1/44. vacuum-assisted closure in the treatment of degloving injuries.Degloving injuries range from the occult, easily missed injury to obvious massive tissue damage. The serious nature of these wounds is exacerbated by mismanagement. It is generally accepted that the degloved tissue should be excised, defatted, fenestrated, and reapplied as a full-thickness skin graft. Dressings are required that provide gentle, evenly distributed pressure and avoid shear stress to the newly grafted skin. Numerous types of dressings have been devised but all are cumbersome and time-consuming. We have found the vacuum-Assisted Closure device to be a rapid, effective, and easy-to-use alternative to traditional methods. The authors examine their experience using a vacuum-assisted closure device to treat nine degloving injuries in 5 patients and discuss the important aspects in using this technique.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/44. Application of base deficit in resuscitation of trauma patients.Clinical measures, such as blood pressure or urine output, have been the traditional methods used to assess tissue perfusion in trauma patients with hypovolemia. Hypoperfusion of tissues results in increased levels of lactate and carbonic acids. Base deficit is a clinical measure of metabolic acidosis that normalizes rapidly with adequate resuscitation and hemorrhage control, and it can be used to monitor the initial care of a patient with trauma. The method used to measure base deficit is discussed, along with its clinical uses and limitations. A case study is used to correlate changes in base deficit with other clinical parameters.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/44. Elastic adhesive dressing treatment of bleeding wounds in trauma victims.Conventional methods for hemorrhage control in the trauma patient fall short of providing a full solution for the life-threatening bleeding injury. The tourniquet is limited specifically to injuries of the distal limbs. Local pressure or tight bandaging with military bandages is cumbersome and often insufficient. Therefore, we sought a superior method to stop bleeding in emergency situations. Our objective is report and description of our experience with this method. Since 1992 our trauma team repeatedly encountered multiple trauma victims presenting with bleeding wounds. We achieved hemorrhage control by means of an adhesive elastic bandage applied directly over a collection of 4 x 4 gauze pads placed on the wound surface. The roll is then wrapped around the body surface, over the bleeding site, until sufficient pressure is reached to terminate ongoing hemorrhage. Three typical cases are described in detail. Adhesive elastic dressing compression was successful in fully controlling bleeding without compromise of distal blood flow. Our method corresponded to the demand for an immediate, effective and lasting form of hemorrhage control without complications. Furthermore, this technique proved successful even over body surfaces normally recognized as difficult to compress. We experienced equal favorable success while working during transit by either ambulance or helicopter transportation. We find our preliminary experience using elastic adhesive dressing for bleeding control encouraging and suggest that this may substitute existing practices as the selected treatment when indicated. This method is presently underrecognized for this purpose. Development of a single unit bandage may further enhance success in the future.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
4/44. Hemodynamic applications of capnography.The measurement of the pressure of exhaled carbon dioxide (PetCO2) via capnography has several useful hemodynamic applications. This article discusses integrating PetCO2 values with hemodynamic assessment. capnography can be applied to hemodynamic assessment in three key ways: (1) identification of end-expiration during pulmonary artery and central venous pressure measurements, (2) assessment of pulmonary perfusion and alveolar deadspace, (3) assessment of cardiopulmonary resuscitative efforts. The article presents research, sample waveforms for end-expiration identification, and case examples.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/44. Physical restraint and subcutaneous hematoma in an anticoagulated patient.A large subcutaneous hematoma extending from the breastbone region to the left axillary region and left flank developed in a 86-year-old anticoagulated man because of repeated microtrauma from a physical restraint used to prevent his rising from a chair. physicians, nurses, and physiotherapists should recognize that physical restraints causing pressure on the skin increase hemorrhagic risk in patients who take low molecular weight heparin. Accordingly, they should systematically check for hemorrhagic complications and attempt to limit the use of such devices.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/44. Disability, injury and ergonomics intervention.PURPOSE: Disability due to work injury, trauma or disease is prevalent in our society. Also, due to slower growth of population and rapid increase in ageing population there may be an increasing pressure on shrinking labour pool. The purpose of this study is to review disability profile with common disabilities, socioeconomic impact of these disabilities, make a case for ergonomics as an enabler, and provide a couple of case studies to illustrate the point. METHOD: Major disability statistical records were reviewed to reveal rates of disability in some countries of the world. Among them the age and gender association of disability has been described. Furthermore the major categories of disabilities associated with systemic disorders and their gradations have been described, e.g. cardiovascular conditions, pulmonary conditions and joint diseases. Finally, using a feed forward mechanism a specific and customized ergonomic intervention was designed for two workers with knee injury. RESULTS: The prevalence of disability has been reported to range between 0.2% -20.9%. A significant association of disability with ageing was reconfirmed. A significant socio-economic impact of disability including differential employment rate for normal and disabled was discovered. A strategy and a means to achieve increased functionality in people with disability using ergonomic intervention has been described. Using a custom designed shin pad for rehabilitation of two workers with injured knee who were also on compensation were successfully returned to work many weeks before they may have been able to resume their work. CONCLUSION: Using a functional classification and developing functional profiles of people with disability may allow ergonomists to develop generic as well as specific solutions to successfully intervene in many cases and improve their functional capacity.