scholarly journals Features of medical care in patientswith elbow joint gunshot wounds

2021 ◽  
pp. 5-8
Author(s):  
Aleksandr Loskutov ◽  
Andriy Domanskyi ◽  
Ivan Zherdev ◽  
Svyatoslav Lushnya
Keyword(s):  
Medical Care ◽  
Elbow Joint ◽  
Damage Control ◽  
Soft Tissue Injuries ◽  
Gunshot Wounds ◽  
Shoulder Injuries ◽  
Combat Injuries ◽  
Limb Injuries ◽  
Two Stages ◽  
Favorable Conditions

Gunshot wounds of the elbow joint are the third most common after knee and shoulder injuries. Features of the anatomical and functional structure of the elbow joint, the close location of the vascular and nervous formations, favorable conditions for the development of infection determine the severity of gunshot wounds and cause the complexity of its treatment. Objective. To evaluate the frequency and nature of the elbow joint gunshot wounds in the structure of the general combat injuries, as well as to determine the volume of medical care and direction of treatment of such injuries in the conditions of the regional hospital as a stage of care. Methods. A retrospective study included 1 809 patients (96.0 % of men, mean age (33.7 ± 0.2) years). Firearms limb injuries were detected in 1 013 (56.0 %) of all victims, of which the elbow joint — 25 (2.47 %). Mines and explosives injuries were in 22 (88 %) of the patients, bullet — in 3 (12 %). Results. Tactics of treatment of elbow joint gunshot wounds depended on the severity of the condition of the victims and the nature of concomitant traumatic injuries. In the structure of combat injury of the elbow joint the majority was combined (52 %) and multiple (40 %) injuries and was accompanied by gunshot fractures in 60 %. In patients who were in severe state, applied the tactics of Damage control in two stages. At the first stage the fractures were fixed with plaster splints or external fixation devices (EF), the wounds were not subjected to full surgical debridment (SD), but only washed with antiseptics and the visible foreign bodies were removed. In patients with soft tissue injuries wounds the primary SD was performed according to general principles, injured nerves were not restored. In the second stage, after patient is stabilized, the repeated SD of the wound was performed. After their uncomplicated healing the EF was removed and the method of fixation was changed to internal osteosyntesis. Conclusions. It is recommended to perform stabilization of intra-articular gunshot fractures of the elbow joint with EF and after uncomplicated wound healing go to the internal osteosynthesis. Key words. Elbow joint, gunshot wounds, treatment.

scholarly journals Surgical tactics for victims of gunshot wounds of the diaphragm specialized stage of medical care in conditions of a modern armed conflict

2019 ◽  
Keyword(s):  
Surgical Treatment ◽  
Medical Care ◽  
Comparison Group ◽  
Care Delivery ◽  
Abdominal Cavity ◽  
Surgical Care ◽  
Gunshot Wounds ◽  
Main Group ◽  
Lung Capacity ◽  
Combat Injuries

Introduction. The diaphragm gunshot wounds are serious combat injuries. The main functions of the diaphragm are to change the intra-abdominal pressure and the outflow of lymph and blood from the abdominal cavity due to the constant contraction and relaxation. Therefore, when it is injured at the same time with a powerful painful impulse, cardiopulmonary disorders quickly arise. Purpose: To improve the results of surgical treatment of patients with gunshot wounds through the introduction of new video endoscopic technologies at the stage of specialized surgical care. Materials and methods. The article analyzes the features of specialized surgical care in 64 patients with gunshot wounds who were treated at the surgical clinic of the Military Medical Clinical Center of the Northern Region (III level of medical care). New minimally invasive methods are proposed to improve the outcomes of surgical treatment of victims with diaphragm gunshot wounds at level III of health care delivery. Results. Thus, the use of video thoracoscopic technique in the surgical treatment of the diaphragm wound and its suturing in the proposed method allowed to improve the results of treatment by increasing the average value of diaphragmatic excursion in deep breath in the main group to 3.73 ± 0.31 cm, whereas in the comparison group 2.21 ± 0.38 cm. The severity of the pain syndrome on the of Visual Аnalogue Scale 5 days after surgical treatment was 5.2 ± 2.3 points in the injured main group, 6.7 ± 2.1 points in the comparison group. The ratio of vital lung capacity to the required vital lung capacity in the main group was 75.3 ± 2.2%, in the comparison group 64.1 ± 1.7%. Conclusions. The use of video thoracoscopy increases the efficiency of the diagnosis of gunshot wounds of the diaphragm. The use of laser imaging and fluorescence diagnosis of diaphragm wounds ensure the adequacy of the removal of paravulary necrotic tissues. The suturing of the wounds in accordance with the anatomical and functional structure of the diaphragm with the use of plaques improves the immediate postoperative results of surgical treatment.

scholarly journals The severity degree estimation for the lower extremity blast injury

2019 ◽  
Vol 21 (2) ◽  
pp. 215-218
Author(s):  
A V Anisin ◽  
A V Denisov ◽  
V M Shapovalov
Keyword(s):  
Lower Extremity ◽  
Medical Care ◽  
Blast Injury ◽  
Clinical Findings ◽  
Unbiased Estimation ◽  
Technological Disasters ◽  
Combat Injuries ◽  
Limb Injuries ◽  
Blast Trauma ◽  
Severity Degree

The present review is concerned with the modern state of the problem connected with the severity degree estimation of the lower extremity blast injury. The specific character of modern combat activity is considered to be the prevalence of the blast trauma in the structure of casualties, this trauma amounting up to 69% of all the combat injuries. The problem of the adequate unbiased estimation of the severity degree for this kind of trauma appears to be critical, because it is important for the appraisal of the necessary volume of medical care provided for the casualties and optimal assignment of the casualties to the medical evacuation stages beginning from the combat zone up to the specialized trauma center. The combat blast trauma is distinguished from the civilian trauma, it also differs from blast injuries occurring during technological disasters. In this regard, the use of traditional estimation parameters for the lower extremity trauma severity, based on clinical findings of civilian injuries, seems not possible. The development of appropriate severity estimation technique for the lower extremity blast trauma is essential not only for the medical care, but also for the adequate experimental modeling processes using human cadavers and biomorphic models, and the development of virtual “mathematical” simulators. Currently, investigators are involved in developing specific severity degree estimation scales for the lower extremity blast injury, based on the case histories analysis and casualties’ follow-up. Foreign experts have proposed a number of assessment classifications of mine-explosive injury, allowing to formulate a diagnosis and determine the severity of the injured explosive limb injuries. In our country, there is currently no generally accepted classification developed in relation to the explosive injury of the lower extremities, but the methods proposed by domestic military field surgeons and traumatologists allow us to effectively assess the severity of this injury and make a certain sorting decision.

Temporary Intravascular Shunts: When Are We Really Using Them According to the NTDB?

2009 ◽  
Vol 75 (7) ◽  
pp. 605-607 ◽  
Author(s):  
Chad G. Ball ◽  
Andrew W. Kirkpatrick ◽  
Ravi R. Rajani ◽  
Amy D. Wyrzykowski ◽  
Christopher J. Dente ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Damage Control ◽  
Venous Blood ◽  
Case Series ◽  
Soft Tissue Injuries ◽  
Gunshot Wounds ◽  
Venous Blood Flow ◽  
Penetrating Injuries

Temporary intravascular shunts (TIVS) are synthetic intraluminal conduits that maintain arterial and/or venous blood flow. This technique can be used for: 1) replantation; 2) open extremity fractures with extensive soft tissue and arterial injuries; or 3) damage control (extremity/truncal). The literature defining TIVS is composed exclusively of small case series (primarily penetrating injuries). Our goal was to identify the injured population who actually undergoes TIVS using the National Trauma Data Bank (2001 to 2005). TIVS were placed in 395 patients (mean Injury Severity Score = 26; initial hemodynamic instability = 24%; mean based deficit = –7.2; mortality = 14%). Blunt mechanisms caused 64 per cent (251 of 395) of cases. Penetrating injuries were primarily gunshot wounds (97%). Concurrent severe extremity fractures and/or soft tissue defects were present in 185 (74%) blunt-injured patients. Only six of 111 centers performing TIVS used this technique five or more times. Only three centers used TIVS more than 10 times. The volume of TIVS use was similar across the study period ( P > 0.05). TIVS is primarily used in blunt motor vehicle collision trauma with concurrent severe extremity fractures and soft tissue injuries. This provides distal perfusion while surgeons assess/fixate the limb. TIVS are placed relatively uncommonly by a large number of trauma centers with a few hospitals using them much more frequently for penetrating injuries.

scholarly journals Emergency Medical Care and Management of Sports Injuries on the Football Court

2021 ◽  
Vol 5 (1) ◽  
pp. 773-777
Author(s):  
Basri Lenjani ◽  
Premtim Rashiti ◽  
Gani Shabani ◽  
Arber Demiri ◽  
Besarta Pelaj ◽  
...  
Keyword(s):  
Medical Care ◽  
Health Care Professionals ◽  
Sports Medicine ◽  
Sports Injuries ◽  
Multiple Injuries ◽  
Emergency Medical Care ◽  
Treatment And Prevention ◽  
Emergency Medical ◽  
Limb Injuries ◽  
Football Field

