1/7. lower extremity injury: complex problems, complex answers.patients with traumatic injury to the lower extremities are admitted to the hospital with multiple interrelated problems requiring an interdisciplinary team approach to meet their needs. This article will explore the assessment and formulation of nursing diagnoses, implementation of care, and patient outcomes achieved. It will describe the nurse's role as the link between the patient and the physician and other members of the health care team. The cooperative actions of the different health care teams that work to achieve the desired outcomes are explained. A case study will be presented to illustrate these points.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Successful use of methadone in the treatment of chronic neuropathic pain arising from burn injuries: a case-study.methadone is used increasingly as a second-line opioid in the management of cancer pain refractory to conventional opioids. Recent case studies suggest that its use as an analgesic could be extended to non-cancer pain, especially neuropathic pain. The present case study reports, for the first time, the efficacy of methadone in a burn patient experiencing neuropathic pain in his healed wounds. The patient sustained extensive (55% total body surface area) chemical burns and developed chronic burning sensations, particularly in the lower limbs where skin grafting had been performed. Conventional pharmacotherapies against neuropathic pain were attempted to control pain for over 5 years. The agents used included long- and short-acting opioids, amitriptyline, clonazepam, and gabapentin, but they all failed to relieve the pain. When methadone (5 mg every 12 h) was introduced, it significantly alleviated the patient's pain within a few days of administration. The patient has now been taking methadone (15 mg every 12 h) for 10 months and reports that the opioid caused 70% pain relief and a 55% amelioration in his quality of life. Although these results are based on a case report, they suggest that a switch to methadone might be useful in some burn patients who have developed chronic neuropathic pain unrelieved by conventional pharmacotherapies. methadone, however, needs to be titrated with vigilance and thus should be administered by a physician experienced with its use in the treatment of chronic pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. lower extremity burns related to sensory loss in diabetes mellitus.A chart review of 37 hospitalized patients with diabetes mellitus who received burn therapy showed that ten (27 percent) had preventable lower-extremity burns related to sensory loss. Most of these ten burns occurred from heat applied for self-care of diabetes, namely, from hot tap water, a hot moist compress, or a heating pad. These ten patients, compared with the other 27 diabetic burn patients, were more likely to be men younger than 45 years old, to have insulin-dependent diabetes, and to have been burned during self-treatment. These findings underscore the importance of injury-prevention educational efforts by physicians in cautioning their diabetic patients, especially those with lower-extremity sensory losses, about potential burns from heat applied to the lower extremities for self-care.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Management of chronic wounds in the elderly.The elderly patient with a chronic wound displays many characteristics peculiar to the age group that must be considered by the treating physician. This article describes a variety of specific age-related influences on wound healing, and incorporates several illustrative case reports.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Proper timing of amputation for open fractures of the lower extremities.Judging the appropriate time for amputating lower extremities with open fractures and major soft tissue damage is a major problem for physicians. limb salvage through vascular repair and external fixation is frequently unjustified. Attempts at saving a limb that should be amputated often are followed by renal failure, sepsis, and death. Much research remains to be done in this area.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Muscular herniation of the lower extremities.Fascial defects are encountered infrequently by physicians who manage disorders of the lower extremities. The correct diagnosis of this condition is important, because the treatment is forthright and will bring the patient relief from symptoms. This article reviews the literature and attempts to aid the clinician in understanding this condition and its treatment. Two illustrative cases are presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. anaphylaxis to topical bacitracin zinc ointment.This report describes a case of systemic anaphylaxis to bacitracin zinc ointment in a 24-year-old man who was injured in a motorcycle accident. Extensive abrasions on the patient's extremities were cleaned with Shurclens before application of viscous Xylocaine and bacitracin zinc ointment. Five minutes later, the patient exhibited symptoms of severe anaphylaxis and required the administration of epinephrine, antihistamines, intravenous fluids, and corticosteroids. Two weeks later, he underwent prick/puncture skin testing to Shurclens and bacitracin zinc ointment as well as prick/puncture, intracutaneous, and subcutaneous challenge with Xylocaine. Only the result of the prick test to bacitracin zinc ointment was positive. Although bacitracin is considered to be a safe topical antibiotic, physicians should be aware of the potential not only for delayed hypersensitivity but also for acute IgE-mediated allergic reactions and life-threatening anaphylaxis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |