1/17. Trauma nursing: an advanced practice case study.Trauma is the leading cause of death in people less than 40 years of age. Blunt or penetrating trauma injuries may be a result of gunshot wounds, stabbings, head injuries,burns, falls or motor vehicle collisions. Unlike other patients entering the health care system, trauma victims have no time for hospital preparation. The physiologic and psychosocial complications resulting directly from the traumatic incident provide response patterns not typical of other patients. Further to this unpredictability, the trauma patient usually sustains multiple system injuries, making it difficult to design critical pathways in care plans. The complexity is heightened by the patient's unique perception of the traumatic event, which can be even more important than the physical injury in determining the ultimate impact of the trauma.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/17. Complex regional pain syndrome type I treated with topical capsaicin: a case report.This report describes the case of a multitrauma patient who underwent an amputation of the left arm and had a complicated left crural fracture with a delayed union. He was treated in an inpatient setting for preprosthetic training for a myoelectric prosthesis and to regain walking abilities. After consolidation of the crural fracture, complex regional pain syndrome type I (CRPS I) developed in the left foreleg, which hindered mobilization. Topical capsaicin .075% was prescribed and a stress-loading mobilization schema was instituted. No other treatment modalities directed at CRPS I were added. After 6 weeks, no signs or symptoms of CRPS I were present and capsaicin was discontinued. capsaicin is a well-accepted and documented treatment modality in neuropathic pain states such as postherpetic neuralgia. However, it has rarely been described in CRPS I. capsaicin is discussed within the framework of recent insights in the neurobiology of nociception, and it is concluded that it may provide a theory-driven treatment for CRPS I, especially in the acute stage, that facilitates physical therapy and prevents peripheral and spinal sensitization.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/17. Congestive heart failure associated with chronic venous insufficiency and leg ulcers secondary to an arteriovenous fistula caused by a shotgun wound 15 years ago.We present a 65-year-old man who had a significant arteriovenous fistula between the right arteria profunda femoralis and vena profunda femoralis. He had evidence of chronic venous insufficiency and chronic leg ulcers on his right leg, and he had clinical findings of congestive heart failure. An arteriovenous fistula was responsible for all of clinical situation that had been caused by a shotgun wound 15 years ago. Using ultrasonography, after palpating a marked thrill and mass during physical examination, established the diagnosis of arteriovenous fistula. angiography was performed both to delineate the suspected vascular anatomy and to show the coronary arteries. The patient was operated on and no complication was experienced during or after the procedure. Dramatic improvement was seen in the clinical picture just after surgery, and heart size markedly reduced both on chest X-ray and echocardiographic examination.- - - - - - - - - - ranking = 4.4098404954025keywords = physical examination, physical (Clic here for more details about this article) |
4/17. The decision to salvage or amputate a severely injured limb.The decision to salvage or amputate a severely injured limb is one of the most difficult an orthopaedic surgeon may face. The inclination to undertake heroic measures to save the limb should be tempered by the realization that doing so may lead to repeated hospitalizations, extensive complications, and a poor functional outcome. Several factors must be considered, including objective elements related to the patient's injury and physical condition and subjective considerations related to the patient's psychologic, social, and economic status. We present a framework, in the context of a case study, which may be used in deciding which patients can benefit from early amputation and review five predictive indices for limb salvage.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/17. Suicidal bus bombing of French Nationals in pakistan: physical injuries and management of survivors.BACKGROUND: Suicidal bombing is particularly devastating and an increasingly common form of terrorist violence. In this paper, we present an epidemiologic description of the physical injuries of patients who survived the suicidal bombing attack in the context of the limited medical resources of a developing nation. methods: The management of individual patients was reviewed from a preprinted trauma form. Information on the nature of injuries, operative management and hospital course was recorded and data analyzed using the Trauma Registry. RESULTS: Twelve survivors out of 36 bomb blast victims brought to the Aga Khan University Hospital were transferred from primary receiving hospitals. The average number of injuries per patient was eight. The mean injury severity score was 10.8. The majority of patients had secondary and tertiary blast injuries. Most of the survivors had calcaneal injuries; these have not been reported in the literature in similar terrorist attacks. Twelve operative interventions were undertaken. All of the 12 patients were stabilized and evacuated within 24 h of admission. CONCLUSIONS: All of the 12 patients transferred to the Aga Khan University Hospital survived. Unlike the reported injuries, calcaneal fractures were most commonly encountered in the survivors.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
