1/23. Cervical spine injuries in the athlete.Special considerations must be brought into play when the physician is consulted about when to allow an athlete to return to play following injury. This is especially true for brain and spinal cord injury. Although it is generally best to be on the conservative side, being too reticent about allowing any athlete to return may be very detrimental to the athlete and/or the entire team. Therefore, it behooves the sports physician to be circumspect with regard to not only the type of injury the athlete has suffered but also the nature, duration, and the repetitive aspects of the trauma along with the inherent strengths of any player. This article will provide the sports physician with criteria for making sound decisions regarding return to competition after cervical spine injury and "functional" cervical spinal stenosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/23. Anaphylactic shock from a latex allergy in a patient with spinal trauma.Allergy to latex is a condition that affects patients as well as health care workers. It is a spectrum of immunologic disorders that ranges from mild hypersensitivity to life-threatening anaphylaxis. Beginning in the early 1970s, the health care community has become more aware of this entity, leading to many improvements in the understanding, diagnosis and treatment of patients with latex allergy. Many hospitals have developed protocols and procedures for patients with latex sensitivity. However, some physicians remain unaware of the logistics of taking care of patients with this disorder. We present a case of a severe anaphylactic reaction to latex in a trauma patient with a spinal cord injury. The difficulty of treating the acutely injured patient with this disorder is illustrated. A list of equipment that may be included in a latex-free emergency kit is provided.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
3/23. Bad breaks. Keep the priority & care of orthopedic injuries in proper perspective.The recognition and appropriate emergency management of orthopedic emergencies is essential to minimize damage and optimize outcome. Priorities, principles and good judgment can make a difference in the overall outcome for the injured patient. These orthopedic emergencies require a team approach to assessment and care. Therefore, collaboration with other EMS providers, nurses, physicians, surgeons and other health-care personnel is essential to the proper care of the patient.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
4/23. Challenges to communication: supporting the patients with SCI with their diagnosis and prognosis.This article discusses some of the common dilemmas that nurses experience when communicating with patients who have recently sustained a spinal cord injury. Drawing on the literature, this article highlights that the nurse's role in giving bad news is unique. nurses are often in the position of clarifying information as patients become aware of their limitations. This awareness prompts the need for support for both patients and their families. nurses must interact with patients during their adjustment to their losses, and this requires good communication skills. The experiences of other health professionals, particularly physicians, are helpful in providing guidance for nurses who reinforce information regarding the patient's diagnosis/prognosis. They must continue to interact with patients during their adjustment to their losses, and this requires good communication skills. This article offers insight into problems as well as strategies to assist nurses in developing their communication skills.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
5/23. Vitamin B12 deficiency in spinal cord injury: a retrospective study.BACKGROUND/OBJECTIVE: Vitamin B12 (or cobalamin) deficiency is well known in geriatric patients, but not in those with spinal cord injury (SCI). This retrospective study describes vitamin B12 deficiency in SCI. methods: This study utilized a retrospective chart review of patients with SCI who had received serum vitamin B12 testing over the last 10 years. RESULTS: Probable vitamin B12 deficiency was noted in 16 patients with SCI. Twelve patients had subnormal serum vitamin B12 levels (< 220 pg/mL), whereas 4 patients had low-normal vitamin B12 levels (< 300 pg/mL) with neurologic and/or psychiatric symptoms that improved following vitamin B12 replacement. Classic findings of paresthesias and numbness often were not evident; such findings likely were masked by the pre-existing sensory impairment caused by SCI. Of the 16 SCI patients, 7 were ambulatory; 4 of the 7 presented with deterioration of gait. In addition, 3 of the 16 SCI patients presented with depression and fatigue, 2 had worsening pain, 2 had worsening upper limb weakness, and 2 had memory decline. Of the 12 patients with subnormal serum vitamin B12 levels, 6 were asymptomatic. Classic laboratory findings of low serum vitamin B12, macrocytic red blood cell indices, and megaloblastic anemia were not always present. anemia was identified in 7 of the 16 patients and macrocytic red blood cells were found in 3 of the 16 patients. Only 1 of the 16 SCI patients had a clear pathophysiologic mechanism to explain the vitamin B12 deficiency (ie, partial gastrectomy); none of the patients were vegetarian. Twelve of the SCI patients appeared to experience clinical benefits from cyanocobalamin replacement (some patients experienced more than 1 benefit), including reversal of anemia (5 patients), improved gait (4 patients), improved mood (3 patients), improved memory (2 patients), reduced pain (2 patients), strength gain (1 patient), and reduced numbness (1 patient). CONCLUSION: It is recommended that physicians consider vitamin B12 deficiency in their patients with SCI, particularly in those with neurologic and/or psychiatric symptoms. These symptoms often are reversible if treatment is initiated early.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