Introduction; Sports medicine is a clinical subspecialty that deals with the examination, monitoring, diagnosis, treatment, and prevention of injuries that occur during sports events, training and physical activities in pre-hospital settings. Managing dramatic situations with minor and multiple injuries is a challenge that requires a quick approach to a dramatic event in managing minor and multiple injuries on the football field and in other sports in support of SHME at pre-hospital and hospital level. Purpose of the paper. Providing emergency medical care at all basic stages of managing minor and multiple injuries on the football field and in other sports in order to implement BLS, ACLS, BTLS, PTLS, ATLS care measures reducing morbidity, disability, and mortality. Material and methods. The research is of retrospective, descriptive, qualitative type. The material was taken from the archive of the Emergency Clinic of UCCK for the period January-December 2019. Only the sick or injured in sports matches were taken in the research; Age, gender, type of illness and injury and type of medical care, equipment available, and training and education. Result. Sports injuries are very costly, and according to the pathology with diseases were 15 cases or 21.4 %, injuries were 55 cases or 78/6 %. Injured by age. The largest number of injured with injuries in the field of football sports the most affected age was the age of 21-25 years with 28 cases or 40.00%, over 25 years were 27 cases or 38.58% and with a smaller number were aged 15-20 years15 cases or 21.42%. Discussion and conclusions. A very important factor in sports injuries is the provision of optimal medical care for footballers and other sports in head, neck, spine, chest, abdomen, and pelvis and limb injuries and with a joint communication with the cooperation of health care professionals in the selection of priority cases. Education of medical staff, nurses, paramedics with courses, use of medical equipment, BLS, ACLS, BTLS, PTLS, ATLS as well as standard procedures for providing and transporting medical care to the hospital.

scholarly journals Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care

2021 ◽  
Vol 26 (4) ◽  
pp. 188-195
Author(s):  
K.D. Babov ◽  
I.P. Khomenko ◽  
S.V. Tertyshnyi ◽  
Babova I.K. Babova I.K. ◽  
R.S. Vastianov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Medical Care ◽  
Soft Tissues ◽  
Lower Extremities ◽  
Gunshot Wounds ◽  
Care Quality ◽  
Rehabilitation Service ◽  
Soft Tissue Defects ◽  
Tissue Defects

Building a modern system of rehabilitation of servicemen in Ukraine is an integral part of providing medical care in armed conflict. Rehabilitation of servicemen after gunshot wounds with soft tissue defects of the lower extremities is a common but difficult problem for surgical and rehabilitation teams. The process of rehabilitation requires the implementation of certain methodological provisions. At present, medical care for servicemen is a four-levels’ one. Rehabilitation service is provided at the third and fourth levels of medical care. The aim of the study was to improve the quality of medical care for servicemen after gunshot wounds with soft tissue defects of the lower extremities by introducing a system of staged rehabilitation. Organizational and methodological bases of the system of staged rehabilitation of wounded servicemen with soft tissue defects at different levels of medical care have been developed. Two models of rehabilitation depending on the severity of the injury and the tactics of surgical treatment are proposed. The division of the stage of early sanatorium rehabilitation for the wounded with severe soft tissue injuries depending on the stage of surgical treatment and the formation of a "skin patch" is justified. The introduction of the proposed models of rehabilitation of wounded with soft tissue defects in the practice of early sanatorium rehabilitation will provide increasing of medical care quality.

Standards for the Management of Open Fractures

2020 ◽  
Keyword(s):  
Soft Tissue Injuries ◽  
Open Fractures ◽  
Evidence Based ◽  
Supporting Evidence ◽  
Blast Injuries ◽  
Psychological Care ◽  
Lower Limb Injuries ◽  
Nice Guidelines ◽  
Limb Injuries ◽  
Key Aspects

Standards for the Management of Open Fractures provides an evidence-based approach for the management of open fractures, focusing on lower limb injuries. It builds on and expands the National Institute for Health and Care Excellence (NICE) Guidelines to provide a practical approach with supporting evidence. The new edition has been extensively updated and expanded to include key aspects of management, ranging from setting up an orthoplastic service, through to dealing with bone and soft tissue injuries, including in young and older people, patient rehabilitation and psychological care, blast injuries, as well as complications such as infection. The book provides an important resource for orthopaedic and plastic surgeons managing patients with these challenging injuries.