6/17. Limb deficiency and prosthetic management. 3. Complex limb deficiency.This self-directed learning module highlights rehabilitation and prosthetic issues associated with complex limb deficiencies. It is part of the chapter on acquired limb deficiencies in the Self-Directed Physiatric education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses rehabilitation and prosthetic management of patients with amputations for complex limb deficiencies secondary to trauma. Mechanisms of injury, prosthetic issues, prosthetic components, and potential problems in prosthetic fitting will be discussed. overall Article Objective: To evaluate common problems associated with complex limb deficiency.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/17. Shark attack.Shark attacks are rare but devastating. This case had major injuries that included an open femoral fracture, massive hemorrhage, sciatic nerve laceration, and significant skin and muscle damage. The patient required 15 operative procedures, extensive physical therapy, and orthotic assistance. A review of the literature pertaining to shark bites is included.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/17. Lawnmower injuries in children: lower extremity reconstruction.Power lawnmower accidents are one of the most frequent causes of mutilating injuries in pediatric patients. Guidelines for the optimal surgical management of children differ from adult patients by several key anatomic, physiologic, and rehabilitative features. Small blood vessels in children less than 2 years old may prohibit microvascular surgery. Older children with larger vessels are often better candidates for microvascular flaps than their adult counterparts. Pediatric patients also resist recurrent ulceration of foot skin grafts, tolerate prolonged immobilization, and are rehabilitated more readily than adults. In considering these facts, we outlined an algorithm for surgical reconstruction. Split-thickness skin grafts are generally the first choice for coverage. The medial gastrocnemius is the workhorse of the knee and upper third leg. The soleus provides coverage for the middle third leg; microvascular flaps are used for large lower third leg defects. Crossleg fasciocutaneous flaps are good alternatives when microsurgery is not feasible. When possible, the weight-bearing surface of the foot should be covered with local vascularized sensate flaps; larger defects may require free flaps, crossleg, or gluteal-thigh flaps. Excellent functional rehabilitation has been achieved in our young patients through the combined efforts of the trauma service, plastic and orthopedic surgery, and physical and occupational therapy services.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/17. The medial head of the gastrocnemius. A review of the basis for partial rupture and for intermittent claudication.Under physical stress, partial or complete tears of the muscle fibers of the medial head of the gastrocnemius may occur. Radiographs made by soft-tissue technique can be especially helpful in diagnosing partial ruptures, which are sometimes difficult to detect. intermittent claudication can be caused by an abnormal position of the medial head of the gastrocnemius, resulting in compression of the popliteal vessels. angiography or computerized tomography will usually disclose the site of local pressure. Surgical intervention may be necessary to eliminate the compression.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/17. Scintigraphy of toddler's fracture.Under ordinary circumstances a toddler's fracture of the lower extremity is diagnosed by clinical evaluation and history. Often the initial conventional radiograph is unrevealing, but the fracture is diagnosed and treated based on appropriate clinical and laboratory findings. In rare instances, a patient with an unsuspected toddler's fracture may present with an atypical history, unusual physical findings, or laboratory values suggesting the presence of an inflammatory process. Skeletal scintigraphy in this small group of patients has been valuable in defining a spiral fracture of the midshaft of the tibia connected with a toddler's fracture. We report the scintigraphic appearance from the findings in six patients with unsuspected toddler's fracture evaluated by this method.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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