
the
arterial
inflow
• Can
immerse
the
limb
in
bags
containing
an8bio8c
solu8on
– May
help
remove
bioburden
in
the
ulcers
12. 9/4/13
12
INTERMITTENT
PNEUMATIC
COMPRESSION:
EVIDENCE-‐BASED
MEDICINE
1. Abu-‐Own
A,
Cheatle
T,
Scurr
JH,
and
Smith
PDC:
Eur
J
Vasc
Surg
1993
2. Agerskov
K,
Ton
HP,
Jensen
FB,
Engell,
Dan
Med
Bull:
1990
3. Alpagut
U,
Dayioglu
E:
Angiology.
56:19-‐23,
2005
4. Amsterdam
EA,
Lee
G,
Tonkon
MJ,
DeMaria
AN
and
Mason
DT:
1977
5. Bergan
JJ,
Sparks
S,
Angle
N:
Vascular
and
Endovascular
Surgery
32:455-‐462,
1998
6. Blackshear
WM,
Pescoo
C,
LePain
F,
Benoit
S,
Dickstein
R,
Seifert
KB:
J
Vasc
Surg
5:432-‐6,
1987
7. Bolli
R,
Marbán
E:
Physiol
Rev
79:609-‐34,
1999
8. Chleboun
GS,
Howell
JN,
Baker
HL,
Ballard
TN,
Graham
JL,
Hallman
HL,
Perkins
LE,
Schauss
JH
and
Conatser
RR:
Arch
Phys
Med
Rehabil
76:744-‐749,
1995
9. Delis
KT,
Nicolaides
AN,
Wolfe
JH,
Stansby
G:
J
Vasc
Surg
31:650-‐61,
2000
10. Delis
KT,
Nicolaides
AN,
Labropoulos
N,
Stansby
G:.
J
Vasc
Surg
32:284-‐92,
2000
11. Delis
KT,
Knaggs
AL:
J
Vasc
Surg
42(4):
717-‐25,
2005
12. Delis
KT,
Nicolaides
AN:
Ann
Surg
241:
431-‐441,
2005
INTERMITTENT
PNEUMATIC
COMPRESSION:
EVIDENCE-‐BASED
MEDICINE
13. Dillon
RS:
J
Clin
Engineering
3:63,
1980
14. Dillon
RS:
Angiology
31:614-‐638,
1980
15. Dillon
RS:
Angiology
37:
47-‐56,
1986
16. Dillon
RS:
Ann
Surg
204:
643-‐649,
1986
17. Dillon
RS:
Vasc
Surg
(Westerminister
Press)
24:
682-‐695,
1990
18. Dillon
RS:
48,
Number
5,
Part
2:
S17-‐S34,
1997
19. Dillon
RS:.
Angiology
48,
Number
5,
part
2:
S35-‐S58,
1997
20. Dillon
RS:
Chapter
13
in
"The
Wound
Management
Manual"
pages
141-‐211.
Bok
Y.
Lee
editor.
McGraw-‐Hill
2005
21. Eze
AR,
Comerota
AJ,
Cisek
PL,
Holland
BS,
Kerr
RP,
Veeramasuneni
R
and
Comerota
Jr.
A|J:
IntermiEent
calf
and
foot
compression
increases
lower
extremity
blood
flow.
Am
J
Surg
172:130-‐135,
1996
22. Filip
JR,
Dillon
RS:
Treatment
of
end-‐stage
"trash
feet"
with
the
end-‐
diastolic
pneumaMc
boot.
Angiology
59(2):214-‐9,
2008
13. 9/4/13
13
INTERMITTENT
PNEUMATIC
COMPRESSION:
EVIDENCE-‐BASED
MEDICINE
23. Ginsberg
JS,
Brill-‐Edwards
P,
Kowalchuk
G,
Hirsh
J:
Arch
Intern
Med
149:
1651-‐2,
1989
24. Kakkos
SK,
Griffin
M,
Geroulakos
G,
Nicolaides
AN:.
J
Vasc
Surg
42:296-‐303,
2005
25. Kakkos
SK,
Geroulakos
G,
Nicolaides
AN:
Eur
J
Vasc
Endovasc
Surg
30:164-‐75,
2005
26. Kavros
SJ,
Delis
KT,
Turner
NS,
Voll
AE,
Liedl
DA,
Gloviczki
P,
Rooke
TW.:
J
Vasc
Surg
47(3):543-‐9,2008
27. Labropoulos
N,
Watson
WC,
Mansour
MA,
Kang
SS,
Lioooy
FN,
Baker
WH:
Arch
Surg
133:1072-‐5,
1998
28. Labropoulos
N,
Leon
LR,
Bhas
A
et
al:.