6/23. Atlanto-occipital dislocation.Reported is the case of a 29-year-old woman who sustained an atlanto-occipital dislocation (AOD). This patient survived the initial resuscitation to expire some 72 hours later. survival of patients with AOD is being reported with increasing frequency and with good neurologic recovery in many cases. Emergency physicians should be aware of this injury and the methods of initial evaluation and stabilization in order to maximize the potential for patients with these serious injuries. Radiographic features of AOD are outlined and the potential hazards of longitudinal traction are emphasized.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
7/23. Fulminant clostridium difficile colitis in a patient with spinal cord injury: case report.BACKGROUND: In certain patients with clostridium difficile colitis (CDC), a life-threatening systemic toxicity may develop despite appropriate and timely medical therapy. DESIGN: literature search and case report. FINDINGS: A 39-year-old man with T10 paraplegia presented with a distended, quiet abdomen following recent treatment with antibiotics for pneumonia. diarrhea was not present. Complete blood counts demonstrated a marked leukocytosis. A CT scan of the abdomen demonstrated a state of diffuse pancolonic inflammation with peritoneal fluid. The patient was taken to the operating room and underwent total abdominal colectomy with oversewing of the rectal stump and end ileostomy for treatment of the fulminant CDC. CONCLUSION: patients with spinal cord injury (SCI) often receive antibiotics for infections of the aerodigestive tree and urinary tract and for problems with skin integrity. A heightened awareness of the development of fulminant CDC remains essential in the care of patients with SCI. Any unexplained abdominal illness after recent antibiotic administration should alert the physician to CDC and its potential as a fulminant, potentially fatal illness.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
8/23. Fatal spinal cord injury of the 20th president of the united states: day-by-day review of his clinical course, with comments.BACKGROUND: This article presents the medical history of the 20th president of the united states, James A. Garfield, with an emphasis on his spinal cord injury (SCI). Numerous references debate the care he received from the medical and surgical perspectives, but little has been written about the essential aspect of his gunshot wound-namely, the damage to his spinal cord. President Garfield was shot in the lumbar spine and was bedridden until he died 80 days following his injury. This article contrasts state-of-the-art care in 1881 to today's standards of care for SCI. METHOD: literature review. A record of daily reports of the president's condition was analyzed. Comparisons were made between the president's care and what is now available. FINDINGS: Although the president had access to the best physicians, the chronicle of his course underscores the deficiencies in basic medical care, the controversies concerning surgical intervention, and the problems inherent in the care of a prominent patient. Press releases did not overtly address spinal cord trauma and its complications so as to avoid conveying the president's degree of incapacity. Garfield's SCI was documented on autopsy. The bullet entered the 10th intercostal space, 3 1/2 inches to the right of the spinous processes, fracturing the 11th and 12th vertebrae and nicking the T1 2-L1 disc. The bullet then passed through the right side of the body of L1 and exited the vertebra anteriorly and to the left and lodged behind the pancreas, where it was found encased by a firm cyst. CONCLUSION: Deficiencies in general medical care and surgical technique at the time contributed to the president's demise. This case was marked by controversies that still are debated today-for example, whether the bullet should have been removed surgically. Examination of available evidence suggests that with today's advances in medical, surgical, and SCI medicine, a person with this type of injury would likely survive and be a candidate for rehabilitation.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
9/23. lightning strikes: nature of neurological damage in patients evaluated in hospital emergency departments.Emergency physicians and staff are usually the first to evaluate and manage victims of lightning strikes. Damage to the nervous system is often the most devastating consequence of lightning strikes. Contrary to most articles in the literature in which neurological disorders are said to be either transient or delayed, we report the cases of six patients with severe, immediate, and in at least three, permanent clinical problems. patients with signs of spinal cord lesions are most likely to have permanent disabilities.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
10/23. pain management with interventional spine therapy in patients with spinal cord injury: a case series.BACKGROUND/OBJECTIVE: chronic pain is common in patients with spinal cord injury (SCI). Any new strategy that is effective in treating this problem would be welcomed by this patient population. methods: A case series is presented of SCI with neuropathic pain. In these 3 cases, interventional spine therapy is used as a diagnostic and/or therapeutic tool in the management of pain. RESULTS: In the cases presented, interventional spine therapy proved useful in identifying the patient's pain generator. In most cases, the intervention was effective in reducing pain for a long enough period to serve as an effective pain management strategy. Other associated problems, such as spasticity, were similarly reduced. CONCLUSION: Interventional spine therapy should be considered as a tool in the armamentarium of any SCI physician managing their patient's chronic pain.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
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