Soft tissue injuries of the hand

2011 ◽  
Author(s):  
David Warwick ◽  
Roderick Dunn ◽  
Erman Melikyan ◽  
Jane Vadher
Keyword(s):  
High Pressure ◽  
Wound Care ◽  
Soft Tissue Injuries ◽  
Gunshot Wounds ◽  
Cold Sensitivity ◽  
Collateral Ligaments ◽  
Injection Injury ◽  
Pressure Injection ◽  
Microvascular Replantation ◽  
High Pressure Injection

Wound care 154Cold sensitivity 155Microvascular replantation 156Revascularization162Amputations164Nail injury170High-pressure injection injury174Extravasation injury176Gunshot wounds178Burns180Frostbite186Factitious injury (Secretans's)189• Thorough cleaning• Dressings• Splints:• Position of safe immobilization (POSI), joints with the collateral ligaments in the longest position preventing contractures....

Abdominal Trauma Revisited

2017 ◽  
Vol 83 (11) ◽  
pp. 1193-1202 ◽  
Author(s):  
David V. Feliciano
Keyword(s):  
United States ◽  
New York ◽  
World War Ii ◽  
Abdominal Trauma ◽  
Damage Control ◽  
Gunshot Wounds ◽  
The United States ◽  
Operative Approach ◽  
Contrast Enhanced Ct ◽  
The 1960S

Although abdominal trauma has been described since antiquity, formal laparotomies for trauma were not performed until the 1800s. Even with the introduction of general anesthesia in the United States during the years 1842 to 1846, laparotomies for abdominal trauma were not performed during the Civil War. The first laparotomy for an abdominal gunshot wound in the United States was finally performed in New York City in 1884. An aggressive operative approach to all forms of abdominal trauma till the establishment of formal trauma centers (where data were analyzed) resulted in extraordinarily high rates of nontherapeutic laparotomies from the 1880s to the 1960s. More selective operative approaches to patients with abdominal stab wounds (1960s), blunt trauma (1970s), and gunshot wounds (1990s) were then developed. Current adjuncts to the diagnosis of abdominal trauma when serial physical examinations are unreliable include the following: 1) diagnostic peritoneal tap/lavage, 2) surgeon-performed ultrasound examination; 3) contrast-enhanced CT of the abdomen and pelvis; and 4) diagnostic laparoscopy. Operative techniques for injuries to the liver, spleen, duodenum, and pancreas have been refined considerably since World War II. These need to be emphasized repeatedly in an era when fewer patients undergo laparotomy for abdominal trauma. Finally, abdominal trauma damage control is a valuable operative approach in patients with physiologic exhaustion and multiple injuries.

External Fixator Frames as Interim Damage Control for Limb Injuries: Experience in the 2010 Haiti Earthquake

2011 ◽  
Vol 71 (6) ◽  
pp. E128-E131 ◽  
Author(s):  
Ehud Lebel ◽  
Nehemia Blumberg ◽  
Amit Gill ◽  
Ofer Merin ◽  
Reuven Gelfond ◽  
...  
Keyword(s):  
External Fixator ◽  
Damage Control ◽  
Haiti Earthquake ◽  
Limb Injuries

Rotator Cuff Training for Pitchers

1998 ◽  
Vol 7 (4) ◽  
pp. 285-299 ◽  
Author(s):  
Michael E. Powers
Keyword(s):  
Rotator Cuff ◽  
Internal Rotation ◽  
High Speed ◽  
External Rotation ◽  
Shoulder Abduction ◽  
Muscular Endurance ◽  
Shoulder Injuries ◽  
Three Stages ◽  
Two Stages

This paper reviews the role of the rotator cuff during two key phases of the pitching sequence and presents a training program for these muscles. The program uses a periodization design consisting of three stages, beginning with a high-resistance/low-repetition eccentric strengthening stage. This is followed by a low-resistance/high-repetition stage for training muscular endurance. The core exercises for these two stages are prone external rotation in the 90/90 position, prone horizontal abduction, side-lying D2 flexion pattern, supine internal rotation in the 90/90 position, prone elevation with 100° of shoulder abduction and external rotation, and standing scapular plane elevation. The final stage of the program uses high-speed functional exercises: 90/90 external rotation, 90/90 internal rotation, D2 PNF flexion pattern, D2 PNF extension pattern, supine plyometric 90/90 internal rotation with a medicine ball, and the “arm whip” through the D2 PNF flexion pattern. The goal of this program is to prepare the muscles for the stresses of pitching and prevent shoulder injuries.

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