Wounds, Fractures, Orthopaedics

2011 ◽  
Author(s):  
Pawan Gupta
Keyword(s):  
Physical Examination ◽  
Soft Tissue Injuries ◽  
Basic Knowledge ◽  
X Rays ◽  
Number Of Patients ◽  
Before And After ◽  
Life Threatening ◽  
Minor Injuries ◽  
High Degree ◽  
Type Of Injury

A significant number of patients attending the ED are those who are often referred to as ‘minors’, ‘streamers’, ‘walking wounded’, etc. These include patients with minor injuries, wounds, fractures or other soft tissue injuries. Therefore, a basic knowledge of anatomy and its application in various circumstances is mandatory. The injuries mentioned above are rarely life-threatening, but they may be limb-threatening and severely disabling. So it is extremely important to avoid errors in diagnosis and management, and to know when to ask for help at the appropriate time. By following the key principles listed below, you will be able to avoid many problems with such patients: • In the history, a detailed description of the mechanism of injury and the patient’s complaint will help in predicting the type of injury sustained. • A careful and thorough physical examination can point to the site and type of injury, on the basis of which appropriate radiological images can then be requested. • A neurovascular examination must be completed and documented in every limb injury, before and after any reductions, and before and after immobilization. • Appropriate radiological imaging, accompanied by a thorough physical examination, can pick up injuries with a high degree of accuracy. Inadequate radiographic films should not be accepted. • Immobilize the patient if a fracture is clinically suspected even if the X-rays are negative. • In cases of dislocations or subluxations, X-rays should be done before and after reductions, except when a delay could be potentially harmful to the patient (for example, when a severe traumatic deformity of a joint threatens to jeopardize the viability of the overlying skin). • The patient should be able to mobilize safely before being discharged from the ED. • Patients should be given proper aftercare instructions before leaving the ED, including how to look after themselves and to recognize limb-threatening features, the follow-up arrangement, and to return if things go wrong. • Ask for senior help if you are not sure about an injury or its management.

scholarly journals Characteristics of Pain Syndrome in Patients with Lumbosacral Discogenic Pathology in Post- OPERATIVE PERIOD

2017 ◽  
Vol 24 (2) ◽  
pp. 32-39
Author(s):  
A. O Gospod ◽  
A. I Krupatkin ◽  
A. A Kuleshov ◽  
T. V Sokolova
Keyword(s):  
Disc Herniation ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Intervertebral Disc Herniation ◽  
Complex Evaluation ◽  
Number Of Patients ◽  
Study Evaluation ◽  
Before And After ◽  
Degree Of Disability ◽  
High Degree

Purpose of study. Evaluation of the pain sources and comparative analysis of chronic pain syndrome peculiarities in patients with various types of disc herniation before and after surgical intervention at lumbosacral level. Patients and methods. The study included 80 patients (20-60 years old) with discogenic pathology at lumbosacral level. The type and size of herniation was assessed by MSU classification. Every patient went through a complex evaluation of low back pain sources, pain syndrome characteristics and personality before and on day 10 after surgery. Results. The most common cause of pain was a musculoskeletal syndrome that was more pronounces in the older (41-60 years) group. Neither correlation between the degree of degenerative dystrophic changes and type and size of discogenic pathology, nor the relation between the disc herniation size and type and neurologic symptoms development was detected. The relation between the intensity and other characteristics of pain syndrome and type of disc herniation was not detected too. Analysis of pain syndrome characteristics and mechanisms in complex with the assessment of pain sources revealed the group of patients with high pain and emotionally affected indices before and after surgical intervention and mild vertebrogenic and other pain sources. That group made up 13% of the total number of patients; the majority of them (75%) were females (mean age 37.8±5.0 years) and in 50% of cases the herniation size and localization corresponded to type 2A. Taking into consideration a high degree of disability and other pain indices in postoperative period we do not recommend surgical intervention in this group of patients. Conclusion. Management of patients with lumbosacral intervertebral disc herniation requires the evaluation of all pain sources and pain syndrome aspects.

scholarly journals Characteristics of Pain Syndrome in Patients with Lumbosacral Discogenic Pathology in Post- OPERATIVE PERIOD