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/44. High-pressure water jet injuries: a surgical emergency.Injuries from high-pressure jet devices are surgical emergencies characterised by small entry wounds with extensive internal damage. Three factors are involved in these injuries. Physical injury can include local soft tissue disruption and vascular and nerve damage; chemical properties of the injectate can exacerbate compressive vascular injuries with increased oedema and inflammation; water-jet injuries can be contaminated by virulent organisms and foreign matter which can lead to unusual infections. Management is usually similar to that for injuries caused by high-velocity missiles, and involves aggressive debridement, irrigation and decompression followed by careful monitoring, and appropriate antibiotic therapy.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
8/44. Prehospital rounds. The quick stop.The coroner's post-mortem examination revealed a tom aorta. This case illustrates that although a patient may appear stable, a major catastrophic event may nonetheless be taking place. How many times have we responded to MVAs similar to the one described here and seen those involved deny injuries? We carry a higher suspicion of aortic injury after someone has been ejected from a vehicle or involved in a high-speed crash. That's not always the case, however, and understanding how internal organs respond to high-speed impacts is crucial. Damage to the aorta may result after a sudden deceleration injury of any type: a fall, vehicle crash or violence. The most common forms of traumatic aortic injury occur where the aorta is "tethered" in place: at its intersection with the heart and at its distal portion just beneath the left subclavian artery near the ligamenta arteriosum. Approximately 80% of patients with aortic injury die at the scene. The injury may be hidden in the other 20%, but they have the potential to rapidly deteriorate and die. Those who survive typically are at a trauma center and are cared for by providers who have a suspicion of the injury. A high index of suspicion should be maintained on all rapid-deceleration injuries and with patients who experience chest pain, dyspnea, a difference in pressure between the upper and lower extremities, and paralysis. paralysis can occur when aortic injury cuts off blood supply [table: see text] to the spinal cord. The spinal cord obtains its blood supply from arteries coming directly off the aorta, and a torn aorta can shear off these vessels, leaving the spinal cord to infarct and the patient to lose all distal function. When a victim sustains a sudden-deceleration injury to the chest, signs of aortic injury should be sought. It is imperative to maintain a high index of suspicion throughout patient care and be aware that although a patient may appear to be quite stable, the reality might be otherwise, and rapid transport to a trauma center will be necessary to save their life.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/44. Portal hypertension due to hepatic artery-portal vein arteriovenous fistula--a case report.A case of portal hypertension secondary to traumatic hepatoportal arteriovenous fistula with portal fibrosis was successfully treated by ligation of the afferent hepatic arteries which decreased significantly portal pressure and corrected the abnormal blood inflow to the portal vein via A-V fistula resulting in a recovery of the disturbed liver function. Collateral blood supply from the left hepatic artery into the right hepatic lobe was found to be quite satisfactory after the ligation of the hepatic artery. Hemodynamic data and clinical findings of the present case suggest that the mechanism responsible for the portal hypertension is the inflow block resulting from the interruption of portal venous flow by the inflow of arterial blood via A-V fistula and the subsequent increased blood pressure in portal vein radicals.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
10/44. Perilymphatic fistula following trans-tympanic trauma: a clinical case presentation and review of the literature.The perilymphatic fistula is constituted by an anomalous connection between the perilymphatic space and the middle ear. The principal accuses are to be sought in the intracranial pressure increasement, cranial traumas, barotraumas, congenital anomalies, trans-tympanic traumas, etc. stapes's dislocation in the vestibule and the fracture of the platina are the most frequent pathogenic mechanisms. In clinical practice, the diagnosis remains a problem rather debated, even if the clinical pattern, the laboratory investigations, the diagnostic images and the tympanic exploration, all together can confirm, in the majority of the cases, the diagnostic suspect. This article presents a clinical case of a transtympanic trauma with perilymphatic fistula caused by a foreign body. The peculiarity of this case must be set in relation with both the aetiopathogenesis of the labyrinthine lesion and the severity of the symptomatology caused by it.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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