J
Vas
Surg
42:710-‐6,
2005
29. Liu
K,
Chen
LE,
Seaber
AV,
Urbaniak
JR:
J
Orthop
Res
17(3):415-‐20,
1999
INTERMITTENT
PNEUMATIC
COMPRESSION:
EVIDENCE-‐BASED
MEDICINE
30. McCulloch
JM,
Marler
KC,
Neal
MB
and
Phifer
TJ:
Advances
in
Wound
Care
7:22-‐26,
1994
31. Montori
VM,
Kavros
SJ,
Walsh
EE,
Rooke
TW:
Int
Angiol
21(4):360-‐6.
2002
32. Morgan
RH,
Carolan
G,
Psaila
JV,
Gardner
AMN,
Fox
RH
and
Woodcock
JP:
Vasc
Surg
25:
8-‐15,
1991
33. Ramaswami
G,
D'Ayala
M,
Hollier
LH
et
al:
J
Vasc
Surg
41:794-‐801,
2005
34. Smith
PC,
Sarin
S,
Hasty
J
and
Scurr
JH:
Surgery
108:
871-‐875,
1990
35. Sultan
S,
Esan
O,
Fahy
A:
Vascular
16:
130-‐9,
2008
36. van
Bemmelen
PS,
Maoos
MA,
Faught
WE,
Mansour
MA,
Barkmeier
LD,
Hodgson
KJ,
Ramsey
DE,
Sumner
DS:
AugmentaMon
of
blood
flow
in
limbs
with
occlusive
arterial
disease
by
intermiEent
calf
compression.
J
Vasc
Surg
19:1052-‐8,
1994
37. van
Bemmelen
PS,
Gitlitz
DB
et
al:
Arch
Surg
136:1280-‐5,
2001
38. Vella
A,
Carlson
LA,
Blier
B,
Felty
C,
Kuiper
JD
and
Rooke
TW:
Vascular
Medicine
5:21-‐25,
2000
14. 9/4/13
14
INTERMITTENT
PNEUMATIC
COMPRESSION
• Group
1
(IPC
group):
– 24
pa8ents,
average
age
70
– Post
pedal
amp
– 85-‐95
mmHg;
3,
2-‐hour
sessions
• 42%
BKA
– Failed
wound
healing
• Group
2
(control):
– 24
pa8ents,
average
age
69
– Post
pedal
amp
• 83%
resulted
in
BKA
Kavros
SJ,
Delis
KT
et
al.
Society
for
Vasc
Surg
2008
Wound
healing
and
limb
salvage
were
significantly
beZer
in
the
IntermiZent
PneumaLc
Compression
Group
Within
18
months,
3
Lmes
as
many
people
with
IPC
healed
their
wounds
and
avoided
BKA
Kavros
SJ,
Delis
KT
et
al.
Society
for
Vasc
Surg
2008
INTERMITTENT
PNEUMATIC
COMPRESSION
15. 9/4/13
15
ARTERIAL
COMPRESSION
PUMPS:
EVIDENCE
• Retrospec8ve
review
– 101
cases
from
Gonda
Vascular
Center
at
Mayo
Clinic
– 2
of
3
used
Air
Cast
Arterial
Flow
for
6
hours
at
home
– 1
of
3
used
Circulator
Boot
in
Wound
Center
for
2,
45-‐minute
sessions
• 47%
complete
wound
healing
Montori
VM,
Kavros
SJ
et
al
Int
Angiology
2002
• 74
year-‐old
male
– Second
opinion
regarding
right
foot
rest
pain
and
wounds
• 10/2008:
right
foot
purple
discolora8on
• 12/2008:
seen
by
Vascular
Surgery
– Angiogram:
• Occlusion
of
the
AT
and
PT
with
patent
peroneal
artery
to
the
level
of
the
foot
• Recommended
right
BKA
INTERMITTENT
PNEUMATIC
COMPRESSION:
CASE
16. 9/4/13
16
PAST
MEDICAL
HISTORY
• CAD
s/p
CABG
LIMA-‐
LAD
and
SVG-‐RCA
• s/p
PTCA
1997
prox
RCA
• HTN
• Hyperlipidemia
• DM2
• Afib
s/p
DCCx2,
s/p
PPM
• Hyperthyroidism
–
amiodarone
induced
• CKD
• Right
LE
– ABI:
1.33
– TBI:
0.23
Recommended:
• Arterial
flow
device
to
use
for
6
hours
a
day
• Aquacell
AG
between
toes
WORKUP
and
PLAN
18. 9/4/13
18
7
MONTHS
aer
INITIATION
of
ARTERIAL
COMPRESSION
PUMP
in
the
HOME
INTERMITTENT
PNEUMATIC
COMPRESSION:
CASE
aer
8
MONTHS
19. 9/4/13
19
WHAT’S
NEW
on
the
WOUND
CARE
HORIZON
• Does
it
provide
beoer
outcomes,
Watson?
• Is
the
therapy
cost
effec8ve?
• Is
it
efficient?
• Technically
simple?
WHAT’S
NEW
on
the
WOUND
CARE
HORIZON
• Hyperbaric
Oxygen
Therapy
• Mesenchymal
Stem
Cell
Therapy
• Arterial
Perfusion
In
Conclusion…