2017 ◽  
pp. 32-39
Author(s):  
A. O. Gospod ◽  
A. I. Krupatkin ◽  
A. A. Kuleshov ◽  
T. V. Sokolova
Keyword(s):  
Disc Herniation ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Intervertebral Disc Herniation ◽  
Complex Evaluation ◽  
Number Of Patients ◽  
Before And After ◽  
Degree Of Disability ◽  
High Degree ◽  
Cause Of Pain

Purpose of study. Evaluation of the pain sources and comparative analysis of chronic pain syndrome peculiarities in patients with various types of disc herniation before and after surgical intervention at lumbosacral level.Patients and methods. The study included 80 patients (20-60 years old) with discogenic pathology at lumbosacral level. The type and size of herniation was assessed by MSU classification. Every patient went through a complex evaluation of low back pain sources, pain syndrome characteristics and personality before and on day 10 after surgery.Results.The most common cause of pain was a musculoskeletal syndrome that was more pronounces in the older (41-60 years) group. Neither correlation between the degree of degenerative dystrophic changes and type and size of discogenic pathology, nor the relation between the disc herniation size and type and neurologic symptoms development was detected. The relation between the intensity and other characteristics of pain syndrome and type of disc herniation was not detected too. Analysis of pain syndrome characteristics and mechanisms in complex with the assessment of pain sources revealed the group of patients with high pain and emotionally affected indices before and after surgical intervention and mild vertebrogenic and other pain sources. That group made up 13% of the total number of patients; the majority of them (75%) were females (mean age 37.8±5.0 years) and in 50% of cases the herniation size and localization corresponded to type 2A. Taking into consideration a high degree of disability and other pain indices in postoperative period we do not recommend surgical intervention in this group of patients.Conclusion.Management of patients with lumbosacral intervertebral disc herniation requires the evaluation of all pain sources and pain syndrome aspects.

The Clinical, Roentgenological and Morphological Effects of an Acute Exposure of Phosgene on the Lungs of Dogs

1971 ◽  
Vol 29 ◽  
pp. 236-237
Author(s):  
R. F. Bils ◽  
W. F. Diller ◽  
F. Huth
Keyword(s):  
Latent Period ◽  
Chemical Industry ◽  
Toxic Substance ◽  
Lung Edema ◽  
X Rays ◽  
Beagle Dogs ◽  
Male And Female ◽  
Morphological Alterations ◽  
Before And After ◽  
Electron Microscopes

Phosgene still plays an important role as a toxic substance in the chemical industry. Thiess (1968) recently reported observations on numerous cases of phosgene poisoning. A serious difficulty in the clinical handling of phosgene poisoning cases is a relatively long latent period, up to 12 hours, with no obvious signs of severity. At about 12 hours heavy lung edema appears suddenly, however changes can be seen in routine X-rays taken after only a few hours' exposure (Diller et al., 1969). This study was undertaken to correlate these early changes seen by the roengenologist with morphological alterations in the lungs seen in the'light and electron microscopes.Forty-two adult male and female Beagle dogs were selected for these exposure experiments. Treated animals were exposed to 94.5-107-5 ppm phosgene for 10 min. in a 15 m3 chamber. Roentgenograms were made of the thorax of each animal before and after exposure, up to 24 hrs.

Effects of Observer Variation on Performance in Probabilistic Diagnosis of Jaundice

1981 ◽  
Vol 20 (03) ◽  
pp. 163-168 ◽  
Author(s):  
G. Llndberg
Keyword(s):  
Physical Examination ◽  
System Performance ◽  
Transition Matrix ◽  
Bayes Theorem ◽  
Observer Variation ◽  
Kappa Statistics ◽  
Diagnostic Categories ◽  
Number Of Patients ◽  
Probability Transition Matrix ◽  
Probabilistic Diagnosis

A system for probabilistic diagnosis of jaundice has been used for studying the effects of taking into account the unreliability of diagnostic data caused by observer variation. Fourteen features from history and physical examination were studied. Bayes’ theorem was used for calculating the probabilities of a patient’s belonging to each of four diagnostic categories.The construction sample consisted of 61 patients. An equal number of patients were tested in the evaluation sample. Observer variation on the fourteen features had been assessed in two previous studies. The use of kappa-statistics for measuring observer variation allowed the construction of a probability transition matrix for each feature. Diagnostic probabilities could then be calculated with and without the inclusion of weights for observer variation. Tests of system performance revealed that discriminatory power remained unchanged. However, the predictions rendered by the variation-weighted system were diffident. It is concluded that taking observer variation into account may weaken the sharpness of probabilistic diagnosis but it may also help to explain the value of probabilistic diagnosis in future applications.

Ion Channel Remodelling in Atrial Fibrillation

2011 ◽  
Vol 7 (2) ◽  
pp. 97 ◽  
Author(s):  
Niels Voigt ◽  
Dobromir Dobrev ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Ion Channel ◽  
Antiarrhythmic Drugs ◽  
Current Knowledge ◽  
Bleeding Complications ◽  
Large Size ◽  
Cardiovascular Morbidity And Mortality ◽  
Number Of Patients ◽  
Life Threatening ◽  
Underlying Mechanisms

Atrial fibrillation (AF) is the most common arrhythmia and is associated with substantial cardiovascular morbidity and mortality, with stroke being the most critical complication. Present drugs used for the therapy of AF (antiarrhythmics and anticoagulants) have major limitations, including incomplete efficacy, risks of life-threatening proarrhythmic events and bleeding complications. Non-pharmacological ablation procedures are efficient and apparently safe, but the very large size of the patient population allows ablation treatment of only a small number of patients. These limitations largely result from limited knowledge about the underlying mechanisms of AF and there is a hope that a better understanding of the molecular basis of AF may lead to the discovery of safer and more effective therapeutic targets. This article reviews the current knowledge about AF-related ion-channel remodelling and discusses how these alterations might affect the efficacy of antiarrhythmic drugs.

Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

2020 ◽  
pp. 1-6
Author(s):  
Paul Park ◽  
Victor Chang ◽  
Hsueh-Han Yeh ◽  
Jason M. Schwalb ◽  
David R. Nerenz ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Readmission Rate ◽  
Rating Scale ◽  
Short Term ◽  
Readmission Rates ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Before And After ◽  
The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

Pancytopenia: A Challenging Problem for Treating Physician

2018 ◽  
Vol 2 (01) ◽  
pp. 22-28
Author(s):  
Md. Rezaul Karim Chowdhury ◽  
Amina Begum ◽  
Md. Haroon Ur Rashid ◽  
Md. Kamrul Hasan
Keyword(s):  
Bone Marrow ◽  
Physical Examination ◽  
Blood Smear ◽  
Peripheral Blood Smear ◽  
Bone Marrow Examination ◽  
Challenging Problem ◽  
Trephine Biopsy ◽  
Life Threatening ◽  
Underlying Pathology ◽  
Careful History

Pancytopenia is an important clinico-haematological entity and striking feature of many serious and life-threatening illnesses. Many haematological and non-haematological diseases involve the bone marrow primarily or secondarily and cause pancytopenia. Decrease in haemopoietic cell production, ineffective haemopoiesis and peripheral sequestration or destruction of the cells are the main pathophysiology of pancytopenia. The cause of pancytopenia thus may be lying in the bone marrow or in the periphery or both. Careful history, physical examination, simple blood work, review of the peripheral blood smear, sometimes bone marrow examination and trephine biopsy are required for diagnosis. Treatment and prognosis depend on the severity of pancytopenia and underlying pathology.

Cerebellotrigeminal Dermal Dysplasia (Gómez-López-Hernández Syndrome)

2018 ◽  
Vol 16 (05) ◽  
pp. 362-368 ◽  
Author(s):  
Federica Sullo ◽  
Agata Polizzi ◽  
Stefano Catanzaro ◽  
Selene Mantegna ◽  
Francesco Lacarrubba ◽  
...  
Keyword(s):  
De Novo ◽  
Chromosomal Rearrangements ◽  
Number Of Patients ◽  
Wide Range ◽  
Visual Problems ◽  
Neurodevelopmental Abnormalities ◽  
Clinical Triad ◽  
High Degree ◽  
Motor Handicap

Cerebellotrigeminal dermal (CTD) dysplasia is a rare neurocutaneous disorder characterized by a triad of symptoms: bilateral parieto-occipital alopecia, facial anesthesia in the trigeminal area, and rhombencephalosynapsis (RES), confirmed by cranial magnetic resonance imaging. CTD dysplasia is also known as Gómez-López-Hernández syndrome. So far, only 35 cases have been described with varying symptomatology. The etiology remains unknown. Either spontaneous dominant mutations or de novo chromosomal rearrangements have been proposed as possible explanations. In addition to its clinical triad of RES, parietal alopecia, and trigeminal anesthesia, CTD dysplasia is associated with a wide range of phenotypic and neurodevelopmental abnormalities.Treatment is symptomatic and includes physical rehabilitation, special education, dental care, and ocular protection against self-induced corneal trauma that causes ulcers and, later, corneal opacification. The prognosis is correlated to the mental development, motor handicap, corneal–facial anesthesia, and visual problems. Follow-up on a large number of patients with CTD dysplasia has never been reported and experience is limited to few cases to date. High degree of suspicion in a child presenting with characteristic alopecia and RES has a great importance in diagnosis of this syndrome.

scholarly journals The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee Arthroplasty

2021 ◽  
Vol 10 (5) ◽  
pp. 971
Author(s):  
Kristoff Hammerich ◽  
Jens Pollack ◽  
Alexander F. Hasse ◽  
André El Saman ◽  
René Huber ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Clinical Success ◽  
Cost Effective ◽  
Revision Total Knee Arthroplasty ◽  
Rotational Stability ◽  
X Rays ◽  
Free Interval ◽  
Major Disadvantage ◽  
Cost Effective Approach ◽  
Before And After

Background: A major disadvantage of current spacers for two-stage revision total knee arthroplasty (R-TKA) is the risk of (sub-) luxation during mobilization in the prosthesis-free interval, limiting their clinical success with detrimental consequences for the patient. The present study introduces a novel inverse spacer, which prevents major complications, such as spacer (sub-) luxations and/or fractures of spacer or bone. Methods: The hand-made inverse spacer consisted of convex tibial and concave femoral components of polymethylmethacrylate bone cement and was intra-operatively molded under maximum longitudinal tension in 5° flexion and 5° valgus position. Both components were equipped with a stem for rotational stability. This spacer was implanted during an R-TKA in 110 knees with diagnosed or suspected periprosthetic infection. Postoperative therapy included a straight leg brace and physiotherapist-guided, crutch-supported mobilization with full sole contact. X-rays were taken before and after prosthesis removal and re-implantation. Results: None of the patients experienced (sub-) luxations/fractures of the spacer, periprosthetic fractures, or soft tissue compromise requiring reoperation. All patients were successfully re-implanted after a prosthesis-free interval of 8 weeks, except for three patients requiring an early exchange of the spacer due to persisting infection. In these cases, the prosthetic-free interval was prolonged for one week. Conclusion: The inverse spacer in conjunction with our routine procedure is a safe and cost-effective alternative to other articulating or static spacers, and allows crutch-supported sole contact mobilization without major post-operative complications. Maximum longitudinal intra-operative tension in 5° flexion and 5° valgus position appears crucial for the success of surgery.

Improving Genetics Clinic Efficiency and Capacity Using Design and Human Factors Methods

2021 ◽  
Vol 10 (1) ◽  
pp. 204-210
Author(s):  
Maryam Attef ◽  
Mireille Cloutier ◽  
Meredith Gillespie ◽  
Chantal Trudel ◽  
Kym Boycott
Keyword(s):  
Human Factors ◽  
Task Analysis ◽  
Healthcare Providers ◽  
Time On Task ◽  
Prenatal Genetics ◽  
Factors Influencing ◽  
Number Of Patients ◽  
Clinic Efficiency ◽  
Before And After ◽  
Improve Access

This quality improvement study focused on developing an understanding of factors influencing the ability of prenatal genetics counsellors (GCs) to efficiently see patients during the COVID-19 pandemic and strategies to improve their workflow using techniques from human factors and design. The demand for Prenatal Genetics Clinics is rising which has increased pressure on GCs to become more efficient. Genetics counsellors can improve access to their services by reducing the time spent on the tasks performed before and after a genetic counselling encounter, thereby increasing the number of patients they see. We were limited to certain methods to understand the differences in workflow before and during the COVID-19 pandemic. This study involved a literature review, archival analysis of workflow studies conducted before the pandemic, stakeholder meetings and mapping, a brainstorming session, as well as documenting time-on-task in a diary and naturalistic observation sessions. A task analysis was developed to identify factors influencing efficiency related to the design of the space, processes and the use of artefacts. Virtual and on-site workflows show that GCs spend at least half of their time on tasks before and/or after the patient’s appointment. Looking at potential inefficiencies or bottlenecks in workflow formed the development of a strategic plan for improving GC workflows at the prenatal Genetics Clinic. Improvements suggested through this analysis were constrained to support the current number of healthcare providers working within the existing space configuration